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Research being conducted by four Robert Wood Johnson Foundation (RWJF) Human Capital grantees reveals new insights on improving health by focusing on the role of physical surroundings and community resources.
Easing the Burden of Poverty
In a study that promises to break new ground, Greg Duncan, PhD, and Jens Ludwig, PhD, co-winners of a 2009 RWJF Investigator Award in Health Policy Research, are analyzing the results of the United States Department of Housing and Urban Development’s (HUD) Moving to Opportunity (MTO) program. MTO is a five-city, randomized social experiment that moved families from some of America’s poorest communities to higher income neighborhoods.
“The project began in early 1990,” explains Duncan, who is also a distinguished professor in the University of California, Irvine’s Department of Education “To assess the impact of place on the well-being of low-income people, families with children who lived in neighborhoods with a poverty level between 40 and 50 percent were selected, through a lottery, and given vouchers to allow them to move to communities with poverty levels at 10 percent or below,” he says.
“Our research focuses on how the program affected their physical and mental health and other outcomes,” Duncan continues. Assessments of MTO families, made 4 to 7 years into the project, reveal surprising findings that may be of great help to others seeking to understand the relationship between poverty and health.
RWJF Community Health All-Stars
Robert Wood Johnson Foundation scholars, fellows and grantees, along with the Community Health Leader award winners, address the health needs of the nation in unique and innovative ways. Whether they are creating healthier environments, bringing needed health resources to underserved communities, diversifying the local health care workforce or generating grassroots programs—they make a difference. This series tells their stories.
“The most important, positive change reported was the relief study participants experienced from escaping high-crime neighborhoods,” Duncan says. “Rates of depression among the groups who moved out of the high-poverty, high-violence communities were one half of those in the control group who stayed in the high-poverty environment.”
“The mothers who moved said that getting away from violence was overwhelmingly the most important and healthy change they experienced. The mental health of the teenage girls also improved. They reported greatly reduced sexual harassment in their new communities and they found ways to adjust to new schools. That was not the finding for the boys. They tended to find peer groups that engaged in problematic behavior,” Duncan says.
Going forward, Duncan and Ludwig’s Investigator project will focus on the policy implications from these early findings (4 to 7 years after baseline), together with a new analysis of long-term outcomes measured 10 to 15 years into the project. The new round of research will more fully explore the impact of culture, class and other factors in an effort to increase understanding of the value of projects like Moving to Opportunity.
Greening for Good Health
RWJF Clinical Scholar (2010-2012) Eugenia Garvin, M. D., is also looking at the role of violence in community health, though she’s taking a different approach. As a surgery resident at Washington University School of Medicine in St. Louis, Mo., Garvin focused on gunshot prevention among urban males. “When I was an intern in St. Louis at Barnes Jewish Hospital, it was the first time I was exposed to the impact of street violence. We would treat these young people—children really—for gunshot wounds and send them right back out without ever addressing the reasons for the violence that sent them to the hospital,” Garvin says.
In an effort to stop that violence at the source, while working as a Clinical Scholar at the University of Pennsylvania, Garvin is evaluating the impact of greening vacant lots in urban neighborhoods. “In our area, the Philadelphia Horticultural Society is working with city officials and local contractors to plant grass, trees and provide fences for the more than 30,000 vacant lots around Philadelphia. The lots tend to be in poor communities and they have often been abandoned by the owners,” Garvin says. “Greening raises property values, encourages construction and while the lots are not parks, people can use the green spaces.”
“For my Clinical Scholar project, I’m focusing on the safety aspect,” she says. “Our research shows that the lots in raw form are easy places to hide guns, drugs and people engaged in illegal activities. They also present a public health hazard because the accumulated trash brings rodents.”
While Garvin and her team have only preliminary results at this point she says, “a good portion of the residents noticed the greening of the lots. People talked about the connections between vacant lots and illegal activity such as drugs or hiding guns and how greening can reduce such activity. Over the next year, we will look at police reported crime in the study areas. The next step is to do a larger greening trial, in which hundreds of vacant lots are greened across Philadelphia.”
Enriched Community Networks Increase Access to Care
As important as safe streets are to health, RWJF Physician Faculty Scholar (2008-2011) Michael Dulin, MD., PhD, is working with a community’s greatest resource—its people. Dulin and his team are finding that the best way to help North Carolina’s growing Hispanic population gain access to quality primary care is to place information about care options in the hands of community organizations and the residents themselves.
A professor at the Carolinas Medical Center, Dulin’s Community-Based Participatory Research (CBPR) project created partnerships between doctors and community organizations to bring provider information directly to the local population.
“In Charlotte, we had the fastest growing Hispanic population in the area, but there weren’t a lot of resources available to them. So we established relationships with free clinics, church-based institutions and other groups and held forums and focus groups with 32 organizations to see what they felt was needed to help this transitioning community get the best primary care,” Dulin says.
“We spent three years building relationships, creating an intervention and then implementing a plan. We learned, among other things, the importance of truly listening to people,” Dulin explains. “Our public meetings, for example, were conducted in Spanish, while the English speakers wore headphones that provided a translation. We also had an external evaluator who observed all community interactions and provided feedback about how we could better partner and engage with the community.”
The RWJF-funded project is due to conclude in 2012 and, “we hope to show how CBPR can create changes in social networks, while showing community partners a new approach to working with a rapidly changing immigrant community,” Dulin says. “Our initial findings indicate that the engagement process itself positively changed the participant’s health behaviors with more community members seeking medical services in primary care clinics rather than hospital emergency departments.”
The RWJF Investigator Awards in Health Policy support ambitious, cutting-edge studies of health policy challenges facing America. The RWJF Clinical Scholars program fosters the development of physicians who are leading the transformation of health care in this country through positions in academic medicine, public health and other leadership roles. The RWJF Physician Faculty Scholar program provides junior faculty with mentoring, protected time, networking and the opportunity to gain valuable research experience.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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