Category Archives: Poverty
Teens who Leave Gangs Still Face Consequences as Adults
A new study in the American Journal of Public Health finds that joining a gang during teen years has significant consequences in adulthood beyond criminal behavior, even after a person leaves the gang.
The study authors followed 808 fifth-grade students from 18 elementary schools in high-crime neighborhoods in Seattle, beginning in 1985. Participants were interviewed every year until the age of 18, then every three years until the age of 33.
Researchers used 23 risk factors, including poverty and associating with kids with problem behaviors, to calculate a child’s propensity for joining a gang, and then compared 173 youth who had joined a gang with 173 who did not but showed a similar propensity for doing so. The average age of joining a gang was just under 15 years old and the majority (60 percent) were in a gang for three years or less.
The study found that subjects between ages 27 and 33 who had joined a gang in adolescence were:
- Nearly three times more likely to report committing a crime,
- More than three times more likely to receive income from illegal sources
- More than twice as likely to have been jailed in the previous year
- Nearly three times more likely to have drug-abuse problems
- Nearly twice as likely to say they were in poor health
- Twice as likely to be receiving public assistanÎ
- Half as likely to graduate from high school.
The study was funded by the National Institute on Drug Abuse the Robert Wood Johnson Foundation, and the National Institute on Mental Health.
Read more on poverty
Stroke Survivors May Lose a Month of Healthy Life for Every 15-Minute Delay in Treatment
Every 15-minute delay in delivering a clot-busting drug after stroke takes away about a month of a healthy life for stroke survivors, according to a new study in the journal Stroke. Researchers at the University of Melbourne in Australia analyzed data from clot-busting trials and applied the time to efficacy to over 2,000 stroke cases in Australia and Finland to calculate what the patient outcomes would have been if they had been treated faster or slower. They found that for every minute the treatment could be delivered faster, patients gained an average 1.8 days of extra healthy life. The researchers also found that while all patients benefited from faster treatment, younger patients with longer life expectancies gained more than older patients
Read more on access to health care
One in Five Older Americans Take Medications that Work Against Each Other
More than 20 percent of older Americans take Medicines that work at odds with each other, and in some cases the medication being used for one condition can actually make the other condition worse, according to a new study in the online journal PLUS One by researchers at Oregon State University and the Yale School of Medicine. The study was conducted by researchers from OSU and Yale with 5,815 community-living adults over a two year period.
“Many physicians are aware of these concerns but there isn’t much information available on what to do about it,” says David Lee, an assistant professor in the Oregon State University/Oregon Health & Science University College of Pharmacy. “As a result,” says Lee, “right now we’re probably treating too many conditions with too many medications. There may be times it’s best to just focus on the most serious health problem, rather than use a drug to treat a different condition that could make the more serious health problem even worse.”
The chronic conditions in which competing therapies are common include coronary artery disease, diabetes, COPD, dementia, heart failure, hypertension, high cholesterol and osteoarthritis and others.
Read more on prescription drugs
Cold Winter Raises Concerns about Energy Insecurity
A new brief by researchers at the Mailman School of Public Health at Columbia University looks at energy insecurity (EI), which is measured by the proportion of household energy expenditures relative to household income. EI tends to impact low-income families in part because they often live in older homes and apartments that haven’t been constructed to conserve heat.
Key findings of the brief include:
- More than half of families affected by economic EI are living in poverty (below 100 percent of the federal poverty level) and about one third are extremely poor.
- Approximately half of all households facing economic EI are black/African-American and about one-third are white.
- Geographically, the largest proportion (46 percent) of children in households with economic EI resides in the South.
- Over half of families with economic EI are renters; 41 percent are homeowners.
According to the Mailman researchers, the main safety net program for EI, the Low-Income Home Energy Assistance Program (LIHEAP), covers only a fraction of the overall need. Of the estimated 10-15 million homes eligible for benefits in 2012, 5.5 million received assistance for reasons such as lack of awareness by people who could benefit and program budget cuts. Read more on poverty.
Many Adults with Depression Symptoms Have Not Consulted a Professional
A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) finds that close to 40 percent of the 15 million American adults who experienced a major depressive episode in the past year did not talk to a counselor or health provider. A major depressive episode is defined as a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of seven additional symptoms reflecting the criteria as described in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of the Mental Disorders (DSM-IV). “This report shows that too many Americans still needlessly suffer in silence instead of reaching out to providers for help in getting them on the road to recovery through effective treatment and supports,” said Paolo del Vecchio, the director of SAMHSA’s Center for Mental Health Services. “We are raising awareness about the hope for recovery from these conditions, helping communities identify their behavioral health needs, and increasing education about access to treatment for all Americans through the Affordable Care Act and the new parity protections for insurance coverage.” Read more about mental health.
