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Shaking Up Systems To Achieve Health Equity

Mar 17, 2016, 10:00 AM, Posted by Catherine Malone, Dwayne Proctor

In order to achieve greater health equity in America, we need to co-create solutions aimed at transforming the many systems that influence where we live, learn, work and play.

A parent reads to a group of children.

Babies born in the shadow of Yankee Stadium are likely to be lifelong fans of the Bronx Bombers. They are also likely to live seven years less than a baby born a handful of subway stops south near Lincoln Center. The same is true in Las Vegas, where a baby born near The Strip is likely to live nine or 10 years less than someone born west of town.

When it comes to health across cities, zip codes are unequal and so are health outcomes. For example, ethnic minorities continue to experience higher rates of morbidity and mortality than whites. Among the 10 leading causes of mortality in the U.S. (e.g., heart disease, cancer or stroke), minority populations experience the highest rate of death.

We write often about the disparities between population groups and the day-to-day experiences of individuals who, for a myriad of reasons—systemic, geographic or financial—do not have the same opportunity to live as healthy a life as their fellow citizens. Our goal is greater health equity in America, a process that begins with including those most affected and co-creating solutions to improve the systems that negatively impact health. The end result should be decreased health disparities.

Here at the Foundation, we know that health disparities are more often caused by systems related to non-medical determinants of health, which is why we’ve specifically invested more than $457 million since 2014 toward eliminating these pervasive gaps in health outcomes.

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What’s the Connection Between Residential Segregation and Health?

Mar 16, 2016, 7:00 AM, Posted by Donald F. Schwarz

Residential segregation is a fundamental cause of health disparities. We need to take steps that will reduce health risks caused by segregation and lead to more equitable, healthier communities.

Graphic illustration depicting residential segregation from 2016 County Health Rankings & Roadmaps.

For some, perhaps the mere mention of segregation suggests the past, a shameful historic moment we have moved beyond. But the truth is, residential segregation, especially the separation of whites and blacks or Hispanics in the same community, continues to have lasting implications for the well-being of people of color and the health of a community.

In many U.S. counties and cities, neighborhoods with little diversity are the daily reality. When neighborhoods are segregated, so too are schools, public services, jobs and other kinds of opportunities that affect health. We know that in communities where there are more opportunities for everyone, there is better health.

The 2016 County Health Rankings released today provide a chance for every community to take a hard look at whether everyone living there has opportunity for health and well-being. The Rankings look at many interconnected factors that influence community health including education, jobs, smoking, physical inactivity and access to health care. This year, we added a new measure on residential segregation to help communities see where disparities may cluster because some neighborhoods or areas have been cut off from opportunities and investments that fuel good health. 

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Revitalizing Newark in a Healthy Way

Feb 24, 2016, 10:00 AM, Posted by Catherine Arnst

An ambitious collaborative effort is revitalizing a long-struggling city in ways that promote not only economic growth, but health and wellness. 

Skyline of Downtown Newark Arthur Paxton/Wikimedia Commons

“Jobs in Newark, New Jersey are as rare as dinosaurs,” says Barbara LaCue. She should know—the 51-year-old Newark resident was unemployed for more than five years after being laid off in 2008 from a steady factory job. She ended up living in a homeless shelter with her two sons.

Then, last October that dinosaur showed up. It took the form of a 67,000 square foot ShopRite, the first full service supermarket to serve the 25,000 people in the city’s struggling University Heights neighborhood.

ShopRite took over a site that had been vacant since the infamous Newark Riots in 1967. It is in a neighborhood where the poverty rate ranges between 25 and 40 percent, and half the households do not have access to a car. ShopRite is the anchor tenant of Springfield Avenue Market, a planned $91 million dollar retail and housing development funded in part by The Reinvestment Fund, with support from the Robert Wood Johnson Foundation.

But to Barbara, what matters most are the 350 full and part-time jobs the store created, most of them filled by people from the community. She is a chef at the deli counter, and she sees the job as more than just a living—it is a creative outlet. Barbara makes a mac n’ cheese to die for, and there are few people who can claim to love their job as much as she does hers. “This store is the best. I love this store.”

Her colleague Donald Douglas, also a lifelong Newark resident, works in the produce section. No one in Newark wanted to hire people from the neighborhood before Shoprite came along, says Donald. “Now, this is my supermarket. We all greet people with a smile here, because we are part of the community.”

