Category Archives: Health disparities
There are an estimated 7,350 homeless people living in San Francisco, yet there are only eight facilities in the city at which the homeless can shower. At each of these facilities, there are at most two shower stalls—meaning that there is at most one shower for every 460 homeless people.
Lava Mae developed a mobile approach to target this public health issue.
The refurbished San Francisco MUNI bus outfitted with two full-service bathrooms successfully made its first rounds on June 28. The bus will travel around the city providing the homeless with mobile public utilities and giving them much-needed access to clean water and sanitation. Without the limitations of stationary locations, Lava Mae is able to aide people across the city while also staying free from high real estate prices, rising rent and potential eviction.
"For at least a decade, bathrooms have stood in for the city's anxieties about homelessness, public utilities, and the changing economy," wrote Rachel Swan in a piece on public bathrooms in SF Weekly. Lava Mae founder Doniece Sandoval hopes that the program will take big steps in improving the health of the homeless and public sanitation by increasing the number and scope of available public restrooms.
The relationship between the health and wellbeing of the homeless population correlates directly with the health of the community as a whole. As the homeless population strives for a better quality of life, so does the community—one shower at a time.
Read the full story, “A Refurbished Bus Will Bring Showers to the Homeless in San Francisco.”
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.
Older Hispanics Taking their Medicines Because of Medicare Prescription Drug Plans
Hispanics have reduced the gap with whites in taking prescribed heart medicines since the 2006 launch of Medicare’s prescription drug benefit—Medicare Part D. The findings were reported in a study presented at the American Heart Association’s Quality of Care and Outcomes Research 2014 Scientific Sessions earlier this month. Researchers reviewed prescription drug data from Medicare’s national Medical Expenditure Panel Survey for white, African-American and Hispanic Medicare seniors for the years 2007-10. After Part D, adherence rates increased among all racial groups, with the highest increase in whites and Hispanics, but increased only slightly among African-Americans.
- Hispanics’ total group adherence rate improved about 60 percent.
- Whites’ adherence rate improved 47 percent.
- African-Americans’ adherence rate improved about 9 percent.
Read more on heart health.
USDA Announces Grants to Help Repair Houses in Rural Areas
The U.S. Department of Agriculture (USDA) has announced it is seeking applications for grants of about $4 million to preserve and repair housing for very-low- and low-income families living in rural areas. The funds are being made available by the USDA Rural Development's Housing Preservation Grant program. Eligible applicants include town or county governments; public agencies; federally recognized Indian Tribes; and non-profit and faith-based organizations. Applications are due July 28. Examples of previous grants include a 2012 award to Habitat for Humanity Lake County (Calif.), which received a $55,000 Housing Preservation Grant to help 12 low-income homeowners repair their homes. One person helped was a Vietnam veteran who used a wheelchair and could not leave his home without assistance. Habitat for Humanity widened his doorway and installed a wheelchair lift. Read more on housing.
Many U.S. Cancer Survivors Face Serious Financial Burdens
Many U.S. cancer survivors face significant economic burdens due to growing medical costs, missed work and reduced productivity, according to a study by the U.S. Centers for Disease Control and Prevention (CDC). “Cancer survivors face physical, emotional, psychosocial, employment and financial challenges as a result of their cancer diagnosis and treatment,” said Donatus U. Ekwueme, PhD, a senior health economist at CDC’s Division of Cancer Prevention and Control. The number of cancer survivors is expected to increase by more than 30 percent in the next decade—to 18 million Americans. Researchers analyzed data from the Agency for Healthcare Research and Quality’s 2008-2011 Medical Expenditure Panel Survey to estimate annual medical costs and productivity losses among cancer survivors aged 18 years and older, and among persons without a cancer diagnosis. Among those employed, more than 42 percent had to make changes to their work hours and duties. The report also found that about 10 percent of survivors aged 65 years and younger were uninsured and likely to have a larger financial burden compared to survivors with some source of payment for medical services. Read more on cancer.
