Category Archives: Poverty
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.
In Doing the Best I Can, Tim Nelson, a lecturer in public policy at Harvard, and his co-author, Kathryn Edin, a professor of policy and management at the Kennedy School of Government at Harvard, take a close look at the inaccurate stereotypes about low-income fathers and how a different approach could lead to more stable, healthier families. The book also calls for reforms in the U.S. including regularly incorporating visitation into child-support orders and improving systemic approaches to fathers with employment barriers that affect their ability to pay support. According to Nelson, these efforts could result in increased income for single-mother families, social supports for dads, and improved father-child relationships.
Just before Father’s Day, NewPublicHealth spoke with Tim Nelson about the book’s findings.
NewPublicHealth: How did you come to write the book?
Tim Nelson: My co-author, Kathryn Edin, has written several books about single mothers in Camden, New Jersey and in Philadelphia, first in the mid-1990s about how single mothers make ends meet on welfare and low wage work and then in the mid-2000s, she co-wrote a book about how single moms make decisions about marriage and childrearing. Doing the Best I Can, is kind of the companion piece to the book on marriage and childrearing, which is called Promises I Can Keep. The men we interviewed are not the partners of the women in the prior book, but they do come from the same neighborhoods and have the same low income status. It’s aimed at getting the fathers’ perspectives and experiences, which are much less well known than the mothers’.
NPH: What needs correcting about the image of low-income fathers and why is it important to correct it?
Past Decade's Poor Economy Drove Health Declines
More than a decade of research points to the negative impact of the austerity that accompanies a flagging economy on the population's health, according to Reuters. The studies will be detailed in a new book to be released by an interesting research pairing including a political economist from Oxford University and a professor of medicine and epidemiology at Standford University. the researchers say more than 10,000 suicides and up to a million cases of depression have been diagnosed during what they call the "Great Recession" and its accompanying austerity across Europe and North America. For example, more than five million Americans have lost access to health care during the latest recession. Researchers also tie cuts in governmental public health programs to excess disease rates. "In Greece, moves like cutting HIV prevention budgets have coincided with rates of the AIDS-causing virus rising by more than 200 percent since 2011—driven in part by increasing drug abuse in the context of a 50 percent youth unemployment rate," according to the Reuters article. Read more on poverty and health.
What Influences Kids to Smoke (or Not to) Changes Over Time
Peer pressure may have a bigger influence on middle school-aged kids in starting to smoke, but that influence may wane as they get older. On the other hand, researchers said parents seem to remain influential over their children's smoking behavior throughout high school, as reported by HealthDay. Researchers looked at data from the Midwestern Prevention Project, the longest-running substance abuse prevention, randomized controlled trial in the United States, which includes 1,000 teens. Read more on tobacco use.
Facebook Could Help Predict, Track and Map Obesity
The higher the percentage of people in a city, town or neighborhood with Facebook interests suggesting a healthy, active lifestyle, the lower that area's obesity rate, according to a new study. At the same time, areas with a large percentage of Facebook users with television-related interests tend to have higher rates of obesity. The study was conducted by Boston Children's Hospital researchers comparing geotagged Facebook user data with data from national and New York City-focused health surveys.
"Online social networks like Facebook represent a new high-value, low-cost data stream for looking at health at a population level," said study author John Brownstein, PhD, from the Boston Children's Hospital Informatics Program. "The tight correlation between Facebook users' interests and obesity data suggest that this kind of social network analysis could help generate real-time estimates of obesity levels in an area, help target public health campaigns that would promote healthy behavior change, and assess the success of those campaigns." The study was published in PLOS ONE. Read more on obesity.
More than 500 public health legal experts, advocates, practitioners and researchers gathered in Atlanta, Georgia, this week to discuss the top issues facing the field. William Foege, MD, MPH, kicked off the conference with a keynote address at the 2012 Public Health Law Conference. Foege is a celebrated epidemiologist and physician who played a leading role in many of the important public health campaigns of the past half-century, including efforts to eradicate smallpox. Dr. Foege previously served as the director of the Centers for Disease Control and Prevention and formed the Task Force for Child Survival and Development.
In his keynote address, Dr. Foege said, “Every public health decision is based on a political decision. The basis for political decisions is law.” He also urged attendees to take action. “Burying our heads is no longer an option. There are solutions, but they require changing the laws that affects what happen to our health.”
We caught up with Dr. Foege to get his take on the critical role of public health law.
>>Follow continued coverage of the Public Health Law Conference.
NewPublicHealth: As keynote speaker, what was important to you to convey to the hundreds of people in public health capacities attending the 2012 Public Health Law Conference?
