Sep 10, 2018, 3:00 PM, Posted by
Donald F. Schwarz
The more local the data, the more useful it is for pinpointing disparities and driving action. The first universal measure of health at a neighborhood level reveals gaps that may previously have gone unnoticed.
When Dr. Rex Archer returned to his hometown of Kansas City, Missouri, to lead its health department in 1998, he was shocked by the city’s inequities. Life expectancy for white residents was 6.5 years longer than that of black residents. Gathering more data, he estimated that about half of the city’s annual deaths could be attributed to conditions in neighborhoods like segregation, poverty, violence, and a lack of education.
I also confronted stark disparities by neighborhood in my years as Philadelphia’s health commissioner, as does most every health commissioner/director across the country. It is truly unsettling to see how small differences in geography yield vast differences in health and longevity. In some places, access to healthy food, stable jobs, housing that is safe and affordable, quality education, and smoke-free environments are plentiful. In others, they are severely limited. Data can help us better understand the health disparities across our communities and provide a clearer picture of the biggest health challenges and opportunities we experience.
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Aug 30, 2018, 1:00 PM, Posted by
How we measure America’s rapidly expanding diversity has critical implications for the nation’s health. A new PolicyLink report offers recommendations for improving how we collect and report data about racial and ethnic subgroups.
Does the kind of data we collect and report ensure everyone has a fair and just opportunity to live their healthiest life possible?
As the country grows more ethnically and racially diverse, there is a growing debate among health researchers about the value of breaking down data in more refined ways. The argument is that simply looking at health outcomes through the lens of broad racial or ethnic categories (e.g., black people or Asian Americans) doesn’t paint an accurate enough picture of health and well-being. It masks what’s happening within subgroups and glosses over the nuanced experiences that greatly influence outcomes in these populations.
Recently, the Robert Wood Johnson Foundation (RWJF) partnered with PolicyLink to identify the needs and gaps in how ethnic and racial data are collected, analyzed, and reported for each of the major aggregated ethnic and racial groups.
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Aug 15, 2018, 11:45 AM, Posted by
Brian Castrucci traces his path to CEO of the de Beaumont Foundation back to a “life-changing” internship at the Robert Wood Johnson Foundation.
Many of us have had those moments in life where the decisions we make alter the path our lives take. Brian Castrucci, the newly appointed CEO of the de Beaumont Foundation, had one of those pivotal moments back when he had completed his first year of graduate study in public health.
At 24 years of age, Brian had a decision to make: return to school to complete his master’s degree in public health or accept a one-year internship at the Robert Wood Johnson Foundation (RWJF). He chose RWJF, and, he says, “it’s made all the difference.”
“What would I have missed if I hadn’t done that internship?” Brian told me in a recent conversation. “Simple. How to think. How to dream. How to boldly take on a change that is needed even when you know it’s going to be really hard.”
He considers that year the base for much of his early career success. Not only did he learn to think strategically and tackle big problems, like youth tobacco and substance use, but he saw models of partnership, collaboration, and how people at the top of their game work together to advance the field and change lives. “I had a chance to interact with, and learn from, leaders who I had read about in class. It was like a public health fantasy camp.”
And then, just as he was considering a career in philanthropy, he was encouraged to walk through another door. As his internship was ending, Brian told RWJF Senior Scientist Tracy Orleans, one of his mentors, that he was interested in staying on at RWJF. She wisely noted that wasn’t the best idea for a young person with a spark of public health passion. If he was to be truly effective in philanthropy, she told him, he needed time in the trenches.
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Aug 9, 2018, 3:00 PM, Posted by
A team from our Clinical Scholars program believes that addressing oral health disparities can improve overall health and well-being, and help end cycles of poverty. They are bringing oral health to the community through school clinics, an app and an oral health protocol development for nurses, physicians, dentists and dental hygienists.
In January 2018, the Hollis Innovation Academy, a K-8 school, opened a dental exam room. Though it may seem unusual to see a dentist’s chair in a school, its presence reflects years of learning within this Atlanta community. Hollis's students live in English Avenue/Vine City, an area with one of the highest poverty rates in Atlanta. They also reside in one of three zip codes with the highest oral cancer rates in the city.
Early in my career as an ear, nose and throat specialist, I witnessed a deeply troubling pattern: on my first visit with a patient, I would diagnose him or her with advanced head and neck cancers. There would have been good treatment options if these patients had been seen much earlier. But time and time again, all we could do was rush the patient into an operating room, put in a tracheotomy to control the airway, and set up end-of-life care. I kept thinking that someone needed to get to this issue much sooner so that people wouldn’t die from something that could be treated effectively if caught sooner.
Eventually, I decided that person was me.
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Jul 25, 2018, 11:00 AM, Posted by
Inclusive public spaces for all are a central part of healthy, resilient communities. A new framework can help ensure that processes for shaping these spaces lead to design decisions that promote equity.
