Category Archives: Underserved populations
Janice Johnson Dias, PhD, is a Robert Wood Johnson Foundation New Connections alumnus (2008) and president of the GrassROOTS Community Foundation, a health advocacy that develops and scales community health initiatives for women and girls. She is a graduate of Brandeis and Temple universities and a newly tenured faculty member in the sociology department at City University of New York/John Jay College of Criminal Justice.
Policy action and discussion this month have focused on poverty, sparked by the 50th anniversary of Lyndon Johnson’s War on Poverty and Dr. King’s birthday. Though LBJ and King disagreed about the Vietnam War, they shared a commitment to ending poverty. Half a century ago, President Johnson introduced initiatives to improve the education, health, skills, jobs, and access to economic resources for the poor. Meanwhile, Dr. King tackled poverty through the “economic bill of rights” and the Poor People's Campaign. Both their efforts focused largely on employment.
Where is health in these and other anti-poverty efforts?
The answer seems simple: nowhere and everywhere. Health continues to play only a supportive role in the anti-poverty show. That's a mistake in our efforts to end poverty. It was an error in 1964 and 1968, and it remains an error today.
Let us consider the role of health in education and employment, the two clear stars of anti-poverty demonstrations. Research shows that having health challenges prevents the poor from gaining full access to education and employment. Sick children perform more poorly in schools. Parents with ill children work fewer hours, and therefore earn less. Health care costs can sink families deeper into debt.
On Martin Luther King, Jr. Day, an RWJF Scholar and Soon-to-Be Physician Resolves to Help End Health Disparities
Cheryl Chun, MS, MA, is a Robert Wood Johnson Foundation Health Policy Scholar (2011) at the Center for Health Policy at Meharry Medical College and a medical student at Meharry Medical College. She received a BS degree from George Washington University and an MA from American University. She taught for Teach for America for two years.
Every year on Martin Luther King, Jr. Day, our country takes a moment to reflect on the progress we have made toward becoming the nation we have always strived to be—one of equality. And while many of us would agree that significant headway has been made, we all know that we still have so much farther to go before we can truly achieve Dr. King’s dream.
I read the local and national news regularly and there always seems to be another article or story that speaks to the ongoing challenges of realizing this equity, including the educational achievement gap, health disparities, and even policies that allow inequalities to continue to exist across our society. It is almost scary that so many critical components of our lives are determined solely by our place of residence. In fact, it’s one’s zip code that often has the greatest impact on the quality of one’s education, one’s future health status, and even the types of food and nutritional resources to which one has access. These social determinants of health ultimately decide who will remain healthy throughout life and who will eventually become unwell.
Newly minted physicians who train in underserved health facilities are much more likely to continue practicing in such facilities after completing their residency training, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, an independent research unit of the American Academy of Family Physicians (AAFP).
The study, “Do Residents Who Train in Safety Net Settings Return for Practice?,” found that up to half of medical residents who trained in rural health clinics, critical access hospitals, and federally qualified health centers—which serve most of the nation's uninsured and underinsured patients—returned to practice in those settings. The study is published in the December issue of Academic Medicine.
“Overall, between one-third and one-half of the residents we identified in any of these settings during training were also identified as practicing in these same settings after training,” writes Robert Phillips, MD, MSPH, and his co-authors.
Telepresence robots are expanding access to specialists in rural hospitals experiencing shortages of physicians, and in other hospitals throughout the country, reports the Associated Press.
Devices such as the RP-VITA, introduced earlier this year, can be controlled remotely with a desktop computer, laptop, or iPad, allowing physicians to interact with patients through video-conferencing via a large screen that projects the doctor's face. An auto-drive function allows the robot to find its way to patients' rooms, and sensors help it avoid obstacles. It also gives the physician access to clinical data and medical images.
Dignity Health, a hospital system with facilities in Arizona, California, and Nevada, started using telepresence robots five years ago to promptly evaluate patients who had potentially suffered strokes. Dignity now has robots in emergency rooms and intensive care units at about 20 California hospitals, giving them access to specialists in areas such as neurology, cardiology, neonatology, pediatrics, and mental health.
Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.
Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.
Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging. This balance can be particularly difficult for students and new clinicians.
Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.
Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.
To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act. The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
The news media has recently covered some innovative programs that are influencing the choices and attitudes of the next generation of doctors.
American Medical News reports on the Buddy Program, which pairs first-year medical students with early-stage Alzheimer’s patients and their caregivers. The program empowers patients, and also serves as a valuable learning tool for the students, heightening “their sensitivity and empathy toward people with the disease.” The program was developed at the Northwestern University Alzheimer’s Disease Center in Chicago; Boston University, Dartmouth College, and Washington University have replicated it.
NPR reports on a program at the University of Missouri School of Medicine that is encouraging more young doctors to pursue primary care in rural areas. During the summers, the school has been sending medical students to work alongside country doctors. While school officials caution they can’t be sure about the reasons, they have discovered that students who took part in the summer program were more likely to become primary care doctors who practice family medicine. Some 46 percent of participants are choosing to work in the country after completing their medical training.
Deborah Gross, DNSc, RN, FAAN, is the Leonard and Helen Stulman Endowed Chair in Mental Health & Psychiatric Nursing at the Johns Hopkins University Schools of Nursing, Medicine, and Public Health. She is also an alumna of the Robert Wood Johnson Executive Nurse Fellows program (2006-2009).
As a child psychiatric nurse, my mission is to make a difference in the lives of families with young children, particularly those living in low-income, urban communities.
There is now wide consensus that early childhood is the most cost-effective time for targeting prevention and early intervention. The foundation for children’s mental health is formed during the first five years of life, when 90 percent of brain development occurs. Since parents are the primary mediators of their young children’s earliest social and learning environments, any effort to promote mental health in young children must first and foremost engage parents and help them build up their strengths and caregiving capacities.
Nearly 20 years ago, I began searching the literature for parenting programs that had a strong evidence base and demonstrated substantial and enduring effects on parenting quality and children’s behavior. What I discovered is that the strongest programs available had been originally developed and tested on White, middle-class families. As a result, their content and delivery methods were often built on values and assumptions many families I knew could not relate to.
The Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College will graduate six scholars with certificates in health policy during Meharry Medical College’s 138th Commencement Exercise this weekend. Having completed the Center’s health policy education program, the scholars are poised to join the nation's leading health policy experts, researchers, and analysts. They will focus on caring for minority and underserved communities in their careers.
The graduating scholars are:
- Kevin Blythe, MSPH, School of Medicine
- Lamercie Saint Hilaire, School of Medicine
- Ashley Huderson, School of Graduate Studies and Research
- Brandon Morgan, School of Dentistry
- Rebbie S. Timmons, School of Graduate Studies and Research
- Nadia Winston, School of Graduate Studies and Research