Category Archives: Public health

Apr 15 2014
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Media Exposure and Acute Stress Following the Boston Marathon Bombings

E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

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A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.

Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).

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Mar 6 2014
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RWJF Scholars in the News: Nurse staffing and patient mortality, communicating about vaccines, specialized HIV training for NPs, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

A study led by Linda H. Aiken, PhD, FAAN, FRCN, RN, and covered by CNN.com, finds that hospital nurse-patient ratios and the share of nurses with bachelor’s degrees both have an important impact on patient mortality. Aiken, a research manager supporting the Future of Nursing: Campaign for Action and a member of the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) National Advisory Committee, found that increasing a hospital nurse’s workload by one patient increased by 7 percent the likelihood of an inpatient death within 30 days of admission. The same research revealed that a 10-percent increase in the number of nurses with bachelor’s degrees at a given hospital reduces the likelihood of a patient death by 7 percent. Aiken’s study has also been covered by the Guardian, Philly.com, and FierceHealthcare, among other outlets.

Public health messages aimed at boosting childhood vaccination rates may be backfiring, according to a new study led by RWJF Scholars in Health Policy Research alumnus Brendan Nyhan, PhD. Campaigns that use studies, facts, and images of ill children increased fears about vaccine side-effects among some parents, NBC News reports. In fact, messaging that debunked myths about links between vaccines and autism actually made parents less inclined to have their children inoculated. Time magazine online also covered the study.

The Johns Hopkins University School of Nursing has developed a new curriculum that provides specialized HIV training to nurse practitioners, with funding from the Health Resources and Services Administration, Medical Xpress reports. “The design of our program starts with the recognition that HIV care cannot be provided in a silo, that it needs to be integrated holistically into primary care," RWJF Nurse Faculty Scholar Jason Farley, PhD, MPH, said in a statement. Farley is the developer of the curriculum.

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Feb 7 2014
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A Call for Better Measures: The Well-Being of a Population is Consequential

Cary Gross, MD, is a professor of medicine and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at Yale University. Carley Riley, MD, MPP, is an RWJF Clinical Scholar and Brita Roy, MD, MPH, MS, is an RWJF/U.S. Department of Veterans Affairs Clinical Scholar. This post is part of the “Health Care in 2014” series.

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As a new year begins, we are inundated with information summarizing the prior year: the top 10 movies, most newsworthy moments, and worst Hollywood breakups. Yet the topic that draws the most attention is the economy and our financial health. We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation. Approximately 5,000 “consumers” are surveyed each month to gauge their confidence. And so on.

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So there you have it: we know that in 2013, the unemployment rate decreased from 7.9 percent to 6.7 percent, about 2.1 million new jobs were created, consumer confidence increased, and the Dow Jones index rose by 26.5 percent. Certainly, the health of the national economy is important, but is this the type of health that really matters most? When envisioning a healthy life, many people think about the sort of health that allows us to engage in enjoyable activities, maintain strong interpersonal relationships, and feel that our lives have purpose. A full assessment of health—of individuals, communities, and the country—should assess these dimensions.

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Aren’t we already awash in data about health and well-being? Yes and no. There are abundant data concerning insurance status, prevalence of diseases, and utilization of health care. Additionally, large national survey efforts through the Centers for Disease Control and Prevention gather information on disease risk factors and health behaviors.  But well-being is not captured by these data. Well-being is a comprehensive construct accounting for interwoven facets—such as physical, mental, and social health—that together comprise a global assessment of true health. It refers to a positive state of health that allows for the pursuit of meaningful activities, formation of a cohesive social network, planning for the future, and coping with, overcoming, and even growing from negative events.

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Jan 3 2014
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RWJF Clinical Scholars Podcast: Health Insurance and Employment

As many as 900,000 people across the country may leave their jobs now that the Affordable Care Act provides health insurance alternatives, according to Craig Garthwaite, PhD. In an interview with Robert Wood Johnson Foundation Clinical Scholar Chileshe Nkonde-Price, MD, Garthwaite uses an analysis of the Tennessee Public Health Insurance Program to explain why a significant number of American workers may not feel the need to stay with their current employers as subsidized health insurance becomes available through health insurance exchanges.

Garthwaite is assistant professor of management and strategy at the Northwestern University, Kellogg School of Management. The interview is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.

The video is republished with permission from the Leonard Davis Institute.

Dec 30 2013
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YOUR Favorite Blog Posts of 2013 – Part One

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Which were your favorites? Today and tomorrow, as the year comes to an end, we’re taking another look at the posts published on this Blog in 2013 that attracted the most traffic.

A Closer, More Dispassionate Look at Obesity  RWJF Scholar in Health Policy Research alumna Abigail Saguy, PhD, discusses how fatness went from being considered a fashion problem to a social problem, a medical problem, and finally the public health crisis we see it as today. She says social perceptions of weight have affected medical interpretations, and shares her concern that some efforts to promote healthy lifestyles will exacerbate weight-based discrimination. Saguy’s interview was also the post most-shared on social media this year, generating more than 2,200 “likes” on Facebook.

