Category Archives: Community Health
A conference in St. Paul, Minn., earlier this month examined ideas and emerging examples for building a healthier Minnesota by promoting the integration of health-related programs and community development to address health where we live, learn, work and play. The conference was convened by the Federal Reserve Bank of Minnesota and Wilder Research, the research arm of the Amherst H. Wilder Foundation. The gathering, which was a follow-up to an initial conference on the intersection of health and community development held in Minnesota a year ago, highlighted current successful cross-sector efforts throughout the state.
Elaine Arkin, manager of the Robert Wood Johnson Foundation Commission to Build a Healthier America, was a keynote speaker at the conference. Her remarks included the announcement that the Commission’s recommendations on early childhood and supporting healthy communities will be released in early 2013.
The highlighted projects included a task force on increasing access to healthier foods, often an obstacle in poorer communities; locating needed services alongside senior housing; a stable housing concept for people at risk of homelessness following a hospital stay; and a project underway to give kids living in trailer parks a safe place to play.
“The strategy that we used this year in engaging people with actual examples...was very effective in really acknowledging that this work is messy, that it does take time and that in order to keep people enthusiastic about it sometimes it does require giving people a pat on the back even just for the small progress that they’ve made,” said Ela Rausch, community development project manager of the Federal Reserve of Minnesota.
Following the conference, NewPublicHealth spoke with Ela Rausch and Paul Mattessich, PhD, Executive Director of Wilder Research.
NewPublicHealth: What were the key goals of this year’s meeting?
Paul Mattessich: The overarching goal is at the national level to bring together public health with community development finance in order to better address health issues, social determinants of health and improved community health. But what we did the first time a year ago was to try to get the two sectors to understand what each other does, what their vocabulary was, how best to work together and to start some networking.
This year the goal was to take the next step and highlight some examples where this cross-sector collaboration occurred, and to use that to try to further that even more and to underscore the fact that the two sectors really do address the same end goal, even though they do it in different ways. And if they team up they can do it more effectively.
Earlier this week, the Robert Wood Johnson Foundation held its first ever “Culture of Health Hangout,” a new series meant to explore what communities across the country are doing to advance and transform public health. This first foray looked at how public health departments have evolved in recent years, and are continuing to evolve to meet the changing needs of the communities they serve. The panel was moderated by Paul Kuehnert, RWJF senior program officer and Public Health team director.
According to Muntu Davis, Public Health Director and County Health Officer of Alameda County, the core role of public health hasn’t really changed—public health departments and officials continue to gather and analyze data to explain what’s happening to the health of a community. However, what has changed is where they put their focus. Now, in health departments across the country, the focus is not simply on individual decisions, but on social and economic factors that dictate which options are truly available.
“Although it does boil down to an individual choice, if there’s no opportunity there for communities, then ‘health’ is definitely not an easy choice to make,” said Davis.
One of the more innovative approaches his health department has undertaken is utilizing maternal and child health workers to provide, in addition to their traditional work, financial coaching to people who may be of lower incomes. “Studies have shown link between income, wealth and life expectancy,” said Davis, and that’s what makes it important for public health to help support not just the immediate health need but also “the full picture of what might be shaping their health.” These workers are able to provide education and assistance, while also linking them to financial coaching and tools that can help them manage the money they have.
Karen DeSalvo, City of New Orleans Health Commissioner, spoke extensively on the importance of community partnerships when it comes to advancing community health. She said Hurricane Katrina was, in a way, a “catalyst for change” that enabled the entire community to hit the reset button, assess where they were and determine how best to move forward together. One of the first realizations was that the city simply did not have a strong enough local health department.
“It allowed us to begin planning, and to decide to move away from an expensive, hospital-based system to one that was more about prevention and primary care,” she said. “And over the course of years, once we stabilized that infrastructure at the frontline of primary care and moved more toward prevention, the glaring need to have a strong public health department became obvious.”
DOT and HUD Release Neighborhood Affordability Tool
The U.S. Departments of Housing and Transportation (HUD and DOT, respectively) have released a Location Affordability Portal, a new tool that lets users estimate housing and transportation costs for neighborhoods across the country.
“Many consumers make the mistake of thinking they can afford to live in a certain neighborhood or region just because they can afford the rent or mortgage payment. Housing affordability encompasses much more than that,” said HUD Secretary Donovan. “The combined cost of housing and transportation consumes close to half of a working family’s monthly budget, and the [Portal] will help to better inform consumers, help them save money, and provide them with a broader perspective of their housing and transportation options.”
