While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Position: President, Union Mission
"Micheal has been instrumental in controlling our city's homeless population, not by giving handouts, but by instilling motivation, using creative resource management, and giving people an opportunity to find a better way of life."—U.S. Representative Jack Kingston (R-Ga.)
"When I need to see someone for my aches and pains or to talk about all my different meds, I don't need to call 911. All of my homeless friends, too, feel very fortunate to have an easily accessible place to go for all their health problems without having to worry about a bill from an ambulance ride, emergency room visit and for who knows what else following them wherever they go. With all of this help, I am on my way to total self-sufficiency."—Client, Union Mission
"I'm a better person than I was a year or two ago. I haven't felt this good about myself since I was 18."—Client, Union Mission
Micheal Elliott was born and raised in Savannah, Ga., to working-class parents. Still, the family was able to send him to college at Georgia Southern University. "I was woefully unprepared," he remembers. "I had a great Southern education, which prepared me for life in the Middle Ages." He struggled at school, finding himself more in tune with rock-and-roll music and the rebellious spirit of the mid-1970s.
Then he got married and had a son—which changed everything. He was just starting his junior year, and now devoted himself more intently to education. He found himself drawn to courses in philosophy, theology and religious literature. Two of his favorite professors, seeing that Elliott was a spiritual seeker, counseled him to enter the Southern Baptist Theological Seminary upon graduation.
Elliott found himself in complete culture shock at the highly conservative seminary in Louisville, Ky., "with all the Baptists with, like, suits and stuff." But a chance opportunity presented itself and wound up altering the course of his life forever. As he recalls it, "This guy came and said, 'You play music. We don't have anybody in our church that does any music. Can you come and play?' So I ended up going to the Jefferson Street Baptist Chapel, a Baptist mission church for the inner city."
There were only a handful of people in the congregation—"mostly little old ladies." He started playing music there. Shortly afterward, the student pastor left. "They looked at me and said, 'Well, you go to seminary. You can be our preacher.' I said I wasn't really interested, but they wouldn't take no for an answer. In fact, their spokesperson was carrying a butcher knife, and when they're pressing upon you, with a butcher knife, it's hard to say no. So I became pastor.
"And then the powers that be came and said, 'You can't be a pastor if you're not ordained.' I wasn't really sure about getting ordained, but they kind of forced the issue, so I became ordained." He was now the Reverend Micheal Elliott, Baptist minister and rock-and-roller. What followed was bound to be a bumpy ride.
It was December 1979. Elliott was still in seminary (he would graduate in 1982) but he now had a congregation—and its mission building—to take care of as well. "I had an apartment in the building, and I had gone downstairs on Sunday morning to turn up the heat for the sanctuary, since people would be coming for the service," he recalls. "And there were all these people huddled in the doorway, just shivering. I went and unlocked the door, really with the intention of saying, 'You guys are gonna distract people from coming to church. You've got to move on.' But I saw how cold it was. So I said, 'Come on in and warm up first.'
"So they came in, and we got to talking. It was my first personal encounter, where I had a prolonged conversation with a group of four or five homeless guys. After that, I couldn't look out the windows anymore without feeling that it was unjust for these folks to be outside, with the wind chill 80 below, and I'm in this big building that's sitting empty. I mean, there was something wrong with that."
Once again, as with the lady with the butcher knife, opportunity had lain down at Micheal Elliott's feet. And once again, he took up the challenge. "Over the next eight years, the church became this wonderful place," Elliott explains. "One thing led to another. At the time, there was no place for homeless folks to eat on weekends. So we decided to start a Sunday morning breakfast at 7 a.m., and the ladies would come and help. They took a lot of interest, because suddenly there were all these guys giving them attention—and there'd be like 100 homeless guys showing up, so the ladies would start hanging around. And then the people in the projects across the street starting noticing all this stuff, so they started coming, just because they were interested. And after that, radical seminarians from the three local seminaries started coming. So it really became this marvelous alternative, radical thing."
