Category Archives: Underserved populations
Time to Understand and Eliminate the Destructive Racial Disparities that Plague Our Health Care System
Historically, it seems that we are a country that takes a step forward only to take two steps back. Consider that May will mark 59 years since our schools were desegregated, yet it required the efforts of the National Guard to allow the “Little Rock Nine” entry into Central High School three years after this declaration. In July we will mark 49 years since President Johnson signed the Civil Rights Act of 1964, one-month after which the bodies of three civil rights workers were found in shallow grave. And, of course, the 20th of this month will mark four years since we inaugurated our first African-American President of the United States, though our health care system is still woefully deficient in providing care to minority groups.
The Affordable Care Act, in many ways, addresses the grave disparities that exist in health care due to race and ethnicity. Extending coverage to the nearly 46 million uninsured Americans—more than half of whom are minorities—will address a serious need, but this act alone will not begin to resolve the larger issue at hand.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio. The RWJF Center for Health Policy at the University of New Mexico is working to increase the diversity of those with formal training in the fields of economics, political science and sociology who engage in health services and health policy research, and to become a nationally recognized locus for health policy research that will support work to inform health policy debates at multiple levels.
The Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico is poised to have a far-reaching impact on the nation. The Center is the only institution dedicated to increasing the number of leaders from Latino and American Indian communities who will help shape the future of our nation’s health and health care.
At the heart of this work is the academic and professional development of its doctoral and post-doctoral fellows, a diverse group who are on their way to careers in health policy, academia, philanthropy, and health care financing and delivery systems.
The Center is dedicated to preparing these future leaders through on-the-job research, policy analysis training, leadership development, and community capacity building. Through interdisciplinary research with health care professionals, and by partnering with other researchers and professional organizations, fellows pursue resolutions for complex policy issues affecting our nation’s health, especially in Latino and American Indian communities.
Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.
The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”
In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”
Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston. She is a 2010 Robert Wood Johnson Foundation Community Health Leader.
The prolonged recession of the last four years has hit many people hard. My work is taking care of homeless women, which I have done for the past 20 years. I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters. We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.
I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers. Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.
Here is a glimpse of our work.
Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.
She is hungover. She drank to escape the horror of having been attacked. She has been on and off the wagon so many times we have all lost count. She’s also been raped and stabbed more times than any of us can remember. She doesn’t go to the police any more. She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork. I give her a hug and remind her that I love her no matter what. I know that she has a library of negative and self-loathing messages in her head. Mine is the one that can break through that chatter and give her a shred of self-respect.
Kynna Wright-Volel, PhD, RN, MPH, PNP-BC, FAAN, an assistant professor at the University of California, Los Angeles and Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar alumna, recently won a five-year, $1.2 million grant funded jointly by the National Institutes of Health’s National Institute of Nursing Research and Office of Behavioral Social Science Research. She will use the grant to work with the Los Angeles Unified School District to launch Project SHAPE LA™, a coordinated school-health program designed to increase physical activity among youth in Los Angeles County schools.
Human Capital Blog: Please share your vision for Project Shape LA™, what its goals are and how many children and teens it will reach.
Kynna Wright-Volel: Project SHAPE LA™ targets 24 middle schools in underserved areas of Los Angeles and will touch nearly 12,000 students. With this grant, we want physical education teachers to ignite a passion for physical activity – to teach kids that by being active, they can be healthy and achieve their dreams. Anticipated outcomes from this program include: increased moderate to vigorous physical activity; increased scores on the California State Board of Education’s FitnessGram Test in the areas of aerobic fitness, body composition and muscular strength/endurance; and increased academic achievement, as evidenced by higher scores on the California standardized test.
HCB: Why is a project like this needed in your community?
Wright-Volel: According to the L.A. County Department of Public Health, one in five children in the Los Angeles Unified School District is considered obese. Health inequities exist as well; children who are racial and ethnic minorities and/or come from families with low incomes have higher rates of obesity.
By Cheryl Chun, MS, MA, Health Policy Scholar, Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College
Being a public school teacher was one of the most challenging and rewarding experiences of my life. I spent my days trying to not only excite my students about mathematics, but also to help change their life trajectory by encouraging them to go to college.
Neither of these tasks was easy. Many of my students cited math as their least favorite subject in school. And despite the college atmosphere my colleagues and I worked diligently to create, many of my students struggled to accomplish the necessary coursework and SAT scores they needed for college.
I realized that teaching high-needs students was more complicated than having a good lesson plan. While I will always believe in the importance of having a good teacher in the classroom and up-to-date resources for them to use, my time in the classroom has showed me that often good students fall behind in school because of obstacles they face outside school. My students had to deal with guns and gang violence, not enough money for basic needs, and inadequate access to medical care. Many had no medical insurance and would miss class to spend all day waiting in line at free clinics to translate for their sick parent; or be too exhausted to come to class after spending all night with their sick child in the Emergency Room. I also saw how inadequate nutrition could affect students’ behaviors and their ability to learn.
