Category Archives: Idea Gallery
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Jeffrey Levi, PhD, Executive Director of Trust for America’s Health (TFAH), writes about the importance of identifying and implementing policies and practices that can benefit health across all populations.
I go to countless meetings where people debate the meaning of “population health”—often for hours and with no resolution.
What’s become clear to me is that no matter what perspective we’re coming from, our actual goal for population health is the same. We want to improve the health of Americans.
But, at the end of day, the problem may be that the hang up on a clear definition is getting in the way of solving one of the health system’s most pressing problems: How do we get the different silos of the system to work better together and improve health inside and outside the doctor’s office?
Because this is so vital, the Robert Wood Johnson Foundation has supported an upcoming National Forum on Hospitals, Health Systems and Population Health, which will go beyond semantics to specifically identify policies and practices that can benefit health, no matter what population you’re talking about. Some of the below examples will be highlighted at the National Forum.
Hennepin Health, a Social Accountable Care Organization (ACO)
When Minnesota expanded Medicaid to a poor, childless adult population in Hennepin County, the relevant parties formed a social ACO, called Hennepin Health. The ACO is comprised of Hennepin County Medical Center; NorthPoint Health and Wellness (a Federally Qualified Health Center); Metropolitan Health Plan; and the county’s Human Services and Public Health Department (including Health Care for the Homeless, the county’s Mental Health Center and other social services). The County has a global budget to spend annually, and the partners take on all the risk as they bill the plan per service and then, at the end of the year, split the gains or losses.
Hennepin Health serves more than 6,000 enrollees. Of this group, 45 percent have chemical dependencies, 42 percent have mental health needs, 32 percent have unstable housing and 30 percent suffer from at least two chronic diseases.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Brian C. Quinn, PhD, the Robert Wood Johnson Foundation’s Assistant Vice President, Research-Evaluation-Learning, provided his perspective on how to address medical conspiracies and other controversial narratives when developing a Culture of Health.
You may have recently seen the headline “Half of Americans believe in medical conspiracy theories”—or one like it—on your favorite news outlet. Or even on The Onion.
When the Robert Wood Johnson Foundation decided to fund the study responsible for grabbing these headlines, we wanted to know much more than just how many—as in, “How many Americans believes in health conspiracies?” We wanted to answer many other “how” questions, too. How do these beliefs spread? How do they correlate with people’s health behaviors? How should providers and others approach treating and talking to those who hold these beliefs?
>>What can medical conspiracy theories tell us about improving health and health care? A lot, as you’ll hear in this conversation between RWJF's Brian Quinn and University of Chicago political scientist Eric Oliver.
It’s important to note that this study’s authors did not set out to pass judgment on these controversial narratives—or those who hold them. In fact, it was critical to the researchers’ success that they remain agnostic in that regard. The bottom line is nearly half of Americans believe in at least one health conspiracy, such as the government is hiding evidence that cell phones cause cancer or the U.S. Food and Drug Administration is intentionally suppressing natural cures for cancer. And, if we are serious about building a Culture of Health, we cannot afford to ignore the perspective of one in every two Americans.
I recently enjoyed a fascinating conversation with the study’s lead researcher, University of Chicago political scientist Eric Oliver, and came away with a few such insights that should enlighten—and may even surprise—some of you.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Bryan Samuels, Commissioner of the Administration on Children, Youth and Families, provides his perspective on how communities and organizations and families can work together to keep children safe, in honor of Child Abuse Prevention Month.
Nancy Barrand, Senior Adviser for Program Development at the Robert Wood Johnson Foundation (RWJF), also weighed in to provide some context for Commissioner Samuels' post:
Few events are more traumatic for children than being removed from their families and entered into the foster care system. In 2010, the Robert Wood Johnson Foundation funded the Corporation for Supportive Housing to develop and implement a pilot program in New York City that uses supportive housing to offer stability to families with children who are at risk of recurring involvement in the child welfare system. The New York pilot initiative, called Keeping Families Together (KFT), showed positive results in keeping and reuniting children with their families in a safe, stable environment. A 2011 evaluation indicates that the KFT pilot generated a 91 percent housing retention rate among participating families. By the end of the evaluation, 61 percent of the child welfare cases open at the time of placement in supportive housing had been closed, and there were fewer repeat incidents of child maltreatment.Now, RWJF has partnered with the U.S. Department of Health and Human Services, Administration on Children Youth and Families and three private foundations – the Annie E. Casey Foundation, Casey Family Programs, and the Edna McConnell Clark Foundation – to jointly fund a $35.5 million initiative to further test how supportive housing can help stabilize highly vulnerable families. The national replication effort will be evaluated and we’re anxious to see whether, again, secure and affordable housing, when paired with the right services for struggling families, can reduce instances of child abuse and neglect. The long-term gains in health and well-being, and costs saved, could be tremendous.
