Category Archives: Social determinants of health

Jul 28 2014
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What Protects Our Children from the Effects of Stress?

Lorraine McKelvey, PhD, is an associate professor of family and preventive medicine and pediatrics at the University of Arkansas for Medical Sciences. She is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program (2008-2009) whose work focuses on vulnerable populations.

Lorraine McKelvey New Connections 2014sm

For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.

Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!

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Jul 24 2014
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RWJF Scholars in the News: Stereotype threat, hand hygiene, misbehaving science, 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:

Anxiety caused by “stereotype threat” could help explain health disparities that persist across race, suggests research co-authored by Cleopatra Abdou, PhD, an RWJF Health & Society Scholars program alumna. News Medical covers the study, describing it as the first of its kind to empirically test, in the context of health sciences, the impact of the “threat of being judged by or confirming a negative stereotype about a group you belong to.” Abdou’s research offers a possible explanation for ethnic and socioeconomic differences in morbidity and mortality between Black and White women because, as Abdou says, the research goes beyond nature vs. nurture, “bringing situation and identity into the equation.” For example, in the study, Black women with a strong connection to their race had the highest anxiety levels when in waiting rooms filled with posters that displayed negative health-related racial stereotypes dealing with such topics as unplanned pregnancy and AIDS.

Having health insurance improves access to medical care for pregnant, low-income women, and results in long-term health benefits for their babies, according to a study by RWJF Scholar in Health Policy Research Sarah Miller, PhD, and RWJF Health & Society Scholar Laura Wherry, PhD, that was reported by Vox. Miller and Wherry found the expansion of Medicaid in the 1980s made prenatal care much more accessible to low-income women, many of whom would otherwise have been without insurance. The result was improvements in obesity, preventable hospitalizations, and preventable, chronic disease-related hospitalizations among children. 

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Jul 22 2014
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A Closer Look at Contributors to Stress for Latinos

Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico (UNM), executive 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. 

Gabriel Sanchez, PhD Gabriel Sanchez, PhD

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.

Yajaira Johnson-Esparza Yajaira Johnson-Esparza

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. 

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Jul 2 2014
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RWJF Scholars in the News: Menopause and heart disease, nurses and health care finance, 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: 

Changes in hormone levels during early menopause could be linked to an increased risk of heart disease, finds a new study co-authored by RWJF Health & Society Scholars program alumna Rebecca Thurston, PhD. Health Canal covers the study, describing it as a first-of-its-kind evaluation because it used nuclear magnetic resonance spectroscopy to assess the lipoproteins that carry cholesterol through the blood, rather than relying on conventional blood tests. Thurston’s study was published in the Journal of Lipid Research.

For Alice Goffman, PhD, an RWJF Scholars in Health Policy Research alumna, an undergraduate assignment turned into a six-year study of a low-income Philadelphia neighborhood in which, she concluded, “the young men in this community feel hunted.” In the resulting book, On the Run: Fugitive Life in an American City, Goffman says that a “climate of fear and suspicion pervades everyday life” in the community. The New York Times Sunday Book Review calls Goffman’s work “riveting” and her ability to understand her subjects “astonishing.”

The Colorado Department of Health Care Policy and Financing has received a $13.6 million grant from the federal Centers for Medicare and Medicaid Services to integrate and coordinate physical, behavioral, and social-health needs for people enrolled in both Medicare and Medicaid, reports the Northern Colorado Business Report. The story quotes Susan Birch, MBS, BSN, RN, executive director of the department: “This grant allows Colorado to coordinate our members' care, while achieving greater value and health outcomes for our citizens who are on both Medicare and Medicaid.” Birch is an RWJF Executive Nurse Fellows alumna.

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Jun 30 2014
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Sharing Nursing’s Knowledge: The June 2014 Issue

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.

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Jun 26 2014
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RWJF Scholars in the News: Unemployment and suicide, prescription painkiller abuse, veterans’ care, 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 generous unemployment benefits can lead to lower suicide rates, according to a study co-authored by RWJF Health & Society Scholars program alumna Maria Glymour, MS, ScD. The Huffington Post covers the study, describing it as the first of its kind to reach that conclusion. Glymour and colleagues speculate that higher benefits help mediate some of the stressors that contribute to suicide.

A survey of licensed nurses in Wyoming examines factors involved in their decisions about whether to continue their education. In a Wyoming Business Report story, Mary Burman, PhD, RN, an alumna of the RWJF Executive Nurse Fellows program, notes that the Institute of Medicine’s Future of Nursing: Leading Change, Advancing Health report recommends that 80 percent of nurses have baccalaureate degrees or higher by 2020. She says findings from the new survey point to strategies that might help achieve that goal, noting “the positive role that employers can play by encouraging and supporting nurses to return to school for their baccalaureate degree.” Burman is dean of the University of Wyoming’s Fay W. Whitney School of Nursing, which collaborated on the survey.