Dr. William Foege: What I have emphasized is that the law is probably the second best tool we have ever had in public health after epidemiology. We’ve used it for a long time even if we did not have a formal organization, and when one looks at all of the spectrum of things accomplished from fluoridation to school entry requirements for immunization to what’s happened with air quality and water quality, you realize that this has been very important for public health.
NPH: What is one public health issue you’d point to that has been helped significantly by laws to carry it forward?
United Way of North Central Florida is focused on the building blocks that lead to a good quality of life – education, income and health – recognizing that communities are stronger when children are successful in school, families are financially stable and people are healthy. One of their primary roles is as a convener, to bring hundreds of organizations together across diverse sectors to set priorities and create change.
As part of our series looking at the work of United Ways across the nation in creating healthier communities, we spoke with Debbie Mason, President and CEO of the United Way of North Central Florida, and Mona Gil de Gibaja, Vice President of Community Impact, about their community planning process, strategies for effective partnerships, and the role of critical partners such as businesses and the local health department.
NewPublicHealth: What is the planning process you’re engaging in to set priorities around education, income and health?
Debbie Mason: Our major focus is education, but this is so inextricably linked to income and health. No matter where you start, you still wrap into the other two.
Environmental issues are consistently a topic of hot debate. A new study reveals that how we talk about these issues could have a big impact on whether people feel compelled to act on them. According to new research led by two awardees of the Robert Wood Johnson Foundation Investigator Awards in Health Policy Research, Matthew C. Nisbet, PhD, MS, and Edward W. Maibach, PhD, MPH, talking about the environmental consequences of climate change may not convince the unconvinced—while talking about the public health consequences might have a better chance.
As the American University and George Mason University professors write in a newly published study in the journal Climatic Change Letters, “Results show that across audience segments, the public health focus was the most likely to elicit emotional reactions consistent with support for climate change mitigation and adaptation.” The study was co-authored with Teresa Myers and Anthony Leiserowitz.
We caught up with Matthew Nisbet to get his take on the latest findings, and how the public health field can do a better job of framing issues in a way that motivates action.
NPH: What is message framing?
Matthew Nisbet: When you frame something as a communicator or as a journalist or as an expert, what you do is you emphasize one dimension of a complex issue over another, calling attention to certain considerations and certain arguments more so than other arguments. In the process, what you do is you communicate why an issue may or may not be a problem, who or what is responsible for that problem and then what should be done. One of the common misunderstandings about framing is that there can be something such as unframed information. Every act of communication, whether intentional or not, involves some type of framing.
NPH: Why is framing so important in communicating about public health issues?
Much attention has been paid on NewPublicHealth and elsewhere to the connection between education, health, economic opportunity, and even life expectancy. Sadly, when we consider the health and life trajectories for our young men of color in this country, it’s clear that we have a lot of work to do. Boys and young men of color are more likely to grow up in poverty, live in unsafe neighborhoods and attend schools that lack the basic resources and supports that kids need in order to thrive. In addition, actions that might be treated as youthful indiscretions by other young men often are judged more severely and result in harsher punishments that have lasting consequences. Only about half of African American, Hispanic and Native American boys graduate from high school on time with their cohort. Down the road, pathways to stable, productive employment can be limited – they commonly lack access to career and positive mentorship connections. And disparities in their access to and quality of health care services persist.
RWJF Program Officer Maisha Simmons attests that the options for our young men of color have been too limited for too long. That’s why today the Robert Wood Johnson Foundation (RWJF), through its Vulnerable Populations portfolio, launched the Forward Promise initiative to strengthen education opportunities, pathways to employment and health outcomes for boys and young men of color. A new Call for Proposals released by the initiative today will focus on the following areas:
- alternative approaches to harsh school discipline that do not push students out of school;
- solutions that focus on dropout prevention and increasing school graduation rates;
- mental health interventions that tailor approaches to boys and young men who have experienced and/or been exposed to violence and trauma; and
- career training programs that blend workforce and education emphases to ensure that students are college- and career-ready.
NewPublicHealth caught up with Maisha about the challenges facing young men of color and the quest for collaborative solutions.
NewPublicHealth: Paint us a picture of the health and quality of life of young men of color. What are some of the causes of the disparities that persist?
Maisha Simmons: If you look at the statistics around men of color, specifically African American men, they usually die sicker and younger than any other population in this country. There are a lot of variables, but what we’ve begun to focus on is, what are some of the non-traditional, non-medical factors that go into that?
So for us, we began to really focus on education, workforce and mental health issues and how they coincide with opportunities for health. When you look at young men and boys of color, their school outcomes are often worse. There are large number of young men not finishing school and they often don’t finish high school with their cohorts. We know the linkages between school and employment often have a collective impact on health outcomes.
