Category Archives: Poverty

Aug 11 2014
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High-Quality Care in Low-Income Communities: Q&A with Steven Weingarten, Vital Healthcare Capital

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Vital Healthcare Capital (V-Cap) and the Robert Wood Johnson Foundation (RWJF) have announced a $10 million investment in Commonwealth Care Alliance (CCA), based in Boston, Mass., to help fund the organization as it rapidly expands its model of care for patients who are dually eligible for Medicare and Medicaid.

The non-profit care delivery system provides integrated health care and related social support services for people with complex health care needs covered under Medicaid and for those eligible for both Medicaid and Medicare. CCA’s expansion comes as Massachusetts continues to pioneer integrated, patient-centered care for people who are eligible for both Medicare and Medicaid though the newly created “One Care: MassHealth plus Medicare” program, one of several financial alignment initiatives for people with dual eligibility established by the Affordable Care Act (ACA) that are launching nationwide.

The loan—the first to be made by Vital Healthcare Capital, a new social impact fund based in Boston, through support from RWJF—provides funds needed by CCA for financial reserves required by the Commonwealth of Massachusetts as the agency expands the number of beneficiaries in its programs.

According to CCA Director Robert Master, the social impact goals are to:

  • Scale a person-centered integrated care model for high-needs populations.
  • Demonstrate what are known in public health as “triple aim” outcomes in health status, care metrics and cost effectiveness.
  • Train, develop and create frontline health care workforce jobs, including health aides, drivers and translators.
  • Create innovations in health care workforce engagement in coordinated care plans to better integrate into the care plan the staff members who most directly touch the lives of its members.

Over the next five years, Vital Healthcare Capital plans to establish a $100 million revolving loan fund, leveraging $500 million of total project capital for organizations working on health care reform for patients in low-income communities.

NewPublicHealth recently spoke with Steven Weingarten, CEO of Vital Healthcare Capital, about the inaugural loan and the firm’s expansion plans going forward.

NewPublicHealth: How did Vital Healthcare Capital get started and what are its overarching goals and investment criteria?

Steven Weingarten: Vital Healthcare Capital has been formed as a new non-profit financing organization to invest in quality health care and good health care jobs in low-income communities. The organization came about after a couple of years of research and development with funding from the Robert Wood Johnson Foundation, as well as from the Ford and Rockefeller Foundations and support from SEIU, the health care union. Healthcare reform is really part of a broader restructuring of health care that has enormous implications for low-income communities, and for the health care providers and plans that have been focused on these communities. Having financial capital to be able to transform health care to a better delivery model will be a critical challenge in upcoming years. So we are coming in to serve that need.

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Jul 31 2014
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PHLR: Interactive Dataset Illustrates Historical Minimum Wage Trends

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The first federal minimum wage was set in 1938 by the U.S. Fair Labor Standards Act. It was 25 cents per hour. Twenty-two subsequent increases now put the wage at $7.25—that equates to about $15,000 per year for a person who works a standard 40-hour workweek.

A new interactive dataset from Public Health Law Research (PHLR) enables researchers, policymakers, media and others to track these and other changes in both the federal and state minimum wages. PHLR is a national program of the Robert Wood Johnson Foundation and Temple University dedicated to building the evidence base for laws that improve public health

“By tracking the changes to the rates and the law’s characteristics over time, we have laid the ground work for researchers and others to study the effects of minimum wage laws on many factors, such as housing, education, and health and well-being,” said Sarah Happy, JD, the PHLR program’s Director of Policy Surveillance, in a release.

Why does income impact health? A good paying job makes it easier for workers to live in healthier neighborhoods, provide quality education for their children, secure child care services and buy more nutritious food—all of which affect health.

Among the facts and trends revealed by the interactive dataset:

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  • Forty-five states and Washington, D.C., have minimum wage laws. The only states that do not are Alabama, Louisiana, Mississippi, South Carolina and Tennessee.
  • In many states, the recent trend has been to increase the minimum wage above the federal rate and adjust it yearly for inflation.  Currently, Washington, D.C., has the highest state minimum wage rate at $9.50 an hour.
  • Arkansas, Georgia, Minnesota and Wyoming all have lower minimum wages than the federal wage, meaning their residents would receive the federal minimum, in most cases.
  • Alaska and Connecticut are the only two states that have had a minimum wage consistently higher than the federal minimum wage rate since 1980.

PHLR’s “Minimum Wage Laws Map joins more than 25 other maps on the PHLR LawAtlas.org website tracking laws across states and over time in more than ten public health issue areas, including chronic disease; injury and violence prevention; and environmental health.

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>>Read more on the impact of income and jobs on health.

May 9 2014
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Public Health News Roundup: May 9

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Starting at Age 30, Inactivity Accounts for Greatest Risk of Heart Disease for Women
A new study in the British Journal of Sports Medicine finds that from the age of 30 onward, physical inactivity exerts a greater impact on a woman's lifetime risk of developing heart disease than other risk factors, including being overweight, smoking and having high blood pressure. The research was based on a longitudinal study of more than 30,000 Australian women ages 22-64 over almost twenty years. Read more on heart health.

