Category Archives: Social determinants of health
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?
How many children could possibly identify with a new Sesame Street character whose dad is in prison? Close to two million, according to many experts. A White House “Champions of Change” event yesterday honored twelve men and women who have spent their careers researching and improving the lives of children who have at least one parent in prison. That explains why Sesame Street released a new video and toolkit yesterday, as part of their "Little Children, Big Challenges" series, that tells the story of Alex, whose dad is in prison. Alex’s grown up and peer friends help him talk, and sing, about his feelings about his dad and how other people speak about his dad’s prison stay. The "Challenges" series includes issues many kids face such as divorce and a parent in the military, and the resources are distributed through therapist's offices, schools, jails and other key places to reach kids.
The White House program, led off by Domestic Policy Council director Cecilia Munoz and Secretary of Health and Human Services Kathleen Sebelius, included panel discussions on the needs of kids whose parents are in jail, which is a recognized “adverse childhood experience” that can lead to poor health outcomes as children become adults. Among the problems kids of incarcerated parents can face are decreased living standards, social isolation because of the stigma they feel about having a parent in prison, and long-term or permanent separation from the incarcerated parent.
>>Watch a CBS News story on the Sesame Street program that will help support kids with incarcerated parents.
U.S. News & World Report has added a new set of rankings, “America's 50 Healthiest Counties for Kids” to its just released annual report on the Best Children’s Hospitals. The top counties have some important measures including fewer infant deaths, fewer low-birth-weight babies, fewer deaths from injuries, fewer teen births and fewer children in poverty than lower ranked counties. Most of the measures were taken from this year’s County Health Rankings, a collaboration of the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.
According to U.S. News, “America’s 50 Healthiest Counties for Kids,” represents the first national, county-level assessment of how health and environmental factors affect the well-being of children younger than 18 and shows that even the highest-ranking counties grapple with challenges such as large numbers of children in poverty and high teen birth rates.
>>Read the full U.S. News & World Report article.
Last week, a lunch briefing hosted by Women’s Policy, Inc., a national nonprofit that focuses on women’s issues, brought together a packed house of policymakers, public health leaders, academics, and legislative staff in key Congressional offices to discuss how data can inform action around women's and population health.
The briefing focused on the County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute that measures the health of every county in the United States and provides tools to help create solutions that make it easier for people to be healthy in their own communities. Measuring health outcomes like length and quality of life along with health factors like education, income, and obesity rates, the Rankings provide an annual snapshot of where counties are doing well and where they can improve.
In turn, the Roadmaps to Health program helps counties partner with other local leaders to use that data to improve the health of residents. One of the featured speakers at the briefing was Claude-Alix Jacob, Chief Public Health Officer of Cambridge, Mass., one of six inaugural winners of RWJF’s Roadmaps to Health Prize.
Jacob pointed out the value of having data to work with determining where to put resources in order to improve community health. Women’s health data points of in Cambridge include:
- Girls reported slightly higher rates of smoking and binge drinking than boys
- Girls reported rates three times higher than boys of verbal abuse.
- Girls reported being three times more likely to hurt themselves than boys
- 87 percent of eligible women have had Pap smears, and 85.5 have had mammograms
- One-third of single mothers live in poverty
One key program that Jacob pointed to that Cambridge has begun is Baby University, a free 16-week innovate program designed for parents with children from birth to age 3. The goal is to increase parents’ knowledge about child-rearing topics, strengthen parent-child relationships and connect parents to community resources. “While the first few cycles have largely included only moms,” said Jacob, “ the two most recent cycles have included more dads.”
The program includes childcare and transportation costs for enrolled parents, as well as home visits by professional staff. Parents who complete the program become part of an alumni association that continues the relationship between the parents and the program staff. So far, the program has had 140 graduates.
>>Read more about the briefing from the County Health Rankings blog.
>>Bonus Link: Among the resources for improving community health discussed at the Women Policy Inc. briefing was the “Town Hall Meeting in a Box” to help facilitate community conversations. The toolkit includes invitation samples, venue ideas and presentation documents. See more County Health Rankings & Roadmaps resources here.
In February, the Robert Wood Johnson Foundation honored six communities with the inaugural RWJF Roadmaps to Health Prize, which recognizes outstanding community partnerships that are helping people live healthier lives.
Recently, NewPublicHealth spoke with Claude-Alix Jacob, chief public health officer at the Cambridge, Mass., department of health, one of the six prize-winning communities to be recognized by the Foundation. Mr. Jacob spoke to NPH about how collaborating around and winning the Prize has impacted the community, including resilience in the face of tragedy.
>>Apply to become a winner of the 2013-2014 RWJF Roadmaps to Health Prize. This year's application deadline is May 23, 2013.
NewPublicHealth: What did winning the RWJF Roadmaps to Health Prize mean to your community?
Claude Jacob: It has been great and exiting news for our community. Over the course of the last few months and through National Public Health Week last month we’ve had a chance to celebrate. We’ve been able to share our public health plans and community partnerships, but also under the aegis of the Robert Wood Johnson Foundation, we now have more credibility for all of our efforts. The Foundation is associated with promoting important health improvement efforts nationwide and just to be linked to the Foundation will open doors, especially now that we’re one of the six inaugural prize winning communities.
During National Public Health Week we invited our community stakeholders to celebrate to thank them for their hard work in helping us to prepare for the site visit that was required of prize finalists. So it’s been a phenomenal few weeks.
NPH: How has winning the prize impacted the health improvements of your community?
Howard County has been the healthiest in Maryland since the Country Health Rankings launched in 2010. NewPublicHealth recently spoke with the county’s executive, Ken Ulman, about how the Rankings have helped drive further progress in improving the health of Howard County. Health initiatives introduced by Howard County have included a program that certifies schools as “Healthy Schools,” if they meet criteria in several areas including nutrition and physical activity, and a smoking ban in all county parks.
