Explore the Blog Explore Blog

African-American Men’s Health: A State of Emergency

Dec 15, 2014, 9:00 AM, Posted by Roland J. Thorpe, Jr.

Roland J. Thorpe, Jr., PhD, MS, is an assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and director of the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held December 5th. The conversation continues here on the RWJF Human Capital Blog.

Scholars Forum 2014 Logo

Nearly half a century ago, Dr. Martin Luther King Jr. famously said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Yet decades later, only modest progress has been made to reduce the pervasive race- and sex-based disparities that exist in this country. African-American men who are at the intersection of race and sex have a worse health profile than other race/sex groups.  This is dramatically evidenced by the trend in life expectancy.

Roland Thorpe

For example, African-American life expectancy has been the lowest compared to other groups ever since these data have been collected. Today the lifespan of African-American men is about six years shorter than that of white men.  Furthermore, a study from the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions provides a financial perspective around this issue.

View full post

How Cataract Surgery Helped Me See the Future of Health Transparency

Dec 12, 2014, 1:34 PM, Posted by Risa Lavizzo-Mourey

Robotic Surgery

More and more health care costs are shifted to consumers. So why, asks RWJF President and CEO Risa Lavizzo-Mourey, can’t we easily discover and compare health care costs and quality?

Here’s how the subject came up. Recently, Lavizzo-Mourey underwent cataract surgery at an outpatient center in Philadelphia. No matter whom she talked to—and she was shunted from one person to the next—she could not learn the all-in cost of the procedure.

Lavizzo-Mourey finally did manage to find out the cost of her surgery: $2,000, including co-pays and deductible. But the whole episode, she says, is illustrative of a larger problem.

Writing in a recent blog post on the professional social networking site LinkedIn, Lavizzo-Mourey asks: “Could there be a clearer example of the lack of transparency in the U.S. health care system?”

To get the information we need, the Robert Wood Johnson Foundation is funding a set of studies to help us better understand how greater price transparency influences consumer and provider decisions. “And in March,” Lavizzo-Mourey adds, “we will host a summit on transparency that will attempt to come up with more answers."

Along those lines, RWJF last year issued a challenge to developers to devise consumer-friendly tools to parse the abundant hospital price data released by Medicare. The winner? Consumer Reports, for the Consumer Reports Hospital Adviser: Hip & Knee, a personalized app for health care consumers seeking the best hospital for hip or knee replacement surgery.

You can help us move the cost and quality needle forward. Do you know of any other price/quality apps or tools? Let us know.

A Brave New ‘Post-Mendelian’ World

Dec 12, 2014, 9:00 AM, Posted by Lainie Ross

Lainie Ross, MD, PhD, is a 2013 recipient of the Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research and a 2014 Guggenheim Fellow. During her fellowship year, she will work on a book tentatively titled, From Peapods to Whole Genomes: Incidental Findings and Unintended Consequences in a Post-Mendelian World.

Lainie Ross

Human Capital Blog: What are some of the incidental findings and unintended consequences you will discuss in your book?

Lainie Ross: First, let me explain what I mean by “incidental findings.” Incidental findings refer to unanticipated information discovered in the course of medical care or research that may or may not have clinical significance. They are not unique to genetics. In some studies, up to one in four diagnostic imaging tests have incidental findings, although most do not have immediate clinical consequences.

One example of an incidental finding that I discuss in the book involves incidental findings uncovered while screening candidates for research participation. This can range from discovering high blood pressure (known as the “silent killer”) to extra sex chromosomes in people who volunteer as “healthy controls.” This raises the question of what is a clinically significant or “actionable” finding, and what information should be returned to the research participant. These types of questions are critical, especially because many research consent forms have historically stated that “no results will be returned.”

View full post

The Unfinished Work of the Affordable Care Act

Dec 12, 2014, 8:45 AM, Posted by Brendan Saloner

Brendan Saloner

The United States is the last remaining rich country in the world where a large percentage of the population lacks health insurance coverage. This situation is being improved under the Affordable Care Act (ACA), with recent estimates showing that from early 2013 to mid-2014 the uninsured rate dropped from 19 percent of adults to 14 percent. The uninsured rate will no doubt continue to fall in 2015, but the problem of the uninsured will not go away with the ACA. It will not go away even if all 50 states expand Medicaid for poor adults, and will not go away if the U.S. Supreme Court rules against the plaintiffs in a pending challenge to the power of the administration to provide subsidies in the federally facilitated insurance exchanges.