A Chief Nursing Officer Who Does Not Have a BSN-Only Hiring Policy in Place  In a blog that is both personal and provocative, RWJF Executive Nurse Fellow alumnus Jerry Mansfield, PhD, RN, shares his journey to become a nurse, the setbacks he overcame, and how he has fulfilled his commitment to lifelong learning. He also addresses how he reconciled his support for the Institute of Medicine’s future of nursing education recommendations with the steps he had to take to meet demand for nurses at his institution. Mansfield is chief nursing officer at University Hospital and Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing.

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Dec 16 2013
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Explaining the Link between Income, Race, and Susceptibility to Kidney Disease

Deidra Crews, MD, ScM, an alumna of the Harold Amos Medical Faculty Development Program (2009-2013), was named the 2013-2015 Gilbert S. Omenn Anniversary Fellow at the prestigious Institute of Medicine. Among her current research is a study examining the association between unhealthy diet and kidney disease among low-income individuals.

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Human Capital Blog: Congratulations on your fellowship! What are your priorities for the coming year?

Deidra Crews: Over the next two years, I'll be participating in different activities of the Institute of Medicine (IOM). I'll be working with IOM committees and participating in roundtables and workshops. That's the main function of the fellowship. The great thing about it is I'll get to experience firsthand the activities of IOM and hopefully contribute to one or more of the reports that will come out of the IOM over the next couple of years. Because of my interest in disparities in chronic kidney disease, I will be working with the committee on social and behavioral domains for electronic health records, which falls under the IOM board of population health and public health practice. We will be making recommendations on which social and behavioral factors should be tracked in patients' electronic health records.

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Dec 9 2013
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Do Mergers with State Medicaid Programs Result in Cuts to State Public Health Department Funding?

Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW).  Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*

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It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.

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Nov 1 2013
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A Closer, More Dispassionate Look at Obesity

Abigail Saguy, PhD, is an alumna of the Robert Wood Johnson Foundation Scholars in Health Policy Research program (2000–2002). In January, she published the book, “What's Wrong with Fat?”

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Human Capital Blog: You argue in your book that the focus on the “obesity epidemic” obscures a deeper, more important question: How has fatness come to be understood as a public health crisis at all? How do you answer that question?

Abigail Saguy: It’s multilayered. On the deepest level, the fact that we perceive obesity as a public health crisis is related to the fact that fatness, or corpulence, has become an undesirable social characteristic. It has not always been that way, and it is not that way everywhere even today. In many places and times in history, being heavier has been considered a positive social characteristic, particularly in times and places where food is scarce. This is why, in certain contexts, women or girls are fattened up for marriage; there, the woman’s fatness symbolizes the wealth or status of their families.

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Sep 17 2013
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“Something Must be Done!” A 20th Century Rallying Cry for the Future of Public Health Nursing

Pamela A. Kulbok, DNSc, RN, PHCNS-BC, FAAN, is a Robert Wood Johnson Foundation Executive Nurse Fellow. She is the Theresa A. Thomas Professor of Nursing and a professor of public health sciences at the University of Virginia, chair of the Department of Family, Community, and Mental Health Systems, and coordinator of the public health nursing leadership track of the master’s in nursing program.

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With the recent release of second edition of the Public Health Nursing: Scope and Standards of Practice (American Nurses Association, 2013), now is a perfect time to reflect on the past and look toward the future of public health nursing (PHN). Public health nurses have always focused on improving the health of populations through health promotion and disease prevention. Since the establishment of visiting nursing in Boston and the Henry Street Settlement in New York City in the late 1800s, public health nurses have worked with families and communities in schools and homes, with immigrant populations in industrialized cities, and with rural communities to address challenging social conditions and to promote the health of the public.

It was evident with the founding of the National Organization of Public Health Nurses in 1912 that “something must be done” to prepare nurses with a broader education and emphasis on social conditions and prevention. Today, more than ever before, when health care in the United States is shifting its emphasis from an illness care system to one focused on health promotion and prevention, we need public health nurse generalists and advance practice public health nurses prepared to lead health care reform. 

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Aug 14 2013
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U.S. Needs Primary Prevention, Especially for the Poor and Underserved

Adrian L. Ware, MSc, is a third-year graduate student in public health at Meharry Medical College. He holds a BSc in biology from Alabama Agricultural and Mechanical University, and an MSc in biology and alternative medicine from Alabama Agricultural and Mechanical University. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.  He aspires to become a Christian psychiatrist serving the poor and underserved. Read all the blog posts in this series.

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With innovation, brilliance, passion, and robust planning, public health students and practitioners ask: How can we protect the health of the nation? According to the Centers for Disease Control and Prevention, seven out of ten deaths in the United States are caused by chronic disease. The need for more cost-effective, comprehensive care has never been greater. Within the world of public health, there are three levels of prevention: primary, secondary, and tertiary.

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Primary prevention reduces both the incidence and prevalence of a disease, because the focus is on preventing the disease before it develops. This can change the health of the nation for the better. Secondary and tertiary prevention are also significant.

It is well known that emergency care is vastly important, given the sheer complexity of episodic clinical cases that present to the emergency room in “life or death” situations. These “provisions” are necessary for the United States to uphold its high ideals of liberty and justice for all. Adequate, culturally competent, comprehensive health care for all citizens is a social justice issue, and a fundamental right. To this point, our health system’s extreme emphasis on tertiary care is amongst the most fiscally irresponsible ways to improve the health of the nation.

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