Category Archives: Social Determinants of Health

Nov 21 2014
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Ebola as an Instrument of Discrimination

Jennifer Schroeder, Stephanie M. DeLong, Shannon Heintz, Maya Nadimpalli, Jennifer Yourkavitch, and Allison Aiello, PhD, MS, professor at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This blog was developed under the guidance of Aiello’s social epidemiology seminar course.

Allison Aiello Allison Aiello

Ebola is an infectious disease that the world has seen before in more moderate outbreaks in Africa. As the devastating Ebola outbreak in West Africa has taken a global turn, fear, misinformation and long-standing stigma and discrimination have acted as major contributors to the epidemic and response. Stigma is a mark upon someone, whether visible or invisible, that society judgmentally acts upon. Ebola has become a significant source of stigma among West Africans and the Western world.

In many ways, the source of this discrimination can be traced back to the legacy of colonialism and the western approach to infectious disease response in Africa. The history of foreign humanitarian aid has sometimes dismissed cultural traditions and beliefs. As a consequence, trust in westerners has eroded and has been compounded by a disconnect between western humanitarian aid approaches and a lack of overall infrastructure investment on the part of African national health systems. This is apparent in the Ebola epidemic in West Africa. Some don’t actually think that Ebola exists; instead they believe that it is a hoax carried out by the Western world. All of these factors are facilitating the rapid spread of the disease.

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Nov 19 2014
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The Imperative to Improve Health Literacy

Joy P. Deupree, PhD, MSN, APRN-BC, is an assistant professor at the University of Alabama (UAB) School of Nursing and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. She is engaged in community participatory research studies on health literacy. For 12 years, Deupree has taught a campus-wide elective on health literacy and has been a guest lecturer on the topic at the UAB schools of medicine, dentistry and public health. She founded the Alliance of International Nurses for Improved Health Literacy and established a nursing special interest group for the Health Literacy Annual Research Conference.

Joy Deupree

Health literacy is extremely important to building a culture of health. Basic understanding of health care information is essential if people are to live healthy lives, but an alarming number of American adults report poor understanding of health care instructions. 

This year marks the 10-year anniversary of the Institute of Medicine (IOM) report, Health Literacy: A Prescription to End Confusion.While progress has been made, the work has really just begun. We can no longer blame the patient for poor health literacy, and we should keep in mind that limited health literacy affects us as all and contributes to increased health care costs. 

American Public Health Association Meeting & Expo

The IOM report defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” These skills involve not only reading ability but also numeracy. Failure to develop the necessary skills to manage health care can cost millions of dollars as well as add to human suffering and even cause death.

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Nov 19 2014
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Population Sickness and Population Health: How Geographic Determinants Differ

Tamara G.J. Leech, PhD, is an associate professor in the Department of Social and Behavioral Sciences at the Indiana University Richard M. Fairbanks School of Public Health, and a former Robert Wood Johnson Foundation (RWJF) New Connections program grantee. She is principal investigator of a William T. Grant Scholar Award, “Pockets of Peace: Investigating Urban Neighborhoods Resilient to Adolescent Violence.”  

Tamara G. Leech

I am particularly excited about the American Public Health Association’s (APHA) Annual Meeting theme this year—Healthography! My research team has spent the past two years examining “cold spots” of urban youth violence. In other words, we have been analyzing areas where—regardless of the increased risk for violence—violence is not occurring or is rarely occurring. This is a departure from the dominant form of research on “hot spots” of violence, or any disease for that matter.  

American Public Health Association Meeting & Expo

For some, this approach has been puzzling. It’s not immediately obvious that the determinants of cold spots are not simply the opposite of the determinants of hot spots.  However, our evidence clearly suggests that the things that help to make a location healthy go well beyond the things that protect a location from high rates of illness.

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Nov 18 2014
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The Stuff That Is Killing Us

Ronald M. Wyatt, MD, MHA, is medical director in the Division of Healthcare Improvement at The Joint Commission. In this role, he promotes quality improvement and patient safety to internal and external audiences, works to influence public policy and legislation for patient safety improvements, and serves as the lead patient safety information and education resource within The Joint Commission. On December 5, RWJF will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.

Ron Wyatt

I first met Don Erwin, MD, in 2010. He was CEO of the St. Thomas Clinic in New Orleans. I sought him out on the recommendation of the CEO of the Institute for Health Care Improvement (IHI), Donald Berwick, MD. I was a fellow of the IHI, and Berwick and I had conversed about inequities in the U.S. health care system. He advised me to travel to New Orleans to speak with Erwin, who would give me insight that would be important to the project that I was working on: “Disparity in the Deep South.”

Scholars Forum 2014 Logo

Erwin was very welcoming and asked why I was there.  In a very academic tone, I told him that I was there to better understand the non-medical determinants of health. With a semi-puzzled look on his face, Erwin asked what I meant. Now I became puzzled and a bit uncomfortable. My response was that I was interested in learning more about the role of social determinants on health.  Erwin said, “Ron, I am not sure what you are talking about.” 

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Nov 18 2014
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On Balance and Contrast

For the 25th anniversary of the Robert Wood Johnson Foundation’s 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 Nicole Stern, MD, member of the class of 1991.

