Category Archives: Poor and economically disadvantaged
Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado. Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.
Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?
We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation). I had learned about hands-only CPR in my medical training. Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.
But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart. Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.
Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?
In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health. After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.
After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?
Human Capital News Roundup: Income-based discrimination, nursing education, bans on sugary drinks, 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 and grantees. Some recent examples:
“As a physician, I have seen the tremendous capabilities of nurses – capabilities that are essential to meeting patient needs,” RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, writes in a June 14, 2012 post on MedScape Today [free subscription]. “But to ensure that they maximize their contributions to health and health care, nurses will need advanced skills and expertise in care management, interdisciplinary teamwork, problem solving, and more. This makes higher levels of education imperative. In addition, having a larger pool of highly educated nurses will be necessary to expand the ranks of nurse faculty, addressing the shortfall that now causes nursing schools to turn away thousands of qualified applicants each year. These advanced degree nurses are also needed to help ameliorate the worsening primary care shortage.” The piece was reprinted from Pediatric Nursing.
RWJF Health & Society Scholar Amy Non, PhD, MPH, is the lead author of a study that finds a significant association between low education levels and hypertension in African Americans. The findings debunk the theory that African ancestry plays a role in the disproportionately high rates of hypertension. U.S. News & World Report, Health magazine, and MSN Health are among the outlets to report on the findings. Read more about the study.
United Press International (UPI) and the Journal Sentinel (Milwaukee, Wis.) report on a study led by Thomas Fuller-Rowell, PhD, also a Health & Society Scholar, that finds social-class- and income-based discrimination harms child health. Read more about the study.
Tamar Mendelson, PhD, is an assistant professor at the Johns Hopkins Bloomberg School of Public Health, and an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006). Her research interests include the development of prevention and intervention strategies for reducing mental health problems, with a focus on underserved urban populations. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health. Mendelson is a member of the program’s 2nd cohort.
Anyone who's ever spread a yoga mat across a floor will tell you that it's about more than flexibility. One of many benefits of yoga is that it helps those who practice it deal with stress in their lives. An emerging body of research points to the conclusion that yoga can have a stress-relieving effect.
One problem with the research base is that it's mostly focused on adults. But grown-ups aren’t the only ones who deal with stress in their lives. Children face it as well, and they often do it without the same resources—emotional, financial and otherwise—that adults have.
Are 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 latest nursing news, research and trends. Here’s a review of what’s in the January issue:
Read about the remarkable journey of RWJF Community Health Leader Jamie Kamailani Boyd, who made a long and arduous climb out of poverty and is now helping others do the same. She has created an academic program called Pathway Out of Poverty, which helps disadvantaged Hawaiians become nurse’s aides and registered nurses.
Several alumni of the RWJF Executive Nurse Fellows program are using the leadership and risk-taking skills they gained in the program to support Partners Investing in Nursing's Future projects in their home states.
This piece examines some of the early work that laid the foundation for even more innovative and ambitious RWJF programs to build nursing leadership, improve nurse education, strengthen the nursing workforce and, ultimately, improve health and health care. Read about former RWJF staff member Terrance Keenan, who influenced the Foundation’s early investments in nursing programs and initiatives.
As the economic downturn made hunger and food insecurity more common last year, RWJF Scholars and alumni stepped up to help in their communities. Read about their work, individually and through their nursing schools.
February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.
Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?
John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.
HCB: Tell us about the school-based programs you put in place.
Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.
We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.
HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.
Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.
The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Suzanne Gagnon, CFNP, RWJF Nursing and Health Policy Fellow, RWJF Nursing and Health Policy Collaborative at the University of New Mexico.
I live, work and study in a state that has one of the highest poverty rates in the nation. It is difficult for me as a nurse practitioner to focus my New Year’s resolution on the health care system. Yes there are health care system problems and complicated ones, but I cannot remove my gaze from the impact of abject poverty and its effects on health. Until New Mexico addresses its poverty, health care will continue to be a trailer indicator, not a primary factor for the state’s overall impact on quality of life.
I work at a School-Based Health Center in a low-income area high school in Albuquerque. I have many patients who have no other means of receiving health care due to immigration status or income-related constraints. I had a student last year who had just moved to New Mexico from another state and wondered why the amount of food stamp assistance he and his mother received was so little in comparison to his previous state. He says: “I’m so hungry all the time, I can never get enough to eat, we don’t have enough to last all month. Why is it like that here?”
We are failing our children and families in fundamental ways. I cannot supply that child with enough food by making changes in the health care system, but eventually the effects of his hunger and poverty will affect the health care system. Currently his poverty and hunger are making a huge impact on his ability to succeed as a student. Elizabeth Bradley and Lauren Taylor nailed this topic in their December 8, 2011 New York Times article, ‘To Fix Health, Help the Poor.’ They pointed out the differences between our country’s investment in health care versus social support. While we spend one dollar on health care and 90 cents on social services, other countries spend the same for health care but double that for social services. Investing in social services can do more to improve health than additional health care reforms.
