When Springtime Turns Ugly: Public Health and Disaster Preparedness

Jun 6, 2014, 11:24 AM, Posted by Beth Toner

MOYER_110506_13128 EMOTIONAL AFTERMATH: A resident of Alabama, overwhelmed by the sight of her ruined home after tornadoes struck at the end of April, 2011.

Ah, springtime: especially welcome for those of us who experienced a particularly harsh winter. Spring often conjures up images of blossoming trees and blue skies, freshly cut grass and picnics.

Yet in May, several anniversaries of devastating natural disasters reminded us that springtime can also bring with it some of nature’s most violent weather phenomena:

  • On May 20, Moore, Okla., marked the first anniversary of the devastating tornado that killed 24, including seven children at an elementary school. It was the second EF-5 tornado to strike the city in 15 years; the May 3, 1999, tornado left 46 dead.
  • In Joplin, Mo., residents remembered the May 22, 2011, EF-5 tornado that killed 161 people.
  • On May 31, Johnstown, Pa,., observed the 125th anniversary of the devastating flood that leveled the entire city and killed 2,209.

While improved warning systems and 21st century technology have certainly played a role in reducing the number of lives Mother Nature’s temper tantrums claim, the fact remains that these events have a substantial impact on our health as a nation.

We recently talked to Paul Kuehnert, director, Bridging Health and Health Care portfolio—as well as a pediatric nurse practitioner and longtime state and local health official—to get his thoughts about the role public health plays in helping us prepare for, cope with, and learn from natural disasters.

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How RWJF Looks to Businesses as Partners to Create Scalable Solutions

Jun 5, 2014, 5:35 PM, Posted by Risa Lavizzo-Mourey

Health is a "multifaceted and interdependent issue," observes RWJF President and CEO Risa Lavizzo-Mourey, MD, in a June 5, 2014, post in the Stanford Social Innovation Review blog. To build a Culture of Health in America, she writes, we must "connect our actions to those of others, forming partnerships with a variety of organizations in all sectors—particularly in the corporate sector."

Lavizzo-Mourey outlines the rationale behind that transformative approach, and suggests that it is "time for new ways of thinking and acting that will encourage organizations of every kind to join the transformative scale movement."

Read the SSIR blog post

A Stronger Future for Young Men of Color

Jun 4, 2014, 11:12 AM, Posted by Maisha Simmons

New Orleans - Forward Promise - Tyrone Turner - 04/2013

 “All hands on deck” is the best way to describe the last three months. Over the last 90 days, many of my colleagues and I have had endless conversations with the 11 foundations working in parallel to the White House’s launch of My Brother’s Keeper. These conversations have enabled us to develop a comprehensive strategy to catalyze broader investments to improve opportunities and outcomes for boys and young men of color. Now, RWJF and our partners are excited to release the executive summary of our new report, A Time for Action: Mobilizing Philanthropic Support for Boys and Young Men of Color.

Read the news release

Together we’ve looked at some of the most promising models for unlocking opportunity for young men despite the multitude of challenges they face. We’ve asked ourselves, “What strategies will move the needle farthest? How can we move beyond adopting programs to fundamentally changing those systems that help shape the experiences and trajectory of our young men?” We’ve shared our foundations’ unique approaches to the work and long-term goals. I’ve been most struck by the underlying passion that each of our foundations has for this work. While we each take a different approach in the grants we make and priorities we’re advancing, at root there is a true and touching shared commitment to improving the lives of our country’s young men of color.

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Two New Mexico Counties: One’s Healthy, One’s Not. Why?

Jun 4, 2014, 10:48 AM, Posted by Barbara Basler

NewMexicoRWJF_0540_RET

The healthiest county in New Mexico—indeed one of the healthiest  counties anywhere in the country—is Los Alamos, ironically the birthplace of the world’s first atomic bomb.

According to the Robert Wood Johnson Foundation’s 2014 County Health Rankings and Roadmaps, Los Alamos, with one of the highest concentrations of PhDs and one of the highest median incomes in the nation, is not only wealthy and wise, but very healthy. In fact, it is a shining example of how education, income, and community—or the lack of—can shape our health, says Julie Willems Van Dijk, deputy director of the Rankings project.

New Mexico is a poor, rural state with a few small pockets of wealth. A 2012 analysis of state income disparities by the Center on Budget and Policy Priorities in Washington found that the gap between New Mexico’s rich and poor is, proportionately the widest in the nation. The County Health Rankings reflect the health consequences of that gap.

