Category Archives: Healthy communities
Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar.
You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.
Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.
Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.
We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress.
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.
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?
How to Advance Minority Health? A Successful, Sustainable Effort to Promote Healthy Choices in Miami.
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, Lillian Rivera, RN, MSN, PhD, administrator/health officer for the Florida Department of Health in Miami-Dade County, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Rivera is an alumnus of the RWJF Executive Nurse Fellows program.
In order to address this question, it is important to identify the areas within your jurisdiction where there are identified health disparities and to develop initiatives with those needs in mind.
Miami-Dade County in Florida is one of the few counties in the United States that is “minority majority,” meaning the minority makes up the majority of the population. More than two-thirds of the 2.5 million residents are Hispanic; 19 percent are Black; more than 51.2 percent are foreign-born and most of them speak a language other than English at home (mostly Spanish and Creole); 19.4 percent live below poverty level; and 29.8 percent of the population under age 65 (more than 700,000 individuals) is uninsured .
Robert Atkins, PhD, RN, is associate professor of childhood studies and nursing at the Camden campus of Rutgers, the State University of New Jersey, and director of New Jersey Health Initiatives, a statewide grantmaking program of the Robert Wood Johnson Foundation (RWJF). He is an alumnus of the RWJF Nurse Faculty Scholars (NFS) program.
Human Capital Blog: Congratulations on your position as director of New Jersey Health Initiatives (NJHI). What is RWJF’s vision for the program and for the state?
Robert Atkins: Thank you. As the largest philanthropy in the country devoted specifically to health and health care, the vast majority of Foundation resources are, of course, targeted outside of New Jersey. However, New Jersey is the Foundation’s home state. Consequently, the Foundation has a history and connection to New Jersey that is distinctly different from other states and reflected in the kinds of grants made by the Foundation that benefit individuals, communities, and institutions in New Jersey. Although NJHI is only one facet of the Foundation’s philanthropy in the state, as the only national program office of the Foundation that focuses on a state, NJHI is “the face of the Foundation in New Jersey.”
The Foundation’s vision for NJHI and its other New Jersey or “backyard” grants is that they reflect the very best of what the Foundation can do to improve health and health care. I think this tradition of meeting the Foundation’s highest standards of excellence is evident in the legacy of NJHI, and it is a tradition that I feel privileged to sustain and improve upon.
Ruchi S. Gupta, MD, MPH, is an alumna of the Robert Wood Johnson Foundation Physician Faculty Scholars program. She is an associate professor of pediatrics and director of the maternal and child healthcare program at the Northwestern University Feinberg School of Medicine, and an attending physician at the Ann & Robert H. Lurie Children's Hospital of Chicago. Learn more at www.ruchigupta.com.
This past spring, 12 students with asthma at James Hedges Elementary in Chicago’s Back of the Yards neighborhood took hundreds of pictures, filmed video Public Serve Announcements (PSAs), created a website, and rolled out a community intervention to improve asthma conditions. These activities were part of the Student Media-Based Asthma Research Team, or SMART program. We developed this program from a previous pilot program in Chicago’s Uptown neighborhood that empowered students to learn about their asthma and challenged them to create change in their own communities.
As the most common chronic condition in children and the most common cause of school absenteeism, asthma is responsible for 13 million days of school missed each year. Asthma disproportionately affects racial and ethnic minorities, as African Americans and Hispanics/Latino children have significantly higher asthma-related morbidity and mortality rates compared to White children. While evidence-based guidelines for asthma care have been available for 20 years, ethnic minorities have a lower likelihood of receiving or following proper asthma treatment. Across and within racial/ethnic groups, asthma care has been shown to be more effective when it is tailored to the individual community instead of one-size-fits-all intervention.
Liana Orsolini-Hain, PhD, RN, ANEF,FAAN, is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program (20112012), through which she worked at the U.S. Department of Health & Human Services Immediate Office of the Secretary. This post is part of the "Health Care in 2013" series.
My New Year’s resolution for the U.S. health system involves all of us. During my tenure as an RWJF Health Policy Fellow in the Immediate Office of the Secretary of Health, I learned how a small percentage of Americans use up a majority of health care resources. The percentage of individuals who consume a high volume of resources will likely increase as we age, with little regard for our own level of health.
We all need to be a part of the solution to making access to health care and access to health sustainable for current and future generations by caring about and for our own health. Do we exercise regularly? Do we get enough sleep? Do we eat fruits and vegetables every day? Have we stopped smoking? Do we manage our stress levels? Do we practice what we preach?
Ten individuals who have overcome significant challenges to help improve health and health care in their communities will be named 2012 Robert Wood Johnson Foundation (RWJF) Community Health Leaders at an awards ceremony in San Antonio.
These remarkable individuals are providing vital health services to residents in their communities, from Anchorage, Alaska to Charleston, South Carolina, and in cities and towns in between. They are helping: refugees grappling with the after-effects of war; low-income workers without insurance; children facing obesity; survivors of sexual violence; senior citizens who live in remote, rural areas; and substance abusers at risk for overdose.
