A Conversation on the Future of Health Equity Research

Jan 12, 2017, 4:43 PM, Posted by Tracy Orleans

In the past decade, the healthy equity research landscape has shifted from building the evidence to identifying solutions. David Williams and Paula Braveman share thoughts on the evolution of research with a look to the future.

The latest National Academies of Science Engineering and Medicine report notes that compared to other fields of health research, health inequities is still a relatively new field that faces significant research and practical application challenges. The consensus report provides specific recommendations including: expanded health disparity indicators, longer-term studies, an examination of structural factors, and new research funding opportunities. RWJF’s Tracy Orleans talks with two of the nation’s leading experts on health equity and health disparities, Dr. David R. Williams and Dr. Paula Braveman, who share their thoughts on some of these issues and the evolution of research with a look to the future. 


Tracy Orleans: Nearly ten years ago you started work together on the RWJF Commission to Build a Healthier America. At the time, gaps in health between groups of people or communities were not news to health experts, but they were surprising to a lot of others. We’ve come a long way since then with a more explicit focus on health equity research. How do you view this shift?

 

David Williams: For a long time, researchers focused on documenting the health differences between populations. Those differences are now well-established and we’re able to point to more scientific evidence about why the gaps exist. For example, there’s a growing body of research around the effects of epigenetic aging, which shows that people who experience discrimination or other trauma are biologically older than people of the same chronological age. Science shows that their telomeres, which protect chromosomes from fraying, are shorter among both children and adults who are black, poor, or from unstable homes. This type of more explicit health equity research is a rapidly growing field.

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What If All Children Could Attend Preschool?

Jan 3, 2017, 3:00 PM, Posted by Susan Mende, Tara Oakman

In Europe, rich and poor kids alike are enrolling in early care and preschool programs in large numbers. These accomplishments offer us insights for our collective efforts to strengthen early education in the U.S.

For the past 18 years, every 4-year-old in Oklahoma has been guaranteed a spot in preschool, for free. These kids are learning their letters, numbers, colors and shapes. They’re also developing arguably more important social and emotional tools--how to make friends, feel empathy, solve problems, manage conflict. These are the kind of building blocks children need to become thriving adults.

Nearly 75 percent of 4-year-olds are enrolled in Oklahoma’s pre-K program. That's one of the highest participation rates in the country. But if we look across the United States, we see that just 61 percent of kids between the ages of 3 and 6 are enrolled in pre-K, daycare or other formal early childhood education program. 

Why? Of course, many parents stay home or have a friend, neighbor or relative take care of their kid. But a recent Harvard poll of parents with children under the age of five highlights the struggles families face in finding quality, affordable child care. Many parents reported having limited options and said that the cost of child care had caused financial problems. Low-income families were especially likely to report difficulty accessing care.

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How a Healthy Food System Can Transform Your Community

Nov 28, 2016, 9:00 AM, Posted by Dana Harvey

Mandela MarketPlace understands that community members hold the key to positive change. By lifting up a culture of community ownership, Mandela is increasing access to healthy food and sustainable business opportunities.

Sixteen years ago, I embarked on what I thought would be a year-long project to help the residents of West Oakland gain reliable access to affordable, nutritious food.

More than 23.5 million people live in low-income areas that are more than a mile from a supermarket, according to the USDA. That includes West Oakland, one of the city’s poorest areas. The community has a high rate of crime, pollution and unemployment—along with dozens of liquor stores and fast food outlets. Health outcomes are dismal; residents are two times more likely to be born at a low birth weight and 2.5 times more likely to die of stroke than residents in the nearby affluent area of Oakland Hills.

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Encouraging Progress on the State of Obesity in the United States

Nov 17, 2016, 3:00 PM, Posted by Donald F. Schwarz, Richard Hamburg

Teaming up to reverse childhood obesity has yielded promising results—including new data that shows rates among 2-4 year olds enrolled in the federal WIC program have declined in 31 states. But the work is far from over. 

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Home Visits Work: Let’s Make Them Universal

Nov 14, 2016, 1:31 PM, Posted by Martha Davis

Every family deserves an equal opportunity to build a healthy, nurturing environment that helps their kids thrive. That’s where home visits come in.

Some of the most fulfilling and valuable experiences of my early career involved working as a home visitor about twenty years ago. I traveled through Philadelphia’s most underserved neighborhoods with a team from the MomMobile, a community-based organization that provides free support and education to families facing the challenges that pregnancy and parenting bring. I’ve personally witnessed the powerful impact home visits have on families, and that’s why I’m so passionate about the role they can play in building a Culture of Health.

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Tackling Life Expectancy Gaps in New Jersey

Nov 9, 2016, 9:00 AM, Posted by Bob Atkins

New Jersey Health Initiatives is driven by five key principles for building empowered, equitable and healthier communities and narrowing the gaps in life expectancy across the state.

It’s a dismaying fact that we’re all familiar with: where you live has an enormous impact on your life expectancy. Indeed, some researchers now quip that your ZIP code may matter just as much, if not more, than your genetic code when it comes to your health. As one journalistic account put it, it’s “Death by Zip Code.”

New Jersey is no different. This summer, the Robert Wood Johnson Foundation (RWJF), together with Virginia Commonwealth University, published analyses of Mercer County, a prime place to showcase the impact of geography on health. It’s home to both affluent Princeton and economically strapped Trenton. And perhaps not surprisingly, life expectancy reflects the gulf in resources between the two towns. While a person born in Princeton can expect to live 87 years, his or her neighbor in Trenton has a life expectancy of 73 years—a staggering 14 year age gap across only a dozen miles.