Study: Medicaid Patients Receive Poorer Cancer Care
People on Medicaid receive poorer cancer care than people with private insurance, according to three new studies presented at the American Society of Clinical Oncology annual meeting in Chicago. Researchers determined that Medicaid patients are less likely to have their cancer caught at an earlier, more treatable phase, as well as far more likely to die from cancer. One of the factors contributing to this disparity is the fact that Medicaid patients have less experience navigating the health care system. "Research has shown that we can screen more patients, but that they get dropped along the way to treatment. We don't give them full access into curative therapy," said Jyoti Patel, MD, an oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, who's also a spokeswoman for the American Society of Clinical Oncology. "We need to do a better job to make sure that people who aren't savvy or can't advocate for themselves have that helping hand." Read more on health disparities.
CDC: Norovirus is the Leading Cause of Disease Outbreaks from Contaminated Food
Norovirus is the leading cause of disease outbreaks from contaminated food in the United States, according to the latest Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). Approximately 20 million people in the United States are sickened by norovirus annually. According to the CDC, because infected workers are often the source of these outbreaks, the food service industry can help prevent outbreaks by enforcing safety practices, including:
- Making sure food service workers practice proper hand washing and use utensils and single-use disposable gloves to avoid touching ready-to-eat foods with bare hands
- Certifying kitchen managers and training food service workers in food safety practices
- Establishing policies that require food service workers to stay home when sick with vomiting and diarrhea and for at least 48 hours after symptoms stop
Read more on food safety.
N.C. Program Successful in Expanding Dental Care to Young, Low-income Children
A North Carolina program to reduce cavities in young, low-income children, has significantly increased the number of children under the age of four receiving preventive dental care since the program began in 2000, according to a new study in the journal Pediatrics. The program works to train physicians in basic dental screening and preventive techniques that can be provided quickly and effectively during regular office visits. “Evaluation studies conducted since the initiation of the program in 2000 have found it to substantially increase access to preventive dental services for young, high-risk children who otherwise would be unlikely to use these services in dental offices, reduce caries-related treatments and costs, avert hospitalizations and improve oral health status,” said study was co-author R. Gary Rozier, DDS, MPH, professor of health policy and management at the UNC Gillings School of Global Public Health, in a release. Read more on pediatrics.
“I don’t miss my family. I miss the family I never had.” That’s the text of a postcard written by a former foster child—one of hundreds of postcards that are a project of the Foster Care Alumni of America to help create a better understanding about life in foster care. May is National Foster Care Month—an annual effort to raise attention about the 400,000 children in foster care.
According to the U.S. Department of Health and Human Services (HHS), most of those 400,000 children will be reunited with their families or find a permanent home with relatives, guardianship, or adoption. But each year 24,000 youth “age out” of foster care without a permanent legal family and many of them have shared their lives in a postcard.
New initiatives on foster care announced by the HHS Children's Bureau in 2014 include:
- Awards for agencies to test new strategies for recruiting resource families for children in foster care.
- Grants to states, localities and tribes to build the capacity of child welfare systems to prevent long-term homelessness among youth and young adults who have been involved with child welfare.
- Funding for states, localities and universities to develop initiatives that will improve the social and emotional well-being of children who are involved with child welfare and have mental and behavioral health needs.
- The National Foster Care Month initiative. This year’s theme is “Building Blocks Toward Permanent Families” in order to promote awareness of children in foster care.
The American Academy of Pediatrics (AAP) defines children in foster care as children with special health care needs because of the very high prevalence of physical, mental, developmental, educational, dental and family relationship problems. Children in foster care have many of the same health problems as other children—they just seem to have more of them more often, according to the AAP.
Among the reasons why medical conditions are so prevalent in foster children:
- Health conditions might be the direct result of trauma or medical neglect.
- Birth parents may seek foster care because they are unable to care for the child’s health problems.
- Emotional stressors may precipitate ﬂares in underlying conditions, such as asthma.
According to the AAP, treating and improving these conditions also improves the chances for reunification with parents or adoption, and is therefore a priority for foster children.
“Hypertension affects nearly one in three adults and kills more people around the world than anything else. It is both too common and too often poorly controlled.”
