Archive for: 2013

A Portrait of Hope

Dec 16, 2013, 4:46 PM, Posted by Jeff Meade

Chuck Connelly Culture of Health Blog Post Artist Chuck Connelly and his monumental remembrance of the children of Sandy Hook

I first came to know Chuck Connelly in April of last year. He’s a gifted, famous and often controversial artist, whose work has appeared in countless galleries, including the Metropolitan Museum of Art. He’s very much his own man, and that man can be difficult. A writer once described Connelly as “Norman Rockwell on acid—a maverick narrative painter pushing the limits of myth into a modern malaise all his own.”

It’s a left-handed compliment, but there’s no getting around the undeniable truth: Chuck Connelly is an extraordinary talent. He may come across as a rumpled, dark-witted cynic, but on the inside, he is a luminous soul.

So here’s how I came to know Chuck Connelly. He’s an Irish-American who lives in Philly's East Oak Lane neighborhood, and I co-author a blog devoted to Irish culture in Philadelphia. So for our purposes, Connelly was grist for the mill.

And so it was that I found myself on the topmost floor of a ramshackle barn one dreary day last April, gazing upon Connelly’s most recent magnum opus: twenty painstakingly detailed oils on canvas, each one bearing the likeness of a first grader murdered by a lone gunman at Sandy Hook Elementary School on December 14, 2012. All of the paintings were clustered in a simple 10- by 12-foot wooden frame. The entire assembly towered over us. It was a breathtaking, shattering remembrance.
 

When news of the shooting broke, Connelly reacted as the rest of us did, with horror, frustration and anger. A couple of days later, he started painting a portrait of one of the young victims, 6-year-old Emilie Parker. At first, he wasn’t sure where the project was taking him. At that point, it really wasn’t a project. “I started to do the one, Emilie, when it first happened,” Connelly explained to me. “Her face was everywhere. I just thought ... what a tragedy. So I painted her. Then I made Dylan (Hockley), and then I thought ... you know what? I gotta do them all.”

Last week, Connelly’s “Children of Sandy Hook” went on display at Villanova University to commemorate the one-year anniversary.

As that anniversary arrived last weekend, I thought about Chuck Connelly’s heartfelt tribute. It caused me to wonder, probably for the millionth time, when we’re ever going to come to grips with the problem of gun violence. Every shot fired wounds us all.

Here at RWJF, we have devoted a great deal of effort toward understanding gun violence and how to prevent it. One well-known example of our work in this area is grantee Cure Violence, formerly Ceasefire.

Here’s how we describe the program:

Cure Violence uses a public health model to reduce gun violence. By treating violence as a learned behavior that can be “unlearned,” Cure Violence offers a solution to a problem that had been seen as unsolvable.”

Obviously, gun violence is one aspect of a much broader and disturbing picture. It’s not an exaggeration to suggest that violence of all kinds is a plague in the United States, and from our description of Cure Violence, you can begin to understand our response to it. We approach violence as a critical public health issue, and that point of view determines our course of action.

A recent example of our work to curb violence further illustrates that particular approach. It revolves around the issue of adverse childhood experiences, or ACEs. That’s a wonky term, but it is meant to describe and encompass the horrors routinely visited upon children, mostly in the form of abuse and neglect. Many of these children live a nightmarish existence.

Some might say we’re swimming against the tide on this one, but we are, as my colleague Susan Promislo wrote in this space a few months ago, “witnessing a health revolution.” Childhood trauma was the subject of a recent summit in Philadelphia, a confab that garnered a great deal of national attention. Throughout the country, more and more experts are turning their expertise to the problem of ACEs, and many of them are doing pioneering work to understand the problem’s causes, document its long-term emotional and physical damage, and develop creative and effective long-term solutions.

From our work, we know that there are no simple answers to countering childhood trauma—or any other kind of violence. Just a few weeks after the Newtown tragedy, a report by Kevin Freking in the Huffington Post cited a particularly painful statistic: “The United States has about six violent deaths per 100,000 residents.”

