The Problem: Communities with Limited Access to Basic Healthcare and Supplies Local Communities

B4P headquarters is based in Ann Arbor, MI where a large portion of our partners are situated in Washtenaw County. Washtenaw County is currently home to two major hospital networks: The University of Michigan Health and St. Joseph Mercy Health (4). Washtenaw County has various initiatives and organizations established to support those who either cannot afford or cannot access proper healthcare. For example, the county created a vital legislature, specifically the Washtenaw Health Plan (WHP), which provides healthcare coverage to low-income county residents who don’t have access to affordable healthcare insurance (5). Organizations such as the Washtenaw Health Project, have been instrumental in providing vulnerable populations access to healthcare by finding ways to cover people’s healthcare needs if they are uninsured. According to Rebecca Fleming, Packard Health’s Director of Community Health Initiatives,

“WHP extends beyond mere insurance coverage.They are equipped with skilled staff that work directly with Packard Health and other non-profit organizations to enroll people in Medicaid”

While the Washtenaw Health Project has been effective in increasing healthcare accessibility, programs focusing on coverage are limited. For instance, about 27% of households are within the Asset Limited, Income Constrained, Employed (ALICE) threshold, meaning they earn more than the Federal Poverty Level but less than the basic cost of living for the county (6). Therefore, they do not qualify for the Affordable Care Act but are still in desperate need of basic healthcare. Furthermore, clinics such as Packard Health and Hope Clinic serve a wide population of immigrants, both documented and undocumented, who do not receive health insurance coverage as even residents with green cards are eligible for Medicaid. The limits of government programs highlight the need for the implementation of further practices like the Washtenaw Health Project which tackle inequity directly, especially since Washtenaw County ranks 81st out of the 83 counties in the state regarding inequity. Inequity in Washtenaw County stems from the stark disparities in income, opportunities, and education between well-developed areas like Ann Arbor and poverty-stricken communities like Ypsilanti, despite their proximity of just eight miles. (6).

Racial discrimination is a critical factor that must be considered when analyzing the contributing factors directly related to poorer health outcomes among certain communities. In Washtenaw County, the life expectancy of a Black resident is 10 years less than White residents, and Black newborns are twice as likely to be born premature than White newborns (7). Predicting health outcomes can be highlighted in areas like Detroit, MI, where Black residents were subjected to redlining— allocating specific areas for non-Whites to live. Often, these neighborhoods would be located in highly polluted areas, such as southern metro-Detroit, which is predominantly Black (8). Though it is no longer permitted, repercussions of redlining are felt by the communities that reside in those areas. During the practice of redlining, cities that were predominantly White received more resources and ready access to healthcare. Over time, redlining has been echoed in the concentration of resources, resulting in the modern issue of unequal access across county lines. This issue can be felt by Ypsilanti, which is predominantly Black, and Pittsfield which is predominantly Hispanic/Latino in contrast to Ann Arbor, which is predominantly White and Asian/Pacific Islander.

Domestic Communities

Our chapters nationwide strive to support neighboring underserved and uninsured communities where access to adequate healthcare is limited. Our chapter, led by students at The University of Southern California, focuses on mitigating the prominent effects of chronic diseases, food insecurity, and other health related concerns in the city and county of Los Angeles, CA (9). In particular, Los Angeles has seen a rise in obesity rates to more than 11% from 1997 to 2007 due to food desert conditions and lack of access to public parks and outdoor recreation areas to exercise. Additionally, the area suffers from some of the highest levels of morbidity and mortality rates compared to any other part in the county, with chronic diseases such as coronary heart disease being reported as the leading cause of deaths (10). Southern Los Angeles has also seen a rapid decline in healthcare environment resources compared to other parts of the county, with an overall 43% difference in their resources compared to Western Los Angeles. Lastly, our USC chapter president has observed high rates of homelessness and uninsured individuals in the area from firsthand accounts of donating supplies to clinics in the area.

