Collins O. Airhihenbuwa, PhD, MPH, is professor and head of the Department of Biobehavioral Health at Penn State University. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.
As we address disparities and inequities, the challenge is to think about solutions and not simply defining the problem. Most would agree that health is the most important part of who we are. It is the first thing we think about in the morning when we greet one another by asking, “How are you this morning?” It is the last thing we think about at night when we wish someone a restful night.
What may be different is what health means to us and our families. This is why place and context are important. How we think about health and what we choose to do about it is very much influenced by where we reside. Our place and related cultural differences about health are less about right or wrong and more about ways of relating and meeting expectations our families and communities may have of us, whether expressed or perceived. More than that is the way we relate to what our place means in terms of how it is defined and subsequently how that definition shapes how we define it for ourselves. In other words the ‘gate’ through which we talk about our place and ourselves is very important in having a conversation about who we are and what that means for our health.
For the 25th anniversary of the Robert Wood Johnson Foundation’s (RWJF) Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Rachel Torrez, MD, a member of the Class of 1990.
The year was 1992. Rachel Torrez, a second-year medical student, was in line waiting for coffee at the University of Washington when a White male student confronted her.
“You took my best friend’s spot because of quotas,” he sneered.
The granddaughter of Mexican migrant workers, Torrez enrolled at a time when students of color were few and some people—especially in Washington state—were questioning the fairness of affirmative action. Clarence Thomas, an outspoken opponent of affirmation action, had recently joined the Supreme Court.
“We don’t have quotas,” Torrez shot back. “I took your best friend’s spot because I was smarter.”
That mix of brains and backbone is characteristic of Torrez, who conquered severe dyslexia and cultural constraints on her way to an MD. Now a family-practice physician in the Ballard neighborhood of Seattle, Torrez gives as good as she gets.
Karen Johnson, PhD, RN, is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and an assistant professor at the University of Texas at Austin School of Nursing. Her research focuses on vulnerable youth. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.
As Americans, we love stories about people who beat the odds and achieve success. We flock to movie theaters to watch inspiring tales—many times based on true stories—of resilient young people who have overcome unthinkable adversities (e.g., abuse, growing up in impoverished, high-crime neighborhoods) to grow into healthy and happy adults. Antwone Fisher, The Blind Side, Precious, and Lean On Me are just a few of my personal favorites that highlight the very real struggles faced by adolescents like those I have worked with as a public health nurse. My work with adolescent mothers and now as an adolescent health researcher has convinced me of the critical importance of focusing on promoting health and resilience among adolescents at-risk for school dropout.
How often do we as a society really sit down outside the movie theater or walls of academia and talk about why these young people are at risk for poor health and social outcomes in the first place, or what it would take to help them rise above adversity? If we look closely at the storylines of resilient youth, we will notice a number of similarities. Being resilient does not happen by chance: it takes personal resolve from the individual—something our American culture has long celebrated. And it takes a collective commitment from society to maintain conditions that empower young people to be resilient, and that is something that we as a society do not recognize or invest in nearly as often.
At 4 p.m. ET (1 p.m. PT) tomorrow, Tuesday, December 9, 2014, the Robert Wood Johnson Foundation’s LEAP project will hold a webinar on innovations in the primary care workforce, and the project’s new online resource, the Improving Primary Care Team Guide. To join Tom Bodenheimer, MD, MPH, professor, Family & Community Medicine, University of California San Francisco, Lisa Letourneau, MD, MPH, executive director, Maine Quality Counts, and the LEAP Team for this free webinar, register here.
Thomas LaVeist, PhD, is founding director of the Hopkins Center for Health Disparities Solutions, and the William C. and Nancy F. Richardson Professor in Health Policy at the Johns Hopkins Bloomberg School of Public Health. He is the chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College. LaVeist will moderate the first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health today, beginning at 10 a.m. Eastern Time. Follow the hashtag, #RWJFScholarsForum, on Twitter for more.
Yesterday I had Camara Phyllis Jones, PhD, MD, MPH, as guest lecturer for my seminar on health disparities. It was a homecoming of sorts for her. She and I first met in the early 1990s when I was a newly minted assistant professor and she was a PhD student at the Johns Hopkins Bloomberg School of Public Health. Jones’ work should be well known to readers of this blog. She has published and lectured on the effects of racism on health and health disparities for many years. She played a leading role in the Centers for Disease Control and Prevention’s work on race, racism, and health in the Behavioral Risk Factor Surveillance System. And she was just elected president-elect of the American Public Health Association. She is a fantastic lecturer and often uses allegory to illustrate how racism affects health.
About midway through her lecture, a student raised his hand and got her attention to ask a question about the utility of “naming racism.” My interpretation and rephrasing of his question—is it helpful to use the word racism or is the word so politically charged and divisive that it causes people to “tune you out?”
The student’s question raises a major challenge for those of us who seek to address health disparities. On one hand racism is fundamental to understanding why disparities exist and persist. I would go as far as to state that in most race disparities research, race is actually a proxy measure for exposure to racism. But, on the other hand, the word racism makes some people uncomfortable, causing them to become defensive or sometimes simply block out your message.