EPA Proposes New Safety Measures to Protect Farm Workers from Pesticide Exposure
The U.S. Environmental Protection Agency (EPA) has announced proposed revisions to the Worker Protection Standard to protect the nation’s two million farm workers and their families from pesticide exposure. The EPA is proposing significant improvements to worker training regarding the safe usage of pesticides, including how to prevent and effectively treat pesticide exposure. Increased training and signage will inform farm workers about their protections under the law. The EPA has also proposed that children under 16 be legally barred from handling all pesticides, with an exemption for family farms. The revisions are based on more than a decade of extensive stakeholder input by federal and state partners and from across the agricultural community including farm workers, farmers and industry. Read more on the Environmental Protection Agency.
A new survey from the U.S. Conference of Mayors released earlier this month found that in many U.S. cities homelessness increased by as much as 4 percent this year. The permanent solution to homelessness will require the concerted efforts of companies, communities, legislatures and individuals and includes affordable housing, jobs and economic policies and strong mental health support. That’s a lot to tackle, but there are some things individuals can do to make life a bit easier — and healthier — for homeless people in their communities.
Here are a few suggestions from online charitable giving site justGive.org, which has a full list of 35 ideas on its site:
- Buy Street Sheet or Street Sense: These biweekly newspapers are sold in almost every major American city and are intended to help the homeless help themselves by offering them economic opportunities and elevating their voices in the discussion on how to end homelessness. For every paper sold, the participants earn five cents deposited in a special savings account earmarked for rent.
- Bring food: When you pass someone who asks for change, offer him or her something to eat. If you take a lunch, pack a little extra. When you eat at a restaurant, order something to take with you when you leave.
- Give recyclables: In localities where there is a "bottle law," collecting recyclable cans and bottles is often a viable source of income for homeless people. It is an honest job that requires initiative. You can help by saving your recyclable bottles, cans, and newspapers and giving them to homeless people instead of taking them to a recycling center or leaving them out for collection (or, worse, not recycling at all!).
- Volunteer your professional services: No matter what you do for a living, you can help the homeless with your on-the-job talents and skills. Those with clerical skills can train those with little skills. Doctors, psychiatrists, counselors, and dentists can treat the homeless in clinics. Lawyers can help with legal concerns. The homeless' needs are bountiful — your time and talent won't be wasted. There are many different volunteer organizations through which you can channel your efforts.
- Volunteer for follow-up programs: Some homeless people, particularly those who have been on the street for a while, may need help with fundamental tasks such as paying bills, balancing a household budget, or cleaning. Follow-up programs to give the formerly homeless further advice, counseling, and other services — and are always in need of volunteers.
- Create lists of needed donations: Call all the organizations in your community that aid the homeless and ask them what supplies they need on a regular basis. Make a list for each organization, along with its address, telephone number, and the name of a contact person. Then mail these lists to community organizations that may wish to help with donations —from religious centers to children's organizations such as Girl Scouts and Boy Scouts.
- Help the homeless apply for aid - Governmental aid is available for homeless people, but many may not know where to find it or how to apply. Since they don't have a mailing address, governmental agencies may not be able to reach them. You can help by directing the homeless to intermediaries, such as homeless organizations, that let them know what aid is available and help them to apply for it. If you want to be an advocate or intermediary for the homeless yourself, you can contact these organizations as well.
- Read the full list of suggestions to help the homeless from justgive.org
- Read a NewPublicHealth post on the recent U.S. Conference of Mayors report on hunger and homelessness.
Unemployment and poverty top the reasons why homelessness and hunger continue to grow in the U.S., according to the U.S. Conference of Mayors 31st Hunger and Homelessness Survey, released yesterday. “There’s no question that the nation’s economy is on the mend, but there’s also no question that the slow pace of recovery is making it difficult and, for many, impossible, to respond to the growing needs of the hungry and the homeless,” said Tom Cochran, executive director of the Conference of Mayors during a conference call with reporters yesterday about the report.
The new report is based on surveys of city officials in the 25 cities that make up the Conference’s task force on Hunger and Homelessness, and all but one of the participating cities said requests for help had either gone up or stayed the same as the previous year.
Additional findings of the report include:
- The number of families and individuals experiencing homelessness increased across the survey cities by an average of 4 percent.
- More than one in five people needing assistance did not receive it because of insufficient city and donated funds.
- Because of the increase in requests many emergency kitchens and food pantries in the 25 cities surveyed had to reduce the amount of food provided to individuals or families.
One positive note in this year’s report was an increase in aid provided to homeless veterans because of targeted efforts by cities, the Department of Housing and Urban Development and the Veterans Administration. Eighty percent of the survey cities were able to find stable housing for some previously homeless veterans.
