Category Archives: Community-based care
Leaders from the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute, who collaborate each year on the County Health Rankings, held a webinar yesterday—the launch day for the 2014 report—to talk about the importance of the Rankings and what’s new this year, as well as to answer questions from a wide ranging Twitter audience.
The webcast is now available online and provides a broad and insightful overview of how the County Health Rankings are helping to improve health across the United States.
"Our vision is a nation where getting healthy, staying healthy and making sure our children grow up healthy are top priorities,” said Michelle Larkin, JD, RN, RWJF assistant vice president for portfolio programs, at the start of the webcast.
Six new measures were added to this year’s report, including housing and transportation.
“The Rankings are only as valuable as the actions they inspire,” said Julie Willems Van Dijk, RN, PhD, Deputy Director of the County Health Rankings & Roadmaps and a panelist on the webinar. She also directed viewers to the Action Center section of the Rankings website, which includes step-by-step guides for policies and activities counties can initiate to help improve health.
Videos shown during the webcast explained the health factors and outcomes that make up the rankings while showcasing efforts to improve health in Western New York, Kentucky and North Carolina. The webcast also highlighted the six 2013 Culture of Health Prize winners whose community efforts to improve health included tackling domestic violence and improving access to preschool education.
Questions poured in via Twitter during the webcast, including a query about how the Rankings have helped changed the conversation about community health.
“There has been an incredible change,” said Van Dijk. “People are starting to talk about the many factors that influence health. When we started people would say, ‘Why are issues such as employment and education in a health report?’” Added Van Dijk, “More and more, we’re seeing people understand that those factors are key determinants of health. And what that has done has increased the sense of awareness that it takes all of us to build a culture of health. We can’t just lay it at the door of hospitals and health departments.”
“We’ve seen mayors and other legislators stand up and take ownership of this report and action on changing policy, such as how people from all income levels have access to quality preschool education,” she added.
Webinar panelist Patrick Remington, MD, MPH, associate dean for public health at the University of Wisconsin School of Medicine and Public Health, encouraged participants to add to the utility of the Rankings report by also using local data to help them drill down on what is impacting local communities. “Differences we see in teenage pregnancies may be two times higher in blacks than whites, but can be fifteen times higher when comparing where people live,” he said.
>>Bonus Link: Read more about the 2014 County Health Rankings reports and featured communities on NewPublicHealth.
Community Health Centers serve more than 22 million people at more than 9,000 sites located throughout all 50 states and U.S. territories, and have become needed health centers in particular for people newly insured under the Affordable Care Act (ACA) who have not previously had relationships with healthcare providers.
The National Association of Community Health Centers (NACHC) was organized in 1971 and works with a network of state health center and primary care organizations to serve health centers in several ways, including to:
- Provide research-based advocacy for health centers and their clients.
- Educate the public about the mission and value of health centers.
- Train and provide technical assistance to health center staff and boards.
- Develop alliances with private partners and key stakeholders to foster the delivery of primary health care services to communities in need.
Ronald A. Yee, MD, became chief medical officer of the NACHC last year. NewPublicHealth recently spoke with Yee about the mission of health centers and their new roles under the Affordable Care Act.
NewPublicHealth: What field of medicine did you practice before taking on your new role?
Ronald A. Yee: I am a family physician. I worked for 20 years at a community migrant health center in Fresno County. I basically practiced full-scope family medicine including obstetrics, so I was delivering babies up until October of last year when I came to NACHC. So I was on the frontlines doing patient care and I was also the chief medical officer for our health center. I got involved earlier in my career with NACHC on a state and then national level, was on the board and then became chief medical officer.
NPH: Who is most likely to use the services of a community health center?
Yee: Health centers provide about one quarter of all the primary care visits for low-income populations, which include about one in seven people who are uninsured, or one out of every 15 Americans. With the roll out of the Affordable Care Act we’re seeing a big surge in demand among the newly insured, whether that’s through Medicaid expansions or the health insurance exchanges. Many of our patients who previously paid on a sliding scale basis are now covered through the ACA, which is helping us extend the funding we have.
The County Health Rankings and Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, will celebrate its fifth anniversary next month. In the last few months, NewPublicHealth has been reporting on the work of programs grantees that are making changes in their communities to help improve population health.
Utah’s Salt Lake County ranks 20th out of 27 counties in social and economic factors. Its high school graduation rate is 72 percent, below the state rate of 76 percent. Approximately 19 percent of the county’s children live in poverty, compared with 16 percent state wide.
South Salt Lake, a city in Salt Lake County, has many resources and assets that make it a great place to live. However, the city’s residents also deal with challenges similar to those faced by individuals living in the elsewhere in the country. Nearly half of South Salt Lake’s residents live in homes with annual household incomes less than $35,000. Among similar-sized communities in Utah, South Salt Lake has some of the highest rates of obesity, chronic cigarette smoking, binge drinking, mental illness and prescription drug abuse. In previous years, South Salt Lake has had the highest rate of violent crime in Utah, but over the past three years the city has noticed a 76 percent decrease in gang-related juvenile crime and a drop in overall crime of 23 percent.
