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How Can Partnering with the Housing Sector Improve Health?

Jun 8, 2016, 11:00 AM, Posted by Pamela Russo, Rebecca Morley

Collaboration between public health and housing sectors can vastly improve the quality of life within communities across