Commissioner Bryan Samuels on Child Abuse Prevention
Throughout the month of April, we turn our attention to the prevention of child abuse and neglect, celebrating those efforts in neighborhoods, faith communities, and schools that keep children safe and help families thrive. Whether formal or informal, these efforts involve wrapping caregivers and children in supports that reduce risk factors for maltreatment and promote protective factors, by decreasing stress, boosting parenting skills, and helping parents manage substance abuse or mental health issues.
Last year, more than 675,000 U.S. children were victims of maltreatment. These children are more likely than their peers to have emotional and behavioral problems, struggles in school, and difficulty forming and maintaining relationships. The effects of abuse and neglect can be pernicious and lifelong.
In recent years, we’ve come a long way in learning what it takes to help children who have experienced abuse and neglect heal and recover. We have interventions that help put families back together after maltreatment has occurred. But preventing abuse and neglect in the first place by giving families the support they need, when they need it, yields the best outcomes.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Jane Isaacs Lowe, Team Director for the Vulnerable Populations Portfolio at the Robert Wood Johnson Foundation, provided her perspective on the critical impact of public policies on the mental health of urban populations.
Recently I attended and spoke at the Social Determinants of Urban Mental Health conference hosted by the Adler School of Professional Psychology. Lynn Todman, the Executive Director of Adler’s Institute on Social Exclusion and the conference’s organizer, has been doing groundbreaking work on the link between public policies and the mental health of urban communities, including the Institute’s Mental Health Impact Assessment, which was developed in part through support from the Robert Wood Johnson Foundation.
It’s been exciting to see the field of health impact assessments grow so rapidly. But, of course, physical health is not the only outcome that matters; equally important is our mental health and its integral connection to physical health, especially for the most vulnerable among us. This is reflected in many of the organizations and models in which we’ve invested and which we’re helping to scale for greater impact. You’ll see it, for instance, in a video we just released on Child First, a psychotherapeutic home-visiting program that works with families with very young children who are showing signs of severe developmental, emotional, and behavioral problems. Child First partners with providers all across the community who touch these families’ lives — including doctors, day care providers, teachers, and social workers. If a provider sees a problem, she makes a referral to Child First, which then arranges a comprehensive assessment and home visit with a team of trained specialists, including a masters-level mental health clinician. That team works on the relationship between the child and parent or caregiver and on environmental factors, such as depression, substance use, domestic violence, food insecurity or homelessness that are detrimental to the child and family.
Ultimately, the goal is to foster strong, stable, nurturing relationships between parents and children and also create a safer and healthier overall environment for the child. In so doing, Child First effectively helps to buffer the developing brains of these young children from the damage caused by repeated exposure to toxic stress, and sets the families on a course toward stability and better health.
As Lynn Todman explains it, effective interventions for addressing the social determinants’ impact on mental health exist along a continuum — from trying to “fix” the individual within the clinical setting to structural reforms that create a social environment that will lead to better mental health outcomes. This is demonstrated in the Child First model, which goes beyond the clinical setting to engage individuals and institutions from across the community united by a common goal. The Adler School wants their students to be able to operate along that continuum, and to understand that, to improve outcomes, change will need to happen outside of the clinical setting, in the context of people’s lives and where they live, learn, work and play. This also must include the realm of policy change. Being able to contribute to this goal was well worth my time.
The other speakers at the conference reflected this belief in the need for interventions along a continuum and which engage individuals and institutions from multiple sectors. Lynn Todman’s background is as an urban planner, which is inherently a multi-disciplinary role. As an urban planner, she needed to understand housing, transportation, social services delivery, fiscal policy, and more. And she needed to be able to apply a lens that allowed her to see the connections between all of these seemingly different issues. It’s worth noting that it’s a lens through which Risa Lavizzo-Mourey is also looking in her recent chapter, “Why Health, Poverty, and Community Development Are Inseparable,” in the book, Investing in What Works for America's Communities. She makes a forceful case that, “community development and health must be partners in planning and building communities.”
We’ve pulled together some of the highlights from the conference, including resources that were shared by speakers. I hope you’ll take a look and, more importantly, put them to use in your own work.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health.