It has been said that inspiration comes when you least expect it. My visit to Melbourne, Australia, inspired me to take an international look at place-making. I was standing in Federation Square, restlessly waiting for my daughter to finish her shift. I hadn’t seen her in nearly a year. I was wearing my mom hat, not my urban planner’s hat.
Nevertheless, as my eyes swept the Square, I had the sense of being in a very special place. And while I didn’t know it at the time, I was not surprised to later learn that Federation Square in the heart of Melbourne has been recognized as one of the best public squares in the world. Fed Square, built on top of a working railway, comprises sculpted and natural elements; it has small spaces like fire pits; and large and medium-size open spaces for planned and unplanned activity. There is a large TV screen that broadcasts international and national sporting events (it is not always on). The Square is open 24 hours a day; has free Wi-Fi for all; rest rooms; and no signs prohibiting activity or lingering. Restaurants open their doors to it; and transit lines and shops surround it.
I visited Fed Square daily for eight days, and what impressed me was how well it reflected Melbourne’s rich cultural diversity; how seamlessly it connected to the streets, buildings and facilities on its periphery; and how welcoming it always felt. It is a place for people—the well-heeled, the not-so lucky—and everyone in between. I should note, though, that Federation Square’s value as an open public space and cultural hub is currently being tested. Controversial changes to it are pushing forward sans public review and participation.
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Jul 12, 2018, 2:00 PM, Posted by
We’ve come a long way in reducing tobacco use, but we can save millions of lives and advance health equity by doing even more.
Although smoking rates have dropped by more than half over the past 50-plus years, tobacco use remains the number one cause of preventable deaths in the United States.
And not everyone has benefited equally from reduced rates in smoking—there are deep disparities in tobacco use and quit rates, depending on where people live, how much money they make, and the color of their skin.
Tobacco products disproportionately harm people with lower incomes and less education; people with mental illness and substance use disorders; people who identify as lesbian, gay, bisexual, and/or transgender (LGBT); and racial and ethnic minorities.
What’s causing these inequities? Part of it is marketing. Tobacco control efforts have not focused on closing racial, ethnic and socio-economic gaps. In fact, we know that the tobacco industry targets certain populations—women, people who are black or Latino, and members of the LGBT community—with higher levels of marketing, exposing them to more tobacco product ads.
In addition, people in many of these groups are less likely to have health insurance—and, as a result, less likely to have access to smoking cessation products and services.
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Jun 21, 2018, 12:00 PM, Posted by
Moving beyond culture competency to cultural humility acknowledges patients’ authority over their own lived experience.
Health care delivery often involves a one-size-fits-all approach. As clinicians, we treat a patient with a particular diagnosis similar to the last patient we saw with the same diagnosis because it’s efficient—we think. But shifting that mindset is one of the best opportunities we have to help people truly thrive. An individual’s lived experience is rich, diverse, and complicated. And what it takes for each individual to live his or her healthiest life possible is as unique as each person is. In other words, a patient’s full life experience should inform how we shape their treatment.
To achieve a deeper understanding of our patients, it is essential for providers to practice “cultural humility” and acknowledge the unique elements of every individual’s identity. Many of us may be familiar with cultural competency—being respectful and responsive to the health beliefs and practices—and cultural and linguistic needs—of diverse population groups.
But cultural humility goes even deeper. It requires you to step outside of yourself and be open to other people’s identities, in a way that acknowledges their authority over their own experiences.
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Jun 18, 2018, 11:00 AM, Posted by
George Hobor, Laura Leviton
A surgeon in Cardiff, Wales, who regularly treated victims of violence, discovered that many cases went unreported. He devised a model for collecting data and collaborating with both law enforcement and community to predict and prevent violence. This approach is now taking root here in the United States.
Weekend after weekend, the wave of emergency department (ED) patients would arrive. Oral and maxillofacial surgeon Jonathan Shepard would treat shattered jaws, knife wounds and other facial injuries at the hospital in Cardiff, Wales. These injuries stemmed from brawls in bars and nightclubs where broken glasses and bottles were wielded as weapons. Strangely, Dr. Shepard found that only 23 percent of these assaults treated in the hospital were reported to law enforcement.
Harnessing the Power of Data for Violence Prevention
Determined to find a way to stem the violence, Dr. Shepard mobilized health care providers, law enforcement heads, city officials and other local leaders in working together to address what was happening within their community.
Local hospitals agreed to gather basic anonymized information from each assault victim admitted to the emergency department, including the specific location of the violent incident, time of day, and weapon involved. They removed patient identifiers and shared the anonymous data with local law enforcement officials, who combined those data with their own records.
With these data, police were able to map when and where violence might happen, and concentrate resources on hotspot locations such as specific streets, businesses, schools, or transit stations, and during particular times of the week, to help prevent incidents.
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