I find myself pondering those damning numbers. Can we really do what we want to do? Can we really make the country a better, less violent place? Sometimes it seems impossible. But if there’s one thing I have come to know about this place, it’s that most of us are incredibly hopeful. You can’t work here and not be an optimist at heart. It would be easy to throw up our hands and give up, but no one here gives up.

If the tragedy of Newtown tells us anything, it’s this: When it comes to the challenge of violence in America, if we are to prevail, we must be guided by hope. And to paraphrase one of my favorite Winston Churchill quotes: We can never, never give up.

Jeff Meade is a senior writer/producer for rwjf.org.



Health Policy Wit or Wit-Out Consumer Input

Dec 13, 2013, 10:56 AM, Posted by David Adler

Consumers Union RWJF Health Care Cost Conference for Advocates Consumer advocates brainstorm about rising health care costs.

Whether you’re a Philadelphia native, a visitor, or just a cheesesteak aficionado, you need to know how to order. When you get to the front of the line at one of Philadelphia’s long-established cheesesteak stands you order your sandwich wit or wit-out. Either with onions or without. Whatever you do, don’t stand at the window and first think about this important decision. Let’s just say it won’t end well. But, as much as I love cheesesteaks (in moderation of course) this is not the most important wit or wit out decision we have to make as a country.

The decision we really need to make is how we want our health policy decisions made. You can have it wit or wit out consumer input. At a recent meeting on health care costs sponsored by the Robert Wood Johnson Foundation and Consumers Union, my colleague Anne Weiss drove this point home.

I’m paraphrasing a bit, but the gist of her remarks (and indeed of the meeting) was that efforts to contain spending and to get more value out of our health care system are going to come about with or without consumer input. She wants it to proceed with it. In other words, Anne’s ordering her health care value steak wit. I second her choice. Personally I think it’s ridiculous to eat a cheesesteak without onions, and I think it’s equally problematic to address health care costs without consumer input.

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A Connections Checklist: Bringing Health Care and Communities Together

Dec 10, 2013, 1:34 PM, Posted by Hilary Heishman

Cure Violence Community meeting

The conversation is nearly everywhere I go for work lately. More than cost trends, or accountable care organizations, I hear people in both public health and health care circles talking about how we need to be better connected.

Across a variety of health roles, many people are embracing the belief that individuals and the communities we live in will be better off—regarding health outcomes, health care cost, health disparities, corporate productivity, individual quality of life, and so forth—if health care providers, the public health system, and social services are better connected to each other and to the communities in which patients live.

Fortunately, it’s not all talk. In communities across the nation people are trying their best to connect systems to improve the overall health of those who live there, driven by a combination of compassion, pragmatism, pressure, policies, and overall gestalt.

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Five Takeaways from the National Transparency Summit: An Issue Whose Time Has Come

Dec 9, 2013, 4:33 PM, Posted by Susan Dentzer

Susan Dentzer RWJF Senior Health Policy Adviser Susan Dentzer
  1. Transparency is an idea whose time has come—in large part because U.S. consumers are feeling so much pain from higher health costs. Health economists have long noted that U.S. health care prices are out of whack and that hospital chargemasters are nonsensical. Recent media coverage of these phenomena has captured widespread attention, perhaps because consumers are being hit so hard in the pocketbook. Since 2000, rising prices of hospital charges, professional services, drugs, devices and administrative costs, are responsible for 91 percent of the increases in health spending. Meanwhile, consumers’ out-of-pocket spending on health care, estimated at $329 billion this year, is projected to rise to $411 billion in 2020—a 25 percent increase. Almost three in five workers in small firms, and one in three workers in larger firms, are in a health plan with a deductible of at least $1,000 for single coverage, and in 2012, nearly one of five U.S. adults was contacted by a collection agency over unpaid medical bills.

    It’s well established that much of this money is being spent on health care of questionable value. With so much of their money—and their well-being—now at stake, “People are going to impose transparency on the health care industry,” predicted Leah Binder, a conference participant who heads the Leapfrog Group.

