Category Archives: Social determinants of health

Jan 23 2014
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Focus on Health to End Poverty

Janice Johnson Dias, PhD, is a Robert Wood Johnson Foundation New Connections alumnus (2008) and president of the GrassROOTS Community Foundation, a health advocacy that develops and scales community health initiatives for women and girls. She is a graduate of Brandeis and Temple universities and a newly tenured faculty member in the sociology department at City University of New York/John Jay College of Criminal Justice.

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Policy action and discussion this month have focused on poverty, sparked by the 50th anniversary of Lyndon Johnson’s War on Poverty and Dr. King’s birthday. Though LBJ and King disagreed about the Vietnam War, they shared a commitment to ending poverty. Half a century ago, President Johnson introduced initiatives to improve the education, health, skills, jobs, and access to economic resources for the poor. Meanwhile, Dr. King tackled poverty through the “economic bill of rights” and the Poor People's Campaign. Both their efforts focused largely on employment.

Where is health in these and other anti-poverty efforts?

The answer seems simple: nowhere and everywhere. Health continues to play only a supportive role in the anti-poverty show. That's a mistake in our efforts to end poverty. It was an error in 1964 and 1968, and it remains an error today.

Let us consider the role of health in education and employment, the two clear stars of anti-poverty demonstrations. Research shows that having health challenges prevents the poor from gaining full access to education and employment. Sick children perform more poorly in schools. Parents with ill children work fewer hours, and therefore earn less. Health care costs can sink families deeper into debt.

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Jan 23 2014
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Human Capital News Roundup: Cost of childbirth, underuse of nurse practitioners, obesity through economic lens, 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:

Recent progress in preventing and treating cancer is not fully reflected in declining death rates from the disease, because improving survival rates for other diseases have resulted in longer lifespans, giving people more years during which cancer may strike. This is the key finding from a study by RWJF Health & Society Scholars alumnus Samir Soneji, PhD. HealthDay reports on Soneji’s research.

A study by Renee Hsia, MD, an RWJF Physician Faculty Scholars program alumna, examines childbirth costs at hospitals throughout California. Hsia found that costs for vaginal deliveries without complications range from $3,296 to $37,277. “The market doesn’t work and the system doesn’t regulate it, so hospitals can charge what they want,” she told the Boston Globe.

Having an incarcerated family member could lead to negative health outcomes, especially for women, according to a study carried by Medpage Today. RWJF Health & Society Scholars program alumna Hedwig Lee, PhD, found that for women, having an incarcerated family member was associated with an increased likelihood of self-reported diabetes, hypertension, heart attack or stroke, obesity, and fair or poor health.

Many health care providers are not making full use of nurse practitioners (NPs), partly due to the limitations of electronic health records (EHRs) and billing software, according a study from Lusine Poghosyan, PhD, MPH, RN, reports EHR Intelligence. Poghosyan, an RWJF Nurse Faculty Scholar, concluded that because such software fails to recognize NPs as providers of record, it restricts their access to patient data and does not accurately reflect their role in patient care.

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Jan 22 2014
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Overcoming Health Disparities: Promoting Justice and Compassion

By Janet Chang, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant professor of psychology at Trinity College in Hartford, Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups. Her RWJF-funded research project (2009 – 2012) examined the relationship between social networks and mental health among Latinos and Asian Americans.

“Injustice anywhere is a threat to justice everywhere.”  
Dr. Martin Luther King, Jr. (Letter from Birmingham Jail, April 16, 1963)

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Dr. Martin Luther King, Jr. is well known for his fight against racial injustice, but he also advocated for socioeconomic justice. In particular, Dr. King said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane” (Second National Convention of the Medical Committee for Human Rights, March 25, 1966). His profound words still resonate with us today.

While strides have been made in the past several decades, there continues to be inequality and unequal treatment. In 1978, the President’s commission reported ethnic/racial disparities in health services, and this is still a vexing societal problem in the United States. Compared to non-minorities, American Indians, Latino Americans, Asian Americans, African Americans, and other ethnic/racial minorities are significantly less likely to receive the care that they need and more likely to receive lower quality health care. Ultimately, these disparities compromise the quality of life of most Americans.

The factors that contribute to heath disparities are complex. As a social-cultural psychologist, I also believe that our tolerance for injustice stems in part from larger cultural forces that shape our psychological tendencies, which simplify our world and constrain our ability to take the perspective of others. In the United States, the cultural values that make our society distinctive, independent, and strong may also serve to limit our potential for greater growth—a healthier, happier, and more productive society. 

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Jan 20 2014
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Compassion and a Coffee Cup

Mia R. Keeys, BA, is a 2008 graduate of Cheyney University of Pennsylvania. Keeys has worked with loveLife, the HIV/AIDS prevention youth campaign of South Africa. She served as a U.S. Fulbright Fellowship in East Nusa Tenggara, Timor, Indonesia and is today a first-year doctoral student in sociology at Vanderbilt University and a Robert Wood Johnson Foundation Health Policy Fellow (2013).

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“'Scuse me, can I sit here?” she asked me.

