Category Archives: Public and Community Health
Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.
When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.
But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?
It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.
Elizabeth Gross Cohn, PhD, RN, is director of the Center for Health Innovation at Adelphi University, an adjunct professor at the Columbia University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
It only took 24 hours for the hospital unit where I work to complete the Ice Bucket Challenge. My colleagues and I were quick to dump ice water on our heads and publicly post a video of it to YouTube. Compare that to the speed at which we adapt other initiatives—even those that benefit our own health.
Why the difference? What is prompting people to action and, more importantly, what can RWJF learn from this campaign as it works to advance a Culture of Health?
In case you’ve been unplugged over the past several weeks, the Ice Bucket Challenge started in golf and baseball but has spread virally. As of today, it has raised $100 million for Amyotrophic Lateral Sclerosis (ALS). Participation begins when you are challenged on social media to—within 24 hours—publicly accept, acknowledge the challenger by name, pour ice water over your head in as dramatic a method as you can imagine or afford, challenge two or three others to participate, and post the results to YouTube. This campaign has been embraced by the general public, celebrities, grandmothers, babies, and teams of teachers, firefighters, nurses, teachers and others.
We public health professionals can learn some important lessons about delivering information and impelling action from this extraordinary cultural phenomenon. Here are five factors that seem most potent to me. Do you see others?
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice and a Robert Wood Johnson Foundation (RWJF) New Connections grantee.
In 1999, 28-year-old Demetrius DuBose, a linebacker for the Tampa Bay Buccaneers, was shot 12 times by two officers in his San Diego neighborhood. DuBose was a former co-captain of Notre Dame’s famed football team. His death came after he was questioned and harassed regarding a burglary in his neighborhood. Officers reported they had no choice but to shoot DuBose while he was handcuffed because they feared for their lives.
Many of these details sound similar to those surrounding the death of Michael (Mike) Brown Jr., who was shot at least six times in Ferguson, Missouri, this month. Brown was unarmed. He was reportedly fleeing from a police officer who also felt his life was in danger.
What is missing from this picture is that black males also feel threatened and distrustful of authority figures and are routinely disengaged from contexts such as schools, medical facilities and neighborhoods. The narrative remains the same: Black males who die from excessive force become involuntary martyrs for the sustained legacy of institutional and interpersonal racism that is associated with the health disparities plaguing black communities.
Audrey Dorélien, PhD, is a 2012-2014 Robert Wood Johnson Foundation (RWJF) Health & Society Scholar studying demography, infectious diseases, and maternal and child health.
Reoccurring outbreaks of measles and other vaccine-preventable diseases are a major killer of children, particularly in sub-Saharan Africa. In 2012, more than 226,000 cases of measles were reported worldwide, with a little less than half of those in Africa. For the World Health Organization to meet its global measles eradication goal and implement more effective supplemental vaccination programs, public health officials will need a better understanding of the mechanism driving seasonal and episodic outbreaks.
Infectious disease ecologists have demonstrated the importance of human demography, and in particular the influence of the birth rate on the dynamics of acute childhood immunizing (ACI) diseases. For instance in London, in the few years prior to 1950, the city experienced annual measles epidemics, but the dynamics changed to biennial epidemics as a result of a decline in the birth rate between 1950 and 1968. How can the birth rate influence disease outbreaks? An outbreak can only occur when the fraction of the susceptible population exceeds a critical threshold. In the case of ACI disease, the majority of the susceptible population are young children; therefore the birth rate influences the rate at which the pool of susceptibles is replenished.
One of the challenges of health care reform is to realign financial incentives so that providers and hospitals have economic inducements to keep patients healthy, rather than just treating them when they’re ill.
In the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars Health Policy Podcast, Maryland Secretary of Health & Mental Hygiene Joshua Sharfstein, MD, discusses a hospital in Hagerstown, Md., that took charge of the local public school health program, hiring school nurses and more “because it’d be an economic winner for them.” The hospital’s economic incentives were such that, “If they did it well, and helped kids with asthma control their asthma so they didn’t need to go to the emergency room, [the hospital] would save money on ER visits,” Sharfstein explains.
Sharfstein is interviewed by Clinical Scholar Loren Robinson, MD. The video podcast 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.
RWJF Scholars in the News: Debt and health, tax exemption controversy, peer influence on adolescent smokers, 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:
In the context of the Obama administration’s efforts to ease student loan debt, TIME reports on a study by RWJF Health & Society Scholars program alumna Elizabeth Sweet, PhD, that explores the toll debt takes on the borrower’s physical health. Past studies have focused on mental health issues, TIME writes, but Sweet’s research links debt not just to mental health, but also to high blood pressure and general health problems. Sweet says the problem has long-term implications. “These health issues are a warning for more health problems down the road,” she says, “so we have to think about this as a long-term phenomenon.” Forbes also highlights her research.