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Building a Culture of Health in Every Community

May 28, 2014, 10:19 AM, Posted by Risa Lavizzo-Mourey

DC metro map

Where you live can make a big difference in how long you live.

With an introduction by American Heart Association CEO Nancy Brown, RWJF President and CEO Risa Lavizzo-Mourey, MD, lends strength to that argument in a new entry in The Huffington Post.

Brown notes that people near the Friendship Heights station of Washington, D.C.'s Metro system live seven years longer than residents of the area surrounding the Tenleytown-AU station—just two stops away. Friendship Heights is in Maryland; Tenleytown-AU is in the District of Columbia. (View maps for Washington, D.C., and several other major cities and areas of the country.)

Lavizzo-Mourey picks up on that theme, elaborating on the findings and recommendations of the Foundation's recently issued County Health Rankings.

"Such socio-economic factors may seem like insurmountable obstacles to good health, but I believe we can use the County Health Rankings to help build a Culture of Health in every community," Lavizzo-Mourey writes. A report by the Robert Wood Johnson Foundation Commission to Build a Healthier America, she adds, also offers practical solutions to the problem, with 10 recommendations "for improving factors that lie far outside the clinic's door, such as early childhood education, adequate shelter, access to fresh produce, and the high levels of stress produced by living in poverty."

Read Lavizzo-Mourey's views in the Huffington Post

Closing the Gap on Child Obesity

May 22, 2014, 9:56 AM, Posted by Susan Dentzer

An elementary school student takes plastic cutlery for the meal he is holding.

Imagine a splashy, big bucks television commercial selling kids on the tantalizing deliciousness of eating ... carrots.          

Or a new course sandwiched into already packed middle-school and high school curricula: “Food Shopping and Cooking for a Healthy Life.”

Sound implausible? Maybe—but then again, such innovations could be a part of what is needed to make more progress in the war on child obesity.

These were some of the suggestions that emerged from a recent conference in Newark, where the Clinton Health Matters Initiative, the Robert Wood Johnson Foundation, and Grantmakers in Health sponsored a day-long summit entitled Closing the Gap: Childhood Obesity (and in which I was a participant). You can watch a video of the meeting here.

As RWJF CEO, Risa Lavizzo-Mourey reminded the audience, the Foundation has set a goal of reversing the U.S. child obesity epidemic by 2015—and as that date approaches, she confessed, “I’m getting a little nervous.” (View Risa's remarks.)

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We’re All in This Together: Let’s Bridge the Gap, Not Widen It

May 12, 2014, 4:14 PM, Posted by Beth Toner

Kathleen Hickey

At the end of April, the New York Times published an op-ed by Sandeep Jauhar, a cardiologist who—reacting to a New York bill granting nurse practitioners the right to provide primary care without physician oversight—argued that in primary care, “there will always be subtleties and complexities that demand a doctor’s judgment.”

His conclusion? “If we want more primary care providers, let’s have them be doctors”—and, he added, “let’s find a way to increase their pay.”

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Here's to the Nurses

May 8, 2014, 10:55 AM, Posted by Brent Thompson

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One evening several years ago, as my grandmother suffered through a painful end to her long life, our family gathered around her bedside at a hospital in South Jersey. She had been unconscious most of the day, but various family members, including my grandfather—her husband of six decades—had kept vigil at her bedside because they wanted to be with her in her last moments.

I was the last to arrive.

Shortly after I joined my family in the room, her physician showed up, checked her charts, and pronounced her “pretty much fine under the circumstances.” Then the doctor hurried off to complete his rounds.

My weary family, girding for the possibility of another long night at the hospital, decided to go downstairs for a bite to eat and some coffee. Because I had just arrived, I wanted some time alone with my grandmother, so I stayed behind in the room.

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To Address Childhood Obesity, Companies Must Join the Fight

May 7, 2014, 4:38 PM, Posted by Risa Lavizzo-Mourey

Risa Trenton Times cropped Risa Lavizzo-Mourey, MD, MPH

We’re seeing signs of promise in the effort to reverse the childhood obesity epidemic in the United States. Overall childhood obesity rates have leveled off—and they’ve even declined in some regions and among some age groups.

But it’s far too early to declare victory, writes RWJF President and CEO Risa Lavizzo-Mourey, MD, in a new post on the professional social networking site LinkedIn. The rate of obesity among U.S. teens, she notes, stands at a “shocking 21 percent, and Hispanic and African-American youth still have higher obesity rates than their white and Asian peers.”

To make more progress, Lavizzo-Mourey says, we need more people and organizations in the fight—particularly the business community.