Elliott's counterculture church found itself more and more out of step with the Southern Baptist hierarchy. As Elliott tells it: "Every month, they would send me this wonderful form that said how many people attended Sunday School for the month, how many attended church, how many got saved, how many got baptized. Baptized? The way the homeless people took baths was to fill up the baptismal pool and I'd pass out soap. So I'd send the form in, saying 2,000 got baptized, never thinking anybody actually read the damn things. And these suits showed up to give me an award for shattering the old record! And when they saw what was actually going on, that was the first time I got in trouble with them."
Though they were annoyed, they did not try to stop Elliott—his congregation was, after all, flourishing and growing—but they did warn that they would watch him closely and judge him by his results.
It was the early 1980s—the Reagan era—and though he'd been warned to avoid overtly political activity, Elliott, who was then studying for a master's degree in social work (which he received in 1986) decided to offer sanctuary in his church for Salvadoran refugees. Unfortunately for him, the story made the front page of the paper, and word got back to the hierarchy. He was called onto the carpet, and defended himself by pointing out that, "Hey, the Bible says we're supposed to give sanctuary, that's all I'm doing."
The emerging AIDS crisis proved the last straw. Elliott became involved in the interfaith St. Jude's Guild, which opened Glade House—one of the first residential facilities for AIDS patients in the entire country. "At the time, HIV was being discriminated against like crazy," Elliott says. "If a landlord found out you were HIV positive, you were out." AIDS was the "gay disease," and when Elliott lauded a gay AIDS activist in a news article, calling him "one of the most Christian people I know," the Baptist hierarchy was furious.
The pressure on Elliott was becoming unbearable. He had been wrestling with his conscience for a long time, and while he loved working with the homeless, and loved his church, he could no longer let himself be ruled by an unmovable, conservative hierarchy. He left his position, over the loud protests of his adoring congregation, and took an administrative job with the Louisville Coalition for the Homeless. He soon came to dislike his new job, which gave him no opportunity to interact directly with homeless people. That Christmas, down in Savannah visiting their families, Elliott and his wife made the decision to come back home.
The following summer, while in the process of moving to a house they'd bought by the beach, Elliott and his son were involved in a car accident. The son was not hurt, but Elliott broke his arm and several ribs—injuries that would take five months to heal. At the same time, his broken spirit was also healing. "I would drag a chair down to the beach," he remembers, "plop it in the surf, sit on it, stare at the ocean and contemplate." The vastness of the ocean reminded him of his place in the universe. His past was behind him, but his future was a blank slate. He knew he could be a writer. He'd had his first book, The Society of Salty Saints, published the year before. It drew inspiration from the stories of the homeless people he'd known back in Louisville. He knew he would continue to tell their stories (he has since had eight more books published), but he wanted to do more.
One thing he had learned from his conversations with the homeless was that they wanted more than a handout—they wanted a hand up. Seeing that services for the homeless in Savannah were doing little more than the former, he determined to change things. In November 1987, with his arm still in a cast, he got a job as president of Union Mission, a tiny but venerable Savannah organization that was trying to help the homeless by following the dictum in Matthew Chapter 25: "If you feed the hungry, you're feeding Jesus. If you clothe the naked, you're clothing Jesus."
But Micheal Elliott had other ideas. "It struck me that it was actually enabling homelessness to continue. If you're homeless, you would go get clothed, you would get fed, you would get somewhere to sleep, and you would wake up the next day still homeless. And it seemed to me that housing, tied to other levels of accountability, and equipping folks with the tools they need to overcome their homelessness, was a much better way to go."
He had a hard time convincing Union Mission's board, which was divided over the issue between those who wanted to follow the biblical dictum and those who understood their mission to be ending homelessness. Elliott offered to resign if he didn't meet a set of benchmarks, such as getting 100 people out of homelessness within a year. He won the battle. "The first thing I did was to excommunicate Jesus from the bylaws," he relates. "I made us a nonprofit, started competing for all kinds of funds. That was 1988, and we had about a $40,000 budget. Now it's about an $8,000,000 budget."
