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Expanding Horizons for Rural Young Men of Color

Sep 8, 2014, 1:55 PM, Posted by Maisha Simmons

Forward Promise - Oakland

When we first began the Forward Promise initiative, we envisioned building the capacity and impact of organizations across the country working with boys and young men of color from every type of community and background. We wanted to identify and support a cohort of grantees that were diverse in their approach, in their geography, and in the racial, ethnic and cultural experiences of the young people that they supported. Once we began doing this work, it didn’t take long to realize we were falling short.

The simple truth is that the majority of organizations who applied for Forward Promise that had demonstrated success and were ready to expand were located in major cities. Few applicants were in the rural beltway that stretches across the Southern United States, from Alabama to Arizona. It would be easy to assume that there weren’t many young men of color there or that there was not much innovation or capacity to support young men of color in that region. But you know what they say about assumptions ...

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The Culture of Mental Health Stigma in Communities of Color

May 20, 2014, 9:00 AM, Posted by Ayorkor Gaba

Ayorkor Gaba, PsyD, is a clinical psychologist and project manager at the Center of Alcohol Studies, Rutgers University, as well as a clinical supervisor at the Rutgers Psychological Clinic. She has a private practice in Highland Park, New Jersey and is an American Psychological Association-appointed representative to the United Nations. She is an alumna of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

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Mental illness affects one in five adults in America. A disproportionately high burden of disability from mental disorders exists in communities of color. Research has shown that this higher burden does not arise from a greater prevalence or severity of illnesses in these communities, but stems from individuals in these communities being less likely to receive diagnosis and treatment for their mental illnesses, having less access to and availability of mental health services, receiving less care, and experiencing poorer quality of care. Even after controlling for factors such as health insurance and socioeconomic status, ethnic minority groups still have a higher unmet mental health need than non-Hispanic Whites (Broman, 2012).  

There are a number of factors driving these statistics in our communities, including attitudes, lack of culturally and linguistically appropriate services, distrust, stigma, and more. In our society all racial groups report mental health stigma, but culturally bound stigma may have a differential impact on communities of color. Stigma has been described as a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses (President’s New Freedom Commission on Mental Health, 2003).  Stigma in the general public often leads to internalized stigma at the individual level.  Several studies have shown that internalized stigma is an important mechanism decreasing the willingness to seek mental health treatment.

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How to Advance Minority Health? Change the Look of Health Care.

Apr 30, 2014, 2:00 PM

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Some people assume that promoting diversity and combating health disparities means giving preferential treatment to minorities over Whites. However, these pursuits simply mean providing equitable opportunities and a health care system that is responsive to everyone. Education studies continuously show that promoting diversity and reducing discrimination benefits all students. Regarding health care, these pursuits may mean life or death.

The percentage of Black physicians has stayed roughly unchanged since the early 1900s. The percentage of Black and Latino professors at research-intensive university shows a similar pattern. I suggest that reducing health disparities and changing our current culture of health is contingent on more effectively integrating minorities into health professions and research positions.

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How Can Health Systems Effectively Serve Minority Communities? Use Electronic Health Records to Discover How to Improve Outcomes.

Apr 30, 2014, 1:00 PM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Bonnie L. Westra, PhD, RN, FAAN, an associate professor at the University of Minnesota School of Nursing, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Westra is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program. 

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Electronic health records (EHRs) are rapidly proliferating and contain data about health or the lack thereof for minority communities. Evidence-based practice (EBP) guidelines can be embedded in EHRs to support the use of the latest scientific evidence to guide clinical decisions.  However, scientific evidence may not reflect differences in minority communities served.

As a first step to compare the effectiveness of EBP guidelines for minority populations, practicing nurses and nurse leaders need to advocate for implementation of EBP nursing guidelines in EHRs. Additionally, EBP guidelines must be coded with national nursing data standards to compare effectiveness within and across minority communities. Nurse researchers need to conduct comparative effectiveness research to learn how to optimize EBP guidelines for minority communities through the reuse of EHR data and to derive patient-driven evidence.

