Category Archives: Public and Community Health

Nov 12 2014
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Connected Health Approaches to Improve the Health of Veterans

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Mitesh Patel

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

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Nov 11 2014
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Let’s Put Veterans in Charge of Their Pain Care

Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.

Erin Krebs (Veterans Day)

How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.

Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.

Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.

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Oct 30 2014
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RWJF Scholars in the News: Scapegoating EHRs, Ebola fears, children fighting cancer, 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 an article published in Healthcare IT News, David Blumenthal, MD, MPP, writes that health care providers may be too quick to blame Electronic Health Records (EHR) for medical errors. Blumenthal notes that EHRs are still imperfect and that improvements will take time, but argues: “There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. The dissatisfaction with the technology will recede as EHRs improve, and as a new generation of young clinicians, raised in the electronic world, populates our health care system.”  Blumenthal is president of The Commonwealth Fund, former National Coordinator for Health Information Technology, and an RWJF Investigator Award in Health Policy Research recipient.

In a blog published by the Washington Post’s “Monkey Cage,” Shana Gadarian, PhD, and her co-author write that Ebola anxiety, while potentially misplaced and harmful, is likely to have an impact on whom Americans trust to handle the disease and what kinds of policies they will support to fight it. The authors have studies society’s reactions to small pox and H1N1 flu. “In general we find that anxiety makes people more supportive of government playing an expansive role in protecting them during a health crisis ... we think our study and the current Ebola outbreak both emphasize that people will rally around experts and increase their support for policies that fight the contagion, even if they hurt civil liberties. Let us hope that the U.S. health system is ultimately worthy of the confidence the public has in it.” Gadarian is an RWJF Scholars in Health Policy Research alumna.

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Oct 24 2014
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Working Together to Draw More Nurses to Public Health

Patricia Drehobl, MPH, RN, is associate director for program development at the Centers for Disease Control & Prevention (CDC). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2007-2010).

Patricia Drehobl

Human Capital Blog: CDC is engaging in new partnerships with the American Association of Colleges of Nursing (AACN) to promote public health nursing. How did the new collaboration come about?

Pat Drehobl: CDC has funded some national academic associations for many years, including the Association of Schools of Public Health, the Association of Prevention Teaching and Research, and the Association of American Medical Colleges. We recognized the need to include nursing representation because nursing is the largest discipline in the public health workforce. We added AACN as a partner in 2012 when we developed our funding opportunity announcement to work with academic partners.

HCB: Why did CDC decide to reach out to the nursing community in 2012?

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Oct 9 2014
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RWJF Scholars in the News: The nurse faculty shortage, teaching empathy, a link between overtime and diabetes, 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:

ABC News explores the nation’s nursing workforce shortage, focusing specifically on the faculty shortage at nursing schools. “Suddenly, we turned around and realized we’re not attracting enough nurses to go into teaching,” said Kimberly Glassman, PhD, RN, chief nursing officer at NYU Langone Medical Center. “The fear is we will have to shrink the number of nurses we can prepare for the future at a time when we need to prepare more.” Glassman is an RWJF Executive Nurse Fellow. The article was republished by Yahoo News and ABC News Radio.

RWJF Health & Society Scholars program alumnus Allison Aiello, PhD, MS, is interviewed for an NBC News story on Enterovirus D-68. She recommends that parents consider getting flu shots for their children, noting that preventing children from getting the flu should help make Enterovirus less complicated to diagnose and treat. The video is available here.

RWJF Harold Amos Medical Faculty Development Program scholar Paloma Toledo, MD, co-authors a Huffington Post blog entry on the need for medical schools to teach students to be empathetic. Over the course of their training, they become less empathetic, as opposed to more empathetic, and the reasons for this are unclear,” Toledo writes, recommending lectures on active listening and communication skills, among other measures. 

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Sep 29 2014
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Intimate Partner Violence: What We Tell Our Children Can Make a Difference

A. Monique Clinton-Sherrod, PhD, is a 2008 alumna of the Robert Wood Johnson Foundation’s New Connections program. She is an RTI research psychologist with extensive experience in prevention research associated with a variety of psychosocial issues.

Monique Clinton-Sherrod

Recently while watching ESPN with my two children, we saw nonstop coverage of the Ray Rice incident, including the video of Mr. Rice violently assaulting Janay Palmer, his then-fiancée. I was peppered with questions from my children. 

“Did he get arrested? Why did he do that? What did she do? Is that something they shouldn’t show on television because it’s private?”

The recurring images and my children’s questions were all the more jarring because I recently lost a sorority sister in a murder-suicide by her former husband. These experiences have served as an unfortunate but teachable moment for my daughter and son, and reinforced the importance of my life’s work—both for my children and for society as a whole. 

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Sep 18 2014
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New Government Funds Will Support Health Workers, Expand Access to Care

The federal government announced new funds this month to expand primary care services and improve access to care.

On Sept. 12, the U.S. Department of Health and Human Services (HHS) announced the availability of $295 million to nearly 2,000 health centers across the country.

Authorized by the Affordable Care Act, the money will support salaries for an estimated 4,750 new health care providers and other staff; allow centers to stay open for longer hours; and add new services in the areas of oral and behavioral health and pharmacy and vision services, according to an HHS statement.

The agency says the money will enable centers to reach an additional 1.5 million new patients nationwide. Today, nearly 1,300 community health centers provide care to some 22 million patients across the nation, according to HHS.

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Sep 12 2014
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Changing the Culture of Health to Prevent Suicide

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.

Alexander Tsai

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.

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Sep 3 2014
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Accepting the Challenge: What the ALS Ice Bucket Challenge Can Teach Us About Public Health

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.

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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?

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Aug 22 2014
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We See the Dead and Don’t See the Living: The Realities of Black Men

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.

Keon Gilbert

Involuntary martyrs.

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. 

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