  2. Consumers and patients deserve to know far more about the costs and quality of care, but unless the two are linked, the public may continue with its longstanding delusion that the more expensive the care, the better the quality. Francois de Brantes, executive director of the Health Care Incentives Improvement Institute, noted that this widespread consumer misapprehension constitutes a “perverse incentive” for providers to continue to raise prices. Meanwhile, evidence of poor quality abounds. Martin Makary, a Johns Hopkins University physician and author of Unaccountable: What Hospitals Won’t Tell You And How Transparency Can Revolutionize Health Care, reminded the conference that preventable adverse events in hospitals are now the nation’s third leading cause of death annually. Many highly esteemed medical centers that end up routinely on “best hospital” lists don’t make the Joint Commission’s tally of top performers on basic quality and safety measures.

    Conference speakers agreed that there’s a pronounced need to combat these trends by developing more and better quality measures—especially those capturing care outcomes, and in particular, the outcomes that are most important to patients. Providers’ scores on these measures should then be funneled to purchasers and the public. “When consumers can really start to see that this hospital is better than this other hospital, or this doctor is better than that doctor, they will start to move,” said Bill Kramer, executive director for national health Policy at the Pacific Business Group on Health.

    Promising prototypes of the platforms that could communicate such information include winners of the RWJF Hospital Price Transparency Challenge—for example, Consumer Reports’ Hospital Adviser: Hip & Knee, which combines hospital quality rankings with Medicare cost data to help consumers pinpoint high value institutions where they could obtain surgery.

  3. Fostering greater transparency will be a long process, but there could be relatively quick “wins.” Many contracts between health insurers and providers contain “gag clauses” that bar both parties from disclosing claims data or prices paid for care. The clauses appear to serve both parties’ interests—helping to protect health plans’ proprietary interests in the provider networks they’ve established, and providers’ desire not to disclose how little they are willing to be paid. California has outlawed such clauses in health plan contracts, and many conference attendees agreed that other states should follow suit.

    What’s more, a total of 16 states have set up mandatory or voluntary all-payer claims data bases (APCDs) to pool statewide data on diagnoses, procedures, care locations, and provider payments. Conference participants agreed that more states should enact mandatory APCD’s, or use the regulatory authority in state insurance laws to compel insurers to issue payment and pricing data, as was done in Rhode Island.   More states could also follow the lead of Maine Quality Counts, the private, independent nonprofit organization that leads the RWJF-sponsored Aligning Forces for Quality coalition in the state, and which has aggregated health plan data for purchasers, consumers and providers to promote transparency on quality and cost.

  4. Transparency in the hands of consumers could be powerful—but in the hands of providers, even more so. Health care providers themselves often lack information about the quality and costs of their care. In particular, transparency can focus attention on the extreme amount of variation among providers in the care they provide. Glenn Steele, president and CEO of Geisinger Health System, described how Geisinger’s physicians came together to define “best practices” across a dozen hospital episodes of care, including heart bypasses, hip replacements, and gastric bypass surgery. As physicians in the system adhered to these guidelines, spending fell, by 20 percent  because doctors narrowed the indications for which they agreed that the procedures were warranted, and 15 percent by reducing unnecessary variation.
  5. Transparency is a necessary but insufficient tool for health system transformation. Openness about price and quality alone is “not going to be enough” to achieve the goals of the Triple Aim, observed Steven Brill, whose Time magazine article in March 2013 gave renewed focus to the issue. Payment reforms and “culture change” that shift providers from a volume-based to-value-based approaches remain critical. What’s more, consumers need to have health insurance benefit designs beyond high-deductible health plans that encourage them to make wise choices, such as “value-based” benefits” that help nudge them toward cost-effective care delivered by low-cost, high quality providers. Others at the conference warned that regulators must stay attuned to unintended consequences of health system transformation, such as the consolidation of health care providers that could lead to attempts to jack up prices.

