Category Archives: Disparities
Janet Tomiyama, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2009-2011), is director of the Dieting, Stress, and Health (DiSH) Lab at the University of California-Los Angeles. She was recently named the 2013 recipient of the Early Career Investigator Award from the Society of Behavioral Medicine.
Human Capital Blog: First, congratulations on receiving the Society of Behavioral Medicine’s 2013 Early Career Investigator Award! What does this award mean for your current research and for your career?
Janet Tomiyama: Thank you! Of course, as I’m fighting my way toward tenure, this kind of recognition is really key to my career. I am trained as a social psychologist, but this award was from the field of behavioral medicine. It shows that my work has interdisciplinary appeal, that people in the medical field find it important. It shows me that I was on the right path in trying to broaden my training through the RWJF Health and Society Scholars program and trying to incorporate aspects of medicine and population health. Getting recognition from a field that’s not my own means a lot to me.
HCB: What specific work did the award recognize?
Tomiyama: I was recognized for a paper about racial disparities in chronic psychological stress and body mass index (BMI) among girls between the ages of 10 and 19. Of all the many, many health disparities out there, the disparity in obesity between Black and White girls in adolescence is one of the biggest. I wanted to tackle a big disparity, and I thought stress had something to do with it. I completed the research during my time as an RWJF Health & Society Scholars fellow.
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
Taylor Hargrove is a PhD student in the sociology department at Vanderbilt University and a graduate fellow at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. Her research interests focus on racial/ethnic stratification, health disparities, social determinants of health, and stress. Her M.A. thesis examines the adequacy and utility of the stress process model among African Americans.
As a rising third year in the sociology doctoral program at Vanderbilt University, I recently attended my first annual meeting of the American Sociological Association (ASA). I didn’t really know what to expect. I suppose I thought it would be like any other conference I had been to, which, up to that point, had been pretty laid back.
The day I went to check-in, I realized I had been mistaken. I stepped inside the doors of the conference hotel and immediately became part of the swarm of sociologists from all around the world. I became instantly overwhelmed. Not only were there a ton of people walking around, but I knew that there was so much knowledge and expertise surrounding me. I also knew that scholars I had, and continue to, read extensively were just inches away from me somewhere.
Matthew M. Davis, MD, MAPP, is associate professor of pediatrics, of internal medicine, and of public policy at the University of Michigan in Ann Arbor and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. In February, he coauthored a commentary in the Journal of the American Medical Association that asked, to paraphrase: Why does the United States ensure universal access to basic, life-saving treatment in emergency rooms but not to more cost-effective, comprehensive, and preventive treatment, and how can it achieve the latter? The RWJF Human Capital Blog asked Davis and his coauthors, both RWJF Clinical Scholars, as well as others from RWJF programs, to respond to the question. Davis’ response follows. Read all the blog posts in this series.
The debate about whether health care is a right or a privilege is familiar and polarized. A quick online search in this topic area yields strong statements, deeply held convictions, and stern admonishments for those who hold opposite views.
As RWJF Clinical Scholars Kate Vickery, MD, and Kori Sauser, MD, (2012-14) point out in their recent blog posts, primary care physicians and emergency physicians can agree that the Emergency Medical Treatment and Active Labor Act (EMTALA)—by focusing exclusively on assuring access to emergency care—fails to ensure that health care is a right for all individuals in the United States across all health care settings.
As the three of us wrote in a Journal of the American Medical Association commentary earlier this year, the Patient Protection and Affordable Care Act (PPACA) will likely fall short of ensuring health-care-as-a-right-for-all as well. That’s largely because one-to-two dozen Americans (or more) will likely remain uninsured even with implementation of all of the coverage provisions of the PPACA. Congress did not have the appetite for even broader coverage initiatives that were considered in PPACA discussions but ultimately left out of the legislation.
This is part of the July 2013 issue of Sharing Nursing's Knowledge.