NPH: What are some other experiences that influence the health and quality of life of young men of color?
The National Prevention and Health Promotion Strategy offers a comprehensive plan to increase the number of Americans who are healthy at every stage of life. A cornerstone of the Strategy is that it recognizes that good health comes not just from quality medical care, but also from the conditions we face where we live, learn, work and play—such as healthy homes, clean water and air and safe worksites. The strategy was developed by the National Prevention Council, which is composed of 17 federal agencies including the Department of Education, the Department of Housing and Urban Development and others.
As the Strategy is rolled out, NewPublicHealth will be speaking with Cabinet Secretaries, Agency directors and their designees to the Prevention Council about their prevention initiatives. Follow the series here.
This week, NewPublicHealth spoke with Estelle Richman, Senior Advisor to the Secretary of the Department of Housing and Urban Development.
NewPublicHealth: Why was it important for the Department of Housing and Urban Development (HUD) to be involved in the development of National Prevention Strategy?
Estelle Richman: HUD’s mission is to create strong, sustainable, inclusive communities and affordable housing for everyone. HUD is more than bricks and mortar. We need to get away from thinking that housing is just about putting a roof over your head. It’s your home, and your family’s health and safety and your children’s education are all dependent on where that home is. HUD views housing as a platform for improving a wide range of outcomes.
That’s what makes HUD dovetail perfectly with the National Prevention Strategy; the whole concept of affordability of housing and the quality of neighborhoods and the understanding of that influence on health. HUD invests about $50 billion annually on affordable housing and community development and these investments impact health. We don’t do it alone and none of our partners can do it alone. But together we can bring significant experience and expertise to the table so that we can truly mitigate and help prevent health hazards.
NPH: What approach is HUD taking to address the challenges of health related to housing?
Estelle Richman: One of the most obvious places where we make a substantial difference is the physical environment of housing, including a focus on lead-based paint hazards, mold and pests and all the many things that contribute to respiratory disease, allergies and other illnesses.
Another factor not always immediately connected is housing affordability and health. Many households are now paying more than 60 percent of their income in order to remain in their homes. And if you’re paying a huge amount of your income just to pay your rent or your mortgage, then you’re cutting something else—such as food, health care, medicine and transportation. That puts people at risk for both physical and mental health problems. Children in families that have been behind on rent are more likely to be in poor health, have increased risk of developmental delays and suffer from food insecurity than children whose families are stably housed.
NPH: What are some of HUD’s key initiatives in helping to foster sustainable, healthy communities?
Estelle Richman: We know that physical and mental health depends on sustainable and economically vital neighborhoods where we have access to transportation, good schools, safe places for children to play and places to go shopping for healthy and wholesome foods.
HUD’s Moving to Opportunity for Fair Housing Demonstration Program has shown that moving to better neighborhood environments is associated with improved mental and physical health for adults, lower rates of extreme obesity, lower rates of diabetes, less psychological stress and less major depression for adult women. So being able to stabilize where you live and the quality of your housing can make a difference.
We’re trying to reach some of these same goals through our Choice Neighborhoods Program, which is part of a partnership between HUD, the Department of Education, the Department of Justice, the Department of Health and Human Services and the Department of the Treasury. Choice Neighborhoods actually builds on the success of Hope VI, which was begun in the 1990s and was set up to transform some of the worst public housing by developing mixed-income communities. In Philadelphia, for example, when they were able to switch to Hope VI, you saw a distinctive change in those neighborhoods. Schools got better, neighborhood stores moved in, transportation became more accessible. When we talk about Choice Neighborhoods now, we consider employment assets, quality education, and a wider range of stakeholders, including nonprofits, private firms, local government and public housing authorities.
NPH: What changes can be made to housing and home standards to help improve home and neighborhood safety?
Estelle Richman: We believe the home environment is a major influence on health and well-being and that threats to housing quality include everything from excess moisture, mold, allergens, and poor indoor air quality, to structural deficiencies and lead contamination.
NPH: And what is the approach to minimizing risks such as lead poising from lead-based paint?
Estelle Richman: Our Office of Healthy Homes and Lead Hazard Control is looking at this. We know that housing that was built before 1978 may have lead-based paint, with homes built before 1940 having the highest levels of lead in paint. So it really doesn’t matter if you make a million dollars—if you’re living in a house built before 1978, the odds that there’s lead somewhere in that house is high enough that everyone needs to be concerned about their children. So the standard has to be set high enough that we protect everyone.
NPH: What is HUD doing in the area of secondhand smoke in homes and who are your partners?
Estelle Richman: That is a big agenda items for many divisions of the Department.
