Category Archives: Community Health
Last month the Washington Post held a live event, Health Beyond Health Care, that brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation (RWJF) and others—was to showcase examples of novel places that are working to create cultures of health, such as a newly designed school that promotes physical activity and healthy eating in Virginia, and free outdoor exercise classes in Detroit.
Videos from the Post event are now online and include conversations with:
- Dan Nissenbaum, managing director in the Goldman Sachs Urban Investment Group, about community development.
- Brookings Institution fellow Alice Rivlin about the RWJF Commission to Build a Healthier America, which released its report Beyond Health Care in January.
- Chris Allen, CEO of the Detroit Wayne County Health Authority, about moving the community from a focus on sick care to a focus on prevention and wellness.
The Post's continuing coverage also includes articles about how city design can open up new opportunities for health; how greenways and complete streets can get people moving; and how workplaces can get a makeover for healthier employees.
Over the next few days, NewPublicHealth will report on additional efforts across the country to promote a culture of health across neighborhoods, schools, homes and workplaces.
Explore the Post’s special report on “Health Beyond Health Care” here.
Study: Global Child TB Rates 25 Percent Higher than Previously Realized
The true number of children who develop tuberculosis (TB) each year in the 22 countries with the worst TB rates is nearly 25 percent higher than the World Health Organization (WHO) estimated as recently as 2012, according to a new study in The Lancet Global Health. Researchers used mathematical modeling to determine that approximately 650,000 children in these countries develop TB each year; the WHO estimate was 530,000. The study also determined that approximately 15 million children are exposed to TB every year and 53 million are living with latent TB infections which can become infectious active TB. While the findings are troubling, they also indicate promising ways to reduce the risk. "Our findings highlight an enormous opportunity for preventive antibiotic treatment among the 15 million children younger than 15 years of age who are living in the same household as an adult with infectious TB,” said lead author Peter Dodd, MD, from the University of Sheffield in the United Kingdom, in a release. "Wider use of isoniazid therapy for these children as a preventative measure would probably substantially reduce the numbers of children who go on to develop the disease." Read more on global health.
Severe Obesity Can Cut a Person’s Lifespan by Nearly 14 Years
Severe obesity can take nearly 14 years off a person’s life, according to a new study in the journal PLOS Medicine. Using data from 20 previous studies, researchers determined that severe obesity—defined as a body mass index (BMI) greater than 40—can cut lives short by anywhere from 6.5 to 13.7 years, due to increased risk of health problems such as heart disease, cancer and diabetes. "We found that the death rates in severely obese adults were about 2.5 times higher than in adults in the normal weight range," said lead investigator Cari Kitahara, a research fellow at the U.S. National Cancer Institute, according to HealthDay. Approximately 6 percent of U.S. adults are severely obese; severe obesity accounts for approximately 509 deaths per 100,000 men annually and 382 deaths per 100,000 women annually. Read more on obesity.
HHS: $100M for 150 New Community Health Centers
The U.S. Department of Health and Human Services (HHS) has announced approximately $100 million in available funds for communities to expand access to affordable, high-quality primary care through an estimated 150 new community health centers in 2015. Currently there are approximately 1,300 health centers with more than 9,200 service sites providing care to more than 21 million people in the United States and its territories. The centers, made possible under the Affordable Care Act (ACA), have also helped approximately 4.7 million people enroll for ACA coverage. Read more on community health.
Late last month several organizations in Washington, D.C., and suburban Maryland—including CASA de Maryland, the Urban Institute, Prince George’s County Public Schools and other Langley Park Promise Neighborhood partners—released the Langley Park Community Needs Assessment Report, a year-long community assessment supported by the U.S. Department of Education Promise Neighborhoods program.
The assessment found that few of Langley Park’s 3,700 children—nearly all of whom were born in the United States—are currently on track for a strong future and that their lives are severely impacted by poverty; poor access to health care; high rates of neighborhood crime; chronic housing instability and school mobility; and low levels of parent education and English proficiency. Fewer than half of the community’s children graduate high school in four years, often because of high rates of early pregnancy and early entry into the work force to help support their families.
Following the release of the report, NewPublicHealth spoke with Zorayda Moreira-Smith, the Housing and Community Development Manager at CASA de Maryland.
