Category Archives: Disparities
Future of Public Health: Q&A with Stephanie Lucas, MPH Candidate at Columbia University Mailman School of Public Health
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Stephanie Lucas, a Masters of Public Health candidate in epidemiology and global health at Columbia University Mailman School of Public Health. Lucas spoke about what helped lead her to the field of public health; her work in migrant health and reproductive health in the Philippines; and where she hopes to go from here.
NewPublicHealth: What encouraged you to pursue a degree and a career in public health?
Stephanie Lucas: I came from a wide variety of backgrounds. I taught English for a while and I did lab work because I was a biology major in my undergraduate studies. I also came from a small college that was really oriented in social justice and there were a number of study and volunteer abroad programs. One year, I decided to go to Belize for spring break and help teach a class. I also went abroad to South Africa and worked with an NGO there that helped street children. I think that’s where my interest in public health began because it was so blatant to see what needed to be done. When I was teaching English and doing lab work, I didn’t feel like I was connected to that enough. I felt like public health allowed me to take all of my background information—like biology and education—and intertwine them in a way that I can put them to good use to improve population health.
NPH: Is there a field within public health that’s of primary interest to you?
Lucas: I actually want to take on a broad range of public health topics. When I went to the Philippines, I did two practica there; one in the field of reproductive health and another in the field of migrant health. I didn’t know anything about migrant health, but that was OK because I just wanted to learn about the spectrum of the different issues in an effort to understand that all of those issues are interrelated.
“I don’t miss my family. I miss the family I never had.” That’s the text of a postcard written by a former foster child—one of hundreds of postcards that are a project of the Foster Care Alumni of America to help create a better understanding about life in foster care. May is National Foster Care Month—an annual effort to raise attention about the 400,000 children in foster care.
According to the U.S. Department of Health and Human Services (HHS), most of those 400,000 children will be reunited with their families or find a permanent home with relatives, guardianship, or adoption. But each year 24,000 youth “age out” of foster care without a permanent legal family and many of them have shared their lives in a postcard.
New initiatives on foster care announced by the HHS Children's Bureau in 2014 include:
- Awards for agencies to test new strategies for recruiting resource families for children in foster care.
- Grants to states, localities and tribes to build the capacity of child welfare systems to prevent long-term homelessness among youth and young adults who have been involved with child welfare.
- Funding for states, localities and universities to develop initiatives that will improve the social and emotional well-being of children who are involved with child welfare and have mental and behavioral health needs.
- The National Foster Care Month initiative. This year’s theme is “Building Blocks Toward Permanent Families” in order to promote awareness of children in foster care.
The American Academy of Pediatrics (AAP) defines children in foster care as children with special health care needs because of the very high prevalence of physical, mental, developmental, educational, dental and family relationship problems. Children in foster care have many of the same health problems as other children—they just seem to have more of them more often, according to the AAP.
Among the reasons why medical conditions are so prevalent in foster children:
- Health conditions might be the direct result of trauma or medical neglect.
- Birth parents may seek foster care because they are unable to care for the child’s health problems.
- Emotional stressors may precipitate ﬂares in underlying conditions, such as asthma.
According to the AAP, treating and improving these conditions also improves the chances for reunification with parents or adoption, and is therefore a priority for foster children.
“Hypertension affects nearly one in three adults and kills more people around the world than anything else. It is both too common and too often poorly controlled.”
So said Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), during a panel discussion at the annual meeting of the American Society of Hypertension (ASH) this past weekend. The panel was convened by ASH, the American Heart Association and the CDC to launch a project supporting improved control of hypertension worldwide. According to the panel an estimated 970 million people have hypertension worldwide, and the disease is responsible for more than nine million deaths, as hypertension can lead to heart disease and stroke.
Data from the groups finds that rates of hypertension have increased in both developed and developing nations, due in part to an aging population and lifestyles that include high salt diets and low physical activity.
For the developing world, the CDC; the Pan American Health Organization; and other regional and global stakeholders are identifying both cost effective medicines and inexpensive delivery strategies for the drugs to help patients afford and receive them.