In spite of these challenges, the schools, community partners and the City of South Salt Lake share a common goal to ensure all of the city’s kids are performing on grade level, graduating high school and pursuing a post-secondary opportunity. To create a foundation to allow children to achieve these goals, United Way of Salt Lake, the City of South Salt Lake and numerous other partners have created the Early Learning Network, a comprehensive, integrated early learning system for children from birth to age five. The program is critical because research shows that evidence-based investments in children from birth to age five improve school readiness; lower rates of crime, teen pregnancy, substance abuse and obesity; are essential to academic achievement; and have a direct impact on people’s health and financial well-being.
The goal of the Early Learning Network is to make sure that by the time a child enters kindergarten, he or she will be ready to learn.
The Early Learning Network is a recipient of a County Health Rankings and Roadmaps community grant. Grantees are funded to work with diverse coalitions of policy-makers, business, education, health care, public health and community organizations to improve the education system in ways that also better the health of the community. Roadmaps to Health grants support more than two dozen projects across the United States that aim to create healthier places for individuals and families to thrive. The Roadmaps to Health Community Grants project is a critical component of the County Health Rankings & Roadmaps program.
NewPublicHealth recently spoke with Elizabeth Garbe and Chris Ellis of United Way of Salt Lake.
NewPublicHealth: Tell us about the Early Learning Network.
Chris Ellis: The Early Learning Network is a coalition of early childhood providers, basic needs groups, government agencies and health organizations. The primary goals of the group are to ensure that kids are demonstrating age-appropriate development and entering kindergarten ready to learn. The Early Learning Network is focused on a specific geography, the City of South Salt Lake. It is a great example of collective impact, as non-profits, businesses and government agencies are working together to determine the most effective way to support children ages 0-5 in this community.
The Network has discussed baseline measures to better understand what services are needed to support the community. Collecting data to set a baseline is essential in order to demonstrate whether we are making any progress on our two goals.
“Building a culture of health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can,” wrote Robert Wood Johnson Foundation president and CEO Risa Lavizzo-Mourrey, MD, MBA in her 2014 President’s Message, released earlier this week. Laying out the plans for achieving those goals, Lavizzo-Mourrey added: “for the Foundation, it also means informing the dialogue and building demand for health by pursuing new partnerships, creating new networks to build momentum, and standing on the shoulders of others also striving to make America a healthier nation.”
The Foundation’s wide-ranging plans to “inform the dialogue” included a plenary talk by Mark McClellan, co-chair of the RWJF Commission to Build a Healthier America, and a former head of both the Food and Drug Administration and the Centers for Medicare and Medicaid Services. McClellan spoke at the AcademyHealth National Health Policy Conference in Washington, D.C., last week — less than a month after the release of the Commission’s 2014 report.
“To become healthier and reduce the growth of public and private spending on medical care, we must create a seismic shift in how we approach health and the actions we take,” said McClellan, “As a country, we need to expand our focus to address how to stay healthy in the first place.”
McClellan told a very attentive audience that critical needed changes include:
- Improve opportunities [for people] to make healthy decisions where we live, learn, work and play
- Improve access to a good education, jobs and health care
- Work across sectors, collaborating to improve the health of all Americans
- Make investing in America’s youngest children a high priority
- Fundamentally change how we revitalize neighborhoods, fully integrating health into community development
- Adopt new health “vital signs” to assess non-medical indicators for health such as jobs, income, housing, transportation and access to healthy food.
- Create incentives tied to reimbursement for health professionals and health care institutions to address non-medical factors that affect health.
McClellan cited two examples of organizations that are addressing issues beyond healthcare in order to improve health:
- Health Leads, a national health care organization, enables physicians and other health professionals to systematically screen patients for food, heat, and other basic resources that patients need to be healthy and “prescribe” these resources for patients.
- The Medical-Legal Partnership program removes legal barriers that impede health for low-income populations by integrating legal professionals into the care team. These volunteers intervene with landlords, social service agencies, and others to address health-harming conditions ranging from lack of utilities to bedbugs to mold in rental properties.
- Read Risa Lavizzo-Mourrey’s President’s Message
- Read the report of the 2014 Commission to Build a Healthier America
Late last year the Grand Rounds program of the U.S. Centers for Disease Control and Prevention (CDC) held a webinar on water fluoridation, a public health intervention that has been a priority in the United States for nearly seventy years.
Fluoridation, which has been shown to significantly reduce cavities in children, has been recognized by the CDC as one of 10 great public health achievements of the 20th century. Despite the benefits such as cost savings, however, CDC says there are ongoing challenges in promoting and expanding fluoridation.
NewPublicHealth recently spoke with Barbara Gooch, DMD, MPH, Associate Director for Science in the Division of Oral Health at CDC’s National Center for Chronic Disease Prevention and Health Promotion, about the challenges and benefits of water fluoridation and other emerging oral health improvement opportunities.