So said Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), during a panel discussion at the annual meeting of the American Society of Hypertension (ASH) this past weekend. The panel was convened by ASH, the American Heart Association and the CDC to launch a project supporting improved control of hypertension worldwide. According to the panel an estimated 970 million people have hypertension worldwide, and the disease is responsible for more than nine million deaths, as hypertension can lead to heart disease and stroke.
Data from the groups finds that rates of hypertension have increased in both developed and developing nations, due in part to an aging population and lifestyles that include high salt diets and low physical activity.
For the developing world, the CDC; the Pan American Health Organization; and other regional and global stakeholders are identifying both cost effective medicines and inexpensive delivery strategies for the drugs to help patients afford and receive them.
In the United States, the Affordable Care Act is expected to increase the number of people on hypertension medications, but despite the availability of coverage for hypertension diagnosis and treatment there remains concern over disparities. A study of more than 16,000 members of the Hispanic community published in the American Journal of Hypertension earlier this year found that while the prevalence of hypertension among Hispanics is nearly equal to that of non-Hispanic whites, diagnosis of the disease is much lower, as is general awareness of its symptoms and treatment options.
"Given the relative ease of identifying hypertension and the availability of low-cost medications, enabling better access to diagnostic and treatment services should be prioritized to reduce the burden of cardiovascular disease on Hispanic populations,” said Paul Sorlie, MD, the lead author of the study and an epidemiologist with the National Heart, Lung and Blood Institute. “This study gives us the information needed to support the development of policies that can improve this access and, subsequently, the overall health of countless US citizens.”
- A new infographic from the Measure Up/Pressure Down initiative of the American Medical Group Association provides some key patient information about hypertension, including normal and dangerous ranges of blood pressure—numbers patients should be familiar with.
- A map from the Institute for Health Metrics and Evaluation at the University of Washington shows hypertension levels for 2001 to 2009 by race and gender.
Despite certain positive shifts in overall health outcomes for residents in Alameda County, Calif., significant inequities exist, particularly among African-Americans, Latinos and Native Hawaiian/Pacific Islanders, as well as low-income residents.
The Alameda County Place Matters team works throughout Alameda County, including the City of Oakland, the largest city in the county.
Team Objectives include:
- Affordable housing
- Quality education
- Access to economic opportunities
- Criminal justice reform including reducing the incidence of incarceration
- Improvements to land use
- Accessible, safe and affordable transportation
Alameda County Supervisor Keith Carson initiated the Alameda County Place Matters team. The team is currently housed within the Alameda County Public Health Department and supported by health department staff. The initiative has numerous community partners that include community-based organizations; city and county government agencies; and nonprofits.
Among the critical issues the Place Matters team is currently focused on are displacement, the built environment, and development and how those impact health, according to team communications lead Katherine Schaff.
The team is working with community partners and planners on a healthy development checklist that the city of Oakland can use to take health considerations into account during city permitting and decision making to try to ensure more transparency and accountability to residents in that process. She said the goal is to have city planners go through the checklist before projects are approved. The checklist, said Schaff, might have allowed for more time for community comment before plans were authorized for a new crematorium that is expected to add to pollution and exacerbate asthma cases.
The Cuyahoga County, Ohio Place Matters team's focus is on ensuring health implications and equity considerations are at the forefront as policy makers and others make decisions that substantially impact the county’s residents and the neighborhoods in which they live.
Key Team Objectives:
- A broader definition of health. Health is not simply the absence of disease—health begins where people live, work, learn, age and play. Health includes the social conditions one lives in, such as the jobs we do, the money we're paid, the schools we attend and the neighborhoods we live in, as well as our genes, our behaviors and our medical care.
- Inform, influence and engage policy makers and community members to develop policies—using an overarching health equity lens—that have long-term impacts, create conditions for optimal health and reduce inequities.
- Utilize "place-based" interventions to engage and empower residents in under-resourced communities to revitalize their communities.
East Cleveland is one of the most densely settled communities in Cuyahoga County. The city has a poverty rate of 32 percent, while its heart disease mortality rates (355/100,000) are higher than in the county (10 percent higher) and the nation (32 percent higher).
