Archive for: June 2013

New Role for Health Care Providers: ‘Hot-Spotting’ Unhealthy Communities?

Jun 28, 2013, 9:21 AM, Posted by Susan Dentzer

In his now legendary approach to urban medicine, physician and Robert Wood Johnson Foundation grantee Jeffrey Brenner, MD, pioneered the technique of hot spotting—making block-by-block maps of Camden, N.J., examining residents’ hospital costs and identifying the handful of patients who cycled in and out of those institutions and racked up stratospheric medical bills.

What if America’s hospitals and health systems used similar techniques to identify the nation’s poorest and least healthy communities—and then teamed up with local community development organizations to set them on a path to better health?

David Fleming, a physician who directs Seattle’s public health department, made that pitch recently to members of the Foundation’s Commission to Build a Healthier America. National health reform, he said at the panel’s June 19 Washington meeting, affords an opportunity to nudge health care providers to reach outside their facilities to hot spot areas in need of health improvement. “The solutions to health in this country lie beyond the walls of the clinic and in our communities,” Fleming argued.

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My Doctor Used the "F" Word

Jun 26, 2013, 12:38 PM, Posted by Najaf Ahmad


He made a remark that I found deeply cutting and hard to digest (no pun intended). “You’re overweight. You need to do something about it”. OK, he didn’t use the word “overweight.” He actually used the “F” word. Fat.

I was taken aback. I was upset and hurt. I really didn’t believe him. Sure, I’d gained some weight, but not that much. I certainly wasn’t gorging on cronuts, sconuts and cookie dough batter. (Although I guess I had rekindled my affair with Ben and Jerry.)

Besides, was a doctor really supposed to be saying this to me? “No!” my friends reassured me. “You’re not fat. Besides, you just had a baby! Dump your doctor and find a new one!”

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Climb Every Mountain

Jun 25, 2013, 1:48 PM, Posted by Risa Lavizzo-Mourey

Risa Lavizzo-Mourey

As vacation time begins, RWJF President and CEO Risa Lavizzo-Mourey, MD, recalls the trip of a lifetime: her exhausting yet thrilling trek to the top of Mount Kilimanjaro in summer 2011.

Writing on LinkedIn as part of its Influencer Summer Guide, Dr. Lavizzo-Mourey relives the experience, made all the more memorable because she was accompanied by her daughter Rel:

"Each day, the air was thinner, the grade sharper, the camps rougher, the fatigue more severe. Finally, in parkas, gaiters, and high-tech hand gear, out-climbing clouds and glaciers and even some of our fellow trekkers, we crested the rocky summit. More moonscape than landscape, it was lonely, beautiful, terrifying, and spectacular. Someone said it was like “wing-walking on a 747.”

Most of us won't hike to the summit of Kilimanjaro this summer, but Dr. Lavizzo-Mourey says there is a lesson to be learned from her ascent to the so-called "roof of Africa." It's simply this: Climb a metaphorical mountain. Take on a challenge once in a while. Force yourself to venture outside your comfort zone. Look at the world from a different perspective. After all, she writes: "Such a challenge can be done in many ways and places, not just at the top of a mountain."

You can read the full blog post here

What Would Melanie Do?

Jun 25, 2013, 11:20 AM, Posted by Beth Toner

 A critical response medical team walking in a hospital corridor.

The Robert Wood Johnson Foundation has long been committed to the improvement of nursing education—and to supporting academic progression in nursing. While nursing shortages may wax and wane, it’s clear that the baby boomers will need high-quality nursing care as they move into later life. Meanwhile, nursing schools turn away more than 75,000 qualified applicants each year.

In short, really good nurse educators have never been more necessary, yet they are increasingly in short supply. Last week, we lost one of the best I’ve ever known.

I heard about Melanie’s death, sadly, the way we sometimes do when we’ve lost touch with people—via a community college classmate on social media. Melanie had learned she had pancreatic cancer in January—and given a grim prognosis; in the end, she lived less than five months after diagnosis, dying far too young—at the age of 58. In the first awful moment, I felt a crush of regret that I’d learned of her death this way. And then I found myself smiling, thinking of when I’d first met Melanie on a warm August night in 2008—squeezed into a stuffy and cramped classroom with 31 other people in a room better suited for 15.

