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What’s Law Got to Do With It? How Medical-Legal Partnerships Reduce Barriers to Health

Jul 8, 2015, 4:59 PM, Posted by Ellen Lawton, Megan Sandel

Civil legal aid agencies are a proven resource for clinics to support patient needs and achieve health equity by addressing the social barriers to health.

Medical-legal partnerships Dr. Alicia Turlington consults with attorney Randy Compton at the Medical-Legal Partnership for Children at Kokua Kahili Valley health center. (Image via Joseph Esser)

A lawyer as part of the health care team? It's not as strange as it sounds. Many of the social conditions that impede health, such as housing, education, employment, food and insurance, can be traced to laws unfairly applied or under-enforced, often leading to the improper denial of services and benefits designed to help vulnerable people.  

There are eight thousand civil legal aid lawyers in the U.S., and much of their work is directly related to improving health. They ensure access to food, health benefits and insurance for their clients. By fighting for better housing conditions and preventing evictions, they help create healthier physical environments. They help keep families safe and stable by establishing guardianships.

There is evidence that lawyers are more critical than ever to the health of vulnerable people. Each year the Department of Veterans Affairs surveys homeless veterans; the most recent CHALENG survey found that six of the top 10 barriers to housing were legal in nature. And a recent study at Lancaster General Hospital found that each of the hospital's highest-need, highest-cost patients had two to three health-harming civil legal problems.

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Mapping a Path to Longer and Healthier Lives Across Atlanta

Jun 10, 2015, 2:52 PM, Posted by Dwayne Proctor

The Atlanta skyline on a sunny day. Image via City Clock Magazine

Two Atlanta neighborhoods, Buckhead and Bankhead, are separated by a mere five miles. Even their names are just two small letters apart. And yet the high-end shopping mecca dubbed Buckhead boasts an average life expectancy of 84 years, while in Bankhead—a neighborhood in transition that’s home to a newly burgeoning arts community—its residents face a life expectancy that’s a full 13 years shorter.  

This map of Atlanta—one of a series from the Center for Society and Health at Virginia Commonwealth University (VCU), funded by RWJF, shows that our zip codes might be a better predictor of health than our genetic codes. Why? Because where we live affects our health and wellbeing in complex ways. Among them, according to VCU, are a scarcity of jobs and quality schools, and fewer opportunities to access healthy affordable foods and safe places to be active.

This isn’t the first time Atlantans have bore witness to to inequity in their community, and today, community leaders are drawing inspiration from their past. Here in the city that served as the capitol of the Civil Rights Movement, community leaders are responding just as previous generations once did—by bringing together a diverse coalition to advance health equity and serve as a model for communities far beyond the Peachtree State.

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Building Healthier Places In Birmingham and Beyond

Jun 1, 2015, 11:46 AM, Posted by Susan Dentzer

How a section of Birmingham, Alabama is redeveloping and offering greater opportunities for people at multiple income levels. The secret? Engaging the community throughout the process.

With its elegant homes, pleasant park and bustling stores, the Woodlawn section of Birmingham, Alabama was described in a 1950 news article as “a really great section of Birmingham...typical of the fine things in life." Then came the racial unrest of the 1960s, disruption from urban renewal gone awry and white flight to Birmingham’s suburbs. Joblessness and poverty took root; the housing stock decayed. Today, median income in Woodlawn is just $21,000, less than half the level for Birmingham as a whole.

But now Woodlawn is in the midst of a turnaround, aiming to become not just a neighborhood that prospers economically, but also one where people live healthier lives.

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One Cure for the World’s Toughest Challenges? Bold Leaders, Connected

May 19, 2015, 9:00 AM, Posted by Herminia Palacio

Change leadership means thinking big about impact, responding to urgent needs, and actively tolerating risk. This is the kind of big, bold way of working—together—that will get us to a Culture of Health.

Members of the Camden Coalition make home visit to patients around Camden, NJ.