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Visibility and Voice: A Call to Action in the Face of Invisibility and Resistance

Jan 7, 2015, 9:00 AM

Janet Chang, PhD, is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant research scientist at the University of Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups.

Janet Chang
Health Care in 2015

In the past year, there has been heightened national press coverage of anti-minority sentiments, and public outcry over discriminatory incidents in the United States. The publicized nature of these events stimulated intense debate. Some, especially those who believe in racial colorblindness, have argued that outraged individuals are overly sensitive and quick to assume that prejudice and discrimination are the cause. On the one hand, this perspective provides psychological comfort by downplaying the importance of race, minimizing the impression of bias, emphasizing our common humanity, and upholding egalitarian principles. On the other hand, it is upsetting and harmful because it denies the lived reality of racial/ethnic minorities. Colorblindness renders well-documented racial/ethnic disparities invisible.

Belief in colorblind ideologies perpetuates false notions that discrimination is rare. As a result, colorblindness, along with a complex host of factors, promotes ethnic/racial disparities in wide-ranging important domains, such as health and health care, criminal justice, housing, education, and employment and advancement in the workplace. Colorblindness reinforces the myth of meritocracy, which places value on individual effort and ability but overlooks structural factors that inhibit positive outcomes for vulnerable or disadvantaged populations.

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African-American Men’s Health: A State of Emergency

Dec 15, 2014, 9:00 AM, Posted by Roland J. Thorpe, Jr.

Roland J. Thorpe, Jr., PhD, MS, is an assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and director of the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held December 5th. The conversation continues here on the RWJF Human Capital Blog.

Scholars Forum 2014 Logo: Disparities, Resilience, and Building a Culture of Health.

Nearly half a century ago, Dr. Martin Luther King Jr. famously said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Yet decades later, only modest progress has been made to reduce the pervasive race- and sex-based disparities that exist in this country. African-American men who are at the intersection of race and sex have a worse health profile than other race/sex groups.  This is dramatically evidenced by the trend in life expectancy.

Roland Thorpe, Assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and director of the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions.

For example, African-American life expectancy has been the lowest compared to other groups ever since these data have been collected. Today the lifespan of African-American men is about six years shorter than that of white men.  Furthermore, a study from the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions provides a financial perspective around this issue.

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Naming Racism

Dec 5, 2014, 7:00 AM, Posted by Thomas LaVeist

Thomas LaVeist, PhD, is founding director of the Hopkins Center for Health Disparities Solutions, and the William C. and Nancy F. Richardson Professor in Health Policy at the Johns Hopkins Bloomberg School of Public Health. He is the chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College. LaVeist will moderate the first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health today, beginning at 10 a.m. Eastern Time. Follow the hashtag,  #RWJFScholarsForum, on Twitter for more.

Thomas LaVeist, Chair of the National Advisory Committee for the RWJF Center for Health Policy at Meharry Medical College.

Yesterday I had Camara Phyllis Jones, PhD, MD, MPH, as guest lecturer for my seminar on health disparities. It was a homecoming of sorts for her. She and I first met in the early 1990s when I was a newly minted assistant professor and she was a PhD student at the Johns Hopkins Bloomberg School of Public Health. Jones’ work should be well known to readers of this blog. She has published and lectured on the effects of racism on health and health disparities for many years. She played a leading role in the Centers for Disease Control and Prevention’s work on race, racism, and health in the Behavioral Risk Factor Surveillance System.  And she was just elected president-elect of the American Public Health Association. She is a fantastic lecturer and often uses allegory to illustrate how racism affects health. 

Scholars Forum 2014 Logo: Disparities, Resilience, and Building a Culture of Health.

About midway through her lecture, a student raised his hand and got her attention to ask a question about the utility of “naming racism.” My interpretation and rephrasing of his question—is it helpful to use the word racism or is the word so politically charged and divisive that it causes people to “tune you out?”

The student’s question raises a major challenge for those of us who seek to address health disparities. On one hand racism is fundamental to understanding why disparities exist and persist. I would go as far as to state that in most race disparities research, race is actually a proxy measure for exposure to racism. But, on the other hand, the word racism makes some people uncomfortable, causing them to become defensive or sometimes simply block out your message.  