Nicole Stern, MD Nicole Stern, MD

First, there’s her heritage: her father is Jewish, her mother full-blooded Mescalero Apache. Then there’s her training: Stern is board certified in internal medicine and sports medicine. And as a woman practicing sports medicine, she is an uncommon presence in a male-dominated profession.

“I certainly have a lot of dual things in my life,” she muses.

Stern’s cultural background gives her a unique vantage point on health care, particularly the disproportionate number of Native versus non-Native practitioners. According to the Association of American Medical Colleges, American Indians represent less than 1 percent of physicians.

As president of the Association of American Indian Physicians (AAIP) from 2012 to 2013, Stern pushed to increase the pipeline of American Indian and Alaska Native medical students. She continues to support AAIP in reversing what she calls a “flatline” in applicants and matriculants from Native populations.

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Nov 17 2014
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Ending Health Inequality, Addressing the Social Determinants of Health

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. On December 5, LaVeist will moderate the first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.

Thomas LaVeist

Research has amply demonstrated that social and economic forces are important determinants of health. They affect where and how people live, work, learn and play; their patterns of social engagement; and the financial and social resources available to them. They thereby shape their health and length and quality of life. 

Scholars Forum 2014 Logo

The World Health Organization’s Commission on Social Determinants of Health suggested four strategies in which policy can be deployed to address health inequalities:

  • decreasing social stratification (e.g., power, prestige, wealth, human capital, etc.);
  • decreasing exposure to risk;
  •  lessening the vulnerability or improving the ability of disadvantaged persons to cope with risk; or
  • intervening through health care to reduce the unequal consequences of social determinants.

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Nov 17 2014
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What Determines Your Health?

Minoo Sarkarati, BA, is a third-year medical student and Robert Wood Johnson Foundation (RWJF) Health Policy Scholar at Meharry Medical College. She completed her undergraduate degrees of psychology and integrative biology at the University of California, Berkeley. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.

Minoo Sarkarati

What determines your health?  Is it your zip code? Is it the clinic or hospital you go to? Is it the physician you see? Or is it you?

American Public Health Association Meeting & Expo

I could not say that the answer to this critical question is solely any one of these. However, understanding how each component plays a role in one’s health, as well as exploring further determinants, is vital to building healthier communities.

This year’s American Public Health Association (APHA) Meeting theme is Healthography. It is an opportunity to explore how our environment—whether it is access to clean air, safe housing, transportation, healthy foods, safe places to exercise, jobs, or quality health care—plays a role in our health. 

As a medical student training in a safety-net hospital, I have seen how each of these elements plays a role in one’s health. Without addressing these factors, a large part of medical care is lost. Encouraging regular exercise is not so simple when you do not have sidewalks or green spaces, or you do not feel safe being outside in your neighborhood. Writing a prescription to treat diabetes becomes meaningless if your patient cannot fill it because he/she does not make enough income to purchase the medication.

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Nov 14 2014
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Are You Going to the American Public Health Association Meeting Next Week?

During this year’s American Public Health Association (APHA) Annual Meeting & Exposition, 10 Robert Wood Johnson Foundation (RWJF) grantees will give short talks at the first-ever RWJF Briefings @ the Booth on Monday, November 17 and Tuesday, November 18. Grantees from a variety of programs, representing numerous health and health care sectors, will share their insights on topics ranging from health literacy to obesity interventions to green building certification.

American Public Health Association Meeting & Expo

The briefings will take place at the RWJF exhibit space in the Ernest N. Morial Convention Center.

Grab a cup of coffee at the RWJF café and join a briefing! The schedule follows.

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Nov 14 2014
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Misfortune at Birth

Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.

Eileen Lake (Smaller photo) Eileen Lake

Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity.  It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery.  It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.

A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior?  A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals.  Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives. 

Jeannette Rogowski Jeannette Rogowski

A Brighter Future

What can be done to make these hospitals better?  A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.

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Nov 3 2014
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Achieving Impossible Dreams

For the 25th anniversary of the Robert Wood Johnson Foundation’s 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 Gloria Sanchez, MD, a member of the 1993 class.

Gloria Sanchez, MD Gloria Sanchez, MD

Can a person thrive in a community ravaged by poverty? Are seemingly impossible dreams attainable?

Gloria Sanchez, MD, grapples with these questions every day, both in her medical practice and while teaching aspiring physicians.

Sanchez is associate program director of the Department of Family Medicine at Harbor–UCLA Medical Center, a publicly funded hospital in Los Angeles. She also oversees UCLA’s PRIME MSIII Primary Care Longitudinal course, which trains medical students to be medical leaders in underserved communities.

The lives of patients Sanchez treats are shaped by social determinants of health—forces that dictate poor health outcomes based on ZIP code more than genetic code. Where you live, work, and play has a profound effect on individual, family, and community health, she says.

“How can someone who doesn’t have a level playing field still attain their goals?” she asks, citing research showing that the stress of social and economic disadvantage contributes to chronic disease. “Poverty can literally change your brain, and your health.”

Noting that Harbor–UCLA Family Medicine’s mission is to advocate for disenfranchised populations, Sanchez says, “That’s why I entered medicine. It may sound impossible, but I’m here to help people attain good health so they can achieve their dreams.”

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