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Dec 8 2014
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At the Crossroads of Risk and Resiliency: Averting High School Dropouts

Karen Johnson, PhD, RN, is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and an assistant professor at the University of Texas at Austin School of Nursing. Her research focuses on vulnerable youth. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.

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As Americans, we love stories about people who beat the odds and achieve success. We flock to movie theaters to watch inspiring tales—many times based on true stories—of resilient young people who have overcome unthinkable adversities (e.g., abuse, growing up in impoverished, high-crime neighborhoods) to grow into healthy and happy adults. Antwone Fisher, The Blind Side, Precious, and Lean On Me are just a few of my personal favorites that highlight the very real struggles faced by adolescents like those I have worked with as a public health nurse. My work with adolescent mothers and now as an adolescent health researcher has convinced me of the critical importance of focusing on promoting health and resilience among adolescents at-risk for school dropout.

Karen Johnson

How often do we as a society really sit down outside the movie theater or walls of academia and talk about why these young people are at risk for poor health and social outcomes in the first place, or what it would take to help them rise above adversity? If we look closely at the storylines of resilient youth, we will notice a number of similarities. Being resilient does not happen by chance: it takes personal resolve from the individual—something our American culture has long celebrated. And it takes a collective commitment from society to maintain conditions that empower young people to be resilient, and that is something that we as a society do not recognize or invest in nearly as often.  

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Dec 8 2014
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Register Now for Tomorrow’s Webinar on Innovations in the Primary Care Workforce

At 4 p.m. ET (1 p.m. PT) tomorrow, Tuesday, December 9, 2014, the Robert Wood Johnson Foundation’s LEAP project will hold a webinar on innovations in the primary care workforce, and the project’s new online resource, the Improving Primary Care Team Guide. To join Tom Bodenheimer, MD, MPH, professor, Family & Community Medicine, University of California San Francisco, Lisa Letourneau, MD, MPH, executive director, Maine Quality Counts, and the LEAP Team for this free webinar, register here

Dec 5 2014
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Naming Racism

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. LaVeist will moderate the first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health today, beginning at 10 a.m. Eastern Time. Follow the hashtag,  #RWJFScholarsForum, on Twitter for more.

Thomas LaVeist

Yesterday I had Camara Phyllis Jones, PhD, MD, MPH, as guest lecturer for my seminar on health disparities. It was a homecoming of sorts for her. She and I first met in the early 1990s when I was a newly minted assistant professor and she was a PhD student at the Johns Hopkins Bloomberg School of Public Health. Jones’ work should be well known to readers of this blog. She has published and lectured on the effects of racism on health and health disparities for many years. She played a leading role in the Centers for Disease Control and Prevention’s work on race, racism, and health in the Behavioral Risk Factor Surveillance System.  And she was just elected president-elect of the American Public Health Association. She is a fantastic lecturer and often uses allegory to illustrate how racism affects health. 

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About midway through her lecture, a student raised his hand and got her attention to ask a question about the utility of “naming racism.” My interpretation and rephrasing of his question—is it helpful to use the word racism or is the word so politically charged and divisive that it causes people to “tune you out?”

The student’s question raises a major challenge for those of us who seek to address health disparities. On one hand racism is fundamental to understanding why disparities exist and persist. I would go as far as to state that in most race disparities research, race is actually a proxy measure for exposure to racism. But, on the other hand, the word racism makes some people uncomfortable, causing them to become defensive or sometimes simply block out your message.  

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Dec 4 2014
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The Transformative Power of Mentors

Alden M. Landry, MD, MPH, is an emergency medicine physician at Beth Israel Deaconess Medical Center in Boston and an alumnus of the Robert Wood Johnson Foundation (RWJF) Summer Medical and Dental Education Program. Landry, 32, is also co-director of Tour for Diversity in Medicine. On December 5, he will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

Alden Landry, MD, MPH

Tour for Diversity in Medicine (T4D) is a grassroots effort to educate, inspire, and cultivate future physicians and dentists of diverse racial and ethnic backgrounds by forming local connections in order to fulfill a national need.  Our concept is simple: Visit students on their home turf; motivate them by introducing them to young, enthusiastic physicians and dentists; and give them the information that they need to be successful. 

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We carefully select mentors based on not only their roles in medicine and dentistry but how they got there. Our mentors are the first in their families to have attended college. Some are first-generation U.S. citizens. They come from single-family homes or families where they are the first to enter a career in medicine. They are gay and straight, married and single. They are passionate about their communities and their careers.

Our mentors do have one thing in common: we intentionally select mentors who are young in their careers and recent to the journey.

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Dec 4 2014
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New Online Resource Provides Tools for Transforming Primary Care

Ed Wagner, MD, MPH, is director emeritus of the MacColl Center for Health Care Innovation. A general internist and epidemiologist, Wagner was founding director of Group Health Research Institute.

Ed Wagner, MD, MPH

Better care. Healthier patients. Happier staff.  A new online resource provides practical, hands-on tools to build better primary care teams that can put those outcomes within reach.

Nationwide, primary care practices are finding that creating more effective practice teams is the key to becoming a patient-centered medical home, improving patients’ health, and increasing productivity. The Improving Primary Care Team Guide (Team Guide) is a free online resource for primary care practices working to do just that. It:

  • Provides hands-on tools and resources that are actionable and measureable
  • Is appropriate for practices at any stage of development
  • Includes modules that enable practices to easily pinpoint relevant topics and areas of interest

The new Team Guide presents practical advice, case studies, and tools from 31 exemplary primary care practices across the country that have markedly improved care, efficiency, and job satisfaction by transforming to a team-based approach. For the last three years, with funding from the Robert Wood Johnson Foundation (RWJF), the LEAP team has identified, studied, and engaged these practices to develop the lessons contained in the Team Guide. 

