Category Archives: Voices from the Field
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.
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.
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.
Meredith Barrett, PhD, is vice president of science and research at Propeller Health, a health technology company working to reduce the burden of asthma and chronic obstructive pulmonary disease (COPD). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), Berkeley and UC, San Francisco. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.
Leaders in Louisville, Kentucky, know first-hand that where you live and work affects your health and well-being. During a special session at the American Public Health Association’s meeting this week in New Orleans, we explore how the air quality in Louisville neighborhoods impacts the health, economy and overall vibrancy of the community. And we’ll highlight how Louisville is the poster child for tackling tough issues like asthma head-on, top-down and bottom-up, through data and collaboration among individual residents, corporate execs, community organizers and public leaders.
Asthma attacks are sneaky, expensive and debilitating, yet almost entirely preventable.
Asthma is one of the most common and costly chronic diseases in the United States, affecting more than 8 percent of the U.S. population. Despite decades of research and the development of effective treatments, rates of morbidity have not declined and health care costs reach more than $50 billion a year. Asthma also leads to more than 13 million missed days of school and 10 million missed days of work, negatively affecting educational achievement, employee productivity and regional business growth. But the most frustrating part is that a large proportion of these hefty impacts could be avoided with improvements in self-management, community policy and advances in digital health care.
Minoo Sarkarati, BA, is a third-year medical student and Robert Wood Johnson Foundation (RWJF) Health Policy Scholar at Meharry Medical College. She completed her undergraduate degrees of psychology and integrative biology at the University of California, Berkeley. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.
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?
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.
Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.
Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity. It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery. It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.
A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior? A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals. Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives.
A Brighter Future
What can be done to make these hospitals better? A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.
Jacquelyn Campbell, PhD, RN, FAAN, is director of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program and Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing. Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and an alumna of the RWJF Nurse Faculty Scholars program.
As two scholars who have worked in research, practice and policy arenas around issues of gender-based violence for years, we honor our veterans this week by paying tribute to the Pentagon and the U.S. Department of Veterans Affairs (VA) for addressing intimate partner and sexual violence among active duty and returning military and their families, and urge continued system-wide involvement and innovative solutions.
In our work, we’ve heard outrageous, painful stories. One female servicemember explained to Angela why she was ignoring the sexual harassment she experienced. She knew that hearing that she was inferior because she was a woman, being called “Kitty” instead of her name, and having the number 69 used in place of any relevant number was harassing. She knew it was wrong. But she had decided that she would not let it bother her. I can acknowledge that he is a jerk, but I can’t let that affect me.
I can’t let his behavior define me as a person. On some level this may seem like an accurate way of dealing with a problem person. However, sexual harassment isn’t just about one obnoxious person. Not telling the story doesn’t make the behavior go away. Rather, it sends the message that the behavior is acceptable and that sexist comments are a normal part of the lexicon of male/female interactions.
Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).
Health and disease are on a continuum. We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.
These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.
I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.
Lori Escallier, PhD, RN, CPNP, is a professor and associate dean for evaluation and outcomes at the State University of New York at Stony Brook School of Nursing. She is her university’s project director for a program that helps veterans earn baccalaureate degrees in nursing (VBSN) and for New Careers in Nursing, a program supported by the Robert Wood Johnson Foundation (RWJF) and the American Association of Colleges of Nursing (AACN) that supports second-career nurses in accelerated master’s and baccalaureate nursing programs.
Human Capital Blog: Please tell us about your university’s program for nursing students who are veterans.
Lori Escallier: The project is entitled Enhancing the Nursing Workforce: Career Ladder Opportunities for Veterans. The purpose is to increase the enrollment, retention and educational success of veterans in the baccalaureate nursing program at Stony Brook. Our program operationalizes the collaborative efforts of the Health Resources and Services Administration, the Department of Defense, and the Department of Veterans Affairs (VA) by providing opportunities for veterans to transition into nursing careers.
HCB: How is the VBSN program helping to build a Culture of Health that more effectively serves veterans?
Escallier: One of the project’s aims is to enhance the nursing workforce with veterans. Veterans certainly have a good understanding of the needs of other veterans and their families. Who better to promote a Culture of Health for veterans than those who have “walked the walk?”
Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.
How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.
Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.
Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.
Tova Walsh, PhD, MSW, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar at the University of Wisconsin in Madison. Her research focuses on the role expectant and new fathers play in the health and well-being of their partners and children, and the influence of parenthood on men's health and well-being. Walsh has used interview, focus group and survey data to examine the experiences of service members returning to family life after deployment.
On Veterans Day, we honor the service and sacrifice of U.S. military veterans. Recognizing that it is not just the individual who serves our country, but his or her entire family, we honor, too, our military families, whose support is essential for our servicemen and women to carry out their duties.
When a service member deploys, partners, children and other family members re-organize their lives to accommodate the physical absence of a loved one. They live each day bearing the burden of separation. When their deployed loved one returns home, they share not only in the joy of long-awaited reunion, but also in the joy and challenges of the extended process of the veteran’s reintegration to home, family and community. The youngest members of our military families are least able to understand or express the impact of these experiences, and yet are deeply affected by these transitions and the accompanying shifts in emotions on the part of the adults who they depend upon for care, love and security.
Steven J. Palazzo, PhD, MN, RN, CNE, is an assistant professor in the College of Nursing at Seattle University, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013 – 2016. ) His research focuses on evaluating the effectiveness of the Teen Take Heart program in mitigating cardiovascular risk factors in at-risk high school students.
Difficult problems demand innovative solutions. Teen Take Heart (TTH) is a program I’ve worked to develop, in partnership with The Hope Heart Institute and with support from the RWJF Nurse Faulty Scholars Program, to address locally a problem we face nationally: an alarming increase in obesity and other modifiable cardiovascular risk factors among teenagers. The problem is substantial and costly in both economic and human terms. We developed TTH as a solution that could, if it proves effective in trials that begin this fall in my native Washington state, be translated to communities across the country.
The State of Obesity: Better Policies for a Healthier America, released recently by the Trust for America’s Health and RWJF, makes it clear that as a nation we are not winning the battle on obesity. The report reveals that a staggering 31.8 percent of children in the United States are overweight or obese and only 25 percent get the recommended 60 minutes of daily physical activity. The report also finds that only 5 percent of school districts nationwide have a wellness program that meets the physical education time requirement.