Category Archives: Health disparities
As thousands of people who are striving to improve health and health care convene in San Francisco, Calif., for the American Public Health Association Annual Meeting, RWJF is hosting brief interviews with thought leaders from across sectors. Brian Gallagher, President and CEO of United Way Worldwide, provided his thoughts on partnerships.
NewPublicHealth also spoke with Stacey Stewart, who was recently named to the new position of president of United Way USA. She was previously the executive Vice President, Community Impact Leadership and Learning at United Way Worldwide. Stewart shared her goals for UnitedWay USA, as well as what she's learned about the integral connections between education, income and health.
To follow is an excerpt of a conversation with Monica Peek, a Robert Wood Johnson Foundation scholar and grantee, who presented at the American Public Health Association Annual Meeting about new research exploring the value of high quality doctor-patient relationships on health outcomes and cost of care.
As a little girl, Monica Peek often went to the doctor with her grandmother, Mae Reather Long. On those visits to the clinic, she recalls, “my grandmother, who had diabetes, hypertension and high cholesterol, would listen patiently to her doctor’s advice. He would advise her to ‘eat healthy.’ She would politely answer that she had been doing so, and that was that.” Her grandmother’s physician didn’t realize that “yes, I’m eating healthy” most likely meant vegetables prepared southern style—with smoked ham. Or that Peek’s grandmother really wanted more time to discuss her medications and how to take them, but she was afraid to ask.
At a presentation at the October 2012 American Public Health Association (APHA) meeting, Peek, who is now an MD, MPH, and diabetes specialist, taught other health care providers how to avoid this type of disconnect with their patients and harness the tremendous power of culturally appropriate communication. Peek’s research, along with her award-winning film on shared decision making between physician and patient and her ongoing work at the South Side diabetes project in Chicago, grew, in part, out of those early lessons learned by her grandmother’s side.
Peek and her colleagues have been investigating the behaviors that encourage share decision making since 2008, with a focus on African Americans, though Peek suggests her findings are also applicable to other ethnic or cultural groups struggling with diabetes. She found that while African American patients wanted to participate in SDM, they were much less likely to be asked by their physicians to engage in it than non-Hispanic Whites.
>>Read the full interview with Monica Peek.
>>Read reflections on APHA 2012 from an RWJF scholar.
>>Watch the award-winning film: Shared Decision Making: The Importance of being Actively Involved in Your Health Care.
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.
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?
Despite advances in health care and increases in life expectancy overall, Americans with less than a high school education have life expectancies similar to adults in the 1950s and 1960s, according to a new study in Health Affairs.
“The most highly educated white men live about 14 years longer than the least educated black men,” says S. Jay Olshansky, professor of epidemiology at the University of Illinois at Chicago School of Public Health and lead author of the study. “The least educated black women live about 10 years less than the most educated white women.” Olshanksy’s research was funded by The MacArthur Foundation Research Network on an Aging Society.
One key finding, according to Olshansky, is that life expectancy for white women with less than 12 years of education has actually declined since 1990, dropping from a life expectancy of 78 to 73 years. Black women with less than 12 years of education can expect to live to age 74, up from age 73 two decades ago.
The researchers speculate that the least educated black women are experiencing high levels of obesity, which is impacting their longevity, and that the least educated white women may be more likely to adopt dangerous health behaviors including smoking and alcohol and drug use.
>>Bonus Link: Listen to a podcast and read a recent interview with Education Secretary Arne Duncan on the critical connection between health and education.
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.
The choice of Washington, D.C. as the site of the 2012 International AIDS Conference is an important one – about 3 percent of the adult and teen residents of the city are HIV positive. That exceeds the definition of an AIDS epidemic by UNAIDS – 1 percent of a population.
A new report from the Kaiser Family Foundation says that, “In many ways, the D.C. epidemic is a microcosm for what is happening nationally”: D.C. is a small, densely populated community with overlapping sexual networks that can fuel transmission, and also faces significant health care access challenges, poverty, drug use, high rates of other sexually transmitted infections, stigma and lack of knowledge about HIV status.
Blacks in D.C. have the highest HIV prevalence rates per 100,000 adults and adolescents (4,264.6)—more than twice the rate among Latinos (1,836.4) and three times the rate among whites (1,226.3). One difference is that in D.C., there is a higher prevalence of HIV among Black women (2.6%) compared with white men (2.4%).
Importantly, though, the report finds gains in HIV awareness and testing in the city. Over 100,000 HIV tests were done in DC last year, triple the number in 2007. And, according to the Kaiser Family Foundation, D.C. was the first jurisdiction to adopt CDC recommendations for routine HIV testing in health care settings and actively works with providers to expand testing. More than four in 10 D.C. residents, ages 18-64, report being tested for HIV within the past year, the highest share of any state.
>>Bonus Link: The Washington Post has been live blogging the AIDS conference this week and the site also has some notable features including an important story on the stigma of AIDS in the South and obstacles in the U.S. to successful treatment for HIV/AIDS.
Public Health Commencement: "It Is Vital That We Have People�Who See Opportunities Where Others See Barriers"
>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.
Commencement speakers at schools of public health graduations brought cache as well as advice this year. The speakers included former FDA commissioner David Kessler, who spoke at Drexel; Michelle Obama who spoke at Oregon State University; and Alex Kotlowitz, producer of the documentary film The Interrupters about CeaseFire, a novel approach to preventing violence now employed in several cities, at the University of Illinois at Chicago.
>>The film The Interrupters will be screened for attendees at the National Association of County and City Health Officials Annual Meeting next week on July 11 at 7:00 p.m.
