Culture of Health Blog

A few years ago, I read a painfully insightful account in the New York Times of what it means to be a black American struggling with mental health. The author vividly describes how socio-historical “trauma lives in our blood,” materializing in our daily lives, and ultimately affecting our mental health.

Editor’s Note: This post originally appeared on the National Civic League website. We are reposting it with permission this February which is Black History Month as well as American Heart Month.

The Southeastern San Diego Cardiac Disparities Project is improving the cardiovascular health of black residents in South San Diego by altering two fundamental systems that can influence their health: faith organizations and health care providers.

Elizabeth Bustos, director of community engagement for Be There San Diego, and Reverend Gerald Brown, executive director at United African American Ministerial Action Council are leading the effort. They are recipients of the 2017 Award for Health Equity, which was presented to them by the National Civic League and Robert Wood Johnson Foundation. The Award honors leaders who are changing systems and showing how solutions at the community level can lead to health equity.

Dr. James Comer is a pioneer. Decades before the science of learning and development caught up to him, he understood that all children need well-rounded developmental experiences in order to seize opportunities in life. His parents hailed from the deeply segregated South, but they helped him thrive in the era of Jim Crow, investing in his social and emotional well-being and providing safe, supportive, nurturing and demanding educational experiences.

Through that lived experience and Dr. Comer’s work as a physician and child psychiatrist, he understood that one of the most important ways to support children was to focus on where they spend a substantial part of their day: schools. He also understood that many children did not have opportunities to benefit from an environment that supported their well-being and their ability to have a full learning experience. He set out to change this through a remarkable model that has earned him the moniker “the godfather of social and emotional learning.”

In the Boston Edison neighborhood of Detroit, black children raised in low-income households have grown up to have an average household income of $28,000/year as adults, and under 1 percent of that population has been incarcerated as adults. In contiguous Dexter-Linwood, just one census tract to the north, the average earnings for the same group is $17,000/year, with adult incarceration rates hovering close to 8 percent.

If some neighborhoods lift children out of poverty, and others trap them there, the obvious next step is to figure out how these communities differ. Travel to Charlotte, N.C., which has one of the highest job growth rates in America. But data reveals (surprisingly) that availability of jobs and a strong regional economy do not translate to upward mobility in this region. Children who grew up in low-income families in Charlotte have one of the lowest economic mobility rates in the nation. What does help, according to the The Opportunity Atlas (the Atlas), is growing up with less discrimination, around people who have jobs and higher incomes—but only when those factors are found in their immediate neighborhood. If they are present a mile away, it doesn’t seem to matter much according to the data.

It’s only January and already, I’m counting down the days to spring when warm weather will arrive. The long, cold months of winter can be isolating—the snow and subzero temperatures make it difficult to get out and about. Winter is particularly tough for children who can’t go outside to play, and for newcomers from warmer climates who are not accustomed to the cold. For people who don’t have meaningful social connections, the cold weather season can exacerbate the isolation they face year-round.

Social isolation is a serious problem for many. It can lead to anxiety, depression, substance abuse, and even suicidal thoughts. Social isolation can impact our health in other ways too—by escalating unhealthy habits, stress, lack of sleep—and putting us at higher risk for coronary heart disease and stroke.

Fortunately, there are many creative ways in which communities across the United States are tackling social isolation and building a sense of community.

The small city of Hudson is nestled in Upstate New York and home to fewer than 7,000 people. The city was hit hard by deindustrialization in the late 20th century, facing economic decline as factories closed and industry jobs left. In recent years development has surged, with the opening of antique stores, restaurants and art galleries. The city has become a popular destination for tourists and second-home owners.

While our town is often celebrated as a story of revival, development has not benefited all of our community’s residents. For example, despite the presence of several high-end restaurants, there is still no grocery store. Rising costs have increased inequity, causing displacement for many families. Public funding is often directed toward maintaining Hudson as an attractive tourist destination versus addressing the needs of local youth and families.

Our organizations here in Hudson, Greater Hudson Promise Neighborhood and Kite’s Nest, have been working in partnership with many community organizations and individuals to improve conditions for youth and families.

There’s no bus service in his small town in rural North Carolina, so Dean* drives 10 miles to The Free Clinics ("Clinics") in Hendersonville every couple of weeks whenever he has money for gas.

Staff there helped him find affordable medications and treatments for cancer and for his shoulder, which he injured by falling 20 feet on a construction site. He’s unable to read due to learning disabilities, so they’ve also helped him find lawyers to file disability claims.

Dean is also one of the patients who attends the Clinics’ Bridges to Health ("Bridges") program, a drop-in group session where patients can discuss their social and emotional concerns as well as medical problems. He has battled depression since the age of five after enduring early childhood trauma. He credits the Bridges sessions, along with the Clinics’ holistic care, with easing his depression and improving his physical health, as well as “opening up avenues for me to get help.”

The amputation was scheduled for that day. John’s* uncontrolled diabetes had stopped blood flow to his lower leg. With the tissue starting to die, it seemed inevitable that his foot would have to be removed to save his life.

Thankfully, a team I work with had recently helped bring telehealth services to the rural Colorado hospital where John had been admitted. A cloud-based video system connected to electronic health records enabled his doctor to consult with an infectious disease specialist hundreds of miles away in Denver. The specialist suggested one last “cocktail” of antibiotics, to be administered by I.V. The protocol worked. John kept not only his foot, but also his livelihood as a rancher: his ability to graze cattle, grow wheat, and provide for his family.

When her regular job hours were cut, Lulu, who is in her 30s and lives in New York, couldn’t find a new full-time job. Instead she now has to contend with unsteady income and an erratic schedule juggling five jobs from different online apps to make ends meet. Cole, in his first week as an Uber driver in Atlanta, had to learn how to contend with intoxicated and belligerent passengers threatening his safety. Diana signed up to help with what had been described as a “moving job” on TaskRabbit. When she arrived, she had to decide whether it was safe for her to clean up what looked to her like medical waste.

Work is a powerful determinant of health. As these stories about taxi, care, and cleaning work from a new report show, it is a central organizing feature of our lives, our families, our neighborhoods, and our cities. And work—its schedules, demands, benefits, and pay—all formally and informally shape our opportunities to be healthy.

But the world of work is rapidly changing. Job instability and unpredictable earnings are a fact of life for millions. Regular schedules are disappearing. With “predictive scheduling,” a retail worker today is essentially on call, making everything from booking child care to getting a haircut impossible until the work schedule arrives. Health and other fringe benefits are less often tied to the job. Nearly six in ten low-wage workers today has no paid sick leave. Two-thirds lack access to employer-based health care benefits.

Medicaid is the largest health care program in the United States and impacts the lives of more than 76 million Americans, nearly one-quarter of the nation’s population. The program can play a powerful role in influencing the health and well-being of individuals and families.

State Medicaid programs can only be truly successful, however, if they are responsive to the needs and priorities of the clients they serve—not providers, but patients and their families. Medicaid officials understand this. However, in the resource- and time-constrained environments in which Medicaid staff operate, finding the right avenues for gathering meaningful consumer input can be a challenge.

The Robert Wood Johnson Foundation has been trying to address these challenges through its work to transform health and health care systems. As part of these efforts, the Foundation along with the Center for Health Care Strategies recently engaged experts, including representatives from across the patient advocacy world, around this issue. These experts include leaders from Altarum, American Cancer Society Cancer Action Network, Community Catalyst, Georgetown Center for Children and Families, Nonprofit Finance Fund, and the Patient Advocate Foundation.