In the United States, the Affordable Care Act is expected to increase the number of people on hypertension medications, but despite the availability of coverage for hypertension diagnosis and treatment there remains concern over disparities. A study of more than 16,000 members of the Hispanic community published in the American Journal of Hypertension earlier this year found that while the prevalence of hypertension among Hispanics is nearly equal to that of non-Hispanic whites, diagnosis of the disease is much lower, as is general awareness of its symptoms and treatment options.
"Given the relative ease of identifying hypertension and the availability of low-cost medications, enabling better access to diagnostic and treatment services should be prioritized to reduce the burden of cardiovascular disease on Hispanic populations,” said Paul Sorlie, MD, the lead author of the study and an epidemiologist with the National Heart, Lung and Blood Institute. “This study gives us the information needed to support the development of policies that can improve this access and, subsequently, the overall health of countless US citizens.”
- A new infographic from the Measure Up/Pressure Down initiative of the American Medical Group Association provides some key patient information about hypertension, including normal and dangerous ranges of blood pressure—numbers patients should be familiar with.
- A map from the Institute for Health Metrics and Evaluation at the University of Washington shows hypertension levels for 2001 to 2009 by race and gender.
Earlier this week the White House honored eleven transportation “Champions of Change” for their roles in ensuring that transportation facilities, services and jobs help individuals and their communities.
- Wanda Vazquez, a mentor and trainer in Chicago who helps Hispanic advocates in the Chicago area become certified child passenger safety technicians, and help families understand the importance of safe transportation for their children.
- Daphne Izer, head of the twenty-year-old Parents Against Tired Truckers.
- Marilyn Golden, a senior policy analyst with the Disability Rights Education & Defense Fund, based in Berkeley, California, where she has advocated for greater access to public and private transportation for people with disabilities.
Research from the U.S. Department of Transportation has found that poor transportation access is a factor preventing lower income Americans from gaining higher income levels than their parents. “Transportation plays a critical role in connecting Americans and communities to economic opportunity through connectivity, job creation, and economic growth,” said U.S. Secretary of Transpiration Anthony Foxx at the event recognizing the Champions. “Recognizing social mobility as a defining trait of America’s promise, access to reliable, safe and affordable transportation is critical.”
Following the awards ceremony, NewPublicHealth spoke with Marilyn Golden about her work.
NewPublicHealth: How much more is there to be done to help people with disabilities to get easier access to transportation to take them where they need to go, whether it’s recreational, medical, or work?
Marilyn Golden: We should acknowledge that a lot has been done under the Americans with Disabilities Act (ADA) by transit agencies, with a lot of thank you to the U.S. Department of Transportation, particularly the Federal Transit Administration for enforcing the ADA in a sufficiently robust manner that transit agencies do respond.
I shouldn’t suggest that every transit agency only acts because of an enforcement action. It’s much more diverse than that, and some are very proactive on their own and really leaders in the industry, and then there are transit agencies that trail behind. We do have many challenges that remain.
After decades of studies demonstrating that poor people and minorities are more likely than their white counterparts to live near health hazards such as toxic waste sites, landfills and congested highways, a new study in the journal PLOS One took a more refined look at a particular aspect in the area of “environmental injustice”: exposure to nitrogen dioxide. The pollutant—which is produced by cars, construction equipment and industrial sources—is linked to higher risk of both asthma and heart attack.
Using data from the 2000 Census, researchers determined that minorities are on average exposed to 38 percent higher levels of outdoor nitrogen dioxide. The gap varies depending where in the country they live, with the upper Midwest and the Northeast seeing the greatest disparities, as well as major cities. All told the disparity accounts for an additional 7,000 deaths due to heart disease annually.
"The biggest finding is that we have this national picture of environmental injustice and how it varies by state and by city," said Julian Marshall, a professor of environmental engineering at the University of Minnesota and one of the authors of the study, according to The Washington Post. "The levels of disparity that we see here are large and likely have health implications."
There are a number of possibilities to account for the disparities. For example, according to The Post, many “urban highways...were originally routed through minority communities that were politically easier to uproot than middle-class white neighborhoods” and “highways and landfills also depress nearby property values, meaning that people who can afford to live elsewhere do, while those who can't remain within their influence.”
