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Reigniting the Push for Health Equity!

Nov 24, 2014, 1:00 PM, Posted by Daniel Dawes

Daniel E. Dawes, JD, is a health care attorney and executive director of government relations, health policy and external affairs at Morehouse School of Medicine in Atlanta, Georgia; a lecturer of health law and policy at the Satcher Health Leadership Institute; and senior advisor for the Transdisciplinary Collaborative Center for Health Disparities Research. On December 5, the Robert Wood Johnson Foundation (RWJF) will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.

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With growing diversity relative to ethnicity and culture in our country, and with the failure to reduce or eliminate risk factors that can influence health and health outcomes, it is imperative that we identify, develop, promulgate, and implement health laws, policies, and programs that will advance health equity among vulnerable populations, including racial and ethnic minorities.

Daniel Dawes

Every year, the Agency for Healthcare Research and Quality publishes its National Healthcare Quality and Disparities Report, which tracks inequities in health services in the United States. Since the report was first published in 2003, the findings have consistently shown that while we have made improvements in quality, we have not been as successful in reducing disparities in health care. This dichotomy has persisted, despite the fact that health care spending continues to rise. In fact, health care costs have been escalating at an unsustainable rate, reaching an estimated 17.3 percent of our gross domestic product in 2009, according to the Centers for Medicare and Medicaid Services. Despite these high costs, the delivery system remains fragmented and inequities in the quality of health care persist. The impact of disparities in health status and access for racial and ethnic minorities is quite alarming.

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Ebola as an Instrument of Discrimination

Nov 21, 2014, 1:00 PM, Posted by Allison Aiello

Jennifer Schroeder, Stephanie M. DeLong, Shannon Heintz, Maya Nadimpalli, Jennifer Yourkavitch, and Allison Aiello, PhD, MS, professor at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This blog was developed under the guidance of Aiello’s social epidemiology seminar course.

Allison Aiello Allison Aiello

Ebola is an infectious disease that the world has seen before in more moderate outbreaks in Africa. As the devastating Ebola outbreak in West Africa has taken a global turn, fear, misinformation and long-standing stigma and discrimination have acted as major contributors to the epidemic and response. Stigma is a mark upon someone, whether visible or invisible, that society judgmentally acts upon. Ebola has become a significant source of stigma among West Africans and the Western world.

In many ways, the source of this discrimination can be traced back to the legacy of colonialism and the western approach to infectious disease response in Africa. The history of foreign humanitarian aid has sometimes dismissed cultural traditions and beliefs. As a consequence, trust in westerners has eroded and has been compounded by a disconnect between western humanitarian aid approaches and a lack of overall infrastructure investment on the part of African national health systems. This is apparent in the Ebola epidemic in West Africa. Some don’t actually think that Ebola exists; instead they believe that it is a hoax carried out by the Western world. All of these factors are facilitating the rapid spread of the disease.

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The Imperative to Improve Health Literacy

Nov 19, 2014, 7:59 PM

Joy P. Deupree, PhD, MSN, APRN-BC, is an assistant professor at the University of Alabama (UAB) School of Nursing and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. She is engaged in community participatory research studies on health literacy. For 12 years, Deupree has taught a campus-wide elective on health literacy and has been a guest lecturer on the topic at the UAB schools of medicine, dentistry and public health. She founded the Alliance of International Nurses for Improved Health Literacy and established a nursing special interest group for the Health Literacy Annual Research Conference.

Joy Deupree

Health literacy is extremely important to building a culture of health. Basic understanding of health care information is essential if people are to live healthy lives, but an alarming number of American adults report poor understanding of health care instructions. 

This year marks the 10-year anniversary of the Institute of Medicine (IOM) report, Health Literacy: A Prescription to End Confusion.While progress has been made, the work has really just begun. We can no longer blame the patient for poor health literacy, and we should keep in mind that limited health literacy affects us as all and contributes to increased health care costs. 

American Public Health Association Meeting & Expo

The IOM report defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” These skills involve not only reading ability but also numeracy. Failure to develop the necessary skills to manage health care can cost millions of dollars as well as add to human suffering and even cause death.