We were, all of us, first-year nursing students on our very first day of nursing school. We were, in many respects, a motley crew—ranging in age from our early 20s to our early 60s (I was somewhere in the middle). Stay-at-home moms rejoining the paid workforce, retired Army medics, and second-career students (like me) all shared one emotion that evening: fear. How would we manage full-time day jobs and evening/weekend classes and clinicals? From studying material that was completely foreign to me—with what felt (at the time) like a worthless master’s degree in journalism—to learning tasks that seemed incredibly complicated (how could I stick a needle in another human being?), I didn’t feel up to the task ahead. What the heck had I been thinking? Me? A nurse?

Melanie gave us an overview of the semester ahead. She calmly answered each agonized question we asked her. As she wrapped up her remarks, she smiled at her nervous charges and said, “I know you feel overwhelmed right now, and you feel like there’s so much to do. I’ll just remind you that you can do this the same way you’d eat an elephant: one piece at a time.”

It was exactly the right thing to say at exactly the right time. Melanie would repeat those words to me—often just saying “one piece at a time”—when she saw me in the hallway, agonizing over a clinical skill I hadn’t mastered or a lab value I couldn’t remember, more times than I can remember. I would often come to class exhausted and near tears from a grim day in corporate America, but Melanie would, with her real-life stories of patients to illustrate that night’s lecture, remind me why I had decided to become a nurse in the first place. We knew her for her pithy summary of the most obvious fact (“smoking is baaaaaaaaaaaaad!” she would say in a near-hiss), but also for her fierce love of, and advocacy for, each and every patient.

I made it through nursing school, passed the NCLEX, and thought of Melanie as I worked weekends in long-term care. If my patient had been Melanie’s mom, what would she have wanted me to do for her? When I felt as if I couldn’t make it through my first night shift alone, I remembered Melanie’s words of advice on that first day.

I thought of her again last week, and realized what a loss the world of nursing education suffered with her passing. It’s not only important to support our nurse educators—and to encourage others to join their ranks—but to thank them for sharing their love of nursing and their patients with us. I never got to say a proper “thanks” to Melanie. But you can bet that I’ll remind each nursing student I see that she (or he) can get there, one piece at a time.

Address Toxic Stress in Vulnerable Children and Families for a Healthier America

Jun 21, 2013, 1:43 PM, Posted by Susan Dentzer

Susan Dentzer

“Speed kills,” warns the traditional highway sign about the dangers of haste and traffic deaths. Now, we know that stress kills, too.

Toxic stress, at any rate. The human body’s response to normal amounts of stress—say, a bad day at the office—is likely to be brief increases in the heart rate and mild elevations in hormone levels. But a toxic stress response, stemming from exposure to a major shock or prolonged adversity such as physical or emotional abuse, can wreak far more havoc.         

In children, science now shows that toxic stress can disrupt the developing brain and organ systems. The accumulated lifelong toll of stress-related hormones sharply raises the risk of chronic diseases in adulthood, ranging from heart disease and diabetes to depression and atherosclerosis.

Thus, the message from a panel of experts to the Robert Wood Johnson Foundation’s Commission to Build a Healthier America was at once simple and challenging: Create a healthier environment for—and increase coping mechanisms and resilience in—the nation’s most vulnerable and stress-ridden children and families.

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Trumping ACEs: Building Resilience and Better Health in Kids and Families Experiencing Trauma

Jun 19, 2013, 4:18 PM, Posted by Susan Promislo

ACEs Mobile

Fifteen years ago the Centers for Disease Control and Prevention’s Adverse Childhood Experiences (ACEs) study found that children exposed to traumatic events were more likely to develop mental and behavioral health problems like depression and addiction. They were also more likely to have physical illnesses like heart disease and diabetes.

Today, based on that evidence, we are witnessing a health revolution.

An op-ed published today in The Philadelphia Inquirer highlights a recent summit and ongoing efforts in Philadelphia to raise awareness about the negative impact of ACEs on health, education, and other outcomes. The piece states:

Neuroscientists have found that traumatic childhood events like abuse and neglect can create dangerous levels of stress and derail healthy brain development, putting young brains in permanent "fight or flight" mode. What scientists often refer to as "toxic stress" has damaging long-term effects on learning, behavior, and health. Very young children are especially vulnerable.

