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International Conference on Health in the African Diaspora 2012: Scholars React

Jul 10, 2012, 11:47 AM

Last week was the International Conference on Health in the African Diaspora (ICHAD), which convened experts from a variety of fields to discuss the health and social experience of African descendants in the Western hemisphere. Below, two scholars from the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College who attended the conference talk about the experience. Helena Dagadu, MPH, is a 2011 health policy fellow and doctoral student in the Department of Sociology at Vanderbilt University, and Tulani Washington-Plaskett, MS, is a Fall 2011 health policy scholar and second-year medical student at Meharry Medical College.



Human Capital Blog: Why did you decide to attend the International Conference on Health in the African Diaspora?

Helena Dagadu: When I met Dr. LaVeist almost two years ago, he shared his idea about ICHAD with me. As he described his vision for the conference, I knew I had to be a part of it. My research and policy interests fit directly with the spirit of ICHAD to both understand and address health disparities among people of African descent. I also attended because this was an opportunity to meet people from different disciplines and gain some insights from their respective perspectives.

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It is Time to Engage in Conversations with People Who Have Ideas We Don't Like

Jul 9, 2012, 9:00 AM, Posted by Andru Ziwasimon Zeller

This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act.  Andru Ziwasimon Zeller, MD, is co-founder of the Casa de Salud family medical office and the Community Coalition for Health Care Access in Albuquerque, and a 2010 RWJF Community Health Leader.

I’m a doctor and supporter of health care for all and happy that we as a nation have achieved almost universal health care.  The Affordable Care Act has flaws and areas of disagreement.  It was forged from 100 years of argument and compromise, bringing together liberal universal health care with conservative personal responsibility

I don’t love every detail of the law but I love that we as a nation, through the leadership of President Barack Obama, have removed a massive injustice in our society which has contributed significantly to stress, disease, death, medical debt and household bankruptcy.  These have been “silent killers" since those affected tend to keep their suffering to themselves.  Many of us have born witness to that suffering.  I am so glad it is coming to an end.

Yet I feel the fear and anger of those in our nation who oppose this new law and see in it an assault on individual freedom, a government invasion of health care, and a grand plan to destroy what is perceived to be our founding principles.

I resonate emotionally with the first point—no one likes to be told what to do.  Seat belts, car insurance, driver’s license to vote, passport to travel, taxes, and now health insurance?  Why not let the hospitals eat that cost?  Or drop it on the county health fund?  Is this a slippery slope to dreaded socialism or an evolution towards health and personal accountability?

Facts are hard to come by.  Trust is next to impossible.  We are a nation of belief against belief in search of the ultimate political power to create a singular vision of the future—Republican vs. Democrat, and who knows what either of those really mean.  This battle, more than anything, is the greatest threat to the vision and political prowess of our founding fathers.  Democracy is conversation, compromise and decision-making for solutions that help us take care of each other and improve our place in this world.

This is our democracy in action.  I give thanks that we fight the ‘war’ between liberals and conservatives with words and election ballots.

The decline of our schools, health care system, manufacturing, and prestige internationally stems from and contributes to our inability to care for each other.  We are squandering our resources, fighting for control instead of forging a better society.  This criticism is not about “hating” America.  I’m saying that we Americans are wasting the equity that all of our forebears gave us.  All of them.  Native Americans and all of the immigrants who come to these shores by force, or hope for a better future.  This hope and equity are not owned by any one segment of our society, they are our shared birthright as Americans.  

It is time we each take a deep breath, do an internal inventory of our emotional tenor, and start to engage in perhaps stressful, but important conversations with people who have ideas that we don’t like.  Passion is a beautiful thing when it can be restrained by reason and respect.  Let’s embrace this challenge as a nation, hear what we each have to offer, and live better lives together.

Read more about Ziwasimon Zeller’s work, visit the Casa de Salud website, and learn about the Robert Wood Johnson Foundation Community Health Leaders.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

A Tale of Two Emergency Rooms

Jul 6, 2012, 6:00 PM, Posted by Julia Lynch

This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Julia Lynch, PhD, is an associate professor at the University of Pennsylvania. Lynch is a recipient of a 2006 RWJF Investigator Award in Health Policy Research at the University of Pennsylvania and an alumna of the RWJF Scholars in Health Policy Research program (2003-2005).

