All For Health, Health For All (AFH) is a non-profit community clinic located in Glendale, California. More than 31% of AFH’s primary service area is located within a federally designated Medically Underserved Area (MUA) , while nearly 60% of AFH’s patients live in an MUA. Access is assured for all patients regardless of ability to pay. In 2003, AFH served 5,869 unduplicated users through 18,780 encounters.
The United Way 2003 State of the County Report indicates that almost 32.6% of Los Angeles Service Planning Area (SPA) 2, in which AFH is located, shows residents living at or below 200% of the Federal Poverty Level (FPL), with those communities from which patients hail, having even higher rates at 36% for Glendale and 48.7% for North Hollywood. The portion of adjacent SPA 4, which also encompasses a portion of AFH’s service area, has 54.8% of its residents living at or below this standard. Public assistance recipients number more than 250,000 in each of the SPAs. Their poverty status has been compounded in recent years by escalating rents, which have increased by an estimated 32% in the past two years.
In addition to the area’s high rate of poverty, it is also ethnically diverse. According to the 2000 Census, the largest minority group in AFH’s service area is Latinos, at 20.7%, followed by Asian and Pacific Islanders, at 14.6%, other (two or more) races at 7.6%, and African Americans at 1.5%. What is not easily reflected in this census data is the high numbers of Armenian and Russian immigrants, most of who do not speak English, and who lack health insurance and access to culturally competent care. A telling statistic is that eight percent of the people in AFH’s service area, who do not speak English well, speak an Indo-European language other than Spanish (Census 2000). This is much higher than the percentage of Indo-European speakers throughout Los Angeles County, which is less than one percent. An estimated 500,000 Armenians live today in Los Angeles and surrounding counties. Among issues that confront health care providers are the Armenian immigrant’s understanding of American values and their trust of helping resources. Having lived under the Soviet regime, patients often are suspect of everyone other than fellow Armenians. “If the name doesn’t end with ‘ian’,” states Dr. Joseph Dadourian, a clinical psychologist and mental health consultant to a local Glendale High School, “there is immediate distrust.” Consequently, their utilization of community-based health services outside of the Armenian community is low.
According to the Census 2000, in the AFH service area, 112,015 individuals, or 33.9% of the population, is below 200%of the FPL. Nearly one-half of residents—49,637—or 15% of the population, are below 100%. Educational attainment in many portions of the area is low; more than 20%of the area’s residents do not have a high school diploma, including nearly 10% with less than a ninth grade education.
An estimated 95% of AFH’s patients are living at or below 200% of the FPL. Only five percent of the patient population is able to pay for the services they receive. An estimated 20%qualifies for Medi-Cal, 15% qualifies for the Medicare Program, and 60% are uninsured. The majority (at least 60%) of the clinic population is comprised of first-generation Armenians and Russians; Latinos comprise approximately 20%African-Americans represent about five percent and Asian Pacific Islanders and whites represent approximately 15%. The vast majority of patients are unemployed (approximately 90%), and 95% depend on some form of public assistance. The median household income of clinic patients is $700 each month, and the median age is 57 years, with 40% more than 65 years of age.