Culture of Health Blog

Janice Johnson Dias, PhD, is a Robert Wood Johnson Foundation New Connections alumnus (2008) and president of the GrassROOTS Community Foundation, a health advocacy that develops and scales community health initiatives for women and girls. She is a graduate of Brandeis and Temple universities and a newly tenured faculty member in the sociology department at City University of New York/John Jay College of Criminal Justice.

Policy action and discussion this month have focused on poverty, sparked by the 50^th anniversary of Lyndon Johnson’s War on Poverty and Dr. King’s birthday. Though LBJ and King disagreed about the Vietnam War, they shared a commitment to ending poverty. Half a century ago, President Johnson introduced initiatives to improve the education, health, skills, jobs, and access to economic resources for the poor. Meanwhile, Dr. King tackled poverty through the “economic bill of rights” and the Poor People's Campaign. Both their efforts focused largely on employment.

Where is health in these and other anti-poverty efforts?

The answer seems simple: nowhere and everywhere. Health continues to play only a supportive role in the anti-poverty show. That's a mistake in our efforts to end poverty. It was an error in 1964 and 1968, and it remains an error today.

Let us consider the role of health in education and employment, the two clear stars of anti-poverty demonstrations. Research shows that having health challenges prevents the poor from gaining full access to education and employment. Sick children perform more poorly in schools. Parents with ill children work fewer hours, and therefore earn less. Health care costs can sink families deeper into debt.

Aric A. Prather, PhD, is an assistant professor of psychiatry at the University of California, San Francisco and an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program.

Heart disease accounts for one in every four deaths in the United States—600,000 deaths per year.  Prevention and treatment regimens for heart disease include important changes in lifestyle, centering primarily on alterations to diet and physical activity.  Interestingly, sleep is rarely part of this discussion.

This is alarming given the growing evidence from large-scale population studies and laboratory-based experiments that demonstrate that sleep plays a larger role in heart health than originally appreciated by the medical community.  For example, in a 2003 study, women with established coronary heart disease who reported poor sleep quality were more than 2.5 times more likely to go on to experience a cardiac event than good quality sleepers. Nevertheless, when it comes to asking patients about their sleep, health care providers routinely hit the snooze button.

In an effort to raise the profile of sleep as a risk factor for cardiovascular disease (CVD), my work has focused on investigating the links between sleep and the biological pathways implicated in CVD development and progression.  Said another way, much of my research focuses on how sleep disturbance gets under the skin. 

Each year, the March of Dimes National Communications Advisory Council, which includes journalists from many websites and magazines that cover pregnancy and early childhood, holds a reporters’ luncheon to share information that can lead to healthier births, babies and mothers. This year’s luncheon, being held tomorrow, focuses on treating mental health conditions in mothers during and after pregnancy. The issue is important for many reasons, in particular because many women have been taking prescription medications for depression, anxiety, panic attacks, ADHD, and other mental health issues since adolescence and may need to change or stop the medicines in order to have a healthy baby, yet run the risk of a relapse or worsening of their health condition.

NewPublicHealth recently spoke with, Siobhan Dolan, MD, a consultant to the March of Dimes and an obstetrician gynecologist and clinical geneticist at Montefiore Medical Center/Albert Einstein College of Medicine about communicating information about treating mental health during pregnancy to both mothers and health care professionals.

NPH: For the upcoming luncheon, the March of Dimes has singled out mental health medications. Why that area of health?

Dr. Dolan: There is a huge overlap between women of reproductive age who are dealing with becoming pregnant and having families and caring for families and women who have mental health issues and may be entering their reproductive years already on medication.

And we know that bonding and creating a family and getting your family life off to a good start in the early postpartum period is much, much better when a woman is in a balanced mental health state. So if there’s either a preexisting depression or a postpartum depression, we need to pay attention to that.

Sesuagno Mola of Ethiopia, married at five, never went to school and had her first child at 14. More children would have followed in quick succession, but Sesuagno got involved with a program in her town run by Girl Up developed by the UN Foundation that empowers young girls to create a life for themselves and their families well beyond poverty and illiteracy.

In Sesuagno’s case, she joined a program developed to help teach literacy, and provide information about family planning, gardening and life skills to help reduce food contamination.

Through the program, Sesuagno learned to build shelves to keep her family’s food off the floor, built a stove that sends the smoke out of the house instead of into her lungs—a cause of pneumonia and death for thousands of girls and women in the developing world—and jointly decided with her husband, because of her time in the program, that they would wait to have their next child.

