Category Archives: Disparities

Jan 16 2014
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The Links Between Education and Health: An Interview with Steven Woolf

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A new policy brief and video released recently by the Virginia Commonwealth University (VCU) Center on Society and Health and the Robert Wood Johnson Foundation show that Americans without a high school diploma are living sicker, shorter lives than ever before, and the links between education and health matter more now than ever before.

While overall life expectancy has increased throughout the industrialized world, life expectancy for Americans is now decreasing for whites with fewer than 12 years of education—especially for white women. Additionally, lower rates of education tend to translate into much higher rates of disease and disability, and place greater strains on mental health.

“I don’t think most Americans know that children with less education are destined to live sicker and die sooner,” says Steven H. Woolf, MD, director of the VCU Center on Society and Health. “It should concern parents and it should concern policy leaders.”

NewPublicHealth recently spoke with Woolf about the new issue brief and video, and the critical need to look at the health impacts of education.

NewPublicHealth: How does the policy brief expand on what was already known about the connection between education and health?

Steven Woolf: We already knew that there was an important relationship between education and health, and that people with limited education have worse health outcomes. The focus now is on the fact that this disparity is getting wider, so the lack of a good education has more severe health consequences nowadays than it did in the past.

NPH: What accounts for the impact of education on health?

Woolf: Some people very superficially think that the reason people with an inadequate education have worse health outcomes is they didn't get a good health education in school, and they didn't learn that smoking was bad for your health, for example. Probably a much more important factor is what we call the “downstream” benefits of education. In a knowledge economy like we have these days, having a good education—a college education or an advanced degree—is very important for getting good jobs, jobs that have better benefits including health insurance coverage, and higher earnings that allow people to afford a healthier lifestyle and to live in healthier neighborhood.

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Nov 25 2013
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Recommended Reading: Q&A with APHA President-elect Shiriki Kumanyika

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Today is Public Health Thank You Day 2013, when Research!America and other leading public health organizations recognize the public health professionals working to improve health where we all live, learn, work and play.

Among the biggest names in public health at the moment is Shiriki Kumanyika, PhD, MPH, a University of Pennsylvania professor who earlier this month became the president-elect of the American Public Health Association (APHA). In a recent Q&A on APHA’s Public Health Newswire blog, Kumanyika spoke about the overall landscape of public health and gave her thoughts on particular issues.

One of the big takeaways from the APHA annual meeting earlier this month—where she was named president-elect—was how APHA is shifting its focus to concentrate more on being an action- and goal-oriented organization, according to Kumanyika.

“We are going to be more convincing about the importance of a focus on prevention and wellness, while making better use of scientific evidence and creating a greater sense of urgency around health equity issues,” she said. “I think that, over time, this new positioning in the public arena will really enhance the sense of community among our thousands of diverse members, attract more members and align our combined efforts for greater overall impact.”

Kumanyika also has particular ideas on the greatest opportunities for improving health in African-American communities, especially when it comes to nutrition and obesity prevention. Not only are unhealthy foods too easily available in the average black community but, when compared to other communities, the situation is even more troubling, with black communities seeing more advertising for unhealthy food. The answer is targeted efforts to promote healthier alternatives.

However, she also noted how food and nutrition present their own particular public health obstacles.

“Food is a particularly complex area; we can’t treat it like tobacco and tell people to avoid it altogether. The changes we need are more complicated and will have huge implications across the spectrum from agriculture to environmental sustainability,” she said. “We have to make both a public health case and a business case for a healthier food supply and for marketing healthier foods and beverages. We have a tremendous opportunity to make progress that will change the food and health landscape for the population at large if we do our health diplomacy well.”

Read the full interview on Public Health Newswire here.

Oct 2 2013
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Exploring the Intersection of Health, Place and Economic Justice

file Brian Smedley, Joint Center for Political and Economic Studies

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.

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Sep 23 2013
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Public Health News Roundup: September 23

UN: Improved Access to HIV/AIDS Treatment Reduces Number of AIDS-related Deaths
The United Nations’ annual report on HIV infections and AIDS related-deaths around the world concluded that increased access to treatment in poorer and middle-income countries has led to positive health outcomes. “AIDS-related deaths in 2012 fell to 1.6 million, down from 1.7 million in 2011 and a peak of 2.3 million in 2005. And the number of people newly infected with the disease dropped to 2.3 million in 2012 down from 2.5 million in 2011.” The executive director of UNAIDS, Michel Sidibé, said that the international community is well on its way to surpass the 2015 goals of expanding access to treatment. Read more on the public health impact of AIDS.

Racism Leads to Negative Effects on Mental Health of Children and Teens
A new report published in the journal Social Science & Medicine examines the link between the mental health and well-being of youth ages 12-18 and racism. The review shows that being a victim of racial discrimination can lead to low self-esteem, reduced resilience, and increased behavior problems. There was also evidence of increased risk of poorer birth outcomes for children when mother experienced racism while pregnant. These types of detriments to children and teen’s mental health and well-being can lead to larger problems in terms of engagement in education and employment later in life, according to study authors. Read more on health disparities.

Positive Relationships May Help Break the Cycle of Maltreatment
In a special supplement released by the Journal of Adolescent Health, investigations on the effects of safe, stable, nurturing relationships found that these types of relationships could help break the cycle of child maltreatment that is often passed along from parents to children. Findings also showed that supportive and nurturing relationships between adults can help protect children as well. This study can provide helpful prevention strategies for breaking the cycle of maltreatment and promoting improved health in the long term. Read more on violence prevention.

Aug 14 2013
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Tobacco-Related Health Equity: What Will It Take?