One of Elliott's first moves was lobbying the state to create the Chatham-Savannah Authority for the Homeless. He became the Authority's chief grant writer as well as a board member (he later became board Chair. This allowed him and his team to bypass county and city bureaucracy, draw up a comprehensive plan for dealing with homelessness in Chatham County (which includes Savannah), and create programs and coalitions targeted to specific problems and needs. Union Mission was one of the main organizations to benefit—it eventually came to represent about half of the Authority's Continuum of Care programs.
One such Union Mission program was Grace House. Under construction when Elliott arrived in Savannah, the men-only shelter opened in December 1987. Two more shelters opened in 1990: the Magdalene Project, the city's first shelter for women and children, and the Phoenix Project, a shelter for people with HIV. In 1993, Union Mission took over the Hacienda, a shelter for women with substance abuse problems, and created Potter's Place, a shelter for men with substance abuse problems. "By then, we had a pretty good continuum of housing folks and moving them along, and dealing with their substance abuse problems, and then getting them jobs," Elliott explains, "but one day I was in the courtyard of our men's shelter, and I looked up and saw all these people with bandages on, coughing and hacking and all that stuff. I said, 'You guys are too sick to be here'—which led me to a growing awareness of hospital discharge practices."
Elliott was sending people to the hospital who were too sick to stay in shelters, and the hospitals were immediately discharging them because they weren't sick enough to stay in the hospital. "I was infuriated," he says. "I had an erroneous notion that a hospital was a place where people went to get well. So I called the CEO of the hospital, wanting a meeting, and didn't get one. Well, somewhere along this time I learned that if you go to the emergency room complaining of a heart attack, they have to see you, give you a complete physical. So I orchestrated, behind the scenes, several homeless folks showing up at the emergency room at the same time, all complaining of chest pains."
Elliott got his meeting with the CEO, and out of that meeting came Health Care for the Homeless, a coalition involving two hospitals, four shelters, the County Health Department and three different levels of government.
Having convinced Memorial Health University Medical Center and St. Joseph's/Candler Health Systems that it was cheaper to treat the homeless in outpatient settings, Elliott received $280,000 to open four shelter-based clinics. In the first 18 months, these clinics saved the two hospitals more than $2 million. This unusual collaboration of two competing hospitals drew the attention of the Robert Wood Johnson Foundation (RWJF), whose Local Initiatives Funding Partners program gave Health Care for the Homeless $475,000 toward the start up of the new J.C. Lewis Health Center, a 32-bed respite care center that opened in 1999. In its first three years of operation, the health center saved the two hospital organizations $34.3 million in uncompensated care, Union Mission reported in August 2003.
"The growth has been incredible," Elliott says with satisfaction. "But it's been very methodical from my point of view. I tried to find a causal factor of homelessness, and then come up with a programmatic response to it, always tying housing to performance by homeless folks—meaning 'If I'm gonna meet your basic needs, then that's half of the equation. The other half is, you're expected to perform in certain areas.'
"If you're not job-ready, we'll get you job-ready, all those things. And the results began to pile up. From 1992 to 2000, we reduced homelessness in Savannah by 58 percent." This by offering not only medical and dental care, but also prevention education, housing and job training.
One signature effort, a garden where the homeless worked growing produce to sell to local restaurants, was so successful that Union Mission soon opened its own restaurant, The Starfish Café, staffed by the homeless, who had been trained in every aspect of the operation by special arrangement with Savannah Technical College. "We're now in our 30th class," Elliott crows. "Our slogan is, 'Where else can you solve a social problem and have lunch at the same time?'"
In 2000, Micheal Elliott won a Robert Wood Johnson Community Health Leadership Award, one of only 10 awarded each year to grassroots health leaders around the country. The award came with $95,000 for Healthcare for the Homeless, and $5,000 for Elliott, who says his entire team at Union Mission earned the award. The money helped purchase a property across from The Starfish Café that is currently being renovated to house an artisan's cooperative, which will consist mostly of the homeless.
But the long-term relationship with the Community Health Leadership Program proved even more valuable. First of all, there was the avalanche of press coverage. His new, higher profile allowed Elliott to get the attention of the Georgia Department of Community Health. It and the Department of Community Affairs agreed to provide seed money for replication of the J.C. Lewis Center in other Georgia cities. The first opened in October 2005, in Macon. Elliott was also appointed to the Georgia Inter-Agency Council on the Homeless and the Georgia Public Health Realignment and Change Team.