NewPublicHealth: What has been the historical impact of fluoridating water in the United States?
Dr. Barbara Gooch: All water generally contains fluoride, but usually at a level too low to prevent tooth decay, so community water fluoridation is a controlled adjustment of fluoride in a public water supply to an optimum concentration for the prevention of tooth decay.
That optimal concentration has historically been set at about 1 milligram (mg) of fluoride per liter of water, or 1 part per million. Fluoride was first introduced in the United States in Grand Rapids, Mich., in 1945. For cities that implemented community water fluoridation in the 1940s and 1950s, there was a dramatic reduction in tooth decay among children. Sometimes that reduction was greater than 50 percent. It has really been a major factor leading to the improvement in U.S. oral health.
When we compare the National Health and Nutrition Examination Survey done in the early 1970s with one conducted from 1999 to 2004, we found that the percentage of adolescents with one or more decayed teeth decreased from 90 percent in the early 1970s to 60 percent in the ’99-’04 National Survey. And while the number of teeth affected by tooth decay was an average of six in the 1970s survey, the instance was reduced to fewer than three in the later survey.
NPH: There are other sources of fluoride now, such as toothpaste. Is community water fluoridation still important?
Gooch: Current studies indicate that community water fluoridation increases the prevention of tooth decay by an additional 25 percent despite other sources. But the other very important factor about community water fluoridation is in order to receive its benefits, if you live in a fluoridated community. all you have to do is drink the tap water. And we can also show cost savings. One study estimates that for every dollar spent on community water fluoridation, you save about $38 in dental treatment costs.
NewPublicHealth Q&A: John Auerbach and Cheryl Bartlett on the Massachusetts Prevention and Wellness Trust
The Massachusetts Prevention and Wellness Trust is a four-year, $60 million project designed to support prevention and health-promotion activities in the state. The first project of its kind in the United States will fund six to 12 collaborative initiatives, and partners on the initiative will include municipalities, community-based organizations, health care providers, regional agencies and health plans. Information on the Trust is detailed in a new report prepared by the Institute on Urban Health Research and Practice at Northeastern University and funded by the Robert Wood Johnson Foundation.
The vision behind the creation of the project is to give all Massachusetts residents the opportunity to live in communities that promote health, as well as seamless access to all community and clinical services needed to prevent and control chronic diseases. It was created because while there is access to health insurance and health care in Massachusetts, health costs continue to rise. The goals of the project include:
- Reducing the rate of the state’s most costly preventable health conditions
- Reducing health disparities
- Increasing healthy behaviors
- Increasing the adoption of workplace wellness programs
- Developing a strong evidence base of effective prevention programs
In order to implement these goals, the Massachusetts Department of Public Health identified four priority areas: tobacco use, childhood asthma, hypertension and elder falls prevention—all of which should be considered closely when working to reduce health disparities and co-occurring mental health conditions in these areas.
A new infographic created for the Prevention and Wellness Trust’s inauguration perfectly illustrates how community links work together to improve health under the principles of the Trust. For example, a diagnosis of hypertension would need a provider to prescribe medications, but the obesity and exercise needs that would also improve the condition for many patients requires input from other community entities, including:
- Classes in exercise, medication and stress reduction by community agencies
- Chronic disease self management classes and home visits for medication use instruction by a community agency
- A neighborhood policy that provides support for transportation changes to encourage walking or biking and zoning for healthy food stores
- A neighborhood policy that provides support for more accessible recreation options in parks and city centers for increased stress reduction
- Workplace policies that provide support for workplace wellness programs that help provide and encourage exercise, healthy foods and stress reduction
NewPublicHealth recently spoke with John Auerbach, a Professor at Northeastern University and the primary author of a report on the Trust, and Cheryl Bartlett, public health commissioner of Massachusetts and the lead person charged with its implementation.
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.
NewPublicHealth is partnering with Grassroots Change: Connecting for Better Health to share interviews, tools, and other resources on grassroots public health. The project of the Robert Wood Johnson Foundation Health Group supports grassroots leaders as they build and sustain public health movements at the local, state and national levels.
In this Q&A, conducted by Grassroots Change, Shannon Frattaroli, PhD, Associate Professor at the Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, shares her perspective on grassroots power and the future of public health. Her research helps answer two critical questions: Why are grassroots movements so important; and what is a public health movement, anyway?
>> Frattaroli’s interview has been edited for NewPublicHealth. View the full interview at GrassrootsChange.net.
Grassroots Change: What do you see as the role of grassroots movements in public health?
Shannon Frattaroli: There’s tremendous potential. Public health at its core is about the public. The public should have a voice in public health, and grassroots movements are one way for that to happen. The public has been very engaged in policy issues or problems throughout the history of public health. When people get engaged and are strategic with regard to policy change, things can happen quickly. And change can happen in a way that feels more legitimate. I think it’s where we should be moving in the future.
GC: What does “grassroots movement” mean? How are grassroots health movements different from other types of advocacy?