Jan 12, 2017, 4:43 PM, Posted by
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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Nov 9, 2016, 9:00 AM, Posted by
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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Oct 26, 2016, 4:00 PM, Posted by
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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Apr 18, 2016, 9:45 AM, Posted by
This $500K competition seeks proposals for studies that will further our understanding of mood and how it relates to daily life.
We know that mood is one of the keys to health. Whether you are happy, depressed, stressed out, anxious—all can impact your physical well-being. However, our knowledge of the relationship between mood and many social and economic factors—such as weather, pollution, access to food, sleep, and social connectedness—remains limited, despite decades of study.
Furthering scientific understanding of mood is critical to building a Culture of Health, and ResearchKit provides a novel way to build that understanding. Mobile-based clinical studies mounted with ResearchKit present exciting opportunities to increase participation in studies and to change the relationship between researchers and the people enrolled in those studies, which is why the Robert Wood Johnson Foundation is sponsoring the Mood Challenge for ResearchKit.
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Dec 7, 2015, 8:00 AM, Posted by
With the right data to inform priorities, and a powerful commitment to equity, places like Tulsa, Okla., are making progress to close health gaps.
What would your ideal future look like? For me and my colleagues at the Foundation, it would be one where everyone has the opportunity to live the healthiest life they can.
An unfortunate reality in this country, however, is that while we continue to realize substantial gains in health, the things that help people become and stay healthy are not evenly distributed across states or even metropolitan areas. Access to healthy foods, opportunities for exercise, good-paying jobs, good schools, and high quality health care services may be readily available in one area, and difficult to come by or nonexistent in another just a few miles away.
Sometimes the differences are particularly stark: In some communities, two children growing up just a short subway or car ride apart could be separated by a 10-year difference in life expectancy.
So how do we square this reality with the Culture of Health we’re working hard with others to build? An important first step is recognizing those disparities and what’s driving them, and ensuring that people in communities across America have strategies – and the data – they can use to proactively close health gaps.
Let’s use Oklahoma, and within it the city of Tulsa, as an example.
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Nov 4, 2015, 3:03 PM, Posted by
A call for proposals seeks to support evaluation of disruptive innovations that improve the health of low-resource communities—without increasing costs.
Many of the resources that influence whether or not people are healthy vary widely from one community to the next. Income, education and employment levels, access to quality, affordable health care, the availability of social services, and the cultural and physical environment—all have a significant impact on health outcomes. Poorer communities, lacking in resources may struggle to offer all the components that create a healthy environment to live, learn, work and play.
By necessity, however, these low-resource communities often find new and creative ways to do more with less to promote health. In an effort to uncover such fresh and disruptive approaches to improving health in these communities, the Robert Wood Johnson Foundation (RWJF) is issuing a call for proposals.
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Aug 10, 2015, 3:25 PM, Posted by
It's been a year since Brownsville, Texas, won the Culture of Health Prize for its engagement of leaders across sectors to improve local health outcomes. Here's what the community has been up to since.
Brownsville, Texas, had plenty to celebrate when it became one of six communities to win the Robert Wood Johnson Foundation’s Culture of Health Prize in June 2014. This predominantly Hispanic city along the U.S.-Mexico border is one of the poorest in the country. Seven in 10 residents are uninsured, 8 in 10 are overweight or obese, and 1 in 3 has diabetes. Yet the community’s efforts to improve health—including new bike trails, community gardens, and a successful bilingual public health education campaign—have earned it wide respect and national recognition, along with $25,000 that goes with the RWJF Culture of Health Prize.
City officials are still discussing how to use the prize money. One option is commissioning a piece of artwork that could be moved around to highlight various initiatives, such as the periodic CycloBia events that make some of the city’s streets car-free for a day so that residents can bike, run, or engage in other physical activity.
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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.
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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Jun 10, 2015, 2:52 PM, Posted by
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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Jun 1, 2015, 11:46 AM, Posted by
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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