“Nursing is something that I can do and be proud of, too. It is a job that is meaningful and important, where people are relying on you to know what you are doing … I had already been to college, so I knew what to expect. Besides the advantage of already having a bachelor’s degree and many of the class requirements, I was an older, more mature student. I’d had those life experiences that prepare you for challenges … When you are dealing with cardiac patients, you are giving people potent medications, you’re operating multiple types of equipment—heart pumps and ventilators, you are nursing people back to health. It’s an eye opening experience.”
-- Vic Barberousse, Wingate Graduate Returns to College at RCC to Become Nurse, Daily Journal, July 1, 2013
“After completing my PhD, I decided that a nursing education would help me get a better handle on the clinical relevance of the questions I was addressing in the lab. It is one thing to manipulate conditions in a petri dish, but when you’re dealing with human beings there are many other factors involved—their diet, their stress level, how they respond to medication. For me, the way to ensure my research translated well to patients was to become a clinician, so I could see the outcomes of the research through my patient encounters … Ethnic health disparities cost this nation more than $6 billion per year, a staggering amount in light of the fact that many are preventable. As minority nurses we need to take a leadership role in the educational, clinical and research arenas to eliminate disparities in healthcare.”
-- Nalo Hamilton, PhD, RN, WHNP/ANP-BC, RWJF Nurse Faculty Scholar, In the Spotlight: Nalo Hamilton, MinorityNurse.com, June 26, 2013
LisaMarie Turk, RN, MSN, is a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico, working toward a PhD in nursing with a health policy concentration. She was awarded a Hearst Foundation Scholarship in 2010. This is part of a series of posts looking at diversity in the health care workforce.
Ample scientific and empirical evidence supports increasing diversity in the health care workforce in order to decrease health disparities and advance health equity.
I am a registered nurse and PhD student in Nursing and Health Policy at the University of New Mexico. New Mexico is known for its depth of cultural diversity; however, this state joins the nation in experiencing negligible diversity in its health care workforce.
I was honored with the opportunity to complete a policy internship focusing on nursing workforce diversity at the Division of Nursing of the Health Resources and Services Administration’s Bureau of Health Professions. From this experience, I gained increased awareness and resources to affect change in nursing and health care workforce diversity in New Mexico.
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. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males. His work seeks to identify sources of individual, cultural, and organizational social capital to promote health behaviors, and health care access and utilization, to advance and improve the health and well-being of African American males. This is part of a series of posts looking at diversity in the health care workforce.
I became a public health professional because I recognized a need to find opportunities and strategies to prevent the chronic diseases I saw silently killing African Americans in the community where I grew up. I vividly recall as a child the whispers surrounding the deaths of community members about cancer, diabetes (or sugar-diabetes, as it is commonly referred to in many communities still today), heart attacks, and strokes. I knew there was stigma and fear, but never heard of programs, interventions, or opportunities to stop these trends.
My interest in addressing these problems led me to pursue summer programs and internships during high school that allowed me to witness amputations of uncontrolled diabetic patients who had a range of clinical and social co-morbid conditions. Many of these amputees were living in poverty, they had Medicare or Medicaid, and the majority happened to be African American. This experience raised the question about prevention: How could I prevent African American men and women from having amputations? I never heard this conversation around prevention in my community. Many people seemed to accept the reality of developing these chronic conditions as a fate that could not be controlled.
I knew there had to be another way.
Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.
I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.
Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.
The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.
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.
A member of the Navajo Nation, Lisa Palucci, MSN, RN, is a nurse consultant at the Centers for Medicare and Medicaid Services and a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico. This post is part of the "Health Care in 2013" series.
As the nation trudges forward in its quest to improve health care access for all Americans, I think it is essential that we continue to make progress in decreasing the health disparities and social determinant of health gaps that continue to be ignored in mainstream health policy initiatives. Throughout the course of my PhD program at the University of New Mexico (UNM), we have had numerous opportunities to experience nursing and health policy in action by attending national conferences, meetings, and orientation programs. To my disappointment, discussion about improving health disparities and social determinants of health are seldom a topic on the agenda. This poses the question: Aren’t the health disparities and social determinants of health what got us to the point of an inequitable health care system in the first place?