    In the end, “We don’t win the game until the care gets better,” observed Jay Want, CEO of WantHealthcare. The nation also must ensure “that the transparency we seek will serve to change the way we think about health and wellness,” said RWJF president and CEO Risa Lavizzo-Mourey. “We need to use our skills, our imagination, our influence, and, yes, our hearts, to transform our nation into one that considers being healthy part of what it means to be an American.”

    To that end, transparency about the choices we face as a nation on the costs and quality of health and health care can give our society a critical lens to look within.

Putting the Great in Grateful

Dec 9, 2013, 11:31 AM, Posted by Joan Barlow

Mercer Street Friends Food Bank Warehouse Trenton Photo courtesy of Mercer Street Friends

We all have the ability to do something great, even if it’s in the smallest gesture.

I love Thanksgiving because it’s “four days, no presents.” There is no need to get caught up in the grind of competitive decorating, shopping ‘til you drop, or agonizing over finding the right gift for that special person. It’s food, family, fun—and, of course, gratitude. After all, you can’t say Thanksgiving without the thanks.

I was lucky to learn at an early age how fortunate I’ve been and I try  to express my gratitude as much as possible. To be healthy, surrounded by family is a true blessing, even when coupled with difficult times. In recent years, I’ve been especially thankful for the opportunity to work at the Robert Wood Johnson Foundation (RWJF). My extended family at work is made up of warm, caring people who are passionate about our mission to ensure that all Americans have an opportunity to lead healthy and fulfilling lives—those same opportunities that I’ve been afforded.

In addition to the Foundation’s national efforts, RWJF makes a special effort in its home state of New Jersey. So last week, several colleagues and I volunteered at Mercer Street Friends Food Bank in Trenton—the largest source of government- and privately-donated food in Mercer County. The Food Bank channels 3 million pounds of food annually to the various food pantries, soup kitchens and shelters.

During our day there, we sifted and sorted, checked expiration dates on donated foods, and, because of the time of year, loaded up bags of Thanksgiving fixings for distribution for many of the 25,000 people at risk for hunger in Mercer County. These are families who go without what many of us often take for granted. It was interesting to me that the cellphones never appeared; there wasn’t that tug to keep checking email or follow Twitter feeds. It wasn’t spoken, but I think we all realized that what we were doing was too important, and deserved all our respect and attention. Even though our effort was small—after all, it was only one day—in someone else’s eyes it might be seen as something great.

As we worked, it brought to light for many of us the sheer volume of food needed, as well as what it takes to put together healthy offerings and supplies for the working poor, children in low-income households, the elderly, disabled, and homeless. I also reflected that, while Thanksgiving is a day when we do recognize what others do without, we don’t often remember that these families live in poverty and need our help—not just around Thanksgiving—but all year long. And not having basic everyday necessities, like nutritious food, can severely impact the health of families, particularly children.

So maybe Thanksgiving shouldn’t come only once a year. After all, aren’t we thankful for the things we have every day? The power of gratitude should be recognized as a challenge to be great—even in the smallest of efforts. Maybe that’s the magic about it.

I was proud—no, I was grateful—to work at Mercer Street Friends, and I will do it again. So as we enter the holiday season, count your blessings each and every day and let gratitude drive you to greatness.

Joan Barlow is the Foundation's Creative Services Manager.

Sprinting Toward Workplace Wellness

Dec 6, 2013, 2:25 PM, Posted by Ari Kramer

Graciela Ruiz

Lots of things can turn a person into a health and fitness nut. For many, it might be influence from friends, or a life episode that demonstrates the pitfalls of focusing too little on health.

For Graciela Ruiz, it was just a matter of landing a job at the right place.

When Ruiz started working at Wakefern Food Corp., the merchandizing and distribution arm for ShopRite and PriceRite stores, she was eating lots of processed foods, and exercise figured very little into her routine. She particularly hated running. “I wouldn’t run unless someone was chasing me,” she says.