Many of the 25 survey cities addressed homelessness and hunger problems by adopting innovative programs specific to their communities to address and improve the situation. The Conference of Mayors report includes many examples both to highlight innovation and to serve as models for other cities working to improve the housing and food security conditions of their citizens:
Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.
In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.
NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.
Report: U.S. Poverty, Uninsured Rates Remain Stagnant
Despite an improving economy that included the creation of more than 2 million jobs last year, the U.S. poverty rate in 2012 remained relatively equal to the previous year, according to a new report from the U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2012. About 46.5 million people lived at or below the poverty line in 2012, or about 15 percent of the nation. That’s about 2.5 percentage points higher than 2007, right before the economic recession. About 48 million people were without health insurance in 2012, only slightly lower than the 48.6 million in 2011. While the recession seems to have leveled out, the fact that poverty rates have yet to truly rebound has many experts concerned. “We’re supposed to be in recovery,” said Austin Nichols, a researcher at the Urban Institute. “Poverty rates should be falling because long-term unemployment is falling. And they're not.” Read more on poverty.
Economic, Mental Toll of Economic Crisis Likely Responsible for Global Jump in Men’s Suicide Rates
The economic and mental toll of the 2008 global economic crisis was likely a major contributor to the surprising increase in the U.S. and global male suicide rates in 2009, according to a new study in the journal BMJ. There were about 5,000 more suicides than expected that year. The male suicide rate in the United States climbed almost 9 percent in the United States in 2009; the overall global rate climbed 3.3 percent, with the largest increases seen in the European Union and North and South American countries. Depression and stress can lead to increased alcohol and drug abuse, which are also suicide risk factors. The study concluded that immediate action, such as job-creation programs, may help prevent a continued increase in suicides. "Unemployment appears to lead to an increase in anxiety and depression -- two psychiatric symptoms that might be intermediate steps toward suicide," said Robert Dicker, MD, associate director of the division of child and adolescent psychiatry at North Shore-LIJ, in New Hyde Park, N.Y., who was not a part of the study. "More unemployment, more family distress, more losses [of status and friends] also most likely are involved." Read more on mental health.
Study: Two Simple Questions on Mobility Can Help Assess, Treat Older Adults’ Physical Declines
Two simple questions about mobility could help doctors more accurately assess and treat an older adult’s physical decline, according to a new study in the Journal of the American Medical Association:
- For health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile?
- Because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?
The answers could help determine whether physical therapy or mobility-assistance devices are needed. The findings emphasize the importance of increased physical activity and exercise in health aging, according to Cynthia Brown, MD, of the division of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham. "With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently,” she said. “The major barriers—lack of physical activity, obesity and smoking—are all risk factors that can be successfully overcome with appropriate treatment and assistance." Read more on aging.
A recent vote by the Washington D.C. City Council requires large retailers to pay a minimum hourly wage of $12.50 an hour—$5.25 more than the current minimum wage of $7.25 nationally and $8.25 in D.C.— and the decision received wide attention, especially when retailers planning to build new stores in the city said they’d pull the plug on the projects if required to pay the higher salaries. But at least two recent magazine articles explain why there’s been a fervent recent push to try to push up the wages of those in low-paying jobs. New York Magazine recently surveyed 100 fast food restaurant employees in that city and asked, among other things, “can you live off your paycheck?” The answer appears to be no. The average pretax monthly pay for the surveyed workers was $984 while average monthly expenses including rent, utilities, groceries and cell phone bills was $1,115—which adds up to $131 more in expenses than pay.
>>Bonus Link: Why does income matter to health? See a NewPublicHealth infographic on how stable jobs and income lead to healthier lives.
And last weeks’ New Yorker Magazine added heft to the need to look at the current minimum wage rate, in light of just how critical that income is to many households. According to the article, while low-wage retail jobs were once squarely aimed at high school students looking for pocket money and those looking for supplemental income, in the last few years of stiff unemployment, studies find that current low-wage workers are responsible for 46 percent of household income. According to the New Yorker article, “Congress is currently considering a bill increasing the minimum wage to $10.10 over the next three years…still a long way from turning these jobs into the kind of employment that can support a middle-class family.”
The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal program for helping low-income families purchase enough food. More than 47 million Americans currently receive SNAP benefits; approximately half of the beneficiaries are children. As part of the debate over the Farm Bill—legislation that authorizes SNAP and other federal nutrition programs—Congress is considering legislation that would cut SNAP benefits and limit who qualifies for the benefits.
Yesterday, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, released a white paper that provides a rigorous, objective and nonpartisan analysis of the potential health impacts of the proposed changes to SNAP.
NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project, along with lead researcher Marjory Givens, to learn more about the study’s findings.
NewPublicHealth: What is the goal of the health impact assessment on the potential changes to the SNAP program?
Aaron Wernham: Congress is deliberating reauthorizing the U.S. Farm Bill, and one of the parts of that is the Supplemental Nutrition Assistance Program or SNAP, which was formerly known as food stamps. This is one of the federal government’s main programs for ensuring that people who have low incomes are able to get enough to eat. We did this health impact assessment because so far the public health effects of these proposed policy changes have not really been a part of the political debate. We wanted to make sure that the best available public health evidence was brought to bear to help ensure that everyone has complete information—those affected by the change, the general public and decision-makers in Congress.
NPH: What’s the big picture on what SNAP has to do with health in the first place?
Wernham: Not having enough to eat—or being what’s called “food insecure”—is attached to a higher risk of a lot of diseases. So, adults who are food insecure have a higher risk of heart disease, high blood pressure, diabetes and some other problems. Children who are food insecure are more likely to be reported by their parents as being in poor health, are more likely to be hospitalized and also have a higher risk for a number of health related problems from asthma, to depression and anxiety. We actually have a number of studies that have looked at the health benefits of receiving SNAP and found, for example, that adults who had access to SNAP when they were children are less likely to have problems in adulthood, such as obesity, high blood pressure and heart disease.
NPH: What did the health impact assessment find?
Wernham: We looked at ways in which the House and Senate have proposed to change how eligibility for SNAP benefits is determined and how the amount of benefits is determined. Both the House and Senate have proposed changes, and we found that as many as 5.1 million people could actually lose eligibility under changes proposed by the House. Under the changes in the Senate, about 500,000 people might receive lower benefit amounts. With the House changes, as many as 1.4 million children and nearly 900,000 older adults would be among those five million people who could be affected. So, for those people, they would lose upward of an average of 35 percent of their total income and would be at higher risk for the health problems that relate to food insecurity.
In 2011, Sonoma County in California established the division of Health Policy, Planning and Evaluation (HPPE) in an effort to move the county up in the County Health Rankings, toward a goal of becoming the healthiest in the state by 2020. As the director of the division, Peter Rumble, MPA, has played a critical role in the development of numerous programs and policy efforts to help create opportunities for everyone in Sonoma County to be healthy. Rumble has worked on programs and policies that go beyond traditional public health activities and aim to address the root causes of poor health, including the local food system, education and poverty.
Following his presentation at the International Making Cities Livable Conference, NewPublicHealth was able to speak with Rumble about the ways in which his work with HPPE is pushing to achieve health equity in Sonoma County. Rumble will soon move into a position as Deputy County Administrator of Community and Government Affairs for the County of Sonoma, where he plans to continue his commitment to a vision of health and quality of life for the county.
NewPublicHealth: Sonoma is making a concerted effort to help address the root causes of poor health, like poverty and lack of education. Tell us about some of those efforts.
Peter Rumble: Health Action is our real heartbeat of addressing social determinants of health, and it’s a roadmap for our vision of being the healthiest county in California by 2020. Health Action is a community council that advises the Board of Supervisors. There are 45 seats on the council, including elected officials, individual community leaders, nonprofit leaders, and representative from the business, financial, labor, media, transportation and environmental sectors. If you pick a name out of the hat for all of the sectors in the community, we’ve got somebody who either directly or tangentially represents that sector. That group began talking about needing to do something around health in 2007.
If we’re going to be the healthiest county in California by 2020, what do we need to do to achieve our ten goals based on the best evidence available? We certainly have goals associated with the health system, but predominantly, we’re focused on influencing the determinants of health. Our first goal is related to education. We want all of our children to graduate from high school on time and ready to either enter a thriving workforce or go into college or a technical career academy.
We started with some grassroots initiatives. Being a real strong agricultural community, iGROW was a good place to start. It was a movement to develop community gardens—for people to tear up their front lawns and plant a garden there, and increasing access to healthy food. That was a huge hit. We set a goal of a few hundred community gardens, and we’re up to a thousand now—it’s just caught fire.
That was all great, but a community garden is not going to make us the healthiest county in California, right? You can see the beautiful posters out on shop windows, you can see your neighbor tore up their front lawn and is growing this beautiful zucchini and has an edible lawn now and all that’s wonderful, but we only have a graduation rate of 70 percent. We’ve got nearly one in four kids living in poverty by the federal poverty standards and if you look at what actually it takes to raise a family in Sonoma County, about half of all families can’t make ends meet.
NPH: Does that surprise people to hear about Sonoma?
Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.
The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.
Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.