The 2012 Community Health Leaders Award recipients are:
- Kay Branch, MA, elder/rural health program coordinator, Alaska Native Tribal Health Consortium, Anchorage, Alaska;
- Fred Brason, CEO of Project Lazarus and Project Director of the Community Care Network Statewide Chronic Pain Initiative, Wilkes County, N.C.;
- Debbie Chatman Bryant, DNP, RN; assistant director for cancer prevention, control, and outreach, Hollings Cancer Center at the Medical University of South Carolina, Charleston, S.C.;
- Beth Farmer, MSW, international counseling and community services program director, Pathways to Wellness Project, Lutheran Community Services Northwest, Seattle;
- Amy Johnson, JD, executive director, Arkansas Access to Justice Commission, Little Rock, Ark.;
- Ifeanyi Anne Nwabukwu, RN, BSN, chief executive officer, African Women’s Cancer Awareness Association (AWCAA), Silver Spring, Md.;
- Cristina Perez, MA, director of community outreach and counselor, Women Organized Against Rape, Philadelphia;
- Marlom Portillo, executive director, Instituto de Educacion Popular del Sur de California (IDEPSCA), Los Angeles;
- Darleen Reveille, RN, senior public health nurse, Garfield, N.J.; and
- Kathi Toepel, director of senior services for the Mother Lode Office of Catholic Charities – Diocese of Stockton, Sonora, Calif.
Chrysanne Grund is Project Director for Greeley County Health Services in Sharon Springs, Kansas, and a recipient of a Robert Wood Johnson Foundation (RWJF) 2011 Community Health Leader Award. She has touched the lives of nearly every resident of Greeley and Wallace Counties in Kansas through her work providing access to free or low-cost prescriptions, developing a parenting class, providing breast cancer awareness information and cooperating with a co-located behavioral health project. She is also the founder of the Greeley-Wallace County Health Foundation, a two-community partnership that provides funds to local cancer patients. The Human Capital Blog asked Grund to reflect on her experience in the year since she was named an RWJF Community Health Leader.
What a surprise to find it has been almost a year since the 2011 Community Health Leader awards. In so many ways, the time has flown by and, in others, it seems like just yesterday. To continue the conundrum, I have found that my life has changed in some immeasurable ways and yet, once again, is very much the same.
As a rural health worker in very frontier Western Kansas, I wear many hats. I am often health care professional, volunteer, coordinator and Mom all at the same time. The level of recognition the Community Health Leader (CHL) Award brought to my work, and most important to my health system, has been very gratifying and professionally rewarding. It is a thrill to be recognized for excellence.
My co-workers, colleagues and community members have been very gracious in their efforts to celebrate the award. There is a level of credibility that comes with this type of award that can’t be duplicated. I was once introduced as a “respected rural health leader in Kansas” and had to look around to be sure it was me! We do our work because it is important to us, we understand what it means to take care of our patients and our community and daily navigate the challenges of doing so. I’m happy to be the flag-bearer in representing rural health needs because I truly believe they are as important and relevant as those of any community. I was, and am, committed to that cause.
Human Capital News Roundup: Dental care for underserved children, HIV/AIDS testing, "mixed-use" neighborhoods, and more.
Around the country, the news media is covering the groundbreaking work of Robert Wood Johnson Foundation scholars, fellows and grantees. Here are some examples.
“Louisville [Kentucky] is going high-tech to try to figure out what’s behind the city’s problem with asthma,” the Courier-Journal reports. The city will use technology developed by Robert Wood Johnson Foundation (RWJF) Health & Society Scholars alumnus David Van Sickle, PhD, MA, that uses global-positioning technology to capture where and when asthma patients use their inhalers. Read a Human Capital Blog Q&A with Van Sickle on his work and upcoming projects.
Lisa Berkman, PhD, a Health & Society Scholars program site director at Harvard University, spoke to U.S. News & World Report about “Why Good Friends Make You Happy.”
Lucy Marion, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program and dean of Georgia Health Sciences University (GHSU) College of Nursing, was recently interviewed by the Augusta Chronicle for two separate articles. She discussed the merger of the nursing programs at GHSU and Augusta State University, and the work of the Greater Augusta Healthcare Network, which she helped found.
"Just about everyone now has heard of someone they know who's done something online that they wish they hadn't done,” RWJF Clinical Scholars alumnus Ryan Greysen, MD, MA, told Health Day. Greysen is the lead author of a study that examined the pervasiveness of physician misconduct online and the repercussions of those actions. “I think the message is that medical professionals are responsible for what they put online—not only responsible for the information, but accountable,” he said.
The Pine Journal (Cloquet, Minn.) spoke to Executive Nurse Fellow Julie Myhre, MS, BA, RN, PHN, about a local initiative to provide reduced-cost dental services for underserved children. Myhre, who is part of the Northeast Minnesota Oral Health Project, said the lack of adequate dental care for children has reached an “epidemic level.”