Category Archives: Disparities
Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico (UNM), assistant director of the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at UNM, and director of research for Latino Decisions. Yajaira Johnson-Esparza is a PhD Candidate in the UNM department of psychology and an RWJF Fellow at the University.
A recent survey conducted by RWJF, NPR, and the Harvard School of Public Health focused our attention on the burdens that stress poses for Americans. We want to focus our attention in this blog post on factors that may be leading to stress among the Latino population. Although the experience of stress is very common, the experience and burden of stress is not uniform across people in the United States.
One of the main findings that emerged from the recent RWJF/NPR/Harvard survey was the strong role of health problems in stress in the United States, with 27 percent of respondents noting that illness or disease was a major source of stress over the past year. In addition to the direct impact of being sick, the financial burdens associated with needing medical care can generate a lot of stress. We have found support for this finding in some of our own work at the UNM RWJF Center for Health Policy. For example, a recent survey we helped produce found that 28 percent of Latino adults indicated that because of medical bills, they have been unable to pay for basic necessities like food, housing, or heat, with 40 percent indicating they have had trouble paying their other bills. The financial stress associated with illness can have a devastating impact on Latinos.
Latinos in the United States also face unique stressors from other Americans due to their language use, nativity, and experiences with discrimination. Being followed in a store, being denied employment or housing, and being told that you do not speak English well can all lead to stress for Latinos.
More specifically, the current political climate surrounding immigration politics and policy has led to an increase in discrimination directed toward Latinos, and consequently stress levels. Our Center has been tracking immigration laws passed at the state level over time; we have found a significant increase in passage of punitive laws during the economic recession, with more than 200 immigration laws being passed in 2009 alone. A June 2011 impreMedia/Latino Decisions (LD) poll reveals that Latino voters are conscious of this tense landscape, as 76 percent of respondents believe that an anti-Hispanic and anti-immigrant environment exists today.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends related to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the June 2014 issue.
Campaign for Action Is Chalking Up Successes that Will Improve Patient Care
Three years after it launched, the Future of Nursing: Campaign for Action is making steady progress on nurse education, practice, interprofessional collaboration, data collection, and diversity, according to a series of indicators released last month. Led by RWJF and AARP, the Campaign has created Action Coalitions in all 50 states and the District of Columbia that are working to implement recommendations from the Institute of Medicine. “Because of the Campaign, there’s more awareness about the importance of preparing the nursing workforce to address our nation’s most pressing health care challenges: access, quality, and cost,” says RWJF Senior Program Officer Nancy Fishman, MPH.
Pioneering Nurse Scientist Addresses Asthma-Related Disparities
Kamal Eldeirawi, PhD, RN, a pioneering scientist with expertise in immigrant health, was born in the Gaza Strip in Palestine, where he saw the profound impact of poverty and disadvantage on health in his own community. A career in nursing, the RWJF Nurse Faculty Scholar believed, would allow him to make a difference at both the individual and population-wide levels. Today, Eldeirawi, is researching risk factors that contribute to asthma in Mexican American children living in the United States, and the effects of immigration and acculturation on children’s health.
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.)
Yolanda Ogbolu, Ph.D., CRNP, is an assistant professor of family and community health and deputy director at the Office of Global Health at the University of Maryland-Baltimore. She is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013-2016).
Human Capital Blog: Congratulations on your recent Outstanding Faculty Award from the University of Maryland-Baltimore! What does it mean for you and for your career?
Yolanda Ogbolu: It was an honor to be recognized by the University of Maryland-Baltimore (UMB) and by my colleagues in the school of nursing who nominated me for this award. It specifically identifies a faculty member on campus who has demonstrated achievements in the area of diversity and inclusiveness. It is presented in the annual Dr. Martin Luther King, Jr., and Black History Month celebration.
Having my colleagues share and honor my passion for addressing health inequities using the social determinants of health model locally and globally was particularly rewarding, as I reflected on the work of Dr. King and others before me. At the same time, I acknowledge that most of my work benefitted from my passion for collaboration. Therefore, I wholeheartedly shared the award with many people who have assisted me along this path. Receiving the award has strengthened my career and enthusiasm for actively engaging in efforts that move forward the ideals of social justice and health equity in a way that transforms practice and patient outcomes in my local and global communities.
David Fakunle, BA, is a first-year doctoral student in the mental health department of The Johns Hopkins Bloomberg School of Public Health. He is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
It is always interesting to speak with my relatives when an egregious act of violence occurs, such as the shooting at Sandy Hook Elementary School back in December 2012. They are always so disheartened about the mindset of an individual who can perpetrate such a horrible act. When I mentioned that this particular perpetrator, Adam Lanza, suffered from considerable mental disorder including possible undiagnosed schizophrenia, the response was something to the effect of, “Okay, so he was crazy.”
That’s it. He was crazy. I love my family dearly, but it saddens me as to how misinformed some of my relatives are about mental health. Notice that I say “misinformed” as opposed to “ignorant” because to me, being ignorant means you are willingly disregarding the information provided to you. But that is the issue: communities of color, in many cases, are not well-informed, if informed at all, about mental health. That is what drives the negative stereotypes that are highly prevalent within communities of color.