The same message was echoed in testimony today at the RWJF Commission to Build a Healthier America convening in Washington, D.C., where panelists like Jack Shonkoff of the Harvard Center for the Developing Child emphasized the need for early childhood interventions that focus on building the capabilities of parents to protect their children from high levels of violence and stress, and model resilience. 

Continuing to develop our understanding of the connection between ACEs and poor health and other social outcomes, and supporting interventions like Child First, Nurse-Family Partnership, and other efforts that work to stabilize fragile families and put children on the path to healthy development  will help shape RWJF’s ongoing efforts to foster a vibrant culture of health in communities nationwide.

Learn more about ACEs

How We're Furthering the Culture of Health This Summer

Jun 19, 2013, 3:28 PM, Posted by Anna Heling

Strawberry Picking RWJF Program Officer Jasmine Hall Ratliff said a trip to the strawberry patch was a great way to show her 3-year-old daughter where food comes from.

Promoting a “culture of health” isn’t just a 9-to-5 job for RWJF employees; many of them also use their time out of the office to further their push toward health and well-being. As Risa Lavizzo-Mourey, MD, president and CEO, describes it, creating a culture of health means having “the kind of values where we can say health, and the policies and practices that go into making sure we are a healthy community, are as much a part of us as are the values that say we pursue life, liberty and the pursuit of happiness.” Here, in the first in a series, members of the RWJF crew talk about how they’re furthering this healthy mindset throughout the summer months.

BEING A HEALTHY ROLE MODEL: Jasmine Hall Ratliff (Program Officer for the Childhood Obesity team)

After losing her mother to cancer at a young age, Hall Ratliff grew up with a single father who instilled in her the importance of healthy living: he used the office gym, cooked at home and encouraged the kids to participate in sports. Now, as a relatively new mom herself, Hall Ratliff is working to foster that same culture of health in her 3-year-old daughter Beverly. She said the family’s garden on the balcony and trips to the local strawberry patch help demonstrate where food comes from and the importance of local produce. For Hall Ratliff, losing her mother to cancer and her dad’s subsequent healthy role modeling reinforced the importance of creating a culture of health. “Losing my mother to cancer at a young age makes me value my own health and do all I can to prevent the diseases that I can prevent. It’s important to me, and I want my daughter to understand healthy living.”

BIKING UP THE COAST OF CONNECTICUT: Robin Hogen (Vice President, Communications)

For the second year in a row, Hogen will bike the 100-mile route from Stamford to Essex to benefit the Connecticut Veterans Legal Center, an organization that provides free legal assistance to veterans recovering from homelessness and mental illness. The cycling enthusiast heard about the Legal Center from a friend and said pushing the pedals is a healthy way to raise money for a cause that’s important to him. He’s prepping for the ride by cycling a few times a week, as well as keeping active through running and sailing. As for the ride, he said it’s all about the exercise—and the organization: “You have to remind yourself that it’s not a race; it’s about finishing. Not finishing first…just finishing.”

GIVING BEES A HOME: Sherry DeMarchi (Communications Specialist)

The animal lover and her husband are prepping their yard for a new type of creature: bees. DeMarchi said she recently learned that the number of wild bee colonies is dwindling fast, which research shows will have an effect on the availability of fruits and vegetables (they pollinate many agricultural crops). “Because of the high use of insecticides and pesticides and habitat loss, we’re seeing this dramatic decrease in the abundance of these bees,” DeMarchi said. “Although it doesn’t involve a lot of physical activity, we feel that we’re contributing toward the culture of health by working toward keeping these important little beings in the ecosystem so they can pollinate…and everybody can eat.” DeMarchi’s prepping her yard for the thousands of visitors, building the hives in an old fort of her son’s and visiting friends who’ve “housed” bees themselves to get some tips.

What’s With Our National Donut Worship?

Jun 18, 2013, 9:50 AM, Posted by Catherine Arnst

Krispy Kreme Sloppy Joe

Just last month the Healthy Weight Commitment Foundation claimed significant progress in reaching their goal of removing 1.5 trillion calories from the U.S. food marketplace. This month, a goodly portion of those calories may be back in play—thanks to the Krispy Kreme Sloppy Joe sandwich.