Another chapter located at The Ohio State University (OSU) in Columbus, Ohio also serves a region with significant challenges in accessing healthcare. Columbus is located in Franklin County, which has over 14% of its inhabitants living below the poverty level and more than 9% without health insurance (11). This economic hardship contributes to higher incidence of chronic diseases like diabetes and hypertension, which disproportionately affect the area’s low- income and minority populations (12). Additionally, food insecurity has increased in Columbus, with 18% of individuals reporting insufficient access to cheap, nutritious food, compounding health disparities. Franklin County, the central county of Columbus, has significant health disparities based on race and ethnicity. The Hispanic population, one of the area’s fastest-growing demographics, has greater rates of uninsured individuals compared to any other groups. This is primarily due to language barriers and insufficient access to culturally appropriate care (13). The chapter president at OSU emphasized the chapter’s continuous relationship with La Clinica Latina, a free clinic that offers medical services to the Spanish-speaking community and targets diabetes and hypertension while minimizing linguistic and cultural barriers, significantly improving the health outcomes of Columbus’ Hispanic community.

International Communities

B4P has the unique ability to provide crisis relief and lifesaving resources to international areas in desperate need of medical supplies. Three of our most recent international shipment locations include Syria; Agua Prieta, Mexico; and Ahmedabad, India.

The earthquakes that struck Syria in early 2023 had a profound impact on communities that were already vulnerable due to over a decade of conflict, economic hardship, and internal displacement (14). With nearly 12 years of conflict, Syria’s population was already highly susceptible to crises, making the earthquake’s impact even more severe. Reports indicate the areas most affected were home to approximately 3 million internally displaced people struggling with inadequate food security, precarious housing, and limited access to basic needs. Women, children, the elderly, and those with disabilities were among the demographics most severely affected, facing compounded difficulties in securing shelter, medical care, and food in the disaster’s aftermath the earthquake, Syria’s healthcare system was severely compromised by the ongoing civil war conflict. Over half of the country’s public hospitals were damaged, with 37% entirely out of service (15). The depletion of healthcare professionals added to the strain, as many doctors, nurses, and other medical professionals had fled the country, leaving critical gaps in medical care availability. Medical facilities were damaged or destroyed in the earthquake, exacerbating the shortage of healthcare personnel, medical supplies, and safe spaces for treatment; affected communities thus became heavily reliant on international assistance. The weak infrastructure of the healthcare system prevented care for all. The distribution of aid faced logistical challenges, especially in remote or conflict-affected areas, which led to uneven access to supplies. Syria’s policies in place for disasters remain limited, with the government struggling to mobilize adequate resources due to years of conflict and international sanctions. International collaboration was essential in filling these gaps, as evidenced by the U.S. Treasury Department’s emergency license to facilitate earthquake relief transactions, allowing smoother financial flows for aid efforts. Yet, challenges such as customs delays and regulatory barriers affected the speed and efficiency of some shipments. Going forward, greater coordination between local and international actors could enhance disaster response, while bolstering Syria’s healthcare infrastructure could improve resilience to future crises.

Systemic barriers in health have also left vulnerable populations without basic medical services and resources in Agua Prieta, Sonora, Mexico. The healthcare infrastructure in this region is very limited; there are only 99 medical professionals for a population of over 70,000 residents—one professional per 710 people, far from the global recommendation of one professional per 200 to 300 people (16). Healthcare disparities within this region are further underscored by the occurrence of chronic and preventable diseases. Agua Prieta’s incidence of Type II diabetes among adults is 15.1%, way above Mexico’s national average of 10.6%. Similarly, 33.5% of the adults in the region have hypertension, and there is a huge difference between the measured and the self-reported cases. Another major hindrance is cultural and logistical barriers. In regions such as Agua Prieta, long-standing differences in education and language skills hamper health literacy and the proper communication with health professionals. For instance, most members of the community do not have access to health information, or even know how to gain access due to lack of transportation infrastructure and public health promotion activities within the areas. Further, there is a scarcity of preventive health care and health education as expressed by community leaders for sustainable approaches in nutrition education and chronic disease management.