So what more can be done? On Thursday, May 8, Lavizzo-Mourey and influential leaders from throughout the nation—including many from the business community—met to consider innovative approaches in a forum, “Closing the Gap in Childhood Obesity,” sponsored by RWJF and the Clinton Health Matters Initiative, in collaboration with Grantmakers in Health. The forum focused on developing solutions to the inequities that exist in childhood health and childhood obesity.

Choosing Wisely: Intensifying the Spotlight On Health Care of Dubious Value

Apr 30, 2014, 8:52 AM, Posted by Susan Dentzer

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“If you study the kinds of decisions that people make, and the outcomes of those decisions, you’ll find that humanity doesn’t have a particularly impressive track record,” write the brothers Chip and Dan Heath in their masterful book Decisive. Invoking research from psychology and behavioral economics, the Heath brothers demonstrate how people often make decisions by looking at what’s in the “spotlight”—the information immediately before them, sparse as it may be.

But what’s in that spotlight “will rarely be everything we need to make a good decision,” the Heaths counsel. To choose wisely, we need to broaden our focus, or “shift the light.”

That’s especially true in health care, where the consequences of any decision, poorly made or not, may be life or death.

Enter Choosing Wisely, a program that shifts the spotlight onto many of the tests and treatments that both providers and patients should question, if not abandon completely.

(Editor's note: On May 2, 2014, RWJF held a First Friday GoogleHangout to explore how Choosing Wiselysprang from critical examination of the overuse of medical care in the United States—and how it’s changing how care is delivered in communities. Watch an archived version of the Hangout, above.)

This two-year old campaign, launched in 2012 by the American Board of Internal Medicine Foundation, has identified more than 250 tests and procedures that warrant scrutiny because they are ineffective, unnecessary, unsupported by evidence, or possibly harmful. Even so, physicians and other clinicians perform them regularly, and patients sometimes request them.

Fifty-four of the nation’s premier medical specialty societies have joined the Choosing Wisely effort, and most of these have contributed to their own lists of questionable care. This week, three non-physician groups will also sign on to the campaign. Among the categories of dubious care identified on various societies’ “top five” lists are these:

  • Excessive imaging: CT or MRI scans for low back pain shouldn’t be ordered within the first six weeks of treating a patient, unless there are severe neurological symptoms, while patients with minor head injuries shouldn’t routinely get a head CT unless they have a skull fracture or are bleeding. Excessive scans expose patients to radiation that increases their lifetime risk of cancer.
  • Unnecessary medications: Antibiotics are not effective against viruses and should not be prescribed for viral illnesses such as sinus infections or bronchitis, particularly in children. But doctors say they frequently feel pressured to write these prescriptions by anxious parents.
  • Superfluous screening or diagnostic tests: Patients with no symptoms of heart disease and are at low risk of developing it are still frequently subjected to electrocardiograms when they get routine physical exams, despite evidence that this routine screening doesn’t improve patient outcomes. By the same token, hospitalized patients may have their blood drawn countless times for costly diagnostic testing that often yield little useful information, and can contribute to anemia.

The Robert Wood Johnson Foundation is supporting Choosing Wisely with a $2.5 million grant to extend the influence of these lists beyond medical specialty societies and into communities. State medical societies in Texas, Oregon, Minnesota, Tennessee, Washington, and Massachusetts have undertaken steps to promote the lists, including developing continuing medical education courses for doctors. So have ten regional health collaboratives, such as Maine Quality Counts and the Washington Health Alliance outside Seattle (both are among RWJF’s Aligning Forces For Quality communities as well).

Consumer Reports and AARP are among organizations that have taken the lead in publicizing the lists for consumers. All told, these efforts have reached an estimated 170,000 or more physicians and 16 million-plus consumers. There’s even a Wikipedia page for the campaign, with the lists of tests and procedures curated by a “Wikipedian” in residence.

Caveats: Although more than 200 articles have been written about aspects of the campaign in medical journals, there is as yet little hard evidence that is has reduced superfluous care. A recent perspective in the New England Journal of Medicine noted that the specialty societies’ lists “vary widely in terms of their potential impact on care and spending”—and suggests that some societies omitted lucrative elective procedures, such as knee replacement surgery, that also aren’t appropriate for many patients.

The bottom line: As a nation, we need to shine a spotlight on an even broader range of questionable health care in the future. But for now, the Choosing Wisely campaign is illuminating plenty of “care” that we can clearly pass up with impunity as we pursue our real objective:  better health.