The new tool was developed with the input of real-estate industry professionals, academics, and staff from HUD and DOT, and uses statistical models that were developed from various sources that capture key neighborhood characteristics including population density, transit and job access, average number of commuters and distance of commutes, average household income and size, median selected monthly owner costs. and median gross rent. Read more on housing and transportation.
Health Index May Reduce Hospital Readmissions
A health risk score used during hospital stays using routine data from hospital electronic medical records may be able to identify patients at high risk of unplanned hospital readmission, according to a study published in Medical Care.
The score is calculated automatically using patient data such as vital signs, nursing assessments, skin condition, heart rhythms and laboratory tests. Lower Rothman Index scores (from a maximum of 100) indicate a higher risk of readmission. The study evaluated the ability of the Rothman Index to predict hospital readmission, based on data from more than 2,700 patients hospitalized during 2011. The researchers found that patients whom the Index calculated as being high risk for readmission were 2.5 times as likely to be readmitted within 30 days of discharge as patients calculated by the Index to be low risk.
About 20 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, at an estimated cost of $17 billion per year, according to the study authors. Medicare has begun reducing payments by up to 2 percent for hospitals with high readmission rates. Read more on community health.
Rapid Flu Testing in the ER Leads to More Effective Treatment
Using rapid influenza tests to diagnose flu in patients who come to the emergency room results in fewer unnecessary antibiotics, increased prescriptions for antiviral medicines, and fewer additional lab tests compared to patients diagnosed with influenza without testing, according to a new study the Journal of the Pediatrics Infectious Diseases Society.
Among patients diagnosed with influenza without rapid testing, 23 percent of the emergency department visits included a prescription for antibiotics, which are not effective in to treat influenza because it is a viral infection. However, for patients who were diagnosed by rapid testing, only 11 percent of visits resulted in the patient getting antibiotics. Additional laboratory tests, including chest X-rays, blood tests, and urinalysis, were also ordered less frequently for patients whose influenza illness was diagnosed with a rapid test.
"While other studies have shown that physicians can accurately diagnose influenza without testing, our results suggest that using an influenza test increases diagnostic certainty and leads to the physician providing more specific and appropriate care,” says Anne J. Blaschke, MD, PhD, of the University of Utah School of Medicine, the study’s lead author. Read more on infectious disease.
The changing environment for health departments under the Affordable Care Act (ACA) was the focus of a very well attended early morning session at the American Public Health Association (APHA) annual meeting in Boston today, moderated by APHA public health policy analyst Vanessa Forsberg, MPP.
Hospitals and private health care providers will soon be competing with health departments for clinical services such as immunizations for a newly insured population, according to Forsberg. However collaboration may help departments keep and grow clinical services, as well as collaborate with new partners under other new ACA rules, such as community benefit requirements for hospitals to improve population and individual health.
“There’s a lot of innovation, a lot of people moving into that space and this is a clarion call to say public health had a head start and don’t let the space be taken from you, learn the finance side,” said James Corbett, M.Div, JD, an ethics fellow at the Harvard Medical School and vice president of charity care and ethics at the Steward Health Care System in Boston.
Opportunities for health departments, says Corbett, include focusing on addressing disparities, preventive health, innovative programs and partnerships that improve care and reduce costs.
A key example Corbett shared was a decision by Steward to hire community health workers whose services can be billed for under the ACA beginning January 1. Corbett says he looked at the hospital’s bad debt documentation by language and found trends, then convinced the hospital’s CEO to allow him to hire community workers who got iPads and then went out into the community to visit patients who hadn’t paid bills. They were able to use the devices to record identification and other information, then help the patients sign up for Medicaid and other assistance that allowed them to be covered and the health system to be paid.
New research presented at the American Public Health Association (APHA) annual meeting in Boston today finds that when public health funding increases in a community, its rates of infant mortality and deaths due to preventable diseases decrease over time, with low-income communities experiencing the largest health and economic gains.
According to the research, conducted by Glen Mays, PhD, MPH, director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research, each ten percent increase in public health spending over 17 years led to a 4.3 percent reduction in infant mortality, as well as reductions of 0.5 to 3.9 percent in non-infant deaths from cardiovascular disease, diabetes, cancer and influenza.
However, these health gains were 20-44 percent larger when funding was targeted to lower-income communities. Increases in public health spending also correlated with lower medical care costs per person, especially in low-income areas. The study, which analyzed data compiled by the National Association of County and City Health Officials from 3,000 local public health agencies over a 17-year period, also found that lower death rates and health care costs were seen especially in communities that allocated their public health funding across a broader mix of preventive services.
“The results clearly show that better health and lower health care costs are possible if we simply change how and where we allocate public health funding, even if new money isn’t available, said Mays. “And it also shows that new resources, such as funding from the Affordable Care Act’s Prevention Fund, can have a larger impact if targeted to lower-resource, higher-need communities and if spread across a range of prevention strategies.”