Read the full story from The New York Times here.
>>Bonus Link: April is National Minority Health Awareness month. Read more of NewPublicHealth’s coverage of the annual event here.
April is National Minority Health Awareness Month. A look back at NewPublicHealth’s coverage of health disparities so far this year shows significant steps being taken to both identify and rectify the public health problem. From understanding why certain demographics are at greater risk for cancer, to how income gaps and ethnicity can collide, to how racism can affect overall health, here’s a review of some of the key stories we’ve reported on health disparities in 2014.
Mistrust, Perceived Discrimination Affect Young Adult Latinos’ Satisfaction with Health Care
Mistrust of the medical community and perceived discrimination can affect how satisfied young adult Latinos are with their health care, which in turn can influence health outcomes, affect participation in health care programs under the Affordable Care Act and contribute to disparities in health care access.
Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs
Faces of Public Health: Louis W. Sullivan, MD
Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.
Study: Many Chronically Ill Adults Forced to Decide Between Medicine, Food
Chronically ill adults who, due to financial instability, lack consistent access to food are far more likely to underuse or even skip their medications completely, according to a new study in The American Journal of Medicine. Researchers analyzed data of 9,696 adults with chronic illness who participated in the National Health Interview Survey, finding that 23.4 percent reported cost-related medication underuse, while 18.8% percent reported food insecurity and 11 percent reported both. Hispanic and non-Hispanic blacks were at the highest risk.
Free to Be You and Me @ 40
Free to Be You and Me, a blockbuster hit album of the 70s and beyond, is still widely available on most music platforms. The television special, filled with skits on gender neutrality, is still a popular kids’ birthday gift, in part because many of the issues it speaks to—especially advancement opportunities and equality—are still being grappled with today.
Don’t judge a change agent by its vinyl. Free to Be You and Me, a blockbuster hit album of the 70s and beyond, and still widely available on most music platforms, was the "Born This Way" by Lady Gaga of its time, with songs, stories and ideas that told kids they could be whoever they wanted.
Stars who recorded songs for the album included Mel Brooks and Diana Ross. Songs included “Parents are People,” about the many professions open to men and women and sung by album creators Marlo Thomas and Harry Belafonte, as well as “It’s Alright to Cry” sung by football player Rosie Grier.
“We wanted to let children know that their wildest dreams were not just OK, but wonderful—and completely achievable,” said Thomas at a recent anniversary celebration for the album at the Paley Center for Media in New York City.
The television special, filled with skits on gender neutrality, is still a popular kids’ birthday gift, in part because many of the issues it speaks to—especially advancement opportunities and equality—are still being grappled with today:
- According to a recent Institute of Medicine report, African Americans live, on average, five years less than other Americans.
- According to the Society for Women’s Health Research, in some cases critical data on sex, age, race and ethnicity does not exist for new drugs, biologics and devices. For instance, women made up less than one-third of the participants in clinical trials on three different coronary stents (which open up blockages), even though 43 percent of patients with coronary heart disease are women.
- According to the Institute for Women’s Policy Research, in 2012 female full-time workers made only 77 cents for every dollar earned by men, a gender wage gap of 23 percent.
>>Bonus Link: Watch a panel discussion among several of the original Free to Be You and Me stars filmed earlier this month at the Paley Center.
A new infographic from the Office of the U.S. Surgeon General highlights collaborations within the federal government and between the health and healthcare sectors to help improve prevention outreach. These efforts are part of the cross sector National Prevention Strategy launched by the office several years ago.
Current examples of collaboration include Million Hearts, an initiative of the U.S. Department of Health and Human Services to prevent one million heart attacks by 2017. The initiative includes a commitment by close to 150 large private medical practices in the United States to get hypertension control rates above 80 percent in their communities.
You can also view the fully interactive infographic here.
>>Bonus Link: Read interviews and listen to podcasts about the National Prevention Strategy conducted with former and current U.S. Cabinet Secretaries and agency heads.