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Lessons from the Arabbers of Baltimore

Nov 28, 2014, 9:00 AM, Posted by Maya M. Rockeymoore

Maya M. Rockeymoore, PhD, is president of the Center for Global Policy Solutions, a nonprofit dedicated to making policy work for people and their environments, and director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation (RWJF). On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

Scholars Forum 2014 Logo: Disparities, Resilience, and Building a Culture of Health.

When I think of the resilience of disadvantaged communities disproportionately affected by health disparities, I think of the Arabbers of Baltimore, Md. They are not Arabic speaking people from the Middle East or North Africa, but scrappy African American entrepreneurs who started selling fresh foods in Baltimore’s underserved communities in the aftermath of the Civil War.

Maya Rockeymoore, Director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation (RWJF).

Their relevance continued into the modern era as supermarkets divested from low-income neighborhoods, leaving struggling residents with few options aside from unhealthy fast food and carry-out restaurants. Driving horses with carts laden with colorful fresh fruits and vegetables, Arabbers sold their produce to residents literally starving for nutritious food.

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What’s Your “Street Race-Gender”? Why We Need Separate Questions on Hispanic Origin and Race for the 2020 Census

Nov 26, 2014, 3:00 PM, Posted by Nancy Lopez

Nancy López, PhD, is an associate professor of sociology at the University of New Mexico (UNM). She co-founded and directs the Institute for the Study of “Race” and Social Justice at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at the UNM. On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

Scholars Forum 2014 Logo: Disparities, Resilience, and Building a Culture of Health.

How should we measure race and ethnicity for the 2020 Census? How can health disparities researchers engage in productive dialogues with federal, state and local agencies regarding the importance of multiple measures of race and ethnicity for advancing health equity for all?  

Portrait of Nancy Lopez, UNM Policy Center.

If we depart from the premise that the purpose of race, ethnicity, gender and other policy-relevant data collection is not simply about complying with bureaucratic mandates, but rather it is about establishing communities of practice that work in concert toward the creation of pathways (from harmonized and contextualized data collection, analysis and reporting) to effective policy solutions and interventions that address the pressing needs of diverse communities across the country, then we have planted the seeds of a culture of health equity and social justice.

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Reigniting the Push for Health Equity!

Nov 24, 2014, 1:00 PM, Posted by Daniel Dawes

Daniel E. Dawes, JD, is a health care attorney and executive director of government relations, health policy and external affairs at Morehouse School of Medicine in Atlanta, Georgia; a lecturer of health law and policy at the Satcher Health Leadership Institute; and senior advisor for the Transdisciplinary Collaborative Center for Health Disparities Research. On December 5, the Robert Wood Johnson Foundation (RWJF) will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.

Scholars Forum 2014 Logo: Disparities, Resilience, and Building a Culture of Health.

With growing diversity relative to ethnicity and culture in our country, and with the failure to reduce or eliminate risk factors that can influence health and health outcomes, it is imperative that we identify, develop, promulgate, and implement health laws, policies, and programs that will advance health equity among vulnerable populations, including racial and ethnic minorities.

Portrait of Daniel Dawes.

Every year, the Agency for Healthcare Research and Quality publishes its National Healthcare Quality and Disparities Report, which tracks inequities in health services in the United States. Since the report was first published in 2003, the findings have consistently shown that while we have made improvements in quality, we have not been as successful in reducing disparities in health care. This dichotomy has persisted, despite the fact that health care spending continues to rise. In fact, health care costs have been escalating at an unsustainable rate, reaching an estimated 17.3 percent of our gross domestic product in 2009, according to the Centers for Medicare and Medicaid Services. Despite these high costs, the delivery system remains fragmented and inequities in the quality of health care persist. The impact of disparities in health status and access for racial and ethnic minorities is quite alarming.

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Misfortune at Birth

Nov 14, 2014, 8:00 AM, Posted by Eileen Lake

Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.

Portrait of Eileen Lake, INQRI. Eileen Lake

Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity.  It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery.  It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.

A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior?  A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals.  Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives. 

Portrait of Jeannette Rogowski, INQRI. Jeannette Rogowski

A Brighter Future

What can be done to make these hospitals better?  A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.

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