We all know that living in a walkable neighborhood is good for your health. The more surrounded we are by trees, water and parks and the more we are within walking distance of meaningful places for daily needs, the more likely these destinations are a part of our day-to-day lives. In a recent op ed for the New York Times, Christopher Leinberger comments on a new Brookings Institution study he co-authored with Mariela Alfonzo, PhD, a research fellow at Polytechnic Institute of New York University, which shows that more walkable neighborhoods also fare better economically. In this Idea Gallery for NewPublicHealth, Leinberger expands on the benefits of walkability for a community.
The takeaway from our report is that there’s been a structural shift in how we build the built environment. This is not a cyclical change caused by a periodic recession. This is a structural shift. The last time we had this was after the Second World War. We’re building fundamentally a different America.
Before you build it you have to be sure that you have the strategy and management structures in place to make it happen. Generally in this country, walkable urban development is illegal—there is no zoning in place to allow it to happen. Plus it works best when the place has a strategy and management entity in place, generally taking the form of a non-profit building improvement district (BID).
There is then the possibility of achieving the triple bottom line: 1) make money, 2) be responsible to the environment, and 3) be socially equitable.
On social equity, certain jurisdictions in this country have said we want a mix of incomes in our neighborhoods, and I believe this is the proper approach. The price premiums telling the real estate industry to build more also portend an inability for working- and even middle-class buyers to live in walkable urban places.
Frontiers in Public Health Services & Systems Research: Making Critical Research Accessible, Quickly
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Glen Mays, MPH, PhD, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health, talks about the launch of a brand new online journal covering public health systems and services research, and why it is so critical right now, to inform smart investments in public health and prevention. The new journal, Frontiers in PHSSR, is designed to disseminate the most critical early findings from PHSSR research much faster—making these findings accessible far in advance of the fully-developed scientific manuscript. To be eligible for inclusion in Frontiers, findings must have the potential to guide future public health practice, health policy, and research. Mays is the editor in chief of the new journal.
Portions of the post below are adapted from the opening commentary in Frontiers, authored by Mays, F. Douglas Scutchfield, Paul K. Halverson, William Riley and Peggy Honore.
The need for a strong and effective public health system in the United States is perhaps more urgent today than at any other time in our nation’s history. Preventable diseases and injuries account for more than three-fourths of the $2.6 trillion in health care expenditures incurred annually in the U.S. The growing prevalence of obesity, diabetes and other preventable conditions constrains the nation’s economic productivity and global competitiveness. The American public health system—the diffuse constellation of governmental public health agencies and their peers and partners in community-based settings and the private sector—is tasked with developing and delivering strategies that promote health and prevent disease and injury on a population-wide basis. They share the mission of creating conditions in which people can be healthy.
The public health system is uniquely positioned—but not optimally equipped or resourced—to take on these challenges. Only about 3 percent of the nation’s $2.6 trillion in annual health expenditures is devoted to public health activities. Some of our greatest uncertainties now lie in how best to organize, finance, and deliver effective public health prevention strategies to communities across the U.S. The field of public health services and systems research (PHSSR) has emerged to fill this void.
Frontiers in PHSSR
The American public health system and the populations it serves do not have the luxury of waiting the 15 years typically required to get research-tested solutions widely adopted into practice. The costs associated with missed opportunities for disease prevention and health promotion are straining government and household budgets now.
To help develop and grow this scientific learning community, we have launched a new, open-access, peer-reviewed journal, Frontiers in Public Health Services and Systems Research. This journal provides a platform for rapidly and widely communicating emerging findings and lessons learned from studies of public health services and delivery systems. Frontiers will feature brief descriptions of preliminary findings from ongoing or recently completed empirical studies and quality improvement projects that answer important questions regarding the organization, financing, and delivery of public health services.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Jennifer L. Howse, PhD, president of the March of Dimes, comments on efforts to give more babies a healthier start in life. This week, a regional Infant Mortality Summit will kick off a collaborative, multi-State initiative to improve infant health outcomes. NewPublicHealth will feature some of the innovative programs and initiatives to support healthy babies.
A baby born in the United States today faces a one out of eight chance of being born too soon. Prematurity is a common, costly, serious and a largely silent health epidemic. The good news is that national, state and local health officials are addressing this problem with historic public health initiatives to give more babies a healthy start in life.
On Nov. 1, the United States received a grade of “C” on the March of Dimes 2011 Premature Birth Report Card. Preterm birth is the leading cause of newborn death. Babies who survive an early birth face an increased risk of serious life-long health challenges, such as breathing problems, cerebral palsy, or learning disabilities. Even babies born just a few weeks early have higher rates of hospitalization and illness than “full-term” infants (39-40 weeks of pregnancy). We’ve developed an educational campaign and a hospital-based toolkit to help parents and professionals better understand the critical importance of those last weeks of pregnancy to a baby’s health.