Harvard School of Public Health dean Julio Frenk, MD, underscored emerging roles and responsibilities of public health graduates at the school’s commencement ceremony: “No government—even that of the wealthiest nation—can afford to pay for all of the scientific research and public health programs that we require to keep people healthy,” Dean Frenk said. “As a result, it is vital that we have people educated in science and public health who see opportunities where others see barriers—who are comfortable moving easily between the worlds of government, business, civil society and academia, to improve people’s health.”
And at the commencement ceremonies of the School of Public Health at UC Berkeley, Angela Glover Blackwell, founder and chief executive officer of PolicyLink, a national organization aimed at advancing social and economic equity, spoke about collateral benefits. Glover Blackwell pointed out the many things in our society that bring collateral benefits including food stamp programs, which have increased the number of grocery stores in middle income communities, and cuts at street corners, which came about through the hard work of advocates for the disabled but benefit parents pushing strollers, people dragging wheeled suitcases, and workmen dragging their wagons and carts with goods. Said Glover Blackwell: “When we work on the problems for the most vulnerable, we end up solving problems for everybody.”
We’ll never know if it was the spirited discussions or Tropical Storm Debby, which is pummeling northern and central Florida, that kept most of the 2,000-plus attendees at this year’s AcademyHealth Annual Research Meeting—this year in Orlando—indoors and packed into the sessions and the exhibit hall at just about every minute of the meeting this year. Public Health was a featured topic, according to AcademyHealth president and CEO Lisa Simpson, and a session on the IOM report on the integration of public health and primary care, led by the committee chair, Paul Wallace, MD, was a featured, and well-attended, session as well.
Not surprisingly, many public health officials made their way into a ballroom very early Tuesday morning to hear three health law scholars, Sara Rosenbaum of the George Washington University, Timothy Jost of Washington and Lee and Mark Hall of Wake Forest, talk about the issues likely contemplated by the Supreme Court Justices as they considered the cases brought against the Affordable Care Act. Critical for public health were the discussion points aired just before the session ended, concerned with continued state and federal budget cuts including cuts to the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services, which could impact public health service delivery now underway, as well as implementation of the Affordable Care Act, if it is upheld.
Health disparities were also a focus of several sessions, as well as the topic that won the student poster award of the conference. Stephen Vance, a fourth-year medical student at the University of North Carolina at Chapel Hill School of Medicine, won the best student poster award for his work with Aida Lugo-Somolinos, MD, of the medical school, on clinical trial enrollment barriers faced by the Hispanic population in North Carolina. Vance’s research found that the barriers identified by the Hispanic participants in the study differ from those expected by clinical investigators.
The study provided a questionnaire for physicians on their perceptions of why more members of the Hispanic community don’t enroll in clinical trials, and also collected patient questionnaires on trial participation from close to 400 members of the Hispanic community.
The physician responses showed that they viewed language and transportation as the key barriers. But the patient responses showed other concerns including worries about what participating might cost them, concern about missed work time and a lack of understanding about the potential benefits of trial participation, including access to health care. The researchers say the following should be considered as a means to enroll more members of Hispanic communities in trials:
- Provide information about studies to health care providers in areas with large Hispanic populations
- In large cities, create partnerships with Hispanic advocacy groups
- Communicate that trial participation is not necessarily costly and may take no more time than a regular doctor’s appointment
- Include a person fluent in Spanish on the research team
“Before this study, I would have thought that transportation and language were the key barriers,” says Vance. “It’s really a lack of understanding of what a clinical research project entails.”
“Perhaps as clinicians, we’re asking the wrong questions,” says Vance, who is on track to get an MBA as well as his MD degree, and plans to go into health management. “This study focuses on the Hispanic community, but should push us to look at the reasons why other groups are underrepresented in trials.”
A research letter published in the Journal of the American Medical Association finds that the life expectancy for Africans Americans and Whites narrowed between 2003 and 2008 based on a review of data from the U.S. National Vital Statistics System. During that time, life expectancy at birth rose from 75.3 years to 76.2 years for White men and from 68.8 to 70.8 years for African American men. For White women, life expectancy increased from 80.3 to 81.2 years; and for African American women increased from 75.7 years to 77.5 years. The gap narrowed from 6.5 years to 5.4 years among men and from 4.6 to 3.7 years among women.
Deaths from HIV, infant mortality, heart disease, homicide and diabetes remain higher among African Americans. Read more on health disparities.
The Walt Disney Company has announced that by 2015, its television, radio and website channels aimed at kids will help promote consumption of fruits and vegetables and ban the marketing of some junk foods. The company will set metrics on the calorie and fat content of foods that can be advertised on its channels. Read more on nutrition.
A study published in Nicotine and Tobacco Research surveyed 1,000 smokers age 25 and older and found that smokers who consumed the most fruit and vegetables were three times more likely to be tobacco-free than those who ate smaller quantities of produce. The researchers say the findings held even when accounting for age, gender, race/ethnicity, education and household income.
The researchers also found that smokers with higher fruit and vegetable consumption smoked fewer cigarettes per day, waited longer to smoke their first cigarette of the day and scored lower on a test for nicotine dependence.
Reasons why consuming fruit and vegetables may impact smoking include the possibility that higher fiber consumption from fruits and vegetables make people feel fuller which may make them feel less of a need to smoke, since smokers sometimes confuse hunger with an urge to smoke, according to the researchers. In addition, unlike other products, such as caffeinated drinks and alcohol, fruits and vegetables don’t enhance the taste of tobacco. Funding for the study was provided by the Robert Wood Johnson Foundation and Legacy. Read more tobacco news.