Mapping trends: How mobile clinics spot emerging issues in public health, from major U.S. cities to America’s rural towns
By Mollie Williams, DrPH, MPH, Harvard Medical School
Public health crises like the recent COVID-19 pandemic underscore the importance of identifying emerging health issues and responding quickly to them. In many communities, mobile clinics serve as the eyes and ears of the healthcare system, and more than 1,000 of these clinics share their latest information with us.
By analyzing data provided by these care providers in the field, we can better understand how mobile clinics play a role in addressing challenges with speed and agility. Here are the four top issues we’re watching right now:
Diabetes, Obesity and Access
Ozempic, Wegovy, and other new diabetes medications are being celebrated in the news and on social media for their potential to lower America’s obesity rate. But for the uninsured, obesity and diabetes continue to pack a life-threatening one-two punch.
Access to insulin – a medication that people with more advanced Type 2 diabetes need to stay alive – remains a financial challenge for many, in spite of some state-mandated price caps and drug companies’ price cuts.
New data from our impact tracker shows that obesity-related screening and counseling is the second most common service provided by mobile clinics. Many clinics also screen for diabetes with the goal of identifying people who don’t know they have the condition. For example, The Family Van, a mobile clinic in Boston, reports that 41% of their clients had higher than normal blood sugar levels despite having never been diagnosed with diabetes.
Evolving Substance Use Crisis
Xylazine, a sedative used by veterinarians that’s increasingly found in street drugs, is often mixed with fentanyl and can cause severe skin ulcers and infections.
Mobile clinics have been on the front lines of treating xylazine-impacted clients and are responding by adding behavioral healthcare and wound care to their services. In fact, over the last three years, the number of mobile clinics providing behavioral healthcare services has tripled.
The staff on La Movil, a mobile clinic operated by Intercambios Puerto Rico, cares for hundreds of people each year who are affected my homelessness, substance use, and mental health challenges. Dr. Elisa Pujals, a physician that works with La Movil, has been treating xylazine related wounds on and off since 2008. She shared that her clients struggle with various infections and prolonged hospitalizations. “Our patients live with chronic osteomyelitis [bone infection], and often die from complications of bacteremia and sepsis at a young age,” Pujals says.
Liz Znamierowski, a nurse practitioner on Yale University’s Community Health Care Van, also leads the drug testing program at New Haven Syringe Services Programs where she tests drugs and drug residue to identify potentially dangerous adulterants. Of particular concern are the increasing number of samples containing xylazine. In preliminary data for 2023 reported by the New Haven Department of Public Health, there were 150 deaths (21.7%) involving a xylazine/fentanyl combination. “The drug supply in New Haven is incredibly unpredictable at the moment. The presence of xylazine in tested samples is especially concerning as it can lead to increased sedation, severe wounds, and does not respond to Narcan,” Znamierowski explains.
Growing Needs of Haitian Refugees
Humanitarian crises, like the one unfolding in Haiti, have led to a surge in refugees who need health care that is trauma-informed, affordable, and accessible. Many also need assistance with basic needs (social drivers of health) such as housing and food. There are already more than 1 million Haitian immigrants in the U.S. with the greatest numbers in Florida, New York, and Massachusetts. Communities, like Boston, which have large Haitian populations, are seeing rapid increases in new arrivals as people come to live with relatives who immigrated to the East Coast during past crises. Massachusetts Governor Maura Healy recently declared a state of emergency in response to the surge of new arrivals and called out the Biden administration for a “federal crisis of inaction that is many years in the making.”
Of the 58 mobile clinics in Florida, 68 in New York, and 32 in Massachusetts on the map, many are already working to respond to the influx. For example, the number of Haitian Creole speakers served by The Family Van increased by 145% over the last 3 years.
Those who delayed or canceled doctor’s appointments over the past few years and are still not catching up. One of the reasons behind the lag: long wait times at primary and specialty care offices, such as imaging centers. As a result, people who are trying to get appointments for important preventive screenings like mammograms and colonoscopies are being forced to wait weeks or months to be seen.
Mobile clinics are helping to bridge this gap by connecting patients with care more quickly. For example, Stony Brook Cancer Center operates a very successful mobile clinic on Long Island, New York. Fifty-eight percent of their patients identify as Latinx compared to 5% of mammography patients at their bricks and mortar location. Dr. Patrick Dineen who leads the mobile program is proud of their impact. “Currently, It takes three months to book a screening mammogram in our breast center. If you call our mobile office, we can get you in tomorrow. Plus, if you need help with transportation, we can offer free Uber rides to wherever the mobile unit is parked that day,” Dineen says.
There are more than 130 mobile mammography programs in the U.S. and 42% of their patients don’t have health insurance – a fact that makes these clinics on wheels especially effective in reaching underserved communities who face barriers of transportation, cost, and childcare.
Create Healthier Communities
From big cities to farming communities, mobile clinics are an essential part of our healthcare system. In rural areas, where medical facilities are increasingly sparse, mobile clinics bring health services to places where the nearest doctor may be hours away. And in urban areas, they make care more convenient and less intimidating, offering medical help to people who are unhoused, uninsured, or marginalized in other ways.
We must ensure that our public health systems become stronger. Funders and legislators have a significant role to play. By allocating resources and support for mobile healthcare, they can ensure healthcare providers have the necessary tools to start and sustain mobile programs. This will ultimately improve access, advance equity, and create healthier communities.
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Mollie is Executive Director of The Family Van and Mobile Health Map and Lecturer of Global Health and Social Medicine at Harvard Medical School. In her free time, she enjoys spending time with her family, traveling, and textile arts.