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
NewPublicHealth spoke with Mays about the new study just before the APHA annual meeting began.
NewPublicHealth: What are the key findings of the study?
Glen Mays: We’ve done prior studies that show communities that invest more on public health realize gains in health status and, over time, those communities see slower growth in medical care costs. So the goal of the study is to look at who benefits most from investments in public health.
What we found was that, not all that surprisingly, communities that are more economically constrained, that have lower income communities with higher poverty rates and lower socioeconomic status, tend to benefit the most from investments in public health activities over time. These low-resource communities see larger reductions in their preventable mortality, and they also see larger reductions in their medical care costs over time from investments in public health spending compared to more affluent communities. We expected to find that, but this is the first time we’ve been able to document the size of that effect. Those communities see about twenty percent higher rates of health and economic gain from their spending compared to more affluent communities.
At the recent Place Matters conference in Washington, D.C., David Williams, PhD, the Norman Professor of Public Health at the Harvard School of Public Health and staff director of the reconvened Robert Wood Johnson Foundation Commission to Build a Healthier America, talked about the need for cooperation between the community development industry and health leaders.
“Community development and health are working side by side in the same neighborhoods and often with the same residents but often don’t know each other or coordinate efforts.”
NewPublicHealth recently asked Dr. Williams about how synergies between the two fields can help improve population health.
>>View David Williams' PowerPoint presentation from the conference:
NewPublicHealth: Is there progress on the community development and health fields working together to help improve the health of communities?
David Williams: I would say there is increasing recognition by individuals both in health and in community development that they are two groups working in many ways on the same challenges and often in the same communities and in many ways there can be there could be synergy from working together. But I would also say that this is all so new, and I don’t think the field has matured in terms of our full understanding of where the potential is. To me, one of the greatest hungers out there is for people to see examples of success and progress and initiatives that in fact have worked well together, and we’re still in the beginnings of seeing that—such as the Federal Reserve healthy communities conferences, which have raised awareness levels and have begun to help similar initiatives. But we’re still in the infancy of really capitalizing on the potential.
One of the key challenges is that this area of healthy communities is a broader issue. And that includes the need to recognize the importance of a health in all policies approach—that policies in many sectors far removed from health have health consequences. A good example is the education sector—and having teachers recognize that they are themselves are health workers in a certain sense because the work they do can have such an important impact on health.
On Wednesday October 2nd, the Joint Center for Political and Economic Studies held its third annual National Health Equity Conference, PLACE MATTERS: Exploring the Intersections of Health and Economic Justice. The Joint Center for Political and Economic Studies was founded in 1970 and is the only research and public policy institute that focuses exclusively on social justice issues of particular concern to African Americans and other communities of color.
The conference focused on the relationship between community development and the creation of healthy spaces and places, and convened key stakeholders, including grassroots leaders, elected officials, researchers, public health practitioners, policymakers, community development practitioners, and community organizers. The conference had several goals, including to:
- Illuminate the mechanisms through which neighborhood conditions directly and indirectly shape the health of children, youth, and families, and document differences in neighborhood conditions resulting from residential segregation;
- Identify common goals and strategies of individuals and organizations working in the community development sector and the health equity sector;
- Elevate promising strategies to improve and sustain neighborhood conditions for health that draw upon effective approaches employed in the community development and health equity sectors; and
- Explore means to better communicate these strategies to key audiences, such as community-based development and health equity organizations, public health practitioners, planners, and elected officials.
Leaders at the Joint Center say that by convening national and local leaders, including individuals at the forefront of community development and health equity movements, they hoped to raise awareness regarding community conditions that shape health and develop policy solutions at the intersection of place and health, particularly as it pertains to people of color and health equity.
NewPublicHealth spoke with Brian Smedley, PhD, Vice President and Director of the Joint Center’s Health Policy Institute about the critical issues of community health and its relationship to health equity.
NewPublicHealth: What do we know so far about the impact of place on health, and what do we still need to learn?
Brian Smedley: There’s a large and growing body of research that demonstrates the relationship between the places and spaces where people live, work, study, and play and their health status, and what we’ve been able to determine is that there are many characteristics of neighborhoods, schools and work places that powerfully shape health. Just as an example, more and more people are paying attention to this concept of food deserts — many communities in the United States that don’t have geographic access to healthy foods. And not only do people have to travel a long distance to access these foods, but they’re often financially out of reach as well.
The business sector is a critical partner when it comes to promoting the health of a community. Employment, income and overall economic stability greatly impact employee and community health. Increasingly, businesses are expanding their efforts from worksite-based health promotion programs to community-wide initiatives to ensure their employees’ access to healthy choices and environments.