The Community Health Leadership Program also put Elliott in touch with a political consultant, Judy Meredith, who coached him on how to work more effectively with government and helped him write a business plan for redirecting the state's approach to mental health, which he submitted to the governor's office. That plan resulted in new contracts for Union Mission.
"Right now we're breaking ground, expanding the J.C. Lewis Health Center," he reports. "We've bought a big building next door to it. We're gonna renovate it, so that it's the behavioral health center for adults in Chatham County. At the same time, I'm developing this permanent housing stop for people with [mental health] disabilities. We're doing a 48-unit apartment complex with a mental health center in the middle of it. It's basically expanding on the kind of housing we've done in our shelters. But this time, it's permanent housing, with services on-site."
The leadership program's annual retreats give Elliott the opportunity to mingle with other award recipients, a priceless opportunity. "There's a strong feeling of camaraderie that's just kind of serendipitous," Elliott reports, "a feeling of coming home and being with family. As we begin to talk and share stories, I just sit in awe of what people have done. So, there's this incredible feeling of mutual respect. And then we all start stealing one another's ideas."
One thing uniting all the awardees is their passion for their work. Elliott believes this is the prime requisite of successful grassroots leadership. To that end, he has mostly promoted from within his own organization. His management style, drawn from Peter Drucker's writings, features a decentralized structure and is heavy on measurement of performance criteria.
Prior to the September 11th attacks and the subsequent drain of monies from health care to pay for national security, Elliott had believed homelessness in Savannah would become a thing of the past, and his task would be preventing it. Unfortunately, the number of homeless has been stable or on the increase since then. Still, he is hopeful about the future—at least in Savannah. "Five years from now," he says, "I will have several hundred permanent supportive housing units that are connecting with my behavioral center and health center, so that these folks have the structure that they need to be successful people. And I am hopeful that the number of units will equal the number of people in need."
As he takes his mission into the future, Micheal Elliott draws satisfaction from those he has already helped, but he knows there is much more work to be done. "Everywhere I go in this town, I run into people who used to be homeless, who aren't anymore, and tell me all about their kids and houses, or smile and just hug me, or wave as they drive by in their cars. And then I've got people who are stuck here, that I see every day, that we can't get through the system. And so every day, on the one hand, I'm gratified, on the other hand, I'm challenged again."
The sense of the universe he developed when he sat watching the ocean in Savannah still governs his thought process. One of his books, Playing Hide and Seek: A Non-Churchgoer's Path to Finding God, depicts God as bigger than institutional religion, and finds the best expression of spirituality to be in the way we connect with other people. "If we're serious and deliberate about helping," he says, "then there's no reason why everybody who needs help can't be helped."
For more information on the Union Mission, see the organization's website. For more on Union Mission's work with its Local Initiative Funding Partner grant, see the Program Results on ID# 037327 linked below.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
RWJF examines the types of competitive foods - foods and beverages schools offer outside of meal programs - available in our nation's school...
Recent studies have demonstrated a connection between low-socioeconomic status and poor health in children. This study builds upon previous ...
This study examined the impact that race has on the prevalence of self-reported diabetes for Hispanic and non-Hispanic people. Data from the...
In this article, the authors consider the social, structural and symbolic effects of the recent and rapid spread of legal gambling in the Un...
Immigrants and their children are one of the fastest growing components of the U.S. population. One in five Americans under the age of 18 is...
Most studies investigating links between social capital and health have relied on work by Robert Putnam who conceptualized social capital as...
The present article considered cardiovascular patients' adherence to physicians' medication recommendations. Nonadherence was defined as fol...
This study examined the prevalence of attention-deficit/hyperactivity disorder (ADHD) among children in the United States. Also of interest ...
The current article explored risk factors for iron deficiency for toddlers in the United States with a focus on Hispanic toddlers. Data from...
The research presented in this article compared the density and concentration of pro-tobacco media messages in African-American and White ma...
This article describes efforts to use information on influenza burden and vaccine efficacy to estimate how influenza vaccine recommendations...