Although the U.S. preterm birth rate has improved slightly in recent years, nearly half a million infants still are born too soon. Each early birth places a terrible emotional toll on families and a financial burden on the health system. In fact, the first year health and medical costs of one preterm birth are nearly ten times more than a full term birth.
But, the problem hasn’t gone unheeded.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Douglas Jutte, MD, MPH, offers a physician's perspective on how unmet social needs—like access to nutritious food, transportation assistance and housing assistance—are affecting the health of Americans.
During medical school and pediatric residency I spent over a year living in the Dominican Republic and Guatemala, so when I finished my training I wanted to continue my work with Spanish-speaking families. My first job was in the neighborhood clinic of East Palo Alto, California, a low-income community inhabited primarily by first- and second-generation Mexican immigrants.
One of my earliest patients in East Palo Alto was a little boy with Down syndrome and a serious congenital heart defect, a common feature of that condition. When I met him, he had recently undergone open-heart surgery and had a gastric tube placed so that he could be fed without requiring him to eat. His mother was enormously attentive but had very limited resources and spoke only Spanish. Together we monitored his health as he stabilized, grew and began to eat on his own. With a full medical recovery, his continued healthy development now relied primarily on obtaining the proper setting for his schooling.
With no caseworker or nurse in my clinic to help me out, I made calls and wrote letters to enroll him in a fantastic school near the Stanford campus. Months later, before a pending well-child visit, I called the school to get an update on his development. I was shocked to learn that it had been weeks since he had last attended. When he and his mother came in for their appointment, I learned her car had broken down. She was saving money for a fix, but had no one to rely on for her son’s transportation and hadn’t known where to turn for help. Desperate, I called the school and discovered that not only did they have a shuttle service but also it was free for needy children.
This was a crystallizing moment for me. The long-term health and well being of a developmentally delayed child whom I had helped coax through recovery from prolonged hospitalizations and multiple complicated surgeries hinged not on the quality of my medical care but on a taxi voucher and a broken carburetor.
This month the Robert Wood Johnson Foundation, in partnership with Harris Interactive, released a poll indicating that the majority of physicians are not only conscious of the relationship between the social risk factors of their patients and poor health outcomes, but they perceive these factors to be as important as their patients’ medical conditions. In regard to that latter point—the recognition that social needs are as important as medical conditions—I was, admittedly, a bit surprised. And when I told a colleague of mine, her response was, “Are you kidding me?”
Our experience has been that, in many ways, the medical field rejects or downplays the notion that social factors are as important to consider as biological factors. It’s not the way we, as doctors, are trained. Two years ago, I completed an article comparing the importance of social and biological risk factors in predicting poor health and educational outcomes for children, but was forced to publish in an epidemiology journal. Several medical journals rejected it, their reason: not “clinically relevant.”
Perhaps the tide is turning. But what can be done to compel more health care providers to recognize this relationship? And what must be done to ensure they have the support to address these important social needs effectively?
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Jeffrey Levi, Executive Director of Trust for America’s Health (TFAH), writes about public health preparedness and a report issued by TFAH and the Robert Wood Johnson Foundation, Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense.
Ten years ago, the September 11th and anthrax tragedies clearly demonstrated that the public health system was not prepared for the range of modern health threats we face. Since then, significant investments have resulted in the country being much better prepared to respond to public health emergencies ranging from threats of bioterrorism to major infectious disease outbreaks like a pandemic flu or natural disasters like hurricanes, tornadoes, and floods.
However, the United States often takes a band-aid approach to public health preparedness. As new emergencies and concerns emerge and attention shifts, it often means resources are diverted from one pressing priority to another, leaving other ongoing areas unaddressed. The unprecedented federal investment in public health preparedness after the September 11th and anthrax attacks was not at a sufficient level to backfill long-standing gaps in infrastructure or update technologies to meet state-of-the-art standards. Currently, there is an additional new threat to preparedness – the current economic climate and budget cuts at the federal, state and local level mean that progress made over the past decade could be lost.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health.
In this era of declining resources for public health, and for that matter all of government, now more than ever it is imperative that we get the maximum bang for our buck. We simply cannot afford to be inefficient and ineffective in the delivery of public services. That means we need the best information, based on rigorous research, about how to provide public health services.
Public health services and systems research (PHSSR) provides answers. It guides us in how best to structure the public health delivery system and assure that what we do is the most efficient and effective way to keep people healthy and protected from disease. Just as good science needs to drive how we provide patient-centered, high quality, cost-effective health care services, we must have the information to assure population-centered, high quality, cost-effective public health services. PHSSR is the tool that allows that to happen.