Ayorkor Gaba, PsyD, is a clinical psychologist and project manager at the Center of Alcohol Studies, Rutgers University, as well as a clinical supervisor at the Rutgers Psychological Clinic. She has a private practice in Highland Park, New Jersey and is an American Psychological Association-appointed representative to the United Nations. She is an alumna of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Mental illness affects one in five adults in America. A disproportionately high burden of disability from mental disorders exists in communities of color. Research has shown that this higher burden does not arise from a greater prevalence or severity of illnesses in these communities, but stems from individuals in these communities being less likely to receive diagnosis and treatment for their mental illnesses, having less access to and availability of mental health services, receiving less care, and experiencing poorer quality of care. Even after controlling for factors such as health insurance and socioeconomic status, ethnic minority groups still have a higher unmet mental health need than non-Hispanic Whites (Broman, 2012).
There are a number of factors driving these statistics in our communities, including attitudes, lack of culturally and linguistically appropriate services, distrust, stigma, and more. In our society all racial groups report mental health stigma, but culturally bound stigma may have a differential impact on communities of color. Stigma has been described as a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses (President’s New Freedom Commission on Mental Health, 2003). Stigma in the general public often leads to internalized stigma at the individual level. Several studies have shown that internalized stigma is an important mechanism decreasing the willingness to seek mental health treatment.
New Participants in RWJF Health & Society Scholars Program to Study Determinants of Population Health
The Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program has announced the selection of 12 new scholars who will investigate how connections among biological, genetic, behavioral, social, economic, and environmental conditions impact the population’s health.
“We’re pleased to announce our newest class of Health & Society Scholars. These new scholars will continue to advance the program’s decade-long mission to answer the questions critical to guiding health policy and improving our nation’s health,” said Jo Ivey Boufford, MD, co-director with Christine Bachrach, PhD, of the national program office for the Health & Society Scholars program, and president of the New York Academy of Medicine.
The program seeks to improve the nation’s health by better understanding and acting on the determinants that can reduce population health disparities. Among many topics, the new scholars will study social factors underlying infectious disease transmission, as well as possible interventions designed to improve urban health. Previous cohorts of scholars have researched how health is influenced by civic engagement, discrimination, human happiness, work environment, public health policies, and many other societal factors.
Deidre Walton, JD, MSN, RN-PHN, is the 11th president of the National Black Nurses Association. She is a graduate of the U.S. Army Command and General Staff College with more than 30 years managed care experience in nursing practice, education, and administration. Walton is a retired commissioned officer for the U.S. Army, holding the rank of Lieutenant Colonel, an ordained elder in the African Methodist Episcopal Church, and the founder of the Imani Community.
I fully embrace the American Nurses Association’s 2014 theme for National Nurses Week: Nurses Leading the Way. This theme flows from the clarion call from the Institute of Medicine that nurses should be full partners with physicians and other health professionals in redesigning health care in the United States.
Strong leadership is critical if the vision of a transformed health care system is to be realized. Because the demographics of the United States are increasingly more diverse, it is also imperative that the field considers not only leaders from diverse backgrounds but also how to lead diverse constituents as partners in our mission.
Strong leadership is also tied to the achievement of a transformed health care system. But the transformation can only come by the field embracing diversity. That is the essential first step. What follows is greater success in combatting health disparities, and supporting development and growth of new leaders.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to blog about improving health care for all. Rashawn Ray, PhD, is an assistant professor of sociology at the University of Maryland and a former RWJF Health Policy Research Scholar at the University of California in Berkeley and San Francisco.
Some people assume that promoting diversity and combating health disparities means giving preferential treatment to minorities over Whites. However, these pursuits simply mean providing equitable opportunities and a health care system that is responsive to everyone. Education studies continuously show that promoting diversity and reducing discrimination benefits all students. Regarding health care, these pursuits may mean life or death.
The percentage of Black physicians has stayed roughly unchanged since the early 1900s. The percentage of Black and Latino professors at research-intensive university shows a similar pattern. I suggest that reducing health disparities and changing our current culture of health is contingent on more effectively integrating minorities into health professions and research positions.
How Can Health Systems Effectively Serve Minority Communities? Use Electronic Health Records to Discover How to Improve Outcomes.
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, Bonnie L. Westra, PhD, RN, FAAN, an associate professor at the University of Minnesota School of Nursing, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Westra is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
Electronic health records (EHRs) are rapidly proliferating and contain data about health or the lack thereof for minority communities. Evidence-based practice (EBP) guidelines can be embedded in EHRs to support the use of the latest scientific evidence to guide clinical decisions. However, scientific evidence may not reflect differences in minority communities served.
As a first step to compare the effectiveness of EBP guidelines for minority populations, practicing nurses and nurse leaders need to advocate for implementation of EBP nursing guidelines in EHRs. Additionally, EBP guidelines must be coded with national nursing data standards to compare effectiveness within and across minority communities. Nurse researchers need to conduct comparative effectiveness research to learn how to optimize EBP guidelines for minority communities through the reuse of EHR data and to derive patient-driven evidence.