A December 29, 2011 op-ed in the Albuquerque Journal by Angela Merkert and Wendy Wintermute, respectively the executive director and advocacy program director of Cuidando Los Ninos and A Home for Every Child, lists the staggering statistics that impact our state’s homeless population:
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Corina Graif, PhD, RWJF Health & Society Scholar at the University of Michigan, Ann Arbor.
In the New Year I hope that our thinking about housing policy will more systematically incorporate the expanding evidence and relevance of housing conditions for population health and health care policy. Many aspects of internal housing conditions are known to affect health. For instance, heating, ventilation, mold and lead are linked to cardiovascular health, excess mortality, asthma, disability, intellectual functioning, ADHD [Attention Deficit Hyperactivity Disorder] and delinquent behavior.
We are also learning more and more about the health relevance of various characteristics of the physical environment surrounding one’s residence. For example noise, spatial proximity to vegetation, to grocery shops and to highways, and other sources of air pollution are linked to cardiovascular, mental health, obesity, asthma and allergic effects. Limited but important evidence also exists on the health implications of the socio-spatial context of housing. For instance, fear of crime, crowding, neighborhood disadvantage, social exclusion, and residents’ social exchange are linked to cardiovascular and mental health, obesity, diabetes and low birth weight.
In my dissertation work and related projects, I ask questions about the spatial context of neighborhood effects to investigate how the urban geography of inequality and cumulative spatial disadvantage shape the health and well-being of the inner-city poor. I analyze residential mobility data from the Moving to Opportunity Experiment in Los Angeles, New York, Boston, Baltimore, and Chicago together with data from PHDCN [Project on Human Development in Chicago Neighborhoods], and a large collection of data based on Census and other administrative records over several years.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nalo M. Hamilton, PhD, MSN, WHNP/ANP-BC, Assistant Professor at the University of California Los Angeles School of Nursing and an RWJF Nurse Faculty Scholar.
As 2012 approaches, I hope that the United States remains resolute in providing access to equitable health care for all, especially women.
We live in a time where women have made significant contributions in academic, social and political areas but their contributions to women’s health care are eroded with every passing year. Currently, as the working poor, a record number of women are living in poverty and are unable to access affordable health care.
Thus, their diaspora of medical conditions go without primary care management resulting in acute conditions that are stabilized in the emergency department. However, once the condition is stabilized, a woman is sent home without the ability to follow-up with her primary care provider, thus continuing the cycle of acute onset, ER admission and discharge.
In my current practice I primarily manage: hypertension, tobacco dependence, obesity, anxiety, depression, dyslipidemia, breast disorders, diabetes, hypothyroidism, infections, dysfunctional uterine bleeding and family planning. For me this list represents the many organs that exist between a woman’s eyeballs and toes. Additionally, these conditions highlight how critical it is for women to have access to health care, not only for chronic conditions but for preventative screening as well.
The Affordable Care Act is a critical first step but much remains to be done at local and national levels.
A new year brings with it new opportunities and hope, so raise your glass with me in a toast to 2012—the beginning of health care equity.
Amy N. Finkelstein, Ph.D., M.Phil., is a 2003 Robert Wood Johnson Foundation Investigator Award in Health Policy Research recipient and a professor of economics at the Massachusetts Institute of Technology (MIT). Finkelstein gave the following interview to the Human Capital Blog as part of our ongoing Voices from the Field series. Read more about her research.
Human Capital Blog: How did you come up with the idea for this study?
Amy Finkelstein: In early 2008 I heard a story on the radio about how the state of Oregon was conducting a lottery for access to Medicaid. It was one of those once-in-a-lifetime moments in which I thought "I must drop everything and look into this right away!" and so that's what I did. This was, literally, the chance of a lifetime: the opportunity to bring the gold standard of medical and scientific research—a randomized controlled trial—to an important social science and policy question.
HCB: Why hasn’t this kind of randomized control trial study of Medicaid been done before?
Finkelstein: There have been two major impediments to doing a randomized control trial of the effects of being uninsured relative to having insurance. The first is ethical concerns regarding doing such a randomization for research purposes. In our case this wasn't an issue because the state of Oregon had decided that a lottery was the fairest way to allocate a limited number of Medicaid slots. It was doing it for policy, not research purposes. Fortunately however the state also saw the enormous potential to learn from this opportunity and generously collaborated with researchers at Harvard, MIT, Providence Health & Services, and the National Bureau of Economic Research to make this possible.
The second major impediment of course was funding. Here we were extremely fortunate to have such generous funders, including of course the Robert Wood Johnson Foundation!
HCB: What were some of the most surprising findings?