Tomorrow from 12 p.m. to 2 p.m. EST Legacy will hold a special online panel discussion as part of the Kenneth E. Warner Lecture Series that puts a spotlight on the social influences on tobacco use and tobacco-related death and disease. The panel will discuss the disproportionate impact of tobacco by race, ethnicity, sexual orientation and socio-economic status to help identify strategies to tackle tobacco-related health inequities.

>>View the live webcast Thursday, August 15, from 12 p.m. to 2 p.m. EST.

Paula Braveman, MD, MPH, a panelist as well as director of the Center on Social Disparities in Health at the University of California San Francisco and Research Director of the Robert Wood Johnson Foundation Commission to build a Healthier America, spoke with NewPublicHealth about the upcoming discussion.

“The purpose of the discussion,” said Dr. Braveman, “is to give wider attention to disparities in tobacco-related health consequences, and to reach a wider audience on the issue of disparities so that it can be dealt with in a more focused way than it has been up until now.”

Dr. Braveman says that a targeted focus is important for ethical and economic reasons. “The consequences of disparities in smoking and tobacco-related illness take a huge economic toll in terms of lost worker productivity and medical expenses that otherwise would not have been needed and in terms of suffering and loss of life. Using the disparities frame helps us to see that the health condition of people who are best off should be possible for everyone.”

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Jul 3 2013
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Commission to Build a Healthier America’s City Maps Show Dramatic Differences in Life Expectancy

Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.

For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.  

The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.

file Life expectancies in the Washington, D.C. area

Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.

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Mar 27 2013
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School-Based Health Programs for At-Risk Youth: Recommended Reading

Every two weeks the Agency for Health Care Research and Quality (AHRQ) releases an Innovations Exchange newsletter in order to share innovative health practices from around the country that can be adapted by other communities. The Innovations Exchange supports the Agency's mission to improve the quality of health care and reduce disparities.

The current issue focuses on school-based programs for youth at risk. According to AHRQ, many adolescents—particularly those in minority and low-income communities—lack access to health information, preventive care, and clinical services, leaving them at risk for untreated physical and mental health issues. School-based health care delivery, according to AHRQ, can improve access to care and address the needs of this vulnerable population. 

The featured innovations for at risk youth include:

  • A school-based program to reduce type 2 diabetes risk factors for children and young adults;
  • An inner city school district's reproductive health services model;
  • A school-based health center that improved access to mental health services, particularly for minorities.

The newsletter also features quality tools that schools can use to support HIV and STD prevention programs in schools and to facilitate school-based preventive, mental health, nutrition, and oral health services.

>>Read the latest issue of the AHRQ Innovations Exchange.

Mar 25 2013
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A Conversation on Community Health: Q&A with Jason Purnell

file Jason Purnell, Washington University in St. Louis

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?

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Dec 12 2012
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Health Enterprise Zones: "I Believe We Can Eliminate Health Disparities"

file Maryland Lt. Governor Anthony Brown (photo courtesy of State of Maryland Office of the Lt. Governor)

The state of Maryland recently passes legislation to address health disparity issues through “health enterprise zones.” The legislation allows local non-profits, health agencies, and local health providers to work together to address this critical issue through innovative public health strategies including tax incentives, financial awards and capital improvement funding for physicians and health care organizations.

Lt. Governor Anthony Brown of Maryland played a key role in establishing the zones, and spoke about them in session at yesterday’s GOVERNING Summit on Healthy Living. Lt. Governor Brown gave some important background on his personal push to establish the health enterprise zones, explaining that his father was a doctor who “taught a lesson of service.” For decades, he said his father saw and cared for patients in some of the poorest neighborhoods in New York. “I saw the file cabinets of unpaid invoices. My father taught me we have a responsibility to serve and care for our neighbors.”

Brown told the audience that, “as we look at health reform, there are real opportunities to address disparities in health. As we expand access, we need to increase quality and equity. I believe we can eliminate health disparities.” NewPublicHealth had the opportunity to speak with Lt. Governor Brown about health enterprise zones.

NewPublicHealth: Is this the first time that a health enterprise zone has been implemented?

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Nov 20 2012
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Angela Glover Blackwell: NewPublicHealth Q&A

file Angela Glover Blackwell, PolicyLink

Health disparities and social equity were key issues addressed at last month’s American Public Health Association (APHA) annual meeting. Angela Glover Blackwell, founder and CEO of PolicyLink, a national research and action institute whose goal is to advance economic and social equity, participated in the APHA president’s panel on the topic, where a key part of the discussion focused on the language used to discuss health disparities in the United States.

NewPublicHealth followed up with Angela Glover Blackwell to get her insights on the language of health disparities.

NewPublicHealth: During the panel at the APHA meeting, you talked about the need to be mindful of the language we use when talking about improving health for all Americans. How should we be characterizing the issues?

Angela Glover Blackwell: It is certainly good to see that the health world, public health and beyond, is talking about health disparities. Because for many years this was not anything that people talked about and it was not a topic at the American Public Health Association or any of the other big main stream meetings where health professionals gathered. So it’s a good thing that people have begun to talk about health disparities.

But, health disparities really talks about things being unequal. That’s what disparity means—unequal, different. But I don’t think that disparity captures what the condition is, nor does it suggest what the solution is. What I have heard others say and I have taken it on myself is the term health inequities, because the term “inequities” suggests unjust, unfair, and not just different. When you call them health inequities you focus on a societal problem that needs to be corrected, not just studied. The goal becomes achieving health equity, just and fair health outcomes.

It’s time that we recognize that we have unequal, unjust, unfair health outcomes and that they are related to race, and income, and place and we need to get sharp strategies that move us towards being able to help all people reach their full potential.

NPH: Where do we need to take the conversation from here?

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