Team objectives include building effective partnerships; striving for equal opportunity for all; equity; recognition that neighborhood condition is the context in which health and wellbeing begins; health in all policies; mobilizing the community for action; and measuring indicators of social determinants of health.
The Prince George's County, Maryland Place Matters team is addressing food inequity by establishing a Food Policy Council and working with the county's recreation department to design and implement after-school healthy eating and active-living programs.
The project is beginning with the waterfront towns of Bladensburg, Colmar Manor, Cottage City and Edmonston, which have drafted a Community Action Plan with strategies on how to reduce chronic disease in Prince George's County. Partners on the Community Action Plan included Kaiser Permanente, the Consumer Health Foundation, United Way of the National Capital Area and the Meyer Foundation. Place Matters plans to replicate the initiative in other county municipalities.
Prince George's County is the most diverse in Maryland; 80 percent of the population is made up of minority groups. According to the 2010 Census, 8 percent of households live below the poverty line, but some of the towns have higher rates of poverty. Cottage City has a 21 percent poverty level, Bladensburg has a poverty level of 12 percent and Edmonston has a poverty rate of 9 percent.
Key Team Objectives:
- Improve healthy food access and wellness for all through food policy and action.
- Create reliable public transit, bike and pedestrian access to schools and recreational facilities.
- Enhance community capacity to lead and support the Community Action Plan.
“What we decided to do was instead of trying to address the full county is to build a model which the county could replicate,” said team co-leader David Harrington. Harrington said the project, which started seven years ago, has “had some good success in helping to address some policy issues and system change issues.”
Place Matters is building a team around stakeholders called the Community Implementation Team and a countywide team called the Policy Development Team, which consists of the county agencies that influence policy and can provide support for help in doing the community work. They were engaged early in the conversation “so that they would consider administrative and other policies that will help them buttress the community work, and then the community work would help then influence their work, so this becomes a supportive concentric circle of activity that helps systems change, as well as change at the community level,” said Harrington.
In 1979 a dam broke at a uranium processing mill in McKinley County, New Mexico, releasing more than 1,100 tons of uranium mining waste and 100 million gallons of radioactive water—the second largest radioactive materials accident in the United States. Since then, say public health experts, minimal attention has been given to the health risks associated with the environmental contamination from the accident, or of the risks posed by plans for new mining opportunities in the region.
The McKinley County Place Matters team and its partners want to ensure that people are aware of the health risks associated with working in the mines, as well as secondary exposure through such things as a relative’s clothes or pollutants from the mines. The team also wants to address the health and social needs that resulted from the accident decades ago. In addition, people living in the community have noticed increased rates of cancers and other health problems, and state health assessment reports show that between 2008 and 2010, cancer was the leading cause of death in McKinley County.
“To proceed with more mines without knowing the scope of impact to people’s health is dangerous,” said Jordon Johnson, the county’s Place Matters team leader.
The team’s vision statement is that “all people in McKinley County live in a safe, healthy, and prosperous environment that honors health-in-all policies and leaves a legacy of responsible leadership grounded in equity.” Its mission is to use a health equity lens to change systems that perpetuate environmental health disparities related to the impacts of multi-generational trauma and institutional racism by empowering participating communities within the county to impact equitable policy change.
Key Team Objectives:
- Heal individual and community health and restore the environment with Traditional and Western values and medicine.
- Use the Navajo Nation Fundamental Laws as the foundation to shift conversations around uranium mining and justice.
- Conduct a health impact assessment on mining in the county to look at determinants of health including environmental pollution and contamination; displacement and relocation; community efficacy; and cultural relevance of the land to holistic health.
- Support the community in building a multipurpose facility to serve as a space to heal, gather for meetings, and provide education.
- To educate decision makers and general public about the poor health outcomes related to uranium mining.
- To model a non-hierarchal structure, establishing shared leadership and creating a safe space for open and honest discussions to emerge about difficult subjects, particularly related to environmental justice and race relations. These conversations, along with a foundational understanding and commitment to moving the local community forward in a culturally relevant way, contribute to elevating the voices of community members participating in local decisions, said team leader Jordon Johnson.