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Two Nurses Serving in Congress Discuss Nurse Leadership

May 12, 2014, 10:10 AM

National Nurses Week HC Blog Logo

For National Nurses Week, two nurses who serve in the U.S. House of Representatives share their views on nurse leadership with the Robert Wood Johnson Foundation (RWJF) Human Capital Blog. Lois Capps, D-Calif., has served in the House since 1998; and Diane Black, R-Tenn., since 2011.

Capps: We Must Increase Our Nursing Workforce


Human Capital Blog:
Prior to running for Congress, you worked as a nurse and a nursing instructor. How does your background as a nurse help shape your agenda on Capitol Hill?

Lois Capps

Rep. Lois Capps: When I began my career as a nurse, I never imagined I would become a member of Congress. But when my husband passed away shortly into his first term in Congress, I was encouraged by my friends and neighbors to run, and I won the seat in a special election. Despite the fact that nurses and other health care professionals often never think about engaging in policy-making careers, I knew my experience as a nurse would make me a great advocate for the health community in Congress. Just as nurses are the best advocates on behalf of our patients, we are naturally inclined to be the best advocates on behalf of our patients in the Capitol.

HCB: You have made addressing the nursing shortage a priority. What has Congress done so far to address past shortages, and what needs to be done to curb future ones?

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Harvard School of Public Health Special Report: The Financial Crisis as a Public Health Crisis

Apr 30, 2014, 2:54 PM

“Five years after the Great Recession officially came to an end, the United States has yet to fully recover from the economic devastation sparked by the collapse of an $8 trillion housing bubble and the ensuing turmoil that saw global financial systems teetering on the brink of collapse. But while the economic costs of the downturn have drawn the lion’s share of attention, the damage to our bodies could end up far surpassing the damage to our bank accounts.”

Those are the opening lines of a new special report from the Harvard School of Public Health (HSPH), “Failing Economy, Failing Health: The Great Recession’s Toll on Body and Mind,” detailing how poverty and inequality resulting from the economic maelstrom pulled down so many—and what that will mean for public health in the long term.

“Health is a long-run thing, but the methods we use to analyze current data only estimate short-term effects,” says SV Subramanian, HSPH professor of population health and geography. “It may take awhile for the health impact of the Great Recession to kick in, but once it does, it could be dramatic.”

The data is strong on the links between employment and health—people who are unemployed, underemployed or laid off are less healthy and don’t live as long. 

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A 2009 study found that in the 12 months after men lost their jobs in mass layoffs, they saw their chances of dying nearly double. While over time the risk lessened it was still significant two decades later. Another study that same year found that losing a job when a business shuts its doors increases the odds of fair or poor health by 54 percent among workers with no preexisting health conditions while also increasing the risk of new health conditions by 83 percent. The stress of the situation, according to the researchers, heightens the odds of stress-related conditions such as stroke, hypertension, heart disease, arthritis, diabetes and psychiatric problems.

Yet another study, this one in 2010, found that about 4 in 10 Americans with heart disease or diabetes and 1 in 5 with cancer said the stress of the Great Recession made it more difficult to manage their illnesses.

What’s more complex is unearthing the pathways behind why this is the case. The HSPH article outlines some of the mechanisms by which unemployment affects health.

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PHLR Infographics: A Look at How Research is Improving Public Health Laws

Apr 10, 2014, 3:30 PM

Happy National Public Health Week! All week we've been sharing stories on the value of public health across all aspects of life, and all ages and stages.

Public Health Law Research (PHLR), a grantee of the Robert Wood Johnson Foundation, has also been participating in the week by contributing graphics and posts on the particular role of public health law—when backed by evidence and grounded in research—to save lives and make a difference. Below, we are highlighting some of the critical statistics PHLR has shared, along with some context on the research behind the numbers.

Child Seat Safety

Today, every state has a law requiring children to be restrained in federally-approved child safety seats while riding in motor-vehicles. These laws differ from state to state based on number of factors (e.g., age, height and weight of the children requiring safety seats). All current child safety seat laws allow for primary enforcement, meaning a police officer can stop a driver solely for a violation of such laws.

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Lead Laws

In 1990 approximately 20 percent of all U.S. children had elevated levels of lead in their blood. However, only a decade later that percentage was down to 1.6 percent, thanks to public health laws researched and crafted to look out for the wellbeing of children. One of the most significant pieces of legislation was The Lead Contamination Control Act of 1988, which was already on the path to improving public health in 1990.

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Watch this video on Philadelphia's lead court.

Sodium Laws

Eating too much sodium can cause high blood pressure, which raises the risk for heart disease and stroke—the first- and fourth-leading causes of death in this country. A variety of laws and legislatively enabled regulations attempt to reduce sodium in the food supply, including lowering the amount of salt in foods served in schools and child care facilities or purchased by state-regulated elder and health care facilities and prisons. Almost half of all U.S. states have laws to help reduce tghe sodium in processed foods.