Nicholas King, PhD, MA, an RWJF Health & Society Scholars program alumnus, investigates the sharp increase in deaths from prescription painkillers in the United States and Canada over the past 20 years, reports Medical Xpress. King and colleagues analyzed research about the “epidemic,” concluding that Internet sales and errors by doctors and patients have not played a significant role in the increase. Rather, they “found evidence for at least 17 different determinants of increasing opioid-related mortality, mainly, dramatically increased prescription and sales of opioids; increased use of strong, long-acting opioids like OxyContin and methadone; combined use of opioids and other (licit and illicit) drugs and alcohol; and social and demographic factors.” Outlets covering King’s work include the Toronto Sun, Fast Company, and the National Pain Report

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Jun 13 2014
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Neonatal Nurse Practitioner Advocates for Culturally and Linguistically Appropriate Services

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).

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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.

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Jun 6 2014
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The Role of Primary Care Providers in Changing the Culture of Care in Communities

The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting, and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. The first webinar addressed the responsibility of health delivery organizations to strengthen community health and the ways primary care providers can address social determinants of health.  It featured leaders from four primary care sites around the country that the LEAP program has deemed exemplars.

Bringing Change to a Low-Income Community in Philadelphia

Patricia Gerrity, PhD, RN, associate dean for community programs at Drexel University and director of 11th Street Family Health Services at Drexel University, discussed the origins and work of her clinic, which is a partnership with the Philadelphia Housing Authority (PHA) that began in 1996. In response to a letter between the University and the PHA, Gerrity worked to gain mutual trust with the aim of improving the residents’ health status.

Getting started wasn’t easy, Gerrity noted.  To achieve some wins, she assigned a public health nursing faculty member from Drexel to each public housing development. The nurse faculty members asked residents about pressing problems—and then became partners in solving them. For instance, residents said car accidents were an issue, so stop signs were put up. Residents wanted to learn CPR, so training was offered. Residents expressed concerns about dog bites, so they worked with Animal Control to remove stray dogs. “We had to have some short term wins to gain trust,” Gerrity said. 

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Jun 2 2014
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Building a National Resource Center for HIV Prevention from the Ground Up

Ann H. Cary, PhD, MPH, RN, is dean and professor at the School of Nursing and Health Studies at the University of Missouri-Kansas City. She was a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow from 2008 to 2011.

Ann Cary

Human Capital Blog: Congratulations on the grant from the Centers for Disease Control and Prevention (CDC) to support the creation of a national resource center for HIV prevention at the School of Nursing and Health Studies at the University of Missouri-Kansas City! What will your role be at the center?

Ann H. Cary: My role is to ensure that the new center has the institutional resources it needs to succeed. This translates into procuring space reallocation and furnishings; supporting personnel hires; consulting with the CDC grant leadership team to remove organizational barriers; assisting in solving any challenges to the center’s rollout; and telling the story about this project through institutional messaging to our community, the discipline of nursing, and to other stakeholders and partners.

HCB: What is your vision for the center?

Cary: That the National HIV Prevention Coordinating Resource Center grant results in a center that leads and coordinates products for providers and the communities they serve to ultimately improve the prevention and treatment of  people living with, or at risk of, acquiring HIV.

HCB: The center will be housed at a school of nursing and health studies. Why is that important?

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May 30 2014
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A Table for Change at the Center of a 'Culture of Health'

Justin List, MD, MAR, is a Robert Wood Johnson Foundation/VA Clinical Scholar and primary care general internist at the University of Michigan. His research interests include community health worker evaluation, social determinants of health, and improving how health systems address the prevention and management of non-communicable diseases.

Justin List

Recently, the Robert Wood Johnson Foundation announced a shift from its focus on health care toward building a “culture of health.” As a buzz phrase, “culture of health” carries promise to transform how Americans think about health, but it carries a risk to mean so many things as to dilute its meaning. For example, I saw a recent picture on Twitter where two people anonymously answered “what does the culture of health mean to you?” with “feeling guilty for not taking a sick day.” If we think of the culture of health as a web of health experiences, that answer might be best placed somewhere along an outer ring of the web. But what would be at the center of the phrase’s web of meaning?

To start, a culture of health goes beyond the health care system and incorporates every day experiences and choices people make that affect their health. Building a culture of health means not only looking at clinics and hospitals under the microscope but also looking more closely at how our communities impact health. The culture of health concept offers every person in America a larger vision and momentum for changing how Americans experience health, and it requires everyone’s participation to make change happen.

As a physician, I struggle with what role my colleagues and I play in building a true culture of health. Recent obesity statistics may suggest we’re not so effective. Obesity rates fell for children ages 2 to 5 years old since 2003-2004, according to researchers from the Centers for Disease Control and Prevention. Meanwhile, obesity rates remained essentially unchanged for most other age groups and even higher in women in over 60. From the health system side of the equation, why might that be?

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