Alden M. Landry, MD, MPH, is an emergency medicine physician at Beth Israel Deaconess Medical Center in Boston and an alumnus of the Robert Wood Johnson Foundation (RWJF) Summer Medical and Dental Education Program. Landry, 32, is also co-director of Tour for Diversity in Medicine. On December 5, he will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
Tour for Diversity in Medicine (T4D) is a grassroots effort to educate, inspire, and cultivate future physicians and dentists of diverse racial and ethnic backgrounds by forming local connections in order to fulfill a national need. Our concept is simple: Visit students on their home turf; motivate them by introducing them to young, enthusiastic physicians and dentists; and give them the information that they need to be successful.
We carefully select mentors based on not only their roles in medicine and dentistry but how they got there. Our mentors are the first in their families to have attended college. Some are first-generation U.S. citizens. They come from single-family homes or families where they are the first to enter a career in medicine. They are gay and straight, married and single. They are passionate about their communities and their careers.
Our mentors do have one thing in common: we intentionally select mentors who are young in their careers and recent to the journey.
Ed Wagner, MD, MPH, is director emeritus of the MacColl Center for Health Care Innovation. A general internist and epidemiologist, Wagner was founding director of Group Health Research Institute.
Better care. Healthier patients. Happier staff. A new online resource provides practical, hands-on tools to build better primary care teams that can put those outcomes within reach.
Nationwide, primary care practices are finding that creating more effective practice teams is the key to becoming a patient-centered medical home, improving patients’ health, and increasing productivity. The Improving Primary Care Team Guide (Team Guide) is a free online resource for primary care practices working to do just that. It:
- Provides hands-on tools and resources that are actionable and measureable
- Is appropriate for practices at any stage of development
- Includes modules that enable practices to easily pinpoint relevant topics and areas of interest
The new Team Guide presents practical advice, case studies, and tools from 31 exemplary primary care practices across the country that have markedly improved care, efficiency, and job satisfaction by transforming to a team-based approach. For the last three years, with funding from the Robert Wood Johnson Foundation (RWJF), the LEAP team has identified, studied, and engaged these practices to develop the lessons contained in the Team Guide.
Katherine Diaz Vickery, MD, MSc, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, an assistant professor of medicine at the University of Minnesota Medical School, and a clinician-investigator in the Division of General Internal Medicine at Hennepin County Medical Center. On December 5, she will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
People who know me–even just a little–know of my pride for my home state of Minnesota. While there are beautiful lakes, biking trails, farmer’s markets, and a ridiculous state fair (that takes special pride in its offerings of various types of food-on-a-stick), there’s something more... Minnesota has been making strategic efforts to improve the health of its communities for many years.
If I could bring you to Minnesota today (bundle up!), I’d show you what I mean by taking you to Hennepin County Medical Center (HCMC) and specifically to a meeting of the patient advisory board of the Hennepin Health Accountable Care Organization (ACO).
I would introduce you to Jorge, a Mexican-American whose road to recovery from severe depression was paved by his multi-disciplinary care team from Hennepin Health. Jorge might tell you about Susan, the social worker who helped him find transitional housing. Or Lucky, a community health worker who gave him a voucher to get a haircut, a toiletry bag, and helped him find a primary care medical home. And if he really opened up, he might tell you of his career aspirations to take courses to supplement his graduate degree from Mexico and become a family therapist or community health worker.
Susan B. Hassmiller, PhD, RN, FAAN, directs the Future of Nursing: Campaign for Action, which is implementing recommendations from that report. Hassmiller also is senior adviser for nursing for the Robert Wood Johnson Foundation.
In 2013, the Institute of Medicine released a report, U.S. Health in International Perspective: Shorter Lives, Poorer Health, that compared the United States with 16 other affluent nations. The United States ranked last or near last on nine key indicators: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This is despite the fact that we spend significantly more on health care than any other nation.
I believe there are five ways nurses can contribute to improving these conditions in 2015.
Nurses Can Help Us Build a Culture of Health
In a Culture of Health, the goal is to keep everyone as healthy as possible. That means promoting health is as important as treating illness. Unless everyone in the country joins this effort, we will remain at the bottom of the list of healthiest nations. “Everyone” means all health care workers, business owners, urban planners, teachers, farmers and others, including consumers themselves. Nurses especially understand wellness and prevention, and have a special role to play in building a Culture of Health.
Stress and Family Support – Two Important Social Determinants of Health for Hispanic/Latino Communities
Rosa M. Gonzalez-Guarda, PhD, RN, CPH, FAAN, is an assistant professor at the University of Miami, School of Nursing & Health Studies and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. On Friday, December 5, she will be a panelist at the RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
My research has focused on understanding and addressing behavioral and mental health disparities experienced by Hispanic/Latino communities. Although I initiated my research looking at substance abuse, violence, HIV and mental health as separate conditions that often co-occurred in marginalized communities, I soon realized that these conditions were just symptoms of an underlying phenomena— something my colleagues and I refer to as the Syndemic factor.
We have been studying the social determinants of the Syndemic factor in hopes of developing culturally tailored interventions that can potentially address multiple behavioral and mental health outcomes for the Hispanic/Latino community. From this research we have learned that interventions that address stress and family support offer promise for this community.