The first emergency room is one you know: the ED in your nearest inner-city or rural hospital. There you’ll find trauma cases, heart failures, emergency appendectomies, heroic rescues by doctors and nurses working through the night, just like on TV. But also, waiting in chairs (lots of chairs), the frequent fliers, the preventable complications of asthma and diabetes, the people awaiting primary care in the worst possible medical environment for it. These are America’s emergency rooms.

And then there are Italian emergency rooms. As an expat living in Italy, I’ve navigated hundreds of miles of red tape to get a car registered, a telephone line installed, a tax ID number. I’ve paid notaries hundred upon hundreds of Euro for the stamps and forms needed to make the transactions of daily life (renting an apartment, selling a car) legal. Just imagine the emergency room. Better yet, don’t. I’ll tell you about it.

Some years ago, just after my husband and I had moved to Italy for my research, he cut his finger while preparing dinner. It looked bad, but it was Saturday night, and the one doctor we knew of who accepted our weird Belgian insurance policy for expats wasn’t in his office. So when the cut failed to stop bleeding overnight, we reluctantly made our way to the city hospital, asked for directions to the pronto soccorso (literally “immediate aid”), and prepared ourselves for a very long wait.

In the area to which the hospital greeter had directed us, we found a closed door, and three empty chairs in the hallway. After some confused wandering around, we knocked on the door, and once again asked for directions to the elusive ER waiting room. A doctor poked his head out, pointed to the three chairs, and said he’d be with us as soon as he finished patching up a motorcycle accident.

How long would that take, we wondered? And how many heart attacks, asthma attacks, and gunshot wounds would come in while we were waiting?

But the remaining chair in the hallway remained empty; and within ten minutes, the very same doctor who had answered our knock glued my husband’s finger back together and sent us on our way. Minimal wait, one doctor, no paperwork, and no charge—despite the fact that neither of us had an Italian National Health Service (NHS) card. Our Belgian insurance policy would not be billed. The doctor explained proudly that Italy’s NHS looked after everyone, even visitors.

And that’s not all: we didn’t know at the time that there is a designated doctor for every quartiere (neighborhood) in Italy, called the guardia medica, on call for minor nighttime emergencies. The doctors of the guardia medica, which I’ve also since had the occasion to call, are paid by the Italian state. They make house calls, with a little black bag and everything. The doctor for our quartiere could have glued my husband up on a Saturday night, in the comfort of our own home, again at no charge.

I know you must be thinking “But all this must be terribly expensive!” It’s true. Since our visit to the Italian ER, many patients of the NHS have been subjected to new out-of-pocket charges for medicines and specialist visits, and lines have grown longer in emergency departments as regional health budgets have come under pressure. But primary and emergency care is still free at the point of service. And Italy still spends considerably less than its neighbors do on health care: $2,870 per capita in 2008, compared to $3,129 in the UK, $3,696 in France, $4,063 in the Netherlands—and $7,538 in the U.S. Even so, income disparities in both access to care and health outcomes remain small in Italy, and most readers of this blog will know that Italy outperforms the U.S. on virtually every indicator of health and well-being.

Where does this tale of two emergency rooms leave us? The Affordable Care Act (ACA) brings us nowhere near a National Health Service on the Italian or British model. And not even the most ardent advocates of cost-effective medicine can imagine a way, under the ACA, to reduce our health care budget by 60 percent to bring us in line with what Italy spends on a per capita basis.

What the ACA does do is bring us one step closer to being able to say -- as that Italian ER doctor could -- that our health care system “looks after everyone.” It may even bring us nearer to the day when the waiting rooms of our emergency departments aren’t packed with patients seeking primary care, and care for complications resulting from a lack of primary care. Perhaps even a day when our emergency departments look a little more like three empty chairs in a hallway.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

The Supreme Court Upholds Health Reform. What Will it Mean to Voters?

Jul 5, 2012, 7:00 PM, Posted by Hahrie Han

This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Hahrie Han, PhD, is an associate professor of political science at Wellesley College. She was an RWJF Scholar in Health Policy Research from 2009-2011.