AHA Releases Stroke Prevention Guidelines for Women
For the first time, the American Heart Association (AHA) has released stroke prevention guidelines for women. The guidelines outline stroke risks unique to women and provide evidence-based recommendations on how best to treat them, including:
- Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
- Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
- Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
- Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
- Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
- Women over age 75 should be screened for atrial fibrillation risks; a risk factor for stroke.
Read more on prevention.
New Study Predicts Flu Severity
Researchers at St. Jude Children’s Research Hospital in Memphis say flu patients, regardless of age, who have elevated levels of three particular immune system regulators, called cytokines, early in the infection were more likely to develop severe flu symptoms and to be hospitalized than patients with lower levels of the same regulators. Study participants ranged in age from 3 weeks to 71 years.
The study, published in the American Journal of Respiratory and Critical Care Medicine, found that cytokine levels early in the infection were predictive of flu-related complications regardless of patient age, flu strain, the ability of the virus to replicate and other factors. The cytokines studied help to regulate inflammation caused by the body’s immune response to the flu until antibodies and T cells take over. Patients with the elevated cytokines seem to develop airway distress as a reaction to the immune response, a development separate from the effects of the flu virus. “We need to explore targeted therapies to address this problem separately from efforts to clear the virus, says study author Paul Thomas, PhD, an assistant member of the St. Jude Department of Immunology. Read more on flu.
Community Health Worker Model Can Reduce Hospital Readmissions
A new study in JAMA Internal Medicine reports on a community health worker (CHW) program developed at the University of Pennsylvania School of Medicine that hired people from the local community to help discharged patients navigate the health care system and address key health barriers, such as housing instability or food insecurity. The study found that the intervention improved patient experiences and health outcomes and reduced hospital readmissions.
The Penn team tested the model in a randomized trial with 446 hospitalized patients who were either uninsured or on Medicaid, and lived in low-income communities in which more than 30 percent of the population lived below the Federal Poverty Level. More than one-third of all readmissions to the hospitals participating in the study come from a five-zip code region. Patients in the trial received support from CHWs hired for traits such as empathy and active listening. The CHWs connected during a patient's hospital stay and continued after they were discharged to help with issues including scheduling doctor appointments, accessing medications, or finding child care or shelter. The control group received routine hospital care, medication reconciliation, written discharge instructions, and prescriptions from the hospital. The CHW group had a 52 percent greater chance of seeing a primary care physician within two weeks after being discharged from the hospital and scores measuring a patient's confidence in managing their own care in the future more than doubled in the CHW group. While the two groups had similar rates of at least one hospital readmission (15 percent vs 13.6 percent), the CHW group was less likely to have multiple readmissions (2 percent vs 6 percent in the control group). Read more on health disparities.
In January 2008, the Texas Health Institute received support from the Joint Center for Political and Economic Studies, a policy think tank with a particular focus on people of color, to track progress on efforts to advance racial and health equity through provisions of the Affordable Care Act (ACA). Shortly after the ACA became law, new support from the W.K. Kellogg Foundation and the California Endowment has led to a series of four reports that have assessed how well the law has been implemented in a way that addresses racial and ethnic health equity across five topic areas:
- Health insurance and exchanges;
- Health care safety net;
- Workforce support and diversity;
- Data, research and quality; and
- Public health and prevention.
To learn more about the reports’ findings, NewPublicHealth recently talked with Dennis Andrulis, PhD, MPH, the Senior Research Scientist at the Texas Health Institute and an Associate Professor at the University of Texas School of Public Health.
NewPublicHealth: How have the reports produced by the Texas Health Institute helped advance what we know about the ability of the Affordable Care Act to advance health equity?
Dennis Andrulis: The reports have provided an update of the progress, or lack thereof, in implementing race, ethnicity, language and equity provisions in the law. Did Congress appropriate dollars to support these provisions? If so, did the appropriations match the original requests and will they continue in future years?
The result is we have mapped out what we believe is a comprehensive overview of about 60 provisions related to health equity. Additionally, we have reported on the content and shape of related new initiatives, innovations, program support and other health care efforts.
NPH: What are some short-term and long-term efforts that your work indicated will help improve some health disparities?
Dennis Andrulis: First we need to have accurate and well-disseminated information about what’s in the law and the opportunities to change disparities that it provides.