Our partners in this are the Housing Authorities, some of the landlords, and just about anyone else who’ll talk to us. My best example of this is the Boston Housing Authority, which is on track to now to implement a total smoke-free policy this fall. They found that their asthma rates were twice as high as those for residents living in non-subsidized housing. They have done a lot of work over the last several years educating themselves, their clients, and offering folks as much support as possible to stop smoking, and now they’re ready to implement a smoke-free policy.
There are several other cities that have announced that they are looking at instituting smoke-free policies—San Antonio, Minneapolis, Portland, Oregon and all of the housing authorities in the State of Maine are among them. We’re offering whatever technical assistance we can to help them do it. We’re working in partnership with HHS, the American Academy of Pediatrics and the American Lung Association and trying to gather many other community supporters.
As we push, I think we will always find folks who believe that they want to continue to smoke, but we’re also finding that there are many people who are ready for smoke-free policies in their housing.
NPH: What are some current efforts of working across sectors to improve housing and better health in that housing?
Estelle Richman: Our Section 811 Project Rental Assistance Demonstration Program is a rental demonstration program to provide housing for people who have disabilities. It provides $85 million in funding to state housing agencies and other appropriate entities to provide long-term housing rental assistance for approximately 2,800 people. Many of these folks will have physical disabilities and will often need assistant care or assistive technology in order to live in the housing, which means that most of them will also be involved with the state Medicaid Agency, as well as their state Health and Human Services Agency.
To develop the program we worked hand in hand with the Centers for Medicare and Medicaid Services. I can’t tell you the number of positive emails I received. People were anxiously awaiting it. It is fully integrated with non-disabled populations, which was critical to the disabled community. To be a part of the program, a state housing agency must partner with the state Medicaid agency to submit a grant. So this is a true partnership. It’s integrated housing, it’s supportive housing and it helps get people out of institutions.
NPH: What are examples of partnerships you have within the Federal government?
Estelle Richman: We meet with our partners at HHS every week. We talk about our joint projects and about projects that we would like to work on together. We’re also a very strong partner with the Department of Veterans Affairs (VA). You may know that we’re working with the VA around eliminating veterans' homelessness by 2015. There is also an HHS part of it so that we can know that our veterans who are coming home not only have good health care, but they also have a place to live. As I’ve said, we all have to have partners and it is, in essence, the core of that partnership that helps us make progress. The National Prevention Council has actually brought these partners together and I credit them for being part of what keeps us working together. It’s very easy in some of these very large bureaucracies to drift off and do your own mission and I think one of the things the National Prevention Council does is help us all realize that we all share prevention, we all work on it together.
NPH: What are some of the other critical partners in communities?
Estelle Richman: In any level of government, the level you need to get to is the level of where the people are. So you need to get down to neighborhoods, you need to get to communities and when you go down in communities, you really need to talk to your hospital and health care systems, community neighborhood groups, schools and PTAs. Also what rises to the top of the page real quickly is transportation. If you have not figured out how to get transportation as a partner then you’re going to have a hard time getting prevention, promotion and health care to work outside the city center.
Each community is different. You need to talk to the folks and get a feel for what’s going to make a difference in that particular community.
NPH: Tell us about the Partnership for Sustainable Communities.
Estelle Richman: It is a multi-partner collaboration among HUD, the Department of Transportation and the Environmental Protection Agency. These two agencies have not always been traditional partners for HUD. Through the Partnership, we are coordinating federal housing, transportation, and environmental investments and looking at things like water infrastructure, roads, sidewalks, transit lines, and job creation opportunities as all of those things are necessary for a healthy and vibrant community life. Several of the Sustainable Communities grant recipients are partnering with the public health sector, including in conducting health impact assessments, increasing access to fresh foods, and encouraging active living that includes opportunities for exercise in one's daily commute and routine. They’re realizing that to improve public health, it’s critical to actually support and create the communities that are not only going to be economically sustainable, but that also maximize environmental, energy-efficient and socially sustainable design and development strategies.
NPH: What had the National Prevention Council brought to the table that was not there before?
Estelle Richman: When you have an initiative like the National Prevention Council, you set goals, you set measurable outcomes and you also have skin in the game of what the big group is doing. You’re held accountable, but you’re asking to be held accountable. And it’s not accountable to your silo, it’s accountable to the larger group.
And I think it’s that choice of accountability to the larger group for health care that affects all of us. The concern about health care is not an issue just for struggling families or folks in foreclosure or families that are in the lower incomes. Health care is something we are all concerned about. In the end, it holds us all accountable for better communities.
>>Catch up on the rest of the National Prevention Strategy series on NewPublicHealth.