The Supreme Court’s decision to uphold the Affordable Care Act is unlikely to change anyone’s mind, but its political legacy may lie in its ability to energize the base of each party.

From a policy standpoint, there is no doubt that the Supreme Court’s decision to uphold the health reform law has vast implications for millions of Americans. The political impact of the decision, however, remains unclear. Will it help Obama in 2012 by affirming the centerpiece of his legislative record? Will it hurt him by firing up the Tea Partiers in opposition? Or, will it have little to no impact on the 2012 election?

Initial polling results from the Kaiser Family Foundation show that people’s views on the law have not changed as a result of the Supreme Court’s decision. People who opposed the law in the past are still opposed to it and people who supported it still support it.

What has changed, according to Kaiser, is the intensity of partisan support for the law. In May, only 31 percent of Democrats reported having “very favorable” views of the ACA. In the days after the Supreme Court’s ruling, that number had jumped 16 percentage points to 47 percent. (Republicans remained consistent in their dislike for the law, with 64 percent reporting “very unfavorable” views.)

This surge in Democratic enthusiasm could make an electoral difference in our polarized political climate. Elections in polarized times are often about turnout more than persuasion. An election that is about persuasion is won or lost on a candidate’s ability to persuade the undecided voter to support his or her side. An election that is about turnout hinges not on the undecided voter but instead on the candidate’s ability to turn out the partisan base. When elections are very polarized, as this year’s presidential election is, the undecided voter is an ever-narrowing slice of the population. Turning out the partisan base thus becomes that much more important.

The question is how stable rising Democratic enthusiasm for the law is. Republican opposition to the law has been very stable and research shows that people are more likely to take political action to fight against laws they do not like (threats) as opposed to supporting laws they do (opportunities). The Supreme Court’s decision seems only to have reinforced Republican opposition to Obama. Will it also solidify Democratic support for Obama?

The Obama campaign’s ability to capitalize on this surge in enthusiasm may depend on its ability to organize its supporters using the venerated organizing machine it built in 2008. As I have argued in my work, people are motivated to take political action when they are personally invested. To connect people’s personal lives to the Supreme Court decision, the Obama campaign would need to rebuild the personal relationships and neighborhood teams that were the secret to its success in 2008.

Political scientist Gerald Rosenberg has argued that the major legacy of the Supreme Court’s decision in Roe v. Wade was not to make legal abortions more widely available to women, but instead to spur a political backlash that polarized the debate over reproductive rights and is still felt today.

Time will tell if the legacy of this decision by the high Court lies in its impact on improving the health of millions of Americans, spurring political backlash, or both.

Learn more about the Robert Wood Johnson Foundation Scholars in Health Policy Research program.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Supreme Court Ruling Offers a Sense of Hope

Jul 3, 2012, 1:00 PM, Posted by Thomas Tsang

This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Thomas Tsang, MD, FACP, is a former Senior Advisor to the Governor, State of Hawaii and alumnus of the RWJF Health Policy Fellows program.

Last week, the Supreme Court upheld the Affordable Care Act (ACA) and ruled that the individual mandate is constitutional. As I reflect upon the positive impact of the Supreme Court decision on the tens of millions of Americans who are uninsured and have no access to affordable care, I reflect also on how my own family could have benefitted from legislation like this two decades ago and how my parents’ health status may be different.

We were the classic immigrant story. We emigrated from Hong Kong in the early 70s with the notion that things would be better in America. My father worked 14-hour days, six days a week as a cook at a Chinese restaurant in suburban New Jersey. The eight of us had no health insurance for close to 20 years. My family did not qualify for Medicaid, and paid for medicines and doctor visits as needed.

Things were fine until my parents reached their late 50s. They were diagnosed with one chronic disease after another because signs and symptoms had appeared that forced them to seek medical attention. First, it was hypertension, then diabetes, then heart disease and ultimately renal disease. We were fortunate that none of us had a life-threatening condition that required acute hospitalizations when we did not have coverage. By the time my parents qualified for Medicare, they each had accumulated at least three chronic conditions and were taking at least six or seven medicines.

Aside from paying for their own medical problems, they needed to pay for the medical care for their six children—visits for dental care, vaccinations, strep throats, food poisoning, high fevers plus the occasional antibiotic shots that my mom requested each time from the pediatrician. My parents had neglected their own medical needs at times in exchange for housing, food and clothes for the eight of us.

