Category Archives: Urban

Apr 28 2014
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How to Advance Minority Health? A Successful, Sustainable Effort to Promote Healthy Choices in Miami.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Lillian Rivera, RN, MSN, PhD, administrator/health officer for the Florida Department of Health in Miami-Dade County, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Rivera is an alumnus of the RWJF Executive Nurse Fellows program.

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In order to address this question, it is important to identify the areas within your jurisdiction where there are identified health disparities and to develop initiatives with those needs in mind.

Miami-Dade County in Florida is one of the few counties in the United States that is “minority majority,” meaning the minority makes up the majority of the population. More than two-thirds of the 2.5 million residents are Hispanic; 19 percent are Black; more than 51.2 percent are foreign-born and most of  them speak a language other than English at home (mostly Spanish and Creole);  19.4 percent live below poverty level; and 29.8 percent of the population  under age 65 (more than 700,000 individuals) is uninsured .

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Nov 19 2013
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Childhood Lead Exposure: Piling Disadvantage onto Some of the Country’s Most Vulnerable Kids

Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.

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Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?

Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.

We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.

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May 2 2013
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Human Capital News Roundup: Medication errors affecting children with cancer, particulate matter, the needs of urban communities, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

CBS Evening News profiled RWJF Community Health Leader Roseanna Means, MD, who founded the nonprofit Women of Means in 1988 to provide free medical care to homeless women in the Boston area. Today, 16 volunteer doctors and staff nurses provide care at the city’s shelters to women with unique sensitivities and needs. Read a post Means wrote about her nonprofit for the RWJF Human Capital Blog.

A study led by RWJF Clinical Scholars alumnus Matthew M. Davis, MD, MAPP, finds more than 40 percent of American parents give over-the-counter cough and cold medicines to children under age 4, despite product label warnings to the contrary. Health Day and the Examiner report on the findings.

Helena Hansen, MD, PhD, an alumna of the RWJF Health & Society Scholars program, is the lead author of an analysis that concludes social determinants—rather than changes in the environment or flawed diagnostic criteria—help explain the dramatic rise in the number of Americans diagnosed with mental disorders in recent years. Health Canal and MedPage Today report on the findings.

Forty-seven percent of children with cancer who receive part of their treatment at home have been exposed to at least one medication error, according to a study led by RWJF Physician Faculty Scholars alumna Kathleen E. Walsh, MD, MSc. Those errors had the potential to harm 36 per 100 patients, and actually did cause injury to four per 100, MedPage Today reports.

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Jan 30 2013
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Primary Care and Population Health: Second in a Five-Part Series

Nicholas Stine, MD, and Dave Chokshi, MD, MSc, writing on behalf of the New York Academy of Medicine Primary Care and Population Health Working Group.

The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the second of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.

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Challenges in the Urban Context: Discussants converged upon care fragmentation and community diversity as the most difficult challenges associated with working in urban settings. There may be enormous heterogeneity within populations in urban areas with respect to racial, ethnic, and sociodemographic characteristics. Subgroups may vary with regard to exposures, behaviors, and values. The sense of community that can be essential to leveraging social groups may not necessarily be present or uniform throughout a geographic area, necessitating multiple tailored communication strategies. Even between cities, there is significant heterogeneity, such that non-clinical interventions may be less transferable than, say, a chronic disease model.

Communities that do exist may not necessarily conform to geographic boundaries, and the geopolitical boundaries and layers of jurisdiction in place may mean little to those communities. This changes how confident clinical systems can be for outreach and aspects of care that might reach beyond the office, and in general it can be particularly challenging to know what services are being provided for a patient, where, and by whom. This accountability problem makes it easier for high-risk patients to fall through the cracks.

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Jun 11 2012
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Mindfulness and Yoga for Disadvantaged Urban Youth

Tamar Mendelson, PhD, is an assistant professor at the Johns Hopkins Bloomberg School of Public Health, and an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006). Her research interests include the development of prevention and intervention strategies for reducing mental health problems, with a focus on underserved urban populations. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health. Mendelson is a member of the program’s 2nd cohort.

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Anyone who's ever spread a yoga mat across a floor will tell you that it's about more than flexibility. One of many benefits of yoga is that it helps those who practice it deal with stress in their lives. An emerging body of research points to the conclusion that yoga can have a stress-relieving effect.

One problem with the research base is that it's mostly focused on adults. But grown-ups aren’t the only ones who deal with stress in their lives. Children face it as well, and they often do it without the same resources—emotional, financial and otherwise—that adults have.

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Jan 5 2012
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Housing, Neighborhoods and Health Disparities

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Corina Graif, PhD, RWJF Health & Society Scholar at the University of Michigan, Ann Arbor.

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In the New Year I hope that our thinking about housing policy will more systematically incorporate the expanding evidence and relevance of housing conditions for population health and health care policy. Many aspects of internal housing conditions are known to affect health. For instance, heating, ventilation, mold and lead are linked to cardiovascular health, excess mortality, asthma, disability, intellectual functioning, ADHD [Attention Deficit Hyperactivity Disorder] and delinquent behavior.

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We are also learning more and more about the health relevance of various characteristics of the physical environment surrounding one’s residence. For example noise, spatial proximity to vegetation, to grocery shops and to highways, and other sources of air pollution are linked to cardiovascular, mental health, obesity, asthma and allergic effects. Limited but important evidence also exists on the health implications of the socio-spatial context of housing. For instance, fear of crime, crowding, neighborhood disadvantage, social exclusion, and residents’ social exchange are linked to cardiovascular and mental health, obesity, diabetes and low birth weight.

In my dissertation work and related projects, I ask questions about the spatial context of neighborhood effects to investigate how the urban geography of inequality and cumulative spatial disadvantage shape the health and well-being of the inner-city poor. I analyze residential mobility data from the Moving to Opportunity Experiment in Los Angeles, New York, Boston, Baltimore, and Chicago together with data from PHDCN [Project on Human Development in Chicago Neighborhoods], and a large collection of data based on Census and other administrative records over several years.

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