In its 2012 baseline estimate, the Congressional Budget Office (CBO) projected that by 2022 the ACA might cut the number of uninsured by half, but would still leave behind 30 million people without insurance. This projection assumed full implementation of the ACA provisions. We don’t yet have a clear sense of how much larger that number will be with incomplete implementation of the core ACA coverage provisions, but even an optimistic assessment is that tens of millions of Americans will continue to spend periods of time without health insurance.

Who does the ACA leave behind? By design, the ACA excludes undocumented immigrants, a group that numbers around 11 million today. Some undocumented immigrants purchase private insurance, receive coverage from an employer, or participate in public programs funded with non-federal dollars, but the majority have no insurance. Undocumented immigrants are prohibited from enrolling in Medicaid, receiving subsidies, and purchasing coverage on the exchanges. Although President Obama recently signed an executive order protecting many undocumented immigrants from immediate deportation, the ACA exclusion will continue in the foreseeable future, barring an act of Congress. 

View full post

How to Build a Healthier Millennial

Dec 11, 2014, 4:50 PM, Posted by Dwayne Proctor, Kristin Schubert

Game of Life Photo: Will Folsom

 

Millennials get a lot of attention as today’s trendsetters. What are they buying? What social media are they using? How are they voting?  But there is an equally important question that is rarely raised: How healthy are 20-somethings? A new report explores that last question, and the answers are not good. An even better question might be: What’s standing in the way of healthier, more productive lives for millennials?

Adults between the ages of 18 and 26 are "surprisingly unhealthy," according to the report from the Institute of Medicine (IOM) and the National Research Council (NRC). One out of every four young adults is obese, and those numbers are rising. One in 10 has suffered from untreated mental illnesses within the past year. What lies behind these disturbing trends might be a much bigger issue than what young people choose to eat or how they handle stress. The report points to big-picture causes—broken pathways from quality education to solid jobs, and widening disparities that make it harder for marginalized young adults to succeed.

View full post

Recent Research About Nursing, December 2014

Dec 11, 2014, 1:00 PM

This is part of the December 2014 issue of Sharing Nursing’s Knowledge.

Study: ‘Alarm Fatigue’ Poses Danger

After a while, alarms stop being so alarming. That’s the warning growing out of a study of the sheer volume of physiological alarms generated by bedside monitoring systems in hospitals. The barrage of beeps can become so overwhelming that it creates “alarm fatigue,” which in turn can lead nurses and other clinicians to discount the urgency of alarms or to ignore them altogether.

In the study, led by University of California, San Francisco (UCSF) School of Nursing Professor Barbara Drew, PhD, MS, researchers tracked the quantity and accuracy of alarms generated in five intensive care units at the UCSF Medical Center over a 31-day period. They found a high rate of false positives—alarms generated when patients were not in need of treatment beyond what they were already receiving. For example, during that time, researchers counted 12, 671 alarms for arrhythmia, 89 percent of which were false positives. Most of those were the result of problems with the alarm system’s algorithms, incorrect settings, technical malfunctions, or brief heart rate spikes that did not require further attention.

In all, during the 31-day period, the systems generated an average of 187 alarms per patient bed per day, adding up to more than 380,000 audible alarms over the course of the month, across the five ICUs.

View full post

In the Media: New Exhibits Shine Light on the History of Nursing

Dec 11, 2014, 9:00 AM

This is part of the December 2014 issue of Sharing Nursing’s Knowledge.

On television and in other media, nurses are often portrayed as gendered stereotypes: the angel, the handmaiden, the battle-axe, or the sex-object.

Turns out, these portrayals aren’t new. That is evident in a new postcard exhibit at the National Library of Medicine in Bethesda, Md., that illustrates cultural perceptions of nursing over the last century.

The exhibit, entitled Pictures of Nursing, hails from a collection of more than 2,500 postcards that were donated by Michael Zwerdling, RN. The collection includes postcards that date to the late 1800s, and features images of nurses portrayed as everything from Greek goddesses to Amazon princesses to the Virgin Mary. It also includes rare images of male nurses.

Some of the exhibit’s more contemporary postcards depict nurses in modern uniforms and as skilled members of health care teams—images that counteract sexist and gendered notions of nursing that come through in other postcards.

View full post

New Network Unites Community Leaders to Improve Health

Dec 10, 2014, 12:55 PM

The Build Healthy Places Network, a new and innovative resource to improve health outcomes in low-income communities, launched last month during the annual meeting of the American Public Health Association.

This groundbreaking network sits at the intersection of public health and community development. The goal of the network is to expand our collective understanding of the social determinants that impact public health and catalyze action. In so doing, the Build Healthy Places Network hopes to create new models and develop new tools to help leaders of low-income communities and create a Culture of Health where every individual lives the healthiest life possible.

Already, cutting edge work is being done in the public health sphere to begin addressing the many factors that impact health. As Douglas Jutte, MD, MPH, the Network’s executive director, recently described, the Network is designed to aggregate the work being done to help build a knowledge base for every community to use. 

“The concept is derived from a series of conferences that the Federal Reserve System has held focusing on both health and community development,” said Jutte. “There was a growing recognition that there needs to be a support system to build bridges between these two distinct sectors. While the conferences were a good start, we saw the opportunity for a network to help build these cross-sectoral connections and keep this field of collaboration moving forward.”

The Network’s website includes resources such as primers on improving the health of communities and stories about communities that are already uniting community development experts and public health experts to build a Culture of Health.

Jutte says a lot of the successes in the field currently are anecdotal and people working in the field often come up them “accidentally.”

“You hear about this amazing work that someone is doing in some corner of a faraway state and that really should end because we have the ability to share that kind of knowledge,” says Jutte.

He continued, “A key goal is to move health and community development from their siloes to collaboration. The Network will serve as a clearing house to bring together stories and evidence and examples of collaboration in communities.”  

Going forward, the Network plans to “synthesize” what is known and what the good examples are “so that we can help communities and leaders who are not even sure where to start, to really understand what’s going on in terms of new models with a focus on measurement, policy, finance and investment,” Jutte said.  

This commentary originally appeared on the RWJF New Public Health blog.

We Are All Tuskegee

Dec 10, 2014, 9:00 AM, Posted by Collins O. Airhihenbuwa

Collins O. Airhihenbuwa, PhD, MPH, is professor and head of the Department of Biobehavioral Health at Penn State University. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.

Scholars Forum 2014 Logo

As we address disparities and inequities, the challenge is to think about solutions and not simply defining the problem. Most would agree that health is the most important part of who we are. It is the first thing we think about in the morning when we greet one another by asking, “How are you this morning?” It is the last thing we think about at night when we wish someone a restful night.

Collins Airhihenbuwa

What may be different is what health means to us and our families. This is why place and context are important. How we think about health and what we choose to do about it is very much influenced by where we reside. Our place and related cultural differences about health are less about right or wrong and more about ways of relating and meeting expectations our families and communities may have of us, whether expressed or perceived. More than that is the way we relate to what our place means in terms of how it is defined and subsequently how that definition shapes how we define it for ourselves. In other words the ‘gate’ through which we talk about our place and ourselves is very important in having a conversation about who we are and what that means for our health.

View full post

Rare Mettle

Dec 9, 2014, 9:00 AM

For the 25th anniversary of the Robert Wood Johnson Foundation’s (RWJF) Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Rachel Torrez, MD, a member of the Class of 1990.

Rachel Torrez

The year was 1992. Rachel Torrez, a second-year medical student, was in line waiting for coffee at the University of Washington when a White male student confronted her.

“You took my best friend’s spot because of quotas,” he sneered.

The granddaughter of Mexican migrant workers, Torrez enrolled at a time when students of color were few and some people—especially in Washington state—were questioning the fairness of affirmative action. Clarence Thomas, an outspoken opponent of affirmation action, had recently joined the Supreme Court.

“We don’t have quotas,” Torrez shot back. “I took your best friend’s spot because I was smarter.”

That mix of brains and backbone is characteristic of Torrez, who conquered severe dyslexia and cultural constraints on her way to an MD. Now a family-practice physician in the Ballard neighborhood of Seattle, Torrez gives as good as she gets.

View full post