I wonder, what if they had access to basic primary preventative services, screenings or physicals when they were 40s or 50s? What if they had subsidies and if their employers had access to affordable plans in a health insurance exchange? Maybe their diabetes and hypertension could have been controlled enough to prevent the nephropathy or the congestive heart failure?

The restaurant where my father and brother worked simply did not make the margins to afford health insurance for their employees. They operated on margins of three to five percent at best. Similarly, my sister who worked in a sewing factory in Chinatown had no insurance until she switched to a manufacturing-job in the suburbs of Philadelphia in her late 50s. Like our parents, she entered the Medicare program with at least two chronic illnesses and four medicines.

The last four years, I worked on the health care reform legislation on the congressional level, implemented parts of it as part of the Department of Health and Human Services and most recently worked on a health care transformation agenda for the State of Hawaii. I am astounded at the how penny-wise and pound-foolish opponents of the Affordable Care Act have been. A study conducted by the Commonwealth Fund in 2009 concluded that the uninsured cost Medicare an average of $1,000 per beneficiary, because they have higher rates of heart disease, diabetes and joint problems compared to those with insurance.

The cost of our health care system is now $2.9 trillion, and close to 18 percent of our Gross Domestic Product. It is unsustainable for American businesses including many of the small businesses such as the ones my father and sister worked in.

The Affordable Care Act offers a glide-path for the delivery system. It pivots us to a path of rehabilitation that will give 30 million Americans access to basic benefits offered in insurance exchanges with tax subsidies. The delivery system innovations such as Accountable Care Organizations supported by holistic payment policies would move us away from the fee-for-service treadmill, improve on quality and likely trigger new innovations for greater efficiency and value.

As the law is implemented over the coming months, the framework of Meaningful Use (from the HITECH Act of 2009) is put in place, and patient-centered delivery system redesigns spread, I feel a sense of hope and order that things will be on the mend. The ACA is far from perfect, but now the country can start healing together and work on finding better solutions for future generations who believe that life is indeed better here in America—as my parents and I still do.

Learn more about the Robert Wood Johnson Foundation Health Policy Fellows program.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

RWJF Statement on the Supreme Court's Affordable Care Act Ruling

Jun 28, 2012, 7:35 PM, Posted by Risa Lavizzo-Mourey

By Risa Lavizzo-Mourey, MD, MBA, President and CEO, Robert Wood Johnson Foundation

Portrait of Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation.

Today’s ruling by the Supreme Court allows the nation to move forward on the road to better health.

The Affordable Care Act, when fully implemented, will expand the number of people with health coverage, introduce strategies for improving the quality of health care, and support plans to make our communities healthier places. For that reason the Robert Wood Johnson Foundation has committed significant resources to help nonprofit organizations, states, communities and the private sector realize the full potential of the law. Today’s ruling by the Supreme Court permits the implementation process to continue in full force, and we look forward to working with everyone who shares our goals to make meaningful improvements in the health and health care of our country.

Improving access to stable, affordable health care is not a partisan issue to us. We’ve been at it for decades, working with people and organizations of all sorts. The Affordable Care Act brings us wonderfully close to achieving that mission. But our ultimate goal of helping Americans lead healthier lives will require more than simply implementing the law. Health care spending continues to rise and crowd out investments in other areas; even for people with insurance, high out-of-pocket costs can be a barrier to accessing care. Furthermore, our health is not just something that comes from the doctor’s office. Community and neighborhood conditions have a significant effect on health. The Affordable Care Act offers ways to address many of these aspects of health, and we will continue to pursue opportunities stemming from the law and elsewhere to improve the health of our nation.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Linking, Exploring and Understanding Population Health Data

Jun 25, 2012, 1:00 PM, Posted by Michael Bader

By Michael Bader, PhD, an assistant professor of sociology at American University and an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2009-2011). His scholarship centers on racial and economic segregation and how unequal neighborhoods might lead to health and nutrition disparities. His recent research focuses on the ways in which people interact within the built environment and how to measure the built environment. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health.