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Population Sickness and Population Health: How Geographic Determinants Differ

Nov 19, 2014, 9:00 AM, Posted by Tamara G. Leech

Tamara G.J. Leech, PhD, is an associate professor in the Department of Social and Behavioral Sciences at the Indiana University Richard M. Fairbanks School of Public Health, and a former Robert Wood Johnson Foundation (RWJF) New Connections program grantee. She is principal investigator of a William T. Grant Scholar Award, “Pockets of Peace: Investigating Urban Neighborhoods Resilient to Adolescent Violence.”  

Tamara G. Leech

I am particularly excited about the American Public Health Association’s (APHA) Annual Meeting theme this year—Healthography! My research team has spent the past two years examining “cold spots” of urban youth violence. In other words, we have been analyzing areas where—regardless of the increased risk for violence—violence is not occurring or is rarely occurring. This is a departure from the dominant form of research on “hot spots” of violence, or any disease for that matter.  

American Public Health Association Meeting & Expo

For some, this approach has been puzzling. It’s not immediately obvious that the determinants of cold spots are not simply the opposite of the determinants of hot spots.  However, our evidence clearly suggests that the things that help to make a location healthy go well beyond the things that protect a location from high rates of illness.

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The Stuff That Is Killing Us

Nov 18, 2014, 1:00 PM

Ronald M. Wyatt, MD, MHA, is medical director in the Division of Healthcare Improvement at The Joint Commission. In this role, he promotes quality improvement and patient safety to internal and external audiences, works to influence public policy and legislation for patient safety improvements, and serves as the lead patient safety information and education resource within The Joint Commission. On December 5, RWJF will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.

Ron Wyatt

I first met Don Erwin, MD, in 2010. He was CEO of the St. Thomas Clinic in New Orleans. I sought him out on the recommendation of the CEO of the Institute for Health Care Improvement (IHI), Donald Berwick, MD. I was a fellow of the IHI, and Berwick and I had conversed about inequities in the U.S. health care system. He advised me to travel to New Orleans to speak with Erwin, who would give me insight that would be important to the project that I was working on: “Disparity in the Deep South.”

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Erwin was very welcoming and asked why I was there.  In a very academic tone, I told him that I was there to better understand the non-medical determinants of health. With a semi-puzzled look on his face, Erwin asked what I meant. Now I became puzzled and a bit uncomfortable. My response was that I was interested in learning more about the role of social determinants on health.  Erwin said, “Ron, I am not sure what you are talking about.” 

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Ending Health Inequality, Addressing the Social Determinants of Health

Nov 17, 2014, 1:00 PM, Posted by Thomas LaVeist

Thomas LaVeist, PhD, is founding director of the Hopkins Center for Health Disparities Solutions, and the William C. and Nancy F. Richardson Professor in Health Policy at the Johns Hopkins Bloomberg School of Public Health. He is the chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College. On December 5, LaVeist will moderate the first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.

Thomas LaVeist

Research has amply demonstrated that social and economic forces are important determinants of health. They affect where and how people live, work, learn and play; their patterns of social engagement; and the financial and social resources available to them. They thereby shape their health and length and quality of life. 

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The World Health Organization’s Commission on Social Determinants of Health suggested four strategies in which policy can be deployed to address health inequalities:

  • decreasing social stratification (e.g., power, prestige, wealth, human capital, etc.);
  • decreasing exposure to risk;
  •  lessening the vulnerability or improving the ability of disadvantaged persons to cope with risk; or
  • intervening through health care to reduce the unequal consequences of social determinants.

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At APHA 2014 Opening Session, Key Leaders Talk Culture of Health

Nov 17, 2014, 12:57 PM


Healthography—or the health of the place where you live—is the theme of this year’s American Public Health Association (APHA) annual meeting, which is taking place in New Orleans this week.

During the opening session, Georges Benjamin, MD, Executive Director of APHA, announced that APHA’s goal is to create the healthiest generation in American history within one generation. Benjamin’s announcement was coupled with announcements from local and national public health leaders that collectively took another step forward in that effort.

For example, the Partnership for a Healthier America announced a new Healthier Campus Initiative, which calls on colleges and universities to adopt recommended guidelines on food, nutrition and physical activity.

“We know that going to college is a time of change for many students—we also know that means it’s a time when new habits are formed,” said Peter Soler, the partnership’s CEO. “By creating healthier food and physical activity environments today, campuses and universities are encouraging healthier habits that will carry over into tomorrow.”

Guidelines being adopted by participating campuses include promoting the consumption of water instead of soda on campus, offering a bicycle sharing program for all students and providing certified personal trainers and registered dietitian nutritionists on campus.