I could have moved away. But, in a sea of patrons, it would have signified more than discomfort. What was I implying by staying seated? Was it a statement—a sit-in, if you will—to prove to myself she is no less valuable in our shared humanity? Was it to quell the guilt that I felt because I wanted to move and, furthermore, failed to ask her name? Her tawny hoodie reeked of the cold of black nights she likely endured in the last week, while I was home wrestling with my white feather-down comforter. From my seat and hers on a faux-leather brown couch—the brown of both our faces—the flames perform within the fireplace in front of us, as I perform indifference for those around me. I am not prejudice. I cross one leg sophisticatedly over the other. I am not prejudice.

A furtive leftward glance at my cell phone (albeit an archaic flip phone) exposed in my open bag—the only object separating our arms from touching. I am not prejudice. A chill in the air tickles my nose, but I resist a sneeze or even a nose-crinkle, lest the gesture of an otherwise trivial facial contortion suggest any discomfort associated with the stench of her clothes. 

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Jan 20 2014
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On Martin Luther King, Jr. Day, an RWJF Scholar and Soon-to-Be Physician Resolves to Help End Health Disparities

Cheryl Chun, MS, MA, is a Robert Wood Johnson Foundation Health Policy Scholar (2011) at the Center for Health Policy at Meharry Medical College and a medical student at Meharry Medical College. She received a BS degree from George Washington University and an MA from American University. She taught for Teach for America for two years. 

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Every year on Martin Luther King, Jr. Day, our country takes a moment to reflect on the progress we have made toward becoming the nation we have always strived to be—one of equality. And while many of us would agree that significant headway has been made, we all know that we still have so much farther to go before we can truly achieve Dr. King’s dream. 

I read the local and national news regularly and there always seems to be another article or story that speaks to the ongoing challenges of realizing this equity, including the educational achievement gap, health disparities, and even policies that allow inequalities to continue to exist across our society. It is almost scary that so many critical components of our lives are determined solely by our place of residence. In fact, it’s one’s zip code that often has the greatest impact on the quality of one’s education, one’s future health status, and even the types of food and nutritional resources to which one has access. These social determinants of health ultimately decide who will remain healthy throughout life and who will eventually become unwell.

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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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Nov 26 2013
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Empathy and Appreciation for the Impact of the Social Determinants of Health

Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.

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Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.

Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging.  This balance can be particularly difficult for students and new clinicians.

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Sep 5 2013
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Human Capital News Roundup: How adverse working conditions affect health, the impact of the “trophy culture” on kids, antibiotic development, 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:

Adverse working conditions contribute substantially to the risk of depression for working-age adults, according to new research from a team led by RWJF Health & Society Scholars alumna Sarah A. Burgard, PhD. The study is the first of its kind to show the impact of the sum total of negative working conditions, rather than focusing on only one particular risk factor, Science Daily reports.

A study led by RWJF/U.S. Department of Veterans Affairs Clinical Scholars alumnus Michael Hochman, MD, finds that the philosophy behind patient-centered medical homes supports improved patient care and better physician and staff morale, Bio-Medicine reports. Hochman and his colleagues studied Galaxy Health, a program jointly operated by the University of California, Los Angeles, and the University of Southern California. "We all know that fewer and fewer young physicians are choosing careers in primary care because of the difficult work schedules, lack of support and lower salaries," Hochman said. "What we did here was to move in the direction of a team-based approach and it resulted in improved satisfaction for physicians in training with their primary care experiences."

RWJF Scholars in Health Policy Research alumna Hilary Levey Friedman, PhD, wrote a column for the Time Magazine Ideas blog, reflecting on a trend in organized children’s activities that she calls “the carving up of honor.” It consists of devising smaller categories that offer more opportunities for prizes. Giving children rewards for doing an activity lowers intrinsic motivation, she writes, which bodes poorly for long-term success and for pride in hard-earned achievement. “The carving up of honor and the trophy culture that accompanies it has clearly gone too far: carving up honor probably doesn’t improve children’s performance or motivation—but it may mean a bigger payday for those who run childhood tournaments.” Friedman identified the trend while researching her new book, Playing to Win.

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Aug 28 2013
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Affirmation at the American Sociological Association’s Annual Meeting

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.

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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.

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Aug 22 2013
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Human Capital News Roundup: Lead exposure and behavior problems, debt's impact on health, health exchange 'navigators,' 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:

More Americans are dying from obesity than previously thought, according to a new study by Ryan Masters, PhD, an alumnus of the RWJF Health & Society Scholars program. In recent decades, 18 percent of deaths of Americans ages 40 to 85 can be attributed to obesity, NBC News, USA Today, and the Los Angeles Times report, which is much higher than the often cited 5-percent toll.

Pennsylvania Governor Tom Corbett last week signed a new health care law based on a plan designed by RWJF Community Health Leader Zane Gates, MD, the Philadelphia Inquirer reports. The measure will provide $4 million to community health centers in rural and underserved areas.

Children exposed to lead are nearly three times more likely to be suspended from school by the 4th grade than their non-exposed peers, according to a study co-authored by Health & Society Scholars alumna Sheryl Magzamen, PhD, MPH. “We knew that lead exposure decreases children's abilities to control their attention and behavior, but we were still surprised that exposed children were so much more likely to be suspended,” she told Science World Report.

WHYY (Philadelphia) spoke to RWJF Executive Nurse Fellows alumna Cheri Lee Rinehart, BSN, RN, about grants to train "navigators" to assist people as they purchase insurance through health exchanges. Rinehart is president of the Pennsylvania Association of Community Health Centers, one of five groups in the state that are receiving the federal funds.

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