NewPublicHealth: One factor in students not finishing high school in Langley Park is that many high schools students ages 16-19 drop out so that they can go to work and help support their families. Is this especially an issue of concern in the Latino community?
Zorayda Moreira-Smith: There are a number of reasons people drop out at that age. One of them is that 35 percent are working because of family need. The safety nets that are generally there for individuals aren’t there for immigrant communities. Most of the parents in these families probably left school after 8th or 9th grade. And once you reach a certain age, you’re also seen as an adult, so there’s an expectation that you help out with the family needs. For most of the families in the area, there’s a high unemployment rate or they have temporary jobs or are day laborers. So, as soon as children reach a certain age, there’s the expectation to start helping out financially and I think it’s very common.
And most immigrant families not only support the people that make up their household here in the United States, but also support their family in the countries of their origin. And while our data doesn’t show it, some of these individuals and kids in households could be living with family members who aren’t their parents—they could be their aunts or their uncles or what not. So, also as soon as they’re working, they’re often supporting their siblings or their parents or their grandparents in their origin countries.
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
This Thursday at Spotlight: Health, the two-and-a-half day extension of the Aspen Ideas Festival, a number of speakers discussed the many facets that are integral to building a community that thrives. Speakers included Kennedy Odede, the Co-Founder, President and CEO of Shining Hope for Communities; Belinda Reininger, Associate Professor of Health Promotion and Behavioral Science and the University of Texas School of Public Health; Gabe Klein, Senior Visiting Fellow at the Urban Land Institute; and Gina Murdock, Founder and Director of the Aspen Yoga Society.
Although the communities they serve and the work they do vary greatly, all four presenters agreed on four key themes:
- The importance of listening to the community
- Working with the residents, rather than over their heads, to create what they believe will be a thriving place to live
- Measuring outcomes
- Setting goals
To the first theme, Odede explained that “people in the community must be ready for change and we can’t import it.” Growing up in Kenya’s Kiberia Slum, Odede went on to found Shining Hope For Communities—an organization that combats gender inequality and extreme poverty in urban slums by linking free schools for girls to holistic community services for all. By connecting these services with a school for girls, Odede and Shining Hope for Communities show that benefiting women has a positive impact on the entire community. The organization’s model relies on community input and solutions.
In Brownsville, Texas, a family-oriented town requires a family-oriented approach to improving health. Sitting in one of the poorest metro areas in the nation, the town is known for its low graduation rates and high prevalence of obesity and diabetes. However, the community had a goal of being one of the healthiest areas in the state and began chipping away at the obstacles by including all residents.
“Everything we do is driven by families,” said Reininger. “We wanted to be the healthiest area in the state, and to get there we all had to be part of it.”
Brownsville is beginning to see improvements across the community in physical activity and food choice. In fact, the thriving and changing community has been selected by the Robert Wood Johnson Foundation (RWJF) as one of this year’s Culture of Health prize winners.
Gabe Klein, who in addition to his work with the Urban Land Institute is a former Vice President of Zipcar, spoke about the importance of communication in affecting community change. “In Chicago, we never talked about bike lanes for the sake of bike lanes, we talked about opportunities for better health and ways to get where you’re going,” said Klein. “You have to communicate the larger vision.”
The session moderator, RWJF President and CEO Risa Lavizzo-Mourey, stressed the importance of goal setting and metrics. According to Lavizzo-Mourey, defining a vision is critical to success and measurements lead you to the outcomes you are trying to reach.
At this week’s Spotlight: Health conference, an expansion this year of the annual Aspen Ideas Festival, angel investor Esther Dyson will be talking about “The Way to Wellville,” a contest that her nonprofit Health Initiative Coordinating Council—or “HICCup”—is organizing to encourage a rethinking of how communities produce health. The Way to Wellville is a five-year national competition among five communities to see which can make the greatest improvements in five measures of health and economic vitality.
“In the end, we hope to show that the best way to produce health is to change multiple interacting factors—diet, physical activity, preventive measures, smoking and the like—as well as more effective traditional health care,” said Dyson. “We’re less concerned with specific ‘innovations’ or digital miracles and more with simply applying what we already know at critical density.”