Data are the sustenance of population health research, and like the food that sustains us, it comes in many forms, shapes and sizes. Also like food, it's best appreciated in combination. A single data source in the absence of context is unfulfilling; but combining datasets that are rich with information and contours — now that's a meal!

One thing I've learned from collecting and interpreting population health data is that not all data sets are created equal. Pundits of late adore "big data"—the troves of market, network and geographic data extracted from our social media accounts. Population health research must learn to harness these tools, while at the same time being careful to avoid blind acceptance of their value.

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Does Fear of Being Labeled "Difficult" Prevent Patients from Expressing Themselves to Doctors?

Jun 4, 2012, 1:00 PM, Posted by Dominick Frosch

Dominick L. Frosch, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and the recipient of an RWJF Investigator Award in Health Policy Research. He is an associate investigator at the Department of Health Services Research at the Palo Alto Medical Foundation Research Institute, and associate professor of medicine at the University of California, Los Angeles. Frosch recently led a study, published in Health Affairs, which examined the reasons patients are reluctant to engage in shared decision making. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health.

Human Capital Blog: Why did you decide to look at this issue?

Dominick Frosch: The role of patients is really changing and, especially over the last decade, we’ve seen a growing emphasis on patient participation in clinical decision making. It’s especially prominent in what we call preference-sensitive care, where patients have multiple potential options for treatment, but the evidence doesn’t identify a clear, superior choice. Making a decision in these cases involves considering the trade-offs between benefits and risks. There’s growing emphasis that patients should have a role to play in these preference-sensitive situations because they have to live with the outcomes of the care they receive.

Until now, we have implicitly assumed that providing patients with information is sufficient to facilitate shared decision making. In reality we know quite little about how patients perceive the communication tasks that are necessary for shared decision making to happen in a clinical consultation, and our objective with this study was to develop a better understanding of that.

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Meet the RWJF Health & Society Scholars Program

May 31, 2012, 7:06 PM

The RWJF Health & Society Scholars program is building the nation’s capacity for research, leadership, and policy change to address the multiple determinants of population health.

How does the neighborhood you live in affect your health? How about the local crime rate, financial debt, or whether the public schools have a no-tolerance anti-bullying policy? These are the kinds of questions that the Robert Wood Johnson Foundation Health & Society Scholars program has explored for the last decade.

Whether people live healthy lives is largely determined by what happens to them outside of the doctor’s office. The program’s scholars are encouraged to look beyond the traditional explanations of health care and biology to examine how powerful social factors such as education, income, race, and neighborhoods affect a population’s health.

Since 2001, the program has built the field of population health by producing leaders who will change the questions asked, the methods used to analyze problems, and the range of solutions offered to improve the health of all Americans. Scholars investigate the connections among biological, behavioral, environmental, economic, and social determinants of health.

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A Nurse-Midwife and a PhD Candidate

May 15, 2012, 3:00 PM, Posted by Elisa Patterson

The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Elisa L. Patterson, MS, CNM, a fellow with the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico.

I have been a certified nurse-midwife for almost 19 years. It is an ingrained part of who I am. I have served women of many different ethnic, socioeconomic, and cultural backgrounds. Being a nurse-midwife embraces my duality of being a nurse and a midwife. I am very proud of these credentials.

As I add to my education in a PhD program – through the RWJF Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing – I have found it a challenge to express in my “elevator speech” how these two credentials enhance my abilities to do policy work. I tried starting with what I am doing as a PhD student at the University of New Mexico. But when I say, “I’m also a nurse–midwife,” listeners seem to tag onto that singular piece of information and forget the rest of the conversation. Then, they might share their personal birth story or one that is a fond memory from a close friend. Or, they might ask me if I deliver babies at home.


I have not been able to figure out how to combine the important and, to me, impressive fact that while, yes, I am a nurse-midwife, I am also very capable of conversing about, researching and representing many other issues.

The American College of Nurse-Midwives (ACNM) has a way to help me and other nurse-midwives who face this dilemma. Next month at their annual gathering, a public relations campaign will be presented to the membership. It will include a vision, mission statement, and core values. The ultimate goal is to describe the value of nurse-midwives and, in general, support the provision of high-quality maternity care and women’s health services by Certified Nurse-Midwives.

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