Category Archives: American Indian (incl. Alaska Native)

Nov 24 2014
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Reigniting the Push for Health Equity!

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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Nov 18 2014
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On Balance and Contrast

For the 25th anniversary of the Robert Wood Johnson Foundation’s Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Nicole Stern, MD, member of the class of 1991.

Nicole Stern, MD Nicole Stern, MD

First, there’s her heritage: her father is Jewish, her mother full-blooded Mescalero Apache. Then there’s her training: Stern is board certified in internal medicine and sports medicine. And as a woman practicing sports medicine, she is an uncommon presence in a male-dominated profession.

“I certainly have a lot of dual things in my life,” she muses.

Stern’s cultural background gives her a unique vantage point on health care, particularly the disproportionate number of Native versus non-Native practitioners. According to the Association of American Medical Colleges, American Indians represent less than 1 percent of physicians.

As president of the Association of American Indian Physicians (AAIP) from 2012 to 2013, Stern pushed to increase the pipeline of American Indian and Alaska Native medical students. She continues to support AAIP in reversing what she calls a “flatline” in applicants and matriculants from Native populations.

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Apr 30 2014
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How to Advance Minority Health? Change the Look of Health Care.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to blog about improving health care for all. Rashawn Ray, PhD, is an assistant professor of sociology at the University of Maryland and a former RWJF Health Policy Research Scholar at the University of California in Berkeley and San Francisco.

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Some people assume that promoting diversity and combating health disparities means giving preferential treatment to minorities over Whites. However, these pursuits simply mean providing equitable opportunities and a health care system that is responsive to everyone. Education studies continuously show that promoting diversity and reducing discrimination benefits all students. Regarding health care, these pursuits may mean life or death.

The percentage of Black physicians has stayed roughly unchanged since the early 1900s. The percentage of Black and Latino professors at research-intensive university shows a similar pattern. I suggest that reducing health disparities and changing our current culture of health is contingent on more effectively integrating minorities into health professions and research positions.

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Apr 30 2014
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How Can Health Systems Effectively Serve Minority Communities? Use Electronic Health Records to Discover How to Improve Outcomes.

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, Bonnie L. Westra, PhD, RN, FAAN, an associate professor at the University of Minnesota School of Nursing, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Westra is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program. 

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Electronic health records (EHRs) are rapidly proliferating and contain data about health or the lack thereof for minority communities. Evidence-based practice (EBP) guidelines can be embedded in EHRs to support the use of the latest scientific evidence to guide clinical decisions.  However, scientific evidence may not reflect differences in minority communities served.

As a first step to compare the effectiveness of EBP guidelines for minority populations, practicing nurses and nurse leaders need to advocate for implementation of EBP nursing guidelines in EHRs. Additionally, EBP guidelines must be coded with national nursing data standards to compare effectiveness within and across minority communities. Nurse researchers need to conduct comparative effectiveness research to learn how to optimize EBP guidelines for minority communities through the reuse of EHR data and to derive patient-driven evidence.

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Apr 30 2014
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How to Address Disparities? Prioritize Participatory Research and Practice.

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, Jamila Michener, PhD, an assistant professor of government at Cornell University, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Michener is an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program at the University of Michigan, Ann Arbor. 

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In my undergraduate class on the politics of poverty, there is an uncomfortable yet persistent question that looms whenever the conversation turns to racial and ethnic disparities: why? The students generally (and rightly) believe that biological distinctions are not the answer and in the search for other solutions, culture frequently emerges as a likely suspect. In response, I challenge these young people to think more conscientiously about cultural explanations of poverty. I push them to problematize the notion that racial and ethnic groups are homogenous bearers of a common and undifferentiated culture. I prompt them to consider how social, economic, and political institutions constitute and are constituted by various elements of culture.

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Apr 30 2014
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How to Address Disparities? Develop Local Leadership, Listen to Communities.

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, Marni Kuyl, RN, MS, interim health and human services director in Washington County, Oregon, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Kuyl is an RWJF Executive Nurse Fellow.

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When I was first asked to consider this question, I pondered the issues by describing theoretical approaches, including the need to address social determinants, use a social-ecologic framework, and take a life course perspective. I threw in the need to use evidence-based practices and research. I gave this first draft to someone and asked ... So what do you think? She very politely asked: Are you in outer space? 

I continue to believe that addressing inequality in our country requires that we recognize, understand, and commit to changing its root causes which include racism, inadequate affordable and safe housing, inadequate access to quality education (pre-to post graduate), and grossly uneven wealth distribution. These are deeply rooted in our political and economic structures and must be fundamentally changed if we truly want to build a culture of equality and health for all. 

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Apr 29 2014
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How to Address Disparities? Meet Patients Where They Are, Connect Health to Community Values.

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, Elizabeth Gross Cohn, PhD, RN, an assistant professor at the Columbia University School of Nursing, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Cohn is an RWJF Nurse Faculty Scholar.

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How can we get more people to think pro-actively about health and health care? One approach would be to identify what people value and think about how to fold health into that equation—especially for populations where disparities exist, like health screening for men. 

In the case of where I live, the answer was cars. Long Island loves cars: hot rods, customs, muscle cars, and classic cars. We are fascinated with antique fire apparatus and old motorcycles. Long Island Cruizin' for a Cure leverages this fascination. Now in its tenth year, with 600 cars, this event attracts, screens, and educates more than 3,500 men about prostate cancer. 

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Apr 29 2014
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How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.

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, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.

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In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care. 

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Apr 29 2014
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How to Advance Minority Health? A Diverse, Culturally Competent Health Care Workforce.

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, Michelle L. Odlum, BSN, MPH, EdD, a postdoctoral research scientist at Columbia University School of Nursing, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Odlum has more than ten years of experience as a disparities researcher. She is a recipient of an RWJF New Connections Junior Investigator award.

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As a health disparities researcher, my health promotion and disease prevention efforts are rooted in sociocultural aspects of health. This approach is critical to improved outcomes. In fact, when socioeconomic factors are equalized, race, ethnicity, and culture remain contributing factors to adverse minority health. I have come to understand that the key to combating health disparities lies heavily in cultural understanding. A diverse, culturally competent health care workforce is essential to health equity.

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Apr 28 2014
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How Can Health Systems Effectively Serve Minority Communities? Improve Medical Literacy, Take a Holistic Approach.

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, Cheryl C. Onwu, BS, a public health graduate student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Onwu is a Health Policy Scholar at the RWJF Center for Health Policy at Meharry Medical College.

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A doctor informed an African American male that he has diabetes mellitus, and medication was prescribed. However, the doctor did not mention the extent of the dangers involved in having diabetes, or “the sugars.” Additionally, the doctor did not explain the detrimental effects if the patient failed to follow the prescription regimens and other recommendations.

Some of the challenges faced by minorities include lack of medical literacy, which can affect their overall health. Clear communication between a health care provider and his or her patients is important, so patients are cognizant of their health status, the importance of maintaining a healthy lifestyle, potential threats to well-being, and how to control health problems.

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