These results are sobering. It’s easy to get despondent over them and locked into a narrative of failure and decline. But RWJF’s Culture of Health efforts involve cultivating potential, even in places where we wouldn’t normally think to find it. That’s where New Jersey Health Initiatives’ (NJHI) work comes in.

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A New Innovation Award for Health Care Provider Training and Education

Nov 1, 2016, 9:00 AM, Posted by Jenny Bogard

Providers need to be equipped with the tools to help patients make healthy choices. That’s why the Alliance for Healthier Generation is recognizing innovative training programs providing nutrition, physical activity and obesity counseling education to their students.

Even at the young age of four, Luke was overweight. In fifth grade, he tried out for the baseball team, and although he made it, he struggled that season. He was slower than the other kids as he rounded the bases, and he started having knee pain from the extra weight on his joints. Luke and his family knew they had to do something. But they dreaded going to the doctor, knowing he’d get weighed and then have to confront the escalating numbers on the scale. Year after year, the same thing would happen, and they’d have the same discussion with his doctor when they finally worked up the nerve to go. But the weight never came off.

Apprehension about a visit to the doctor is something we all face, no matter our age or health. Who among us doesn’t get a little nervous before our annual visit, knowing we might face a difficult conversation about losing weight, or flossing more, or stopping smoking? These are things we all know, but have a hard time talking about.

And even worse, if we do have these important conversations, they can lead to feelings of shame and disappointment.

But the reality is that it’s not necessarily your doctor’s fault. Even with the hundreds of thousands of hours of education your doctor gets in classrooms and hospitals, most receive little to no training in how to talk to patients about making healthy choices. In fact, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise recommended by the National Academy of Sciences, Engineering and Medicine.

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Lessons from Culture of Health Prize Winners in the Northeast

Oct 26, 2016, 4:00 PM, Posted by Amy Slonim

Past prize-winners recently convened to discuss their experiences. They share powerful lessons on how they are improving health and health equity within their communities.  

We started the day with an icebreaker.

“I harness the collective power of leaders, partners, and community members,” read the moderator.

“That’s me!” shouted the group of several dozen people gathered on the campus of Yale University in New Haven, Conn., for a reunion of sorts. They came from diverse sectors and systems—from health care, education, nonprofits and government agencies—and their communities all had this in common: They are past winners of the RWJF Culture of Health Prize.

Each year, RWJF honors and elevates U.S. communities that are making great strides in their journey to better health and well-being. So far, 27 places—cities, counties, tribes, and more—across the country have claimed the distinction of receiving the Prize.

This year, communities across the United States have until November 3rd to apply for the Prize. Winners will receive up to $25,000 and have their stories spread broadly to inspire others toward locally-driven change.

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Parents Need Flexible and Affordable Child Care

Oct 18, 2016, 10:00 AM, Posted by Kristin Schubert

Child care plays a critical role during the formative years and is key to familial stability. A new poll illustrates the challenges that parents face in accessing quality, affordable child care, and the opportunities for improvement.

I remember how it felt when I returned to work after the birth of my first son. Trying to figure out child care was confusing, overwhelming, and downright stressful. Of course I wanted the very best care for my baby, but I didn’t know what “high quality” really looked like. Our first arrangement was with a nearby woman who cared for a few other children in her home. Pretty quickly, I decided it wasn’t the right fit. I cobbled together a mix of family and part-time care while searching for a new solution. I am so grateful I had friends, family, and a supportive work environment to pull this off. I then tried in-home care, hiring a string of visiting nannies, none of which worked out. One of them quit with no notice, leaving me in a very difficult position at work.

Then I found what seemed like a great center-based program, and was prepared to sign up. But as I left the building after my initial visit, I bumped into a friend who had a bad experience there and advised looking elsewhere. What if she was right? I couldn’t take the chance, so I kept searching, relying on the generosity of family in the meantime.

Eventually I found a center that worked out. I felt my baby was nurtured and well-cared for, but the costs were enormous, and frankly, to this day I am still not sure if it was truly “high quality.”

A poll released yesterday by NPR, The Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health finds that parents and caregivers, like me, recognize the value of high quality child care and early education experiences.

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How a Swedish Model of Care is Making an Impact in the U.S.

Oct 5, 2016, 9:35 AM, Posted by Laura Leviton, Susan Mende

Disease registries designed to support clinical research can be reimagined to create a new and more effective kind of patient-centered care. Just take a look at Sweden.

The Karolinska Institutet building in Sweden. The Karolinksa Institutet in Solna, Sweden. Photo by Pelle Sten via Flickr.

Large-scale collection of patient data into disease-specific databases, or registries, is vital to research. These registries house standardized information on patients’ diagnoses, care, and outcomes, supporting large-scale comparison and analysis which can lead to better population health management and interventions. But can disease registries also help to move us closer to patient-centered care?

We’re learning from examples overseas that, with the help of new interactive technologies, they can.

Sweden created a disease registry for rheumatology that is much more than a data storage house. The Swedish Rheumatology Quality Registry (SRQ) is an interactive tool that helps patients and doctors prepare for and make better use of their office visits. It helps them to work like a team—to “co-produce” care together.

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