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Sports-Related Traumatic Brain Injuries

As many as 300,000 kids suffer traumatic brain injuries (TBIs) from playing sports each year. TBIs can have serious short- and long-term health effects. Can public health law make a difference? The latest study finds that while all 50 states have laws in place to combat this problem, they haven't helped stop kids with concussions from playing. However, the research does help provide some context on how those laws have been implemented and how they might be revamped to work better.

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

Public Health Campaign of the Month: Air Pollution and Heart Health

Feb 10, 2014, 1:35 PM

>>NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to info@newPublichealth.org.

In honor of American Heart Month, held each February, the U.S. Environmental Protection Agency (EPA) has created a new Public Service Announcement (PSA) to educate the public and health care providers about the risks of air pollution to the heart.

"Over more than four decades of EPA history, we've made tremendous progress cleaning up the air we breathe by using science to understand the harmful effects of air pollution," said EPA Administrator Gina McCarthy. “While EPA continues to fight for clean air, Americans can take further action to protect their heart health by following the advice in our new PSA.”

One of EPA’s commitments in the U.S. Surgeon General’s National Prevention Strategy is to educate health care professionals on the health effects of air pollution, including heart risks. This PSA supports the Million Hearts Initiative, launched by the U.S. Department of Health and Human Services in September 2011, to prevent one million heart attacks and strokes by 2017. 

Research has shown that air pollution can trigger heart attacks, stroke and worsen heart conditions, especially in people with heart disease—that’s one in three Americans. According to the EPA, very small particles are the pollutants of greatest concern for triggering health effects from exposure to air pollutants. These particles are found in transportation exhaust, haze, smoke, dust and sometimes even in air that looks clean. Particle pollution can also be found in the air at any time of the year. 

The new PSA advises people with heart disease to check the daily, color-coded Air Quality Index forecast. At code orange or higher, particle pollution can be harmful to people with heart disease. On bad air quality days, it is recommended to reschedule outdoor exercise or to exercise indoors instead, and avoid exercising near busy roads.

Air Quality Index forecasts for more than 400 cities are available on the forecast map through a free AirNow app for iPhone and Android phones, and through the free EnviroFlash e-mail service. To sign up, visit here and click on the “Apps” or “EnviroFlash” icons.

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

In San Diego, a Big Push for Better Health

Jan 31, 2014, 1:25 PM

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Many of the sessions at the National Association of Counties (NACo) Health Initiatives Forum meeting in San Diego this week have been moderated by Nick Macchione, director of San Diego’s Health and Human Services Agency and vice chair of the Healthy Counties Initiative Advisory Board. Macchione is a key architect of Live Well San Diego, a program voted in by the San Diego Board of Supervisors that is a long term, comprehensive and innovative strategy on wellness with a goal of helping all San Diego County residents become healthy, safe and thriving.

NewPublicHealth spoke with Nick Macchione ahead of the forum. Senior Policy Advisor Julie Howell and Dale Fleming, director of strategic planning and operational support, joined the conversation.

NewPublicHealth: The buzz about San Diego is that you’re working hard toward population health improvement.

Nick Macchione: I think the excitement about San Diego is that we have earned a reputation as a health innovation zone by having a collective impact on health and wellness. Our deeds demonstrate our words because over the past decade there have been five major broad-based population health improvements: reduction of heart disease and stroke; reduction of cancer rates; reduction of childhood obesity; reduction of infant mortality; and reduction of children in foster care. That reduction is extremely important to population health because we also look at the social determinants of health and not just pure health care.

We've taken an ecological approach to population health—working with partners across all sectors and coming together not just from traditional health care but beyond that to public health, social services, business, community, schools and the faith community.

And we’ve done that in the context of optimizing existing resources to improve outcomes. We’ve been blessed with a lot of competitive federal grants and philanthropy investments, but really the framework is how we leverage and optimize what we have first before we go and seek to augment with other resources. That has worked exceptionally well and that’s earned us that innovation zone reputation.

NPH: Tell us about Live Well San Diego.

Macchione: Live Well San Diego is a comprehensive public health initiative that involves widespread community partnerships to address the root causes of illness and rising health care costs. The tagline is healthy, safe and thriving. We think it’s a great template that communities can use, it’s transferable because San Diego has every imaginable bio-climate except a tropical rainforest. So we have desert towns, we have rural communities, we have mountain villages, we have beach towns and everything in between urban core. We also call it Project 1 Percent because 1 percent of San Diego represents the nation both in its diversity and its population. So, if we can achieve what we're achieving on advancing population based health in a broad scale it can be demonstrated throughout the country.

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Better Health, Better Care, and Lower Costs Through Telehealth

Jan 24, 2014, 4:28 PM, Posted by Kristi Henderson

Kristi Henderson, DNP, NP-BC, FAEN, is the chief advanced practice officer and director of telehealth for the University of Mississippi Medical Center, where she holds dual appointments in the School of Medicine and School of Nursing. She has an administrative and clinical practice as a family and acute care nurse practitioner, and is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. This post is part of the “Health Care in 2014” series.