A Medscape story about a study that shows a direct correlation between vaccinating health care personnel against influenza and reducing cases of flu in the community quotes Mary Lou Manning, PhD, RN, CPNP, an RWJF Executive Nurse Fellows alumna. “We now actually have evidence indicating that higher health care worker vaccination rates in hospitals are having a community effect; they’re actually resulting in lower rates of influenza in the community. That’s remarkably exciting,” says Manning, who is president-elect of the Association for Professionals in Infection Control and Epidemiology. The article is available here (free login required).
Modern Healthcare reports on federal efforts to address concerns about tax exemption for certain nonprofit hospitals, citing research by Gary Young, JD, PhD, recipient of an RWJF Investigator Award in Health Policy Research. In order to obtain tax-exempt status, the Affordable Care Act requires nonprofit hospitals to track and report the charity care and community benefits they provide. Young found wide variation in the contributions of nonprofit hospitals. “The current standards and approach to tax exemption for hospitals is raising concerns about a lack of accountability for hospitals,” he says, and creating problems because “hospitals don’t really know what’s expected of them.” The Internal Revenue Service has proposed a rule to address the issue. (Free registration is required to view the article.)
How to Advance Minority Health? A Successful, Sustainable Effort to Promote Healthy Choices in Miami.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Lillian Rivera, RN, MSN, PhD, administrator/health officer for the Florida Department of Health in Miami-Dade County, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Rivera is an alumnus of the RWJF Executive Nurse Fellows program.
In order to address this question, it is important to identify the areas within your jurisdiction where there are identified health disparities and to develop initiatives with those needs in mind.
Miami-Dade County in Florida is one of the few counties in the United States that is “minority majority,” meaning the minority makes up the majority of the population. More than two-thirds of the 2.5 million residents are Hispanic; 19 percent are Black; more than 51.2 percent are foreign-born and most of them speak a language other than English at home (mostly Spanish and Creole); 19.4 percent live below poverty level; and 29.8 percent of the population under age 65 (more than 700,000 individuals) is uninsured .
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Ann H. Cary, PhD, MPH, RN, dean and professor at the University of Missouri at Kansas City, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Cary is an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program (2008-2011).
In April, the Centers for Disease Control and Prevention (CDC) published a morbidity and mortality report that suggests effective public health strategies for closing health equity gaps among diverse populations. In highlighting the promising evidence in four areas, the CDC reminds us that linear and silo approaches are no longer effective to solving these kinds of “wicked problems.”
Effective public health programming, it says, rests on six dimensions:
- The use of innovation to develop technical aspects of the programming;
- Packaging synergistic evidenced-based practices;
- Real-time monitoring that incorporates just-in-time learning into continuous improvements;
- Coalitions across boundaries and sectors;
- Effective communication and social marketing to change perceptions; and
- Engaged political commitments.
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.
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).
An interview with Renee Hsia, MD, a Robert Wood Johnson Foundation Physician Faculty Scholars program alumna and associate professor of emergency medicine at the University of California, San Francisco. She is the co-author of “Emergency Care: Then, Now and Next,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: Other than the obvious changes in technology, how are emergency departments (EDs) different today than they were 50 years ago?
Renee Hsia: We’ve had a dramatic transition since the 1950s, in terms of what emergency departments do, and the patient outcomes we expect. We mention in the article, for example, that years ago many emergency departments used funeral hearses to transport patients to the ED. Now transport is usually in vehicles with all sorts of life-saving equipment on board. That’s one reason the mortality rate is a lot lower now than it was then; death is much rarer in the emergency room today.
Another dramatic transition has been the rise of the specialist in emergency medicine. It used to be more common to have physicians trained in other specialties taking turns in the emergency room. You still see that in some rural areas, but it’s far less common. There’s been a gradual movement toward the understanding that we need people who are masters in the acute presentation of illness.
We’ve also seen the beginnings of a system transition, with a growing focus on regionalization. We have to account for the reality that not all community EDs and hospitals are equipped with the same technology as tertiary hospitals, such as a cardiac catheterization lab, for example. We need to be sure that we can get patients “the right care in the right place at the right time,” and that requires close coordination within the larger health care system.
HCB: You discuss the relationship between ED crowding and changes in primary care practice. Could you tell us about that?