In addition, Louisiana’s Secretary of Health and Hospitals, Kathy Kliebert, discussed the state’s “Well-Ahead” initiative, which promotes and recognizes smart choices that are made in the spaces and places where people live and work, and which make it easier to live healthier lives. Kliebert told the audience that Well-Ahead promotes voluntary changes without imposing new taxes or creating new rules.

Within the host city of New Orleans, a couple of initiatives to improve health within the Crescent City were also discussed at APHA’s opening session.

One such initiative to combat obesity—known as Fit Nola—now has 100 miles of bike lanes throughout the city. Also, next week legislation will be introduced to ban smoking in the city’s bars, casinos and public spaces.

APHA’s opening session ended with a talk by Pulitzer Prize winner Isabel Wilkerson, who spoke about her book “The Warmth of Other Suns.” A book 15 years in the making, “The Warm of Other Suns” describes the migration of African Americans in the 20th century from the South to the North for a better life for themselves and their children. For example, the parents of Olympian Jesse Owens worried their son would not have the strength to work in the fields, so they moved north to Cleveland, Ohio, where he started running track—a sport that would take him around the world and across the global stage.

Whether the generation of migrants profiled in Wilkerson’s book realized it, their stories epitomize the power of place, and the influence of geography on health, wellbeing and opportunity of every individual. 

>>Bonus Link: Also in attendance at yesterday’s opening session was Peter Salk, son of the world famous Jonas Salk, MD, who was on hand to accept a posthumous award from APHA for his father’s discovery of a vaccine for polio. Watch the trailer above for the film “The Shot Felt Round the World” to learn more about the elder Salk’s successful search for a cure.

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

What Determines Your Health?

Nov 17, 2014, 9:00 AM, Posted by Minoo Sarkarati

Minoo Sarkarati

What determines your health?  Is it your ZIP code? Is it the clinic or hospital you go to? Is it the physician you see? Or is it you?

American Public Health Association Meeting & Expo

I could not say that the answer to this critical question is solely any one of these. However, understanding how each component plays a role in one’s health, as well as exploring further determinants, is vital to building healthier communities.

This year’s American Public Health Association (APHA) Meeting theme is Healthography. It is an opportunity to explore how our environment—whether it is access to clean air, safe housing, transportation, healthy foods, safe places to exercise, jobs, or quality health care—plays a role in our health. 

As a medical student training in a safety-net hospital, I have seen how each of these elements plays a role in one’s health. Without addressing these factors, a large part of medical care is lost. Encouraging regular exercise is not so simple when you do not have sidewalks or green spaces, or you do not feel safe being outside in your neighborhood. Writing a prescription to treat diabetes becomes meaningless if your patient cannot fill it because he/she does not make enough income to purchase the medication.

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Are You Going to the American Public Health Association Meeting Next Week?

Nov 14, 2014, 1:00 PM

During this year’s American Public Health Association (APHA) Annual Meeting & Exposition, 10 Robert Wood Johnson Foundation (RWJF) grantees will give short talks at the first-ever RWJF Briefings @ the Booth on Monday, November 17 and Tuesday, November 18. Grantees from a variety of programs, representing numerous health and health care sectors, will share their insights on topics ranging from health literacy to obesity interventions to green building certification.

American Public Health Association Meeting & Expo

The briefings will take place at the RWJF exhibit space in the Ernest N. Morial Convention Center.

Grab a cup of coffee at the RWJF café and join a briefing! The schedule follows.

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American Public Health Association Meeting: All About Where You Live

Nov 14, 2014, 9:55 AM, Posted by Linda Wright Moore

Commission NOLA built environement 4

The Robert Wood Johnson Foundation (RWJF) has long embraced the idea that advancing America’s health is a community affair. Much of our work—and our current vision for building a Culture of Health—is grounded on the basic premise that where we live, work, learn, and play is inextricably connected to our health and well-being.

Consider that life expectancy can differ by 25 years in neighborhoods just a few miles apart; that a ZIP code can determine rates of preventable disease, violence, and access to healthy food. With this in mind, RWJF supports a wide range of programs designed to foster healthy communities—including efforts to prevent obesity and chronic disease, reduce disparities in health and access to care, and improve early childhood development.

We recognize that the best strategies are driven by local data and address the unique challenges and characteristics of individual communities. We know that what works for Camden, N.J., might not fly in Minneapolis or Baltimore.

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