Next Tuesday at 3 p.m., a County Health Rankings webinar will take a look at how local health leaders and businesses can work together to advance the health improvement efforts in their communities. The webinar will feature guest speaker Cara McNulty, Senior Group Manager for Prevention and Wellness at Target Corporation, which according to webinar organizers is “known for its commitment to community giving.” McNulty will share examples and lessons learned from her experience at Target to answer key questions:
- What kinds of partnerships are businesses looking for?
- What do communities and businesses need to understand about each other in order to forge successful partnerships?
>>Join the webinar to learn how to build common ground with businesses in your community and advance community health together.
Public Health Presentations Cap First Class of Network for Public Health Law Mentorship Program for Young Attorneys
Laws and policies that impact public health can create healthier conditions for entire communities—a more cost-effective approach than treating one person at a time, and then only after they’re sick. Last week, five inaugural Visiting Attorneys in Public Health Law presented on their efforts over the past year as part of a program hosted by the Network for Public Health Law and the Robert Wood Johnson Foundation (RWJF). The attorneys focused on public health law around:
- The legality of tobacco “power walls” that put colored cigarettes boxes directly in the line of vision of children
- The impact of environmental noise on heart disease
- Displacement of residents through gentrification
- The challenges and promise of “health in all policies”
- Legal avenues toward reducing sodium intake by the public
The post-JD program is designed to help develop exceptional skills in practice-based public health law than can help lawyers to advance their public health law careers. During the program, the five attorneys were each located at a host site under the mentorship of a renowned public health legal expert. This year’s mentors included Doug Blanke, founder and director of the Public Health Law Center at the William Mitchell College of Law in Minnesota, and Clifford Rees, practice director of the western region of the Network for Public Health Law.
“This fellowship is one that we developed in conjunction with the Network for Public Health Law to help to build the field of public health law and to allow bright, new attorneys with an interest in public health, to be able to experience working in [that] setting while being mentored and coached by leaders in the field,” says Angela McGowan, JD, MPH, RWJF’s senior program officer.
McGowan says RWJF hopes this type of experience will highlight that public health law is an exciting career option, as well as show the value of engaging new professionals in this practice as a way of making meaningful impacts at the local, state and federal levels of public health. McGowan added that the Visiting Attorneys were able to really be engaged with the real work that public health and law practitioners face daily, and to apply their legal knowledge to solving public health problems.
New York City is currently developing a pilot public health program known as NYC Macroscope — the first domestic effort to aggregate electronic health record (EHR) data into a surveillance tool to inform public health decisions. The population health surveillance system will compile electronic health records from primary care practices to help city health officials monitor—and respond to—the real-time prevalence of conditions that impact public health. The project is the result of a partnership between the New York City Health Department and the CUNY School of Public Health, with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, and additional support from the de Beaumont Foundation, Robin Hood and the New York State Health Foundation.
NewPublicHealth spoke with Carolyn Greene, MD, Deputy Commissioner of the NYC Department of Health and Mental Hygiene’s Division of Epidemiology, about the plans and goals for the program.
NewPublicHealth: Tell us about NYC Macroscope and how it will work.
Carolyn Greene: NYC Macroscope is going to be New York City’s first electronic health record surveillance system. We have a program here at the health department called Primary Care Information Project (PCIP), and it’s one of the nation’s largest distributed electronic health record networks. PCIP began in 2005. It concentrated on primary care practices in high need areas where the Health Department really wanted to encourage providers to use electronic health records. The program has been extremely successful and they’ve completed many different activities to improve the quality of clinical care.
But in recent years, we’ve been asking the question: Can we use electronic health records for more than just patient care? Can we, in fact, use electronic health records to monitor the health of the population? Here at the Health Department, we have many different ways to conduct population health surveillance. We have surveys that we conduct by telephone, we have disease registries that we host, and we have our vital statistics registry on deaths and births. All these data are very important. But they are costly, resource-intensive and they often have a time lag from when the data are collected to when we can actually find the results from the data, so the advantages of an electronic health record surveillance system are many.
One advantage is that the architecture is already there. If you already have the electronic health records in place, you don’t have to find additional resources to collect the data because you’re already collecting the data through the EHR architecture. Other advantages are that potentially you can collect data in real time and potentially at low cost.
NPH: Do you see any potential disadvantages?
Greene: I think the first one is we always have to ask how representative the data will be in terms of representing the population as a whole. First of all, electronic health records only collect data on people who are in care and, because sicker patients go to the doctor more frequently, there’s a greater likelihood that we may be picking up more information on sicker patients. So we have questions about how representative are the data.