Healthcare disparities also played a significant role in Ahmedabad, especially during the COVID-19 pandemic. The pandemic’s impact was evident in both urban and rural areas (17). Urban centers, such as Ahmedabad, Surat, Vadodara, and Rajkot, accounted for two-thirds of Gujarat’s total COVID-19 cases, placing significant strain on urban healthcare infrastructures. In rural regions, the challenges were compounded by inadequate medical facilities and a surge in cases, leading to higher mortality rates. The lack of resources made access to healthcare a privilege, leaving many unable to bid farewell to loved ones who succumbed to the virus. However, Ahmedabad’s response to the crisis demonstrated a commendable level of adaptability through the establishment of a three-tier healthcare system. This innovative framework categorized patients by the severity of their conditions, allowing for more efficient allocation of medical resources and timely prioritization of care (18). Such an approach highlighted the city’s ability to implement organized crisis management, reminiscent of the support mechanisms that aided overwhelmed facilities. The model illustrated the importance of strategic resource distribution and coordination between healthcare providers to manage surges effectively and prevent the system from collapsing under pressure. Also, healthcare disparities emphasized the urgent need for comprehensive, long-term strategies to strengthen healthcare infrastructure and public health systems. Measures such as deploying mobile medical units for rapid response and enhancing communication among healthcare facilities proved vital during the crisis (19). Ensuring a continuous supply of critical medical resources, like oxygen and vaccines, became an immediate priority as shortages magnified the severity of the situation. Building a resilient public health framework, informed by these experiences, is essential for protecting communities and empowering healthcare providers to confront future pandemics and large-scale health challenges more effectively.

The Solution: Blueprints for Pangaea’s Impact in the Past Five Years

Hope Clinic and Packard Health are clinics that offer free primary and specialized medical care, including cardiology, gynecology, psychiatry, and more. B4P donated $2,000 worth of medical supplies to Hope Clinic and about $3,000 to Packard Health, leading to a total reduction of 175 pounds of supplies that otherwise would have been sent to a landfill. Hope Clinic’s primary clientele are immigrants and low-income individuals who are uninsured, especially those within the ALICE threshold. Packard Health also supports a variety of demographics, including a growing immigrant population, unhoused individuals through an on-site clinic and recuperative care program with the Delonis Center, and Spanish speaking clients.

University of Southern California (USC), located in southern Los Angeles, has run three major shipments in the past year, reducing medical waste by 288 lbs and donating supplies valued over $16,000 USD. USC primarily targets homeless populations in southern Los Angeles by donating to clinics focusing on homeless healthcare. Additionally, The Ohio State University (OSU), located in Columbus, Ohio, has also organized three major shipments in the past year, reducing healthcare waste by 550 lbs and cutting clinic operating costs by over $18,000. OSU primarily supports the underserved and hispanic population in Columbus, Ohio by supplying essential medical items to free clinics.

• Syria: This effort supplied clinics with life-saving tools valued over $225,000, enabling resource-constrained facilities to redirect funds toward other essential services and infrastructure improvements.

• Mexico: B4P HQ coordinated a shipment of much-needed medical equipment valued at $87,797 and weighing over 2,020 pounds to Agua Prieta, Sonora, Mexico, helping local clinics manage chronic illnesses, such as diabetes and hypertension, while improving overall patient care.

• India: These essential supplies were entrusted to a local grassroots organization, Manav Sadhna, to deliver medical aid to vulnerable populations in the region. This cost-saving measure enabled grassroots initiatives to expand their services to underserved communities in Ahmedabad and reallocate resources during the pandemic.

Discussion

The cost of healthcare in the United States far exceeds that in other high-income countries and only continues to grow (20). In 2020, U.S. healthcare costs grew 9.7%, totalling $4.1 trillion, or about $12,530 per person. The median price of hospital admissions varies from procedure to procedure; regardless, out-of-pocket spending can be thousands of dollars in the U.S. However, the list prices often are much higher than the actual payments made to providers by public or private insurance companies. In fact, out-of-pocket spending for healthcare has doubled in the past 20 years, from $193.5 billion in 2000 to $388.6 billion in 2020 and has disproportionately fallen on those with the fewest resources, specifically those who are uninsured, Black and Hispanic people, and families with low incomes. Nonetheless, healthcare unaffordability is an issue to many Americans— insured and uninsured— with nearly one in five Americans having medical debt. High prices deny many people healthcare, reflecting inequity of healthcare. As previously discussed, resources become concentrated in the areas that can afford healthcare. Therefore, policymakers stress reducing the cost burden for patients to help all Americans.

One strategy to do so would be reducing the cost of medical supplies. Currently, medical waste disposal by hospitals and other producing facilities is regulated under the Medical Waste Regulatory Act (21). However, there is no regulation on the quantity of waste produced. A recent study at the University of California, San Francisco found that their medical center wastes about $1,000 of medical supplies per surgery (22). In 2021, the Michigan Medical Center conducted about 67,514 surgeries, which using the value determined by UCSF, would lead to about $67,514,000 of medical waste in one year (4). Therefore, measures to reduce medical waste such as the work of MSROs are crucial in mitigating waste and increasing access to healthcare. Moreover, the donations from MSROs like B4P that are redistributed to free clinics are then effectively put to use, breaking barriers in healthcare access.