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How to Address Disparities? Prioritize Participatory Research and Practice.

Apr 30, 2014, 11:30 AM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Jamila Michener, PhD, an assistant professor of government at Cornell University, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Michener is an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program at the University of Michigan, Ann Arbor. 

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In my undergraduate class on the politics of poverty, there is an uncomfortable yet persistent question that looms whenever the conversation turns to racial and ethnic disparities: why? The students generally (and rightly) believe that biological distinctions are not the answer and in the search for other solutions, culture frequently emerges as a likely suspect. In response, I challenge these young people to think more conscientiously about cultural explanations of poverty. I push them to problematize the notion that racial and ethnic groups are homogenous bearers of a common and undifferentiated culture. I prompt them to consider how social, economic, and political institutions constitute and are constituted by various elements of culture.

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How to Address Disparities? Develop Local Leadership, Listen to Communities.

Apr 30, 2014, 9:00 AM

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When I was first asked to consider this question, I pondered the issues by describing theoretical approaches, including the need to address social determinants, use a social-ecologic framework, and take a life course perspective. I threw in the need to use evidence-based practices and research. I gave this first draft to someone and asked ... So what do you think? She very politely asked: Are you in outer space? 

I continue to believe that addressing inequality in our country requires that we recognize, understand, and commit to changing its root causes which include racism, inadequate affordable and safe housing, inadequate access to quality education (pre-to post graduate), and grossly uneven wealth distribution. These are deeply rooted in our political and economic structures and must be fundamentally changed if we truly want to build a culture of equality and health for all. 

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How to Address Disparities? Meet Patients Where They Are, Connect Health to Community Values.

Apr 29, 2014, 12:00 PM

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How can we get more people to think pro-actively about health and health care? One approach would be to identify what people value and think about how to fold health into that equation—especially for populations where disparities exist, like health screening for men. 

In the case of where I live, the answer was cars. Long Island loves cars: hot rods, customs, muscle cars, and classic cars. We are fascinated with antique fire apparatus and old motorcycles. Long Island Cruizin' for a Cure leverages this fascination. Now in its tenth year, with 600 cars, this event attracts, screens, and educates more than 3,500 men about prostate cancer. 

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How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.

Apr 29, 2014, 10:30 AM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.

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In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care. 

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How to Advance Minority Health? A Diverse, Culturally Competent Health Care Workforce.

Apr 29, 2014, 9:00 AM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Michelle L. Odlum, BSN, MPH, EdD, a postdoctoral research scientist at Columbia University School of Nursing, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Odlum has more than ten years of experience as a disparities researcher. She is a recipient of an RWJF New Connections Junior Investigator award.

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As a health disparities researcher, my health promotion and disease prevention efforts are rooted in sociocultural aspects of health. This approach is critical to improved outcomes. In fact, when socioeconomic factors are equalized, race, ethnicity, and culture remain contributing factors to adverse minority health. I have come to understand that the key to combating health disparities lies heavily in cultural understanding. A diverse, culturally competent health care workforce is essential to health equity.

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How Can Health Systems Effectively Serve Minority Communities? Improve Medical Literacy, Take a Holistic Approach.

Apr 28, 2014, 2:45 PM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Cheryl C. Onwu, BS, a public health graduate student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Onwu is a Health Policy Scholar at the RWJF Center for Health Policy at Meharry Medical College.

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A doctor informed an African American male that he has diabetes mellitus, and medication was prescribed. However, the doctor did not mention the extent of the dangers involved in having diabetes, or “the sugars.” Additionally, the doctor did not explain the detrimental effects if the patient failed to follow the prescription regimens and other recommendations.

Some of the challenges faced by minorities include lack of medical literacy, which can affect their overall health. Clear communication between a health care provider and his or her patients is important, so patients are cognizant of their health status, the importance of maintaining a healthy lifestyle, potential threats to well-being, and how to control health problems.

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