Just over a year ago, I started in a new role at the Robert Wood Johnson Foundation. Not long after, my colleagues and I began the exciting, challenging, and collaborative process of co-designing four new programs that will develop, train, and network change leaders who will help build a Culture of Health.

You may be wondering – What is change leadership? How do we know it when we see it? And, why is it essential for achieving RWJF’s vision?

>>Could your organization serve as a National Leadership Program Center? View the call for proposals.

Here's the type of challenge our nation's leaders often face:

“For a half-century, charities, nonprofits and local and federal governments have poured billions of dollars into addressing the problems plaguing [many] Americans. But each issue tends to be treated separately – as if there is no connection between a safe environment and a child’s ability to learn, or high school dropout rates and crime.” –The Wall Street Journal, September 2013

Now here's an example of what change leadership looks like:

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Retail Clinics Are Expanding Their Role Within the Health Care System

May 6, 2015, 3:38 PM, Posted by Tara Oakman

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

CVS Retail Clinic

My husband had been suffering from a very painful sore throat for a couple of days when he finally decided to call his doctor. Just one problem: It was a Friday morning and the office was booked for the day. The doctor called back later in the afternoon and told my husband it sounded like a virus and he should simply “wait it out.” With the weekend approaching, the next available appointment—if needed—was on Monday. Rather than suffer all weekend with a raw throat, my husband followed the advice of a relative (who also happens to be a physician) and went to a clinic at our local CVS. Less than an hour later he was diagnosed with strep throat and started on antibiotic therapy he picked up at the pharmacy. By Saturday evening he was feeling a lot better.

Access to quick, convenient care on nights and weekends is one of the prime selling points of “retail clinics” based in pharmacies, groceries, and big-box retailers. With longer operating hours and no need for an appointment, these clinics, sometimes called “doc-in-a-box,” give patients more flexibility to avoid time away from work and family. Plus, a trip to a retail clinic costs about one-third less than a visit to a doctor’s office, and is far cheaper than an emergency room. Retail clinics usually accept private insurance, Medicare, and, in many cases, Medicaid; yet people without insurance or a personal physician also are using them for treatment of routine illnesses, basic health screenings, and low-level acute problems like cuts, sprains, and rashes.

New shopping list: Pick up milk, breakfast cereal, and toilet paper; get a flu shot and that weird rash checked out.

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Design That Heals: The American Institute of Architects Rewrites the Rules

Apr 9, 2015, 9:27 AM, Posted by Sheree Crute

The South Bronx's Via Verde, an award-winning affordable housing complex designed around equity and social cohesion, shows us a new era of healthy design is here—and it's contagious.
 

Via Verde (Image credit: David Sundberg/Esto)

Each winter, Raquel Lizardi and her heartiest garden club members brave the New York City cold to tend their community’s apple trees. “They are very delicate,” Lizardi says, sharing her training at GrowNYC, a nonprofit that seeks to create a healthier environment in the city, block by block. Their efforts ensure that the small orchard yields barrels of sweet Red Delicious, Gala, and slightly tart McIntosh apples for Lizardi and her neighbors in the fall.

Come spring, the group turns its attention to planting enough organic spinach, collards, kale, berries, tomatoes, other vegetables, and herbs to keep all of their tables filled with free, fresh produce.

The orchard, gardens, and grove of evergreens where Lizardi and her neighbors come together are a center of community activity at Via Verde/The Green Way, an award-winning, affordable housing development that rises above a quiet street just off bustling Third Avenue in the South Bronx. Built on a former garbage-strewn lot and Brownfield in 2012, Via Verde is now an international symbol of healthy design achievement.

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The 2015 Rankings and Philadelphia’s Power of ‘Brotherly Love’

Mar 25, 2015, 12:15 AM, Posted by Donald F. Schwarz

Rather than taking poverty and its ravaging effects on health as a given, Philly leaders and citizens came together to usher in change that would make the city a healthier and better place to live for everyone.