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As we ring in the New Year, do any of these scenarios ring true for you or your family?

  • There is someone who suffers from diabetes but lives an hour from a diabetes specialist. They can’t stay in the community where they live for treatment and an already-taxing diagnosis becomes a burden to treat. What if there was a way that the diabetes specialist, diabetes educator, pharmacist, ophthalmologist, and nutritionist could all be brought to this patient virtually by way of today’s technology? What if there was a way for a treatment plan to be customized to each patient and adjusted in real-time from information uploaded from a smartphone?

  • There is someone who has heart failure and for every ‘flare up’ the only option is to go to the local emergency room (ER). Medication and check-up regimens are followed every year but the ER visits are the only way to see a health care provider at a moment’s notice. What if health stats, vital signs, and symptoms could all be tracked by the health care provider to identify subtle changes early on, or when symptoms begin to worsen, and interventions could avoid an ER visit? Imagine if symptoms, vital signs, weight and medication side effects were monitored while a patient with heart failure goes about their day, not just at their scheduled check-ups.

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A Remedy for What Ails the Urban City

Dec 27, 2013, 9:00 AM

By Santa J. Ono and Greer Glazer

Santa J. Ono, PhD, is president of the University of Cincinnati. Greer Glazer, PhD, is dean and Schmidlapp professor of nursing at the University of Cincinnati College of Nursing, and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This piece first appeared in the Cincinnati Enquirer; it is reprinted with permission from the newspaper.

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The children of poor Cincinnati neighborhoods are 88 times more likely to require hospitalization to treat asthma than their peers across town. That’s an urban health disparity born of unequal access to the kind of consistent, attentive, high-quality health care that renders asthma a controllable condition.

In academic medicine, we chart the credentials of our staff and the test scores of our students. We tout the wizardry of the medical technology we bring to bear on exotic maladies. But too often we lose sight of the fact that the ultimate test of an academic medical center isn’t what’s inside the building, it’s what’s outside. If we are improving the health of the communities we serve, then we are truly succeeding.

By that score, we are falling short.

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The “Next Best Thing” to Being There: Robots Expand Physicians’ Reach

Dec 3, 2013, 12:00 PM

Telepresence robots are expanding access to specialists in rural hospitals experiencing shortages of physicians, and in other hospitals throughout the country, reports the Associated Press.

Devices such as the RP-VITA, introduced earlier this year, can be controlled remotely with a desktop computer, laptop, or iPad, allowing physicians to interact with patients through video-conferencing via a large screen that projects the doctor's face. An auto-drive function allows the robot to find its way to patients' rooms, and sensors help it avoid obstacles. It also gives the physician access to clinical data and medical images.

Dignity Health, a hospital system with facilities in Arizona, California, and Nevada, started using telepresence robots five years ago to promptly evaluate patients who had potentially suffered strokes.  Dignity now has robots in emergency rooms and intensive care units at about 20 California hospitals, giving them access to specialists in areas such as neurology, cardiology, neonatology, pediatrics, and mental health.

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Could Good Health Be Contagious?

Nov 18, 2013, 6:00 PM, Posted by Pioneer Blog Team

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A study released this week at the American Heart Association’s Scientific Sessions provides early evidence indicating that social networks can be leveraged to spread good health. The study, which is the first long-term randomized trial of its kind in the U.S., recruited friends and families in rural Kentucky into "microclinic" social network clusters. Together, the microclinic groups attended weekly social events, such as physical activity sessions and nutrition classes.  Collectively called Team Up 4 Health, these activities were supported with gifts from Humana, a health care company focused on wellness, as well as funding from the Mulago Foundation and the Goldsmith Foundation. Microclinic members lost more weight and more inches from their waistlines than those who received standard individual care. Microclinic participants sustained these results over time, lasting beyond the 10-month program period to even six months later.

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A Closer Look at the Quality of Cardiac Care in the United States

Sep 20, 2013, 9:00 AM, Posted by David S. Jones

David S. Jones, MD, PhD, is the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard Medical School's Department of Global Health & Social Medicine. He is a 2007 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, and the author of Broken Hearts: The Tangled History of Cardiac Care.

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Every day, all over America, people visit their doctors with chest pain and other symptoms of coronary artery disease. Each year, more than a million of them choose to undergo bypass surgery or angioplasty. Are these decisions good ones? Even though modern medicine has committed itself to an ideal of evidence-based medicine, with its clinical trials, meta-analyses, and practice guidelines, the answer is not always clear. By looking closely at the history of these procedures, it is possible to understand some of the reasons why this is the case. With support from a RWJF Investigator Award in Health Policy Research, I looked at three specific questions: the role of evidence and intuition in medical decisions, the reasons why it can be so difficult to determine the risks of medical interventions, and the problem of “unwarranted variation” in medical practice.

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