The five health measures have not been finalized yet, but are likely to include health impact, financial impact, social/environmental impact (such as crime rate or high school graduation rate), sustainability (such as a health financing system) and a specific “wild card” that each community will set for itself, such as teenage pregnancy or smoking rates.
NewPublicHealth spoke with Dyson ahead of the Spotlight: Health conference about the Wellville contest.
NewPublicHealth: How did the contest come about?
Esther Dyson: I had signed up to be a judge on the Health Care X Prize, but unfortunately it never materialized. For the next few years I kept thinking somebody should do this, and as I got more and more interested in health, I thought that with greater and greater enthusiasm. I had to give some remarks at a quantified self conference last year and was going to say that “someone should do this.” But I realized that would be a very lame talk and ultimately I announced that I would do it. Having appointed myself, I arranged several open-call brainstorming sessions. At one of them, a nice gentleman showed up with lots of awkward questions about metrics, funding, evaluation...the usual! So I appointed him as CEO. That’s Rick Brush, who formerly worked at Cigna and more recently has been running asthma-prevention programs with innovative financial models.
Building a Culture of Health—one where health is a part of everything we do—will not be an easy task. In fact, it will be very hard, admitted Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation.
It’s a “call to action for all of us,” said Bill Frist, “but these six communities show it can be done.” The six communities in question are the 2014 winners of the RWJF Culture of Health Prize, announced yesterday at the Aspen Ideas Festival. Each community, while different in its own way, thinks about health in a whole new way, as being impacted by all aspects of daily life—from food production to urban design.
Why were these communities chosen from more than 250 applicants from across the country? They’re harnessing the power of partnerships; focusing on lasting solutions; working on the social and economic factors that impact health, such as education and poverty; creating equal opportunities for health for everyone in the community; making the most of resources; and measuring and sharing results.
But what really sets the Prize communities apart, said Lavizzo-Mourey—the “magic ingredient” and the “secret sauce”—are passion, purpose and even joy.
“What we mean by ‘building a Culture of Health’ is shifting the values—and the actions—of this country so that health becomes a part of everything we do,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of theRobert Wood Johnson Foundation (RWJF), during her keynote address at Spotlight: Health. RWJF is a founding underwriter of the two-and-a-half day expansion of the annual Aspen Ideas Festival.
“With health, each one of us can make the most of life’s opportunities,” she said. “That’s why we at the Robert Wood Johnson Foundation have made building a Culture of Health our North Star—the central aim of everything we do.”
Lavizzo-Mourey explained that the Foundation brought the Culture of Health concept to the Festival because of this year’s theme of “Imagining 2024.”
“When it comes to building a Culture of Health, I believe a decade from now we will have a powerful story of how we resolved to no longer accept that our nation spends more than $2.7 trillion dollars on health care, and yet continues to lose $227 billion dollars in productivity each year because of poor health,” she said.
Lavizzo-Mourey told the audience—which included health thought leaders from around the country—that building a true Culture of Health means changing our current understanding of health and creating a society where everyone has the opportunity to lead a healthy life. She gave the example of the Metro system in Washington, D.C., where babies born in the region of the Red Line—which intersects some of the wealthiest counties in the country—can expect to live to be 84 years old. However, babies born just a few stops away will have lives that are up to seven years shorter.
According to Lavizzo-Mourey, there are multiple ideas being practiced around the country that contribute to the emerging Culture of Health, including:
- Helping patients with things such as housing and food assistance at every medical visit.
- Changing the workplace culture to be a healthier one, including using stairs instead of elevators and holding standing or walking meetings.
She also enumerated several key ways that RWJF is working to build a sustainable Culture of Health, including committing $500 million toward reversing the U.S. childhood obesity epidemic; helping to ensure that everyone who is eligible for health care coverage knows about the benefits available to them; encouraging businesses to take the lead in investing in the wellbeing of the communities they serve; and addressing community violence.
Health Beyond Healthcare: RWJF-Sponsored Washington Post Live Event Sparks Conversation on Creating a Culture of Health
“Health Beyond Healthcare” was the focus of a Robert Wood Johnson Foundation (RWJF)-sponsored Washington Post Live Forum today that looked at how creative minds in traditionally non-health fields—such as bankers, architects, designers and educators—are working together to build a Culture of Health in the United States.