“What we support are comprehensive services for adolescent services for girls to help improve access to health services, education and safe spaces,” says Andrea Austin, a spokesperson for the UN Foundation.

By Elizabeth A. Kostas-Polston, PhD, ARNP, WHNP-BC, Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and assistant professor, University of South Florida; and Versie Johnson-Mallard, PhD, MSMS, ARNP, WHNP-BC, RWJF Nurse Faculty Scholar alumna and assistant professor, University of South Florida.

On November 14, 2012, we met a princess. No, we were not at Disneyworld or Disneyland. The princess was beautiful, talented and focused on making a difference in her country for girls and women. The princess’s name is Princess Bajrakitiyabha Mahidol, her Royal Highness of Thailand. We met her when we were invited to Thailand to present at the International Council on Women’s Health Issues (ICOWHI) 19th International Congress on Women’s Health 2012:  Partnering for a Brighter Global Future. 

During the conference we unveiled our national/international initiative, The Blue Bra Campaign: Leading Global Change in Women’s Health. The Blue Bra Campaign is housed at the University of South Florida College of Nursing, under our leadership. The name for the campaign was inspired from an international event that occurred in 2011, when a young Egyptian woman was beaten, stomped on and nearly stripped while participating in a political demonstration. Aside from the sheer brutality inflicted upon her by Egyptian police, what stood out to millions viewing the nightmare as it unfolded on international television was the young woman’s abaya falling open to reveal a lacey, bright-blue bra. That moment was so unexpected, so shocking—so transforming!  The young woman, covered from head to toe in traditional dress, refused to remain invisible demonstrating her femininity through her choice of undergarment—a blue bra!

The first Vital Signs health indicators report of 2013 from the U.S. Centers for Disease Control (CDC) and Prevention finds that binge drinking is too often not recognized as a women’s health problem. The report found that nearly 14 million U.S. women binge drink about three times a month, and consume an average of six drinks per binge. CDC researchers determined the rate of binge drinking among U.S. women and girls by looking at the drinking behavior of approximately 278,000 U.S. women aged 18 and older for the past 30 days through data collected from the 2011 Behavioral Risk Factor Surveillance System, and for approximately 7,500 U.S. high school girls from the 2011 National Youth Risk Behavior Survey.

For women and girls, binge drinking is defined as consuming four or more drinks on one occasion. Drinking excessively, including binge drinking, causes about 23,000 deaths among women and girls in the United States each year. About 1 in 8 women and 1 in 5 high school girls report binge drinking, with the practice most common among women ages 8-34, high school girls, whites, Hispanics and women with household incomes of $75,000 or more. Half of all high school girls who drink alcohol report binge drinking.

While they make up 73 percent of medical and health services managers, women account for only a small portion of CEOs at hospital and health care organizations, according to a report by RockHealth. The analysis of data from the U.S. Bureau of Labor Statistics and other surveys finds that just 4 percent of health care organization CEOs and 18 percent of hospital CEOs are women.

RockHealth’s report highlights a range of barriers to women’s advancement, including persistent gender roles in the workplace, a lack of mentors and role models for women, and more. To understand what women in the health care workforce thought, RockHealth conducted interviews with 100 women in the field. Nearly half the survey respondents reported that insufficient self-confidence was one of the biggest barriers to their career advancement. Among other reported obstacles: time constraints (45 percent) and the ability to connect with senior leadership (43 percent).

The Robert Wood Johnson Foundation has long championed leadership development, for women and men alike. Many of the Foundation’s programs offer leadership training for nurses, physicians and other health care professionals, to help advance their careers. Learn more about RWJF programs at RWJFLeaders.org.

What do you think? Are females underrepresented in health care leadership? What can we do to increase their representation? Register below to leave a comment.

See the RockHealth Women in Health Care report.
Read coverage of the report from Fierce Healthcare and Forbes.

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

Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston.  She is a 2010 Robert Wood Johnson Foundation Community Health Leader.

The prolonged recession of the last four years has hit many people hard.  My work is taking care of homeless women, which I have done for the past 20 years.  I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters.  We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.

I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers.  Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.

Here is a glimpse of our work.

Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.

She is hungover.  She drank to escape the horror of having been attacked.  She has been on and off the wagon so many times we have all lost count.  She’s also been raped and stabbed more times than any of us can remember.  She doesn’t go to the police any more.  She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork.  I give her a hug and remind her that I love her no matter what.  I know that she has a library of negative and self-loathing messages in her head.  Mine is the one that can break through that chatter and give her a shred of self-respect.