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Dec 3 2014
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Caring for Patients Across Disciplines

Katherine Diaz Vickery, MD, MSc, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, an assistant professor of medicine at the University of Minnesota Medical School, and a clinician-investigator in the Division of General Internal Medicine at Hennepin County Medical Center. On December 5, she will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

Katherine Vickery Katherine Diaz Vickery, MD, MSc

People who know me–even just a little–know of my pride for my home state of Minnesota. While there are beautiful lakes, biking trails, farmer’s markets, and a ridiculous state fair (that takes special pride in its offerings of various types of food-on-a-stick), there’s something more... Minnesota has been making strategic efforts to improve the health of its communities for many years.

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If I could bring you to Minnesota today (bundle up!), I’d show you what I mean by taking you to Hennepin County Medical Center (HCMC) and specifically to a meeting of the patient advisory board of the Hennepin Health Accountable Care Organization (ACO).

I would introduce you to Jorge, a Mexican-American whose road to recovery from severe depression was paved by his multi-disciplinary care team from Hennepin Health. Jorge might tell you about Susan, the social worker who helped him find transitional housing. Or Lucky, a community health worker who gave him a voucher to get a haircut, a toiletry bag, and helped him find a primary care medical home. And if he really opened up, he might tell you of his career aspirations to take courses to supplement his graduate degree from Mexico and become a family therapist or community health worker. 

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Dec 3 2014
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The Top Five Issues for Nursing in 2015

Susan B. Hassmiller, PhD, RN, FAAN, directs the Future of Nursing: Campaign for Actionwhich is implementing recommendations from that report. Hassmiller also is senior adviser for nursing for the Robert Wood Johnson Foundation.

Susan Hassmiller

In 2013, the Institute of Medicine released a report, U.S. Health in International Perspective: Shorter Lives, Poorer Health, that compared the United States with 16 other affluent nations. The United States ranked last or near last on nine key indicators:  infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This is despite the fact that we spend significantly more on health care than any other nation.

I believe there are five ways nurses can contribute to improving these conditions in 2015. 

Nurses Can Help Us Build a Culture of Health

In a Culture of Health, the goal is to keep everyone as healthy as possible.  That means promoting health is as important as treating illness. Unless everyone in the country joins this effort, we will remain at the bottom of the list of healthiest nations. “Everyone” means all health care workers, business owners, urban planners, teachers, farmers and others, including consumers themselves.  Nurses especially understand wellness and prevention, and have a special role to play in building a Culture of Health. 

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Dec 2 2014
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Stress and Family Support – Two Important Social Determinants of Health for Hispanic/Latino Communities

Rosa M. Gonzalez-Guarda, PhD, RN, CPH, FAAN, is an assistant professor at the University of Miami, School of Nursing & Health Studies and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. On Friday, December 5, she will be a panelist at the RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

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My research has focused on understanding and addressing behavioral and mental health disparities experienced by Hispanic/Latino communities. Although I initiated my research looking at substance abuse, violence, HIV and mental health as separate conditions that often co-occurred in marginalized communities, I soon realized that these conditions were just symptoms of an underlying phenomena— something my colleagues and I refer to as the Syndemic factor.

Rosa Gonzalez-Guarda

We have been studying the social determinants of the Syndemic factor in hopes of developing culturally tailored interventions that can potentially address multiple behavioral and mental health outcomes for the Hispanic/Latino community. From this research we have learned that interventions that address stress and family support offer promise for this community.

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Dec 1 2014
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Why ZIP Codes Matter: Advancing Health Equity in All Policies

Harry J. Heiman, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program. He practiced clinical family medicine for more than 20 years and is currently director of health policy at the Satcher Health Leadership Institute, Morehouse School of Medicine. On December 5, Heiman will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

Harry Heinman

The importance of place and geography and its impact on health is not a new concept in public health, but one that has been largely overlooked until recently. John Snow’s map of the London cholera outbreak in 1854, a precursor of today’s more sophisticated geo-spatial mapping, reminds us of the powerful impact public health has always had through assessment and intervention at the neighborhood level. Health care not only drains a disproportionate share of our resources, it also gets a disproportionate share of our attention. Access to affordable, quality health care is necessary, but not sufficient. While important and often life-saving to individuals, it is a relatively weak determinant of population health.[1]

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A large body of research has demonstrated the importance of health behaviors, with almost half of all deaths attributable to tobacco, diet and sedentary lifestyle, alcohol and substance use, firearms, and sexual behavior. What has not been adequately understood or discussed is the influence of the social and economic environment on health behaviors. People in lower social classes are more likely to have unhealthy behaviors—something that is strongly associated with the lack of available healthy choices and the impact of increased psychosocial stress. The impact of stress is life-long, occurring not only in childhood, but prenatally, leading to what some experts refer to as inherited disadvantage.

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Nov 28 2014
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Lessons from the Arabbers of Baltimore

Maya M. Rockeymoore, PhD, is president of the Center for Global Policy Solutions, a nonprofit dedicated to making policy work for people and their environments, and director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation (RWJF). On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

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When I think of the resilience of disadvantaged communities disproportionately affected by health disparities, I think of the Arabbers of Baltimore, Md. They are not Arabic speaking people from the Middle East or North Africa, but scrappy African American entrepreneurs who started selling fresh foods in Baltimore’s underserved communities in the aftermath of the Civil War.

Maya Rockeymoore

Their relevance continued into the modern era as supermarkets divested from low-income neighborhoods, leaving struggling residents with few options aside from unhealthy fast food and carry-out restaurants. Driving horses with carts laden with colorful fresh fruits and vegetables, Arabbers sold their produce to residents literally starving for nutritious food.

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