Philadelphia skyline

If you want to understand the texture of a large city, drive from its downtown and make your way out to the suburbs. With few exceptions, you’ll encounter pockets of poverty transitioning into mixed income neighborhoods and, finally, wealth and privilege in the suburbs.

I have lived in Philadelphia—the nation’s 5th most-populous city and 21st most populous county—for most of my adult life, and that is her reality. As a former public health official, I can tell you that such income gradients have a profound impact on the health of our populations.

The 2015 County Health Rankings released today are unique in their ability to arm government agencies, health care providers, community organizations, business leaders, policymakers, and the public with local data that can be applied to strengthen communities and build a true Culture of Health.

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Research Designed Through the Eyes of Youth

Mar 17, 2015, 12:30 PM, Posted by Alonzo L. Plough, Dwayne Proctor

There's power in giving youth the means to document what they see as the barriers to their community's health. This project from Charlotte, N.C. shows us how this innovative research design can be a step to addressing local disparities.

Last year, we at the Robert Wood Johnson Foundation asked our community a bold question: What was considered the most influential research around identifying and eliminating disparities? In our first-ever Culture of Health reader poll, a winning research paper emerged in Por Nuestros Ojos: Understanding Social Determinants of Health through the Eyes of Youth, published in the Summer 2014 edition of Progress in Community Health Partnerships. The research project equipped young people in Charlotte, N. C., with cameras to identify and document environmental factors that impact health in their Latino immigrant community. What really makes this paper resonate for us—and, it seems, for many of you—is that it provides a clear example of how community-based participatory research (CBPR) is an important approach to understanding the multiple factors underlying health disparities.

We wanted to learn more about this interesting example of participatory research and how the Por Nuestros Ojos project is helping advance health equity in Charlotte. Recently, our blog team had a conversation with three of the study’s authors to find out how employing a participatory research model can help enormously in understanding and eliminating disparities in marginalized communities. Below is an interview with Johanna (Claire) Schuch, research assistant and doctoral candidate at the University of North Carolina at Charlotte (UNCC); Brisa Urquieta de Hernandez, project manager at the Carolinas HealthCare System and doctoral student at UNCC; and Heather Smith PhD, professor, also at UNCC.

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Poll: People Worry about Far More than Disease When it Comes to Health

Mar 3, 2015, 9:52 AM, Posted by Catherine Arnst

Q&A with Robert Blendon, Harvard T.H. Chan School of Public Health

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This week a public opinion poll was released by NPR, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health asking people to list the factors most likely to cause ill health in adults. The top five included lack of access to high-quality medical care (42%), and viruses or bacteria (40%)—not a surprise—but also such socio-economic factors as personal behavior (40%), high stress (37%), and exposure to air, water, or chemical pollution (35%). And a majority (54%) said that being abused or neglected in childhood is an extremely important risk factor for ill health later in life.

Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health, led the poll and recently talked to RWJF Media Director Catherine Arnst about some of the key results. (Both questions and answers were edited for clarity)  

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What Will It Take to Diversify Medicine?

Jan 28, 2015, 3:00 PM, Posted by Sheree Crute

Every few weeks, Dana Todd, MD, does something rare for an American physician:  She makes a house call. The visits are her way of making life easier for a bedridden stroke survivor and her caregiver daughter.

“One afternoon, I looked out into the clinic waiting room and there they were,” Todd recalls. “My patient was laying on a stretcher. Her daughter was by her side. Her family was adamantly against putting her in a nursing home because she is only in her 50s, so coming in was the only way she could get care. I just hated seeing her that way so I said, ‘Next time, I’ll come to you.’”

Todd is one of four primary care physicians who, along with a small group of nurse practitioners, provide care for residents of Greensboro, Ala., population 2,440, in rural Hale County. The little town, though, is a lot more to Todd than a place to work. 

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