In light of increasing healthcare costs, clinics serving uninsured and marginalized communities such as Packard Health and Hope Clinic are instrumental with Packard Health Pharmacy seeing over 1,287 unique patients and Hope’s Ypsilanti Medical Clinic seeing over 2,316 patients (23, 24). Nonetheless, their efficiency is determined by funding and equipment, so high medical supply costs and insufficient financial support pose challenges to their ability to help people. According to Hope’s Medical Director Dr. Martha Kershaw, expensive equipment like an EKG machine may be useful for diagnosing cardiac issues but is too difficult to maintain.

Moreover, both Packard and Hope source supplies through specialized vendors such as Henry Schien but their budget is very limited. Donations are often inconsistent or of one-time use, which is not reliable to depend on. To alleviate this issue, when working with local clinics, B4P could provide a steady stream of supplies to long-term partners. The most common supplies received by B4P Headquarters from Michigan Medicine are blood collection kits and PPE, which also are more commonly requested by local clinics.

Nationally, many of B4P chapters have strong foundations in tracking their progress and impact on clinics both locally and internationally. In particular, the USC B4P chapter meticulously records KPIs including beneficiaries and dollar value of all supplies donated in one document for each shipment rather than utilizing a grand master shipment database, allowing us to track concrete impacts on reducing clinic costs. Furthermore, the OSU chapter has adopted projects outside of shipments such as a mental health pamphlet to broaden B4P’s reach. Overall, our chapters, including HQ, could benefit from adopting similar processes similar to USC to track B4P’s efficiency specifically for local clinics and expand B4P’s impact by diversifying measures of outreach.

On a global level, B4P shipments to Syria, India, and Mexico shine light on internal methods of improvement. In Agua Prieta and Sonora, Mexico, the lack of data collected on the long-term benefits of the shipments—such as clinical outcomes and operational improvements—makes the case for continued intervention. In India, the COVID-19 pandemic revealed deep inequalities in Ahmedabad’s healthcare system, especially during the second wave, which strained both urban and rural infrastructures. B4P’s delivery of 12 pallets of essential medical supplies helped grassroots organizations like Manav Sadhna provide care to underserved communities, showing how targeted support can make a meaningful difference during times of crisis. Building strong local partnerships, planning ahead, and focusing on specific needs are essential to reducing disparities. In Syria, the shipment of 13 pallets of medical supplies in March 2023 was a pivotal effort in addressing the healthcare disparities plaguing a region devastated by years of conflict and economic instability. By redistributing these resources, B4P enabled Syrian clinics to save $225,000 in operating costs, allowing them to reallocate scarce funds toward pressing priorities like infrastructure repairs, staff wages, and patient care programs. This intervention directly alleviated some of the strain on fragile healthcare systems, providing tangible support to communities with limited access to medical supplies amidst rising healthcare demands. Navigating the complexities of conflict-affected supply chains and ensuring timely delivery to regions with fragile infrastructure required extensive planning and coordination. In Syria, the importance of building strong, localized partnerships has become clear, as these collaborations ensure that resources are distributed effectively and address the most pressing needs of vulnerable populations. Looking towards the future, B4P aims to deepen its partnerships with local organizations that possess a nuanced understanding of regional challenges to enhance the effectiveness of its interventions and continue reducing disparities and strengthening healthcare systems in Syria.

A study conducted by Johns Hopkins researchers provides compelling evidence for the potential impact of such initiatives. The authors tracked 19 high-demand surgical items donated to Ecuadorian hospitals over three years, then extrapolated the amount and value and the donations to 232 U.S. surgical centers with caseloads similar to that of The Johns Hopkins Hospital. The results showed that if the 232 U.S. hospitals saved and donated their unused surgical supplies, they would generate 2 million pounds of materials, totalling $15 million over a single year (25). Costs that patients are covering in the U.S. are preventing many from being able to afford healthcare or treatment. The approximate 5 billion pounds of waste generated by the U.S. healthcare system can be reallocated to areas of need, domestically and internationally (26). Problems encountered by people of lower socioeconomic status reap the harmful impacts of not reallocating waste, thus it is crucial to support efforts that work towards mitigating this issue.