“No matter where you live and how much money you have, you should have the opportunity to live a Culture of Health,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA.
>>View the full archived live stream of the forum.
Lavizzo-Mourey said RWJF began its work on the concept of a U.S. Culture of Health in 2009, when the foundation’s Commission to Build a Healthier America released a report recommending the concept. Last year, the Commission came together to see what progress had been made. Among the sites embracing the concept is Marvin Gaye Park in Washington, D.C. Once known as “Needle Park,” the community has transformed itself through lighting and landscaping. This was possible “because the community embraced the principles of a Culture of Health and demonstrated how, from the ground up, people partnering can change the nature of their community and make it healthier,” she said.
Pointing to the most recent Commission report, Lavizzo-Mourey said that looking at communities undergoing changes pushed the Commission to conclude that in order to improve health as a nation, we have to change communities—especially low-income communities—so that people can make healthy choices every day. That also means that health care has to connect with non-health care.
“Each of you,” she told the audience of thought leaders and policy makers, “is uniquely positioned to make changes that can get us to a nationwide Culture of Health.”
The day’s speakers spoke about innovations in their fields that are helping to create local changes in health, and which are often scalable for communities across the country.
“The most successful projects are those that start with bringing communities together to first assess the need, and then prioritize them and move forward with a particular project,” said Sister Susan Vickers, RSM, Vice President of Community Health, Dignity Health, who added that just about all the loans that Dignity Health has made to nonprofits in the community have been repaid.
Why a focus on health? “Health summarized all [of the other factors],” said David J. Erickson, PhD, Director, Center for Community Development Investments, Federal Reserve Bank of San Francisco. “The best predictor for future health for a third grader is whether they are reading on a grade level. Community development is big, but not big enough, and the medical system is not big enough either. We need to start aligning all of these sectors so we’re all working in the same direction to turn these neighborhoods around.” [Editor’s Note: Read a previous NewPublicHealth Q&A with Erickson.]
“We have to treat health as a national treasure—a natural resource—and put it up on the level of the seriousness of the economy,” said Rear Adm. Boris D. Lushniak, Acting U.S. Surgeon General. “The economy doesn’t do anything without a healthy people.”
Application Problems Mean 2.2M People Risk Losing ACA Coverage
Inconsistencies in their application data means that approximately 2.2 million people who enrolled for coverage under the Affordable Care Act could risk losing their coverage in isolated cases. A report from the U.S. Centers for Medicare and Medicaid Services (CMS) found that 1.2 million people filed health insurance enrollment applications with questionable income data, 461,000 had issues with citizenship and another 505,000 had issues with immigration. However, CMS also noted that 59 percent of the applications were within a 90-day window allowing them to resolve the problems. “Consumers experience regular changes in income and various life circumstances and the law accounts for these kinds of situations," said CMS, according to Reuters. "It is not surprising that there are income discrepancies given that this is a brand new process." As of mid-April more than 8 million people had enrolled for health coverage. Read more on the Affordable Care Act.
Study: Skipping Breakfast Doesn’t Hurt Efforts to Lose Weight
Common wisdom holds that people who skip breakfast actually increase their risk of obesity. However, a new study in the American Journal of Clinical Nutrition found that passing up on the first meal of the day neither helps nor hurts a person’s efforts to lose weight. The study involved 309 overweight and obese adults between the ages of 20 and 65—who were told to either eat or skip breakfast—and a control group provided with health nutrition information. Researchers found no difference when it came to efforts to lose weight. "The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested," senior investigator David Allison, director of the UAB Nutrition Obesity Research Center, said in a university news release. "This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered." Read more on obesity.
HHS: $300M Available to Expand Services at Community Health Centers
An additional $300 million in funding is available to community health centers as part of the Affordable Care Act, U.S. Health and Human Services Secretary Kathleen Sebelius announced this week. The funds will go toward expanding service hours and the hiring of more medical providers, as well as the expansion or addition of oral health, behavioral health, pharmacy and vision services. There are approximately 1,300 health centers operating more than 9,000 service delivery sites and providing care for more than 21 million U.S. patients. Read more on community health.