Domestic Violence Victims More Likely to Take Up Smoking
A new study in 29 low and middle-income countries by researchers at the Mailman School of Public Health at Columbia University links intimate partner violence (IPV) with smoking. The researchers examined the association between IPV and smoking among 231,892 women ages 15-29 data collected from health surveys. Reports of IPV ranged from 9 to 63 percent, and using a meta-analysis that accounted for other factors including age, education, and household wealth, the researchers found a 58 percent increased risk for smoking among the women who experienced IPV. The study points to a specific need for investments to help IPV victims avoid tobacco, according to the researchers, who suggest that information about the consequences of smoking, motivation to quit smoking and smoking-cessation treatments could be incorporated into IPV treatment by health care providers who routinely interact with IPV victims. Read more on violence.

Many Veterans Face Food Insecurity
A new study by researchers at the University of Minnesota School of Public Health has found that 27 percent of veterans of the wars in Iraq and Afghanistan are facing food insecurity—nearly double the rate of the general population. The findings came from a university-supported sturdy of veterans’ behavioral health begun in 2001. Researchers found that people who report being food insecure tend to get less sleep, report using cigarettes, tend to be unemployed, ten not be married or partnered and have lower incomes. Veterans would be helped by increasing awareness of the issue so that they are connected to assistance both for food and for employment opportunities. Read more on poverty.

May 2 2014
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Place Matters: Eliminating Health Disparities in Cuyahoga County, Ohio

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The Cuyahoga County, Ohio Place Matters team's focus is on ensuring health implications and equity considerations are at the forefront as policy makers and others make decisions that substantially impact the county’s residents and the neighborhoods in which they live.

Key Team Objectives:

  • A broader definition of health. Health is not simply the absence of disease—health begins where people live, work, learn, age and play. Health includes the social conditions one lives in, such as the jobs we do, the money we're paid, the schools we attend and the neighborhoods we live in, as well as our genes, our behaviors and our medical care.
  • Inform, influence and engage policy makers and community members to develop policies—using an overarching health equity lens—that have long-term impacts, create conditions for optimal health and reduce inequities.
  • Utilize "place-based" interventions to engage and empower residents in under-resourced communities to revitalize their communities.

East Cleveland is one of the most densely settled communities in Cuyahoga County. The city has a poverty rate of 32 percent, while its heart disease mortality rates (355/100,000) are higher than in the county (10 percent higher) and the nation (32 percent higher).

Team objectives include building effective partnerships; striving for equal opportunity for all; equity; recognition that neighborhood condition is the context in which health and wellbeing begins; health in all policies; mobilizing the community for action; and measuring indicators of social determinants of health.

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Apr 30 2014
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Harvard School of Public Health Special Report: The Financial Crisis as a Public Health Crisis

“Five years after the Great Recession officially came to an end, the United States has yet to fully recover from the economic devastation sparked by the collapse of an $8 trillion housing bubble and the ensuing turmoil that saw global financial systems teetering on the brink of collapse. But while the economic costs of the downturn have drawn the lion’s share of attention, the damage to our bodies could end up far surpassing the damage to our bank accounts.”

Those are the opening lines of a new special report from the Harvard School of Public Health (HSPH), “Failing Economy, Failing Health: The Great Recession’s Toll on Body and Mind,” detailing how poverty and inequality resulting from the economic maelstrom pulled down so many—and what that will mean for public health in the long term.

“Health is a long-run thing, but the methods we use to analyze current data only estimate short-term effects,” says SV Subramanian, HSPH professor of population health and geography. “It may take awhile for the health impact of the Great Recession to kick in, but once it does, it could be dramatic.”

The data is strong on the links between employment and health—people who are unemployed, underemployed or laid off are less healthy and don’t live as long. 

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A 2009 study found that in the 12 months after men lost their jobs in mass layoffs, they saw their chances of dying nearly double. While over time the risk lessened it was still significant two decades later. Another study that same year found that losing a job when a business shuts its doors increases the odds of fair or poor health by 54 percent among workers with no preexisting health conditions while also increasing the risk of new health conditions by 83 percent. The stress of the situation, according to the researchers, heightens the odds of stress-related conditions such as stroke, hypertension, heart disease, arthritis, diabetes and psychiatric problems.

Yet another study, this one in 2010, found that about 4 in 10 Americans with heart disease or diabetes and 1 in 5 with cancer said the stress of the Great Recession made it more difficult to manage their illnesses.

What’s more complex is unearthing the pathways behind why this is the case. The HSPH article outlines some of the mechanisms by which unemployment affects health.

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Mar 14 2014
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Public Health News Roundup: March 14

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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

Feb 25 2014
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Public Health News Roundup: February 25

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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.

Dec 26 2013
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Help the Homeless: What You Can Do

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:

  1. Buy Street Sheet or Street SenseThese 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.
  2. 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.
  3. 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!).
  4. 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.
  5. 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.
  6. 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.
  7. 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.

>>Bonus Links:

Dec 12 2013
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New Report: Continued Rise in Hunger and Homelessness for 2014

Chefs cooking in restaurant kitchen. Food pantries in 25 cities surveyed had to reduce the amount of food provided because of budget challenges.

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:

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Nov 20 2013
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How Do You Transform a Community After a Century of Neglect?

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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.

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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.

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