No, I am not making this up. The donut-shrouded sloppy joe is the proud creation of Chicken Charlie’s, food provider to county fairs in California. What’s more, it’s been written up in numerous media outlets, including Time magazine, which also provided the valuable service of informing its readers about Dunkin Donut’s entry into the lunch category, the doughnut bacon sandwich. Time has alerted America to the imminent arrival of the salty caramel pretzel donut as well. Gee, thanks.  

How discouraging that, despite the escalating obesity crisis in the U.S. among adults and, even more scarily, children, America seems to be obsessed with donuts. Or at least the media is. NBC’s Today show,  the BBC, and numerous other outlets have all done fawning features on a baked good hybrid that is evidently the must-have food item in New York City right now—the cronut, a hunk of dough that is a cross between a croissant and a donut. New Yorkers and tourists alike are standing in line for up to two hours to shell out $5 each. Limit, six to a customer. 

Now the cronut has competition from the sconut, a cross between a donut and a scone, discovered recently by intrepid reporters at Newsday and NPR.  In case donuts aren’t your thing, you can keep abreast of the news of the nationwide shortage of Speculoos, cookie butter sold by Trader Joe’s—a national crisis for sure.

None of this is news you can use.  Right now, 30.5 percent of U.S. children between the ages of 10 and 17 are obese. The highest levels of obesity are found in low income and rural neighborhoods where fast food outlets selling donuts and the like are far more common than supermarkets.  I’d like to see some media coverage of some of the many efforts to combat obesity, not add to it, such as the Healthy Food Access Portal, the first comprehensive  web portal designed to help communities launch healthy food retail projects across the country. It was created by PolicyLink, The Food Trust, and The Reinvestment Fund with a grant from RWJF.

Or how about a story on some of the many community gardens where children are learning not only how to grow vegetables, but like them?  More articles like this, about the value of cooking at home, and some easy, affordable recipes, for families with little time to whip up gourmet meals, would also be nice.

In December the New York Times did a page one story about the first declines in the rates of childhood obesity in several cities, after decades of steady increases--the kind of media story it would be great to see more often. Hopefully we won’t see that progress fall to the wayside this summer because of this national celebration of all things donut-related.

An Ambitious Effort to Get Americans Covered

Jun 17, 2013, 4:38 PM, Posted by Andrew Hyman


As the nation’s largest public health philanthropy, addressing the crisis of the uninsured is central to our mission.

A 2009 RWJF-funded study by the Institute of Medicine documented severe consequences to the long-term health prospects of people living without health insurance. Put simply, the uninsured live sicker, suffer more, and die younger. And beyond the impact on the individual and their families, high rates of uninsurance strain communities’ health systems, limiting access to quality care for those with insurance.

Sadly, 50 million of our fellow Americans—nearly one in six of us—are uninsured.  For decades, RWJF has worked to remedy the crisis of the uninsured, and this week marks an especially important milestone, as “Get Covered America” kicks off across the nation. A grassroots, consumer-driven campaign, “Get Covered America” will educate Americans about new opportunities to obtain affordable health insurance in advance of open enrollment season this fall.

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This Year’s Health Care Transformation Oscar Goes To…

Jun 17, 2013, 3:55 PM, Posted by Mike Painter

A doctor reviews information with a patient.

For an actor—let’s call her Jennifer for discussion purposes—who suddenly has a big award-winning breakthrough—there is nothing sudden about her success.  Jennifer’s accolades come to her not by accident but rather after years of below-the-radar hard work, striving and struggle.  That same principle applies to seeming sudden success in other fields—say, health care.  In fact, today let’s go crazy and salute some breakthrough health care actors.  Health care is transforming before our very eyes. 

Hang onto your hats, because it’s changing from one predominantly focused on churning out more services and procedures to one relentlessly driving the right care at the right time at the best price. 

That’s not happening all by itself. That slowly accelerating transformation could seem sudden—or spontaneous.  It might seem like it’s happening effortlessly—almost by magic.  Nothing, of course, could be further from the truth.  Trust me— there is a bunch of struggling, starving transformation artists who have been working years for this moment—like the great people at the Consumer-Purchaser Disclosure Project.

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