Witnessing these needs in my classroom inspired me to go back to school and become a physician.
While I hope that I made an impact on my students while I was their teacher, I know they made an impact on me and changed my life trajectory. I hope to one day practice in a medically underserved area and help provide care to those who need it most.
Human Capital News Roundup: Dental care for underserved children, HIV/AIDS testing, "mixed-use" neighborhoods, and more.
Around the country, the news media is covering the groundbreaking work of Robert Wood Johnson Foundation scholars, fellows and grantees. Here are some examples.
“Louisville [Kentucky] is going high-tech to try to figure out what’s behind the city’s problem with asthma,” the Courier-Journal reports. The city will use technology developed by Robert Wood Johnson Foundation (RWJF) Health & Society Scholars alumnus David Van Sickle, PhD, MA, that uses global-positioning technology to capture where and when asthma patients use their inhalers. Read a Human Capital Blog Q&A with Van Sickle on his work and upcoming projects.
Lisa Berkman, PhD, a Health & Society Scholars program site director at Harvard University, spoke to U.S. News & World Report about “Why Good Friends Make You Happy.”
Lucy Marion, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program and dean of Georgia Health Sciences University (GHSU) College of Nursing, was recently interviewed by the Augusta Chronicle for two separate articles. She discussed the merger of the nursing programs at GHSU and Augusta State University, and the work of the Greater Augusta Healthcare Network, which she helped found.
"Just about everyone now has heard of someone they know who's done something online that they wish they hadn't done,” RWJF Clinical Scholars alumnus Ryan Greysen, MD, MA, told Health Day. Greysen is the lead author of a study that examined the pervasiveness of physician misconduct online and the repercussions of those actions. “I think the message is that medical professionals are responsible for what they put online—not only responsible for the information, but accountable,” he said.
The Pine Journal (Cloquet, Minn.) spoke to Executive Nurse Fellow Julie Myhre, MS, BA, RN, PHN, about a local initiative to provide reduced-cost dental services for underserved children. Myhre, who is part of the Northeast Minnesota Oral Health Project, said the lack of adequate dental care for children has reached an “epidemic level.”
Fourth in a Series: A Call to Action on Oral Health Care, Bringing Dentistry to Children Who Need It
On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Kris Volcheck, D.D.S., M.B.A., a 2010 Robert Wood Johnson Foundation Community Health Leader, discusses community-specific solutions to oral health care disparities. Volcheck is director of the CASS Dental Clinic for the homeless and the Murphy Kids Dental Clinic in Phoenix, Arizona. See all the posts in this series.
Just down the street from the CASS Dental Clinic for the Homeless in Phoenix are four elementary schools, in the very impoverished Murphy school district. Although this is the urban core, it might as well be rural America. The families in these neighborhoods live on minimal incomes and don’t have transportation, making everything a long distance hike – grocery stores with fresh produce, medical centers and, not surprisingly, dentists. When basic health care is secondary to just surviving, oral health care falls by the wayside.
Last year we decided to open a dental clinic for impoverished children, as an extension of the homeless clinic we’ve had in place for more than 10 years, and in collaboration with a community funded health center already in the works. But the tough economic times meant the Murphy elementary schools we had planned to serve were unable to pay for transportation and chaperones to bring students to our clinic. And because the schools’ funding is closely tied to student performance, they were hesitant to disrupt the school day to bring children to our site.
So we refocused, and decided to bring the dental clinic straight to the children.
We now operate a portable, school-based dental clinic in the elementary schools twice a year. The Murphy Kids Dental Clinic brings oral health professionals, supplies and technology into the elementary schools to provide comprehensive dental care to children who would otherwise go without it.
The care available to underserved and vulnerable populations –in rural settings and in the middle of a city alike – lags behind those available in middle- and high-income communities. There’s a high density of dentists in high-dollar areas, but we’re scarce in the urban core.
The Institute of Medicine (IOM) and the National Research Council released a report Wednesday that makes a compelling and urgent case for expanding access to basic oral health care for vulnerable and underserved populations. Commissioned by the Health Resources and Services Administration and the California HealthCare Foundation, the report assesses the oral health care system and offers recommendations for ways to improve oral health care for children, seniors, minorities and other underserved populations.
Among its recommendations is the integration of oral health care into overall health care, by training non-dental health care professionals to screen for oral disease and administer preventive care. The report also recommends an improved dental education system that includes residencies and clinical experience with vulnerable and underserved populations, and increased recruitment to bring more people from minority, low-income and rural populations into the oral care field.
The Robert Wood Johnson Foundation (RWJF) is working to promote and increase diversity in the dental workforce. Its Summer Medical and Dental Education Program works with college freshmen and sophomores from underrepresented populations to increase the competitiveness of their applications for dental or medical school. The free, six-week summer academic enrichment program operates at 12 sites across the country. RWJF’s Pipeline, Profession & Practice: Community Based Dental Education Program (the Dental Pipeline program) operated until 2010, reaching dental schools all across the country with strategies that increased diversity in the profession and increased access to oral health care among underserved populations.