NewPublicHealth: Howard County has been consistently been ranked the healthiest county in Maryland. What key factors do you credit for that?
Ken Ulman: We start with some advantages. We have the blessings of a highly educated population that cares deeply about their community and have good jobs, and many, though not all, have [adequate financial] resources and access to care. We also have the advantage of having a nonprofit, the Horizon Foundation, based in Howard County that is dedicated to improving the health and wellbeing of people living and working in our county.
So it’s a combination of policy initiatives coupled with a public that really wants to make progress in these areas.
NPH: Have the County Health Rankings helped drive any of your public health and prevention initiatives?
Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in three U.S. cities to explore what it takes to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.
NewPublicHealth recently spoke with Robert Simmons, DrPH, MPH, head of the Master’s Program in Public Health at Thomas Jefferson University who was part of a recent panel. Other speakers on that panel included entertainer and activist Dr. Bill Cosby; Dr. Alvin Poussaint, professor of psychiatry at Harvard Medical School; Dr. Irwin Redlener, Clinical Professor of Population and Family Health at the Columbia University School of Public Health; Diane Cornman-Levy, executive director of the Federation of Neighborhood Centers and Sarah Martinez-Helfman, executive director of the Eagles Youth Partnership.
NewPublicHealth: Tell us a bit about your background.
Dr. Simmons: I’ve worked in public health for 40 years including at the County Health Department in San Diego, the State Health Department in California, and the American Lung Association, where I was program director on issues of asthma and tobacco and cardiopulmonary disease. In the last five and a half years, I’ve been directing the public health program at Thomas Jefferson University in Philadelphia.
NPH: What do you think have been key improvements in addressing population health?
As research builds showing that where you live has a big impact on how healthy you are, organizations and businesses across the country are joining the dialogue on how to create healthier communities. Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it takes, to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.
Jason Q. Purnell, PhD, MPH, Assistant Professor at the Brown School of Social Work and Public Health at Washington University in St. Louis, was a panelist at the St. Louis Conversation on Community Health, along with Jackie Joyner-Kersee and others. Recently, Dr. Purnell shared his vision for community health, and the critical role of broad collaboration across sectors, with NewPublicHealth.
NewPublicHealth: What's your vision of a healthy community?
Jason Purnell: My vision for a healthy community includes the elimination of health disparities by race and ethnicity and socioeconomic status. It involves everyone, regardless of zip code or net worth, having the resources to lead full, productive lives. I follow the World Health Organization in its holistic focus on social, emotional, and physical well-being rather than a more narrow focus on disease prevention. A healthy community allows everyone in its boundaries to express their full potential; it allows them to participate in the life of the community, in life itself, to the fullest extent possible.
NPH: Your efforts have included collaboration across psychology, public health, oncology, and primary care. Similarly, the Conversation on Community Health series includes participants from across sectors. Why does public health require such broad collaboration?
Organization and business leaders across the country are realizing that every sector needs to join the fight—or at least the conversation—to create healthier places to live. While altruistic motivations play an important role in this movement, a growing body of research also points to the idea that better health is a major driver for a healthier economy.
Recently, GlaxoSmithKline (GSK) partnered with The Atlantic to host “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it means, and what it takes, to create a healthy community. NewPublicHealth checked in with GSK’s Senior Vice President and Corporate Medical Director, Robert Carr, MD, MPH, FACPM, to get his take on why businesses should care about community health, and why a broad, cross-sector dialogue is a critical next step.
>>Read more on communities that were recognized for innovations that are improving the health and lives of their residents, with the 2013 RWJF Roadmaps to Health Prize.
NewPublicHealth: What prompted you and GSK to start thinking about community health?
Dr. Carr: As an HR executive and medical director of a global business, I’m acutely aware that employees are—first and foremost—members of families and communities. The places where they live and the choices made by the people around them profoundly influence the health of our employees. We regularly hear that our employees want to know not only what they can do to lead healthier lives but also what we can do as a company to improve the health of their own community. They want us to dig in and find out what’s needed. Similarly, we recently conducted some research about what Americans are looking for more broadly, and we learned that they want the same thing from GSK. They want us to do more in their communities.
We heard them loud and clear, and we are digging in, starting with understanding what it means and what it takes to be a healthy community. Last year we kicked off a program we call “Healthy Communities.” As part of this attempt to learn more, directly from those on the ground in different American cities, we partnered with The Atlantic for “A Conversation on Community Health.”
NPH: What’s the focus of the “Conversation on Community Health” series?
How healthy is your county? Answers are out today in the 2013 County Health Rankings, which examine the health and well-being of people living in nearly every county in the United States and show that how long and well people live depends on multiple factors beyond just their access to medical care. The Rankings allow counties to see what’s making residents sick or healthy and how they compare to other counties in the same state. The County Health Rankings, now in its fourth year, is a joint project of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.
“The County Health Rankings can be put to use right away by leaders in government, business, health care, and every citizen motivated to work together to create a culture of health in their community,” said Dr. Risa Lavizzo-Mourey, RWJF president and CEO. “The Rankings are driving innovation, unleashing creativity, and inspiring big changes to improve health in communities large and small throughout the country.”
The Rankings examine 25 factors that influence health, including rates of childhood poverty and smoking, obesity levels, teen birth rates, access to physicians and dentists, rates of high school graduation and college attendance, access to healthy foods, levels of physical inactivity, and percentages of children living in single parent households.
Although the Rankings only allow for county-to-county comparisons of ranks within a state, this year’s Rankings show significant new national trends: