Now Viewing: Scholars Forum

Achieving Health Care Equity Begins with Relationships

Jan 19, 2015, 9:00 AM

Have you ever had the experience of being sick and in need of help from a health professional? How about having a parent, child, other family member, or friend who had some health issue for which he or she was seeking answers? What was that like for you? How did you feel, and what were you looking for from that doctor, nurse, or therapist?

Did you ever feel afraid, and alone? Confused?  That no one understood what you were going through? Or cared? Or even worse, that the health professionals may have made some assumptions about you or your family member that were wrong – even perhaps blamed you for having your condition or judged you for how you were dealing with it?

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If so, you are not alone. Many people who find themselves in the role of a patient have felt these same feelings and had these same thoughts. And if you are poor, don’t have private health insurance, or if you are a person of color or belong to another minority group in our country, you are more likely than others to encounter these problems.

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Being Willing to Really Listen Can Help Those Facing Extreme Disparities and Challenges

Jan 9, 2015, 9:00 AM, Posted by Malia Davis

Malia Davis, MSN, RN, is a nurse practitioner and the director of nursing and clinical team development at Clinica Family Health Services in Lafayette, Colorado. She has cared for patients in the community, including those who are homeless, for more than a decade. She is a 2014 Robert Wood Johnson Foundation Executive Nurse Fellow.

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Social and economic disparities define my work each day, and have provided powerful motivation for me to commit my professional life to attempts to minimize these disparities in the health care setting. Community health centers, which provide health care for the homeless, are where some of the sickest and poorest people in our communities seek medical and behavioral health care from people like me, a nurse practitioner who is honored to serve each of these individuals and families. 

I believe one common misperception is that some of my patients fail to contribute to society. Working in community health care for 12 years—10 of them serving homeless people—I have found that most people are very hardworking. Many work at day labor and other low-wage, temporary jobs that are physically demanding and fraught with challenges of all kinds. I often hear of workers experiencing abuse, failing to get paid, and experiencing unsafe working conditions.

They have, of course, none of the benefits we usually associate with jobs. Instead, they face the stress of not knowing day to day if they will find work and be able to support their families—or not. This stress is often compounded by the personal experience of witnessing, surviving, and overcoming trauma or violence, often while in poverty and with very limited resources for healing physically or emotionally. 

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'We Need People to be Incensed by the Health Inequality that Persists in This Country'

Jan 5, 2015, 9:00 AM

Felesia Bowen, PhD, PCPNP-BC, is an assistant professor at Rutgers University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2014-2017). Her research focuses on community-based pediatric asthma care.

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When I first began working as a pediatric nurse in New Jersey 20 years ago, I was committed to getting asthma care right. I worked hard to educate my young patients and their families about the disease, how to avoid the triggers that cause attacks, and how to use their medications. I wrote asthma action plans and prescribed the correct medications to control symptoms. 

It wasn’t always enough. One Monday morning, one of my young patients experienced asthma symptoms. The family followed his asthma action plan, “stepping” his medications in an effort to relieve his asthma symptoms. On Tuesday, he wasn’t feeling better, and went to the nurse practitioner (NP) in his school’s health office, who appropriately modified his treatment plan and called the asthma specialist to get a next-day appointment for him.

She remembers the young man telling her that he really needed to feel better, because he was going to his middle school graduation dance Wednesday night. On Thursday morning, he visited the NP again, still with asthma symptoms. He told her that he had missed the appointment with the asthma specialist because his mom couldn’t make it—she had health issues of her own, and three other children to care for. But he’d gone to his dance and proudly showed her his middle school class ring.

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Health Reform is Important, But Collaboration is Key

Dec 29, 2014, 9:00 AM

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Relative to national averages, many people of color have poorer health from the cradle to the grave—beginning at birth, with higher rates of low birth weight and infant mortality; through childhood and adolescence, with higher rates of asthma and unhealthy weight; into adulthood, with higher rates of chronic disease and disability; and at the end of life, with higher rates of premature death and shortened lifespans.  

Public health research shows that these health inequities are mostly attributable to factors beyond health care access and quality: As a result of residential segregation, people of color are more likely than whites to live in neighborhoods with a high concentration of health risks, and a relative paucity of health-enhancing resources. Highly-segregated communities of color are too often overrun with environmental health threats brought about by polluting industries, and vendors selling unhealthy products such as tobacco, alcohol, and high-fat, high-sugar, and/or high-sodium products.  At the same time, many of these same communities lack access to affordable, nutritious food; safe spaces for exercise, recreation, and play; and high-quality schools that prepare children well for the high levels of education that are often protective of health.

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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.

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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.

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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We Are All Tuskegee

Dec 10, 2014, 9:00 AM, Posted by Collins O. Airhihenbuwa

Collins O. Airhihenbuwa, PhD, MPH, is professor and head of the Department of Biobehavioral Health at Penn State University. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.

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As we address disparities and inequities, the challenge is to think about solutions and not simply defining the problem. Most would agree that health is the most important part of who we are. It is the first thing we think about in the morning when we greet one another by asking, “How are you this morning?” It is the last thing we think about at night when we wish someone a restful night.

What may be different is what health means to us and our families. This is why place and context are important. How we think about health and what we choose to do about it is very much influenced by where we reside. Our place and related cultural differences about health are less about right or wrong and more about ways of relating and meeting expectations our families and communities may have of us, whether expressed or perceived. More than that is the way we relate to what our place means in terms of how it is defined and subsequently how that definition shapes how we define it for ourselves. In other words the ‘gate’ through which we talk about our place and ourselves is very important in having a conversation about who we are and what that means for our health.

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At the Crossroads of Risk and Resiliency: Averting High School Dropouts

Dec 8, 2014, 12:35 PM, Posted by Karen Johnson

Karen Johnson, PhD, RN, is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and an assistant professor at the University of Texas at Austin School of Nursing. Her research focuses on vulnerable youth. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.

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As Americans, we love stories about people who beat the odds and achieve success. We flock to movie theaters to watch inspiring tales—many times based on true stories—of resilient young people who have overcome unthinkable adversities (e.g., abuse, growing up in impoverished, high-crime neighborhoods) to grow into healthy and happy adults. Antwone Fisher, The Blind Side, Precious, and Lean On Me are just a few of my personal favorites that highlight the very real struggles faced by adolescents like those I have worked with as a public health nurse. My work with adolescent mothers and now as an adolescent health researcher has convinced me of the critical importance of focusing on promoting health and resilience among adolescents at-risk for school dropout.

How often do we as a society really sit down outside the movie theater or walls of academia and talk about why these young people are at risk for poor health and social outcomes in the first place, or what it would take to help them rise above adversity? If we look closely at the storylines of resilient youth, we will notice a number of similarities. Being resilient does not happen by chance: it takes personal resolve from the individual—something our American culture has long celebrated. And it takes a collective commitment from society to maintain conditions that empower young people to be resilient, and that is something that we as a society do not recognize or invest in nearly as often.  

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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

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. 

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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The Transformative Power of Mentors

Dec 4, 2014, 11:00 AM

Alden M. Landry, MD, MPH, is an emergency medicine physician at Beth Israel Deaconess Medical Center in Boston and an alumnus of the Robert Wood Johnson Foundation (RWJF) Summer Medical and Dental Education Program. Landry, 32, is also co-director of Tour for Diversity in Medicine. On December 5, he will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.

Tour for Diversity in Medicine (T4D) is a grassroots effort to educate, inspire, and cultivate future physicians and dentists of diverse racial and ethnic backgrounds by forming local connections in order to fulfill a national need.  Our concept is simple: Visit students on their home turf; motivate them by introducing them to young, enthusiastic physicians and dentists; and give them the information that they need to be successful. 

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We carefully select mentors based on not only their roles in medicine and dentistry but how they got there. Our mentors are the first in their families to have attended college. Some are first-generation U.S. citizens. They come from single-family homes or families where they are the first to enter a career in medicine. They are gay and straight, married and single. They are passionate about their communities and their careers.

Our mentors do have one thing in common: we intentionally select mentors who are young in their careers and recent to the journey.

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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.  

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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.

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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