One day, the organizer of Wakefern’s run/walk club signed her up for the Jersey Shore Relay Marathon. He gave her the race’s shortest leg, a 5K, and she trained hard and did better than expected. Fast forward five years, and Graciela is now highly active in the club and numerous other wellness programs at the company. She says she will “run for two hours and be happy about it,” and has changed her eating habits to a point where “I’ll eat vegetables all day long.”

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A New Holiday Tradition—Tasty Recipes that are Healthy, Too

Nov 26, 2013, 5:01 PM, Posted by Catherine Arnst

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Thanksgiving is almost upon us, ushering in a month-long season of holiday parties, groaning boards of food, favorite family recipes, cookie swaps, and an extra five pounds around the waistline. Instead of just giving in to the excess and making January the month of dieting, perhaps we could make a few adjustments. I’ve asked around the Foundation staff for some healthy holiday recipes instead of the usual green bean casserole and cream-laden sides. Here are some tried and true alternatives, that are kid–friendly as well!

In fact, why not invite any children about the house (or adults who are still kids at heart) to help whip up some of these dishes. Children love to grate, stir, and shake, and the older ones will go at chopping with a vengeance. It’s never too early to teach them to cook, as discussed on this blog a few days ago.

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“An Educated Consumer is Our Best Customer:” Four Things to Know About Transparency In Health Care Prices, Costs and Quality

Nov 26, 2013, 10:14 AM, Posted by Susan Dentzer

Watch our December 6, 2013, FirstFriday Google+ Hangout archive on transparency in health care.

Panic about high health insurance premiums. Fears about high-cost health-care providers being cut out of health plan networks. Worries that the health plans now available through health insurance exchanges won’t cover the care that patients need.

Welcome to the rollout of Obamacare....right?

Actually, with the exception of the new health insurance exchanges, all of the phenomena described above have a long history. Similar concerns were voiced loudly in the late 1980s and 1990s, when “managed care” in health insurance became a dominant force on the health care and health insurance landscape.

What’s amazing to people who lived through both of these eras—then and now—is how little has changed.  

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Get Out of the Drive-Thru Lane. Learn to Cook!

Nov 22, 2013, 1:32 PM, Posted by Catherine Arnst

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Some statistics worth pondering: According to the U.S. Bureau of Labor Statistics, the average American spends only 33 minutes a day on food preparation. Just over half of Americans bother to cook every day. On the other hand, 33 percent of children and 41 percent of teenagers eat fast food, every single day.

These fast food children are consuming 126 additional calories, and the teens 310 extra calories, than if they had avoided the chains, says Fast Food Facts 2013, a new report by the Yale Rudd Center for Food Policy & Obesity and funded by RWJF. Most of these children are eating adult meals, too, not the smaller-portioned children’s meals on offer. Not that it would matter, since less than one percent of all kids’ meal served at fast food chains meet recommended nutrition standards.

It’s not much of a stretch to link the lack of home cooking, a diet of fast food, and the fact that a third of U.S. children and adolescents are obese. So, what’s a parent to do? Well for one thing, we could learn to cook.

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Shielding Young Brains from the Effects of Toxic Stress

Nov 13, 2013, 3:45 PM, Posted by Kristin Schubert

Child First

Before the science on addiction was developed, we blamed smoking on bad choices. Once we understood how the brain worked, we were able to devise strategies to change behavior, and smoking plummeted. 

As David Bornstein points out in two outstanding recent New York Times columns, the science of toxic stress is setting the stage for another health revolution that is just as far-reaching. It is forcing us to rethink the way communities deliver services─health care, education, and more─to our most vulnerable.

Read the first column

Read the second column

Every day, there are young children who are abused. Who witness violence in their homes or neighborhoods. Who are malnourished. Or who have parents who struggle with drug or alcohol use. We now know that those adverse experiences change the way their young brains develop, and affect their mental and physical well-being later in life. These children are more likely to have heart disease, cancer, and hypertension as adults. They are more likely to use drugs, suffer from depression, and commit suicide. They are more likely to drop out of school, spend time in prison, and be homeless. 

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