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.

 

A Healthier Denver

Apr 29, 2014, 8:55 AM, Posted by Shale Wong

Bldg a Healthier Denver Members of the Collective - GlaxoSmithKline

I live in Denver. I work in Denver. And as a pediatrician, I’ve dedicated my life to the health of Denver’s kids. It is remarkable to me how connected our health is to our community. In Denver, we have some of the finest health care in the state, yet more and more of our kids are struggling to maintain a healthy weight. It takes much more than having great hospitals in our community for our kids to live a healthy life.

If we want all our kids to grow up healthy in Denver and throughout the United States, we must recognize all of the elements that affect their well-being. That means ensuring our communities are safe, with strong education and ample access to healthy foods and recreational spaces. And it means addressing poverty whether it is tucked into pockets or widespread in our communities.

This connection between our health and our community was affirmed by the release of the latest County Health Rankings and Roadmaps—an initiative of the University of Wisconsin Population Health Institute and sponsored by the Robert Wood Johnson Foundation. The latest installment showed that those of us who live in the least healthy communities in America are twice as likely to live shorter lives as those who live in healthy communities. And these least healthy communities have twice as many kids living in poverty.

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From Trauma to TED: Boston Marathon Survivor Adrianne Haslet-Davis on Recovery, Care, and Collaboration

Apr 21, 2014, 12:30 AM, Posted by Shaheen Mamawala

Boston Marathon survivor Adrianne Haslet-Davis performs at TED2014 Adrianne Haslet-Davis (photo by James Duncan Davidson)

Last month, I attended my first TED conference in Vancouver, Canada. Though inspiring, it was also overwhelming—in a sea of over 1200 guests, it can often be challenging to make meaningful personal connections. However, when I saw Adrianne Haslet-Davis step onto the stage and dance a beautiful rumba while wearing her prosthetic leg, I knew she was someone I wanted to meet.

While Adrianne and I had just a quick exchange of hellos in person at TED, I was further inspired by the message she wrote when she stopped by our RWJF Culture of Health Café. There she offered her own vision of a Culture of Health, framed within her personal experiences as a victim of the 2013 Boston Marathon bombing. Adrianne graciously offered to expand on her personal Culture of Health vision in a brief interview with me.

Shaheen: You recently returned from TED2014 in Vancouver, where you gave a powerful dance performance. Tell us about that experience.

Adrianne: It was no question at all where I wanted to dance [publicly] again for the first time.  It was important for me to do it at TED because I so strongly believe in TED’s message of getting people to think outside the box about issues that maybe we don’t know we’re interested in. I think it’s really eye-opening in that way.

I went into the project with Hugh Herr, director of the Biomechatronics Group at the MIT Media Lab, who came to me and said “Adrianne, I think we can make this [performance] happen but I’m not going to guarantee it. Are you in?” I said yes because it really helped me have a goal.

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Reflections on TED2014: Ideas Worth Spreading … FASTER!

Apr 18, 2014, 2:11 PM, Posted by Lori Melichar

Pattie Maes on stage at TED2014 (Photo: Bret Hartman) Pattie Maes, MIT Media Laboratory, speaking at TED2014

When people find out I work for the Robert Wood Johnson Foundation, they often want to tell me their idea for solving the problems that keep Americans from being as healthy as they can be. It's one of the pleasures of my job. Some of these ideas are indeed pioneering,  with the potential for breakthrough change.  All of them are helpful in shaping my vision of a path to achieving a Culture of Health.

I heard a lot of ideas last month while representing RWJF at TED2014. If you aren’t familiar, TED is an organization dedicated to spreading ideas through inspiring talks and conversations. Their annual conference is a great place to meet leaders from a variety of disciplines, from science and technology to business and the arts, and it was a privilege to attend.

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The Doctor Will Share With You Now

Apr 17, 2014, 4:43 PM, Posted by Risa Lavizzo-Mourey

Elaine Benes Seinfeld Screen Grab for Risa OpenNotes LinkedIn blog post

What does an episode of the Seinfeld show have in common with an RWJF national initiative?

In the first case, Seinfeld character Elaine Benes gets to see the notes written about her by her doctor. In the second, OpenNotes promotes exactly the same thing—patient access to the visit notes written by their doctors.

In Elaine’s case, that access was accidental. She took a quick look at her chart, only to see herself described as “difficult.” And merriment ensued.

Under the OpenNotes initiative, which started in 2010, Elaine would have been able to check out her doctor visit notes via a web-based portal. She wouldn’t have needed to sneak a peek. It’s unlikely she would have been described as “difficult.”

Numerous studies show that patients do want to see their records, and the evidence suggests that when they do, it leads to better health.

In a new post on the professional social networking site LinkedIn, RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, notes that the concept is catching on, and OpenNotes is leading the charge. “OpenNotes will lead not only to a more efficient health care system,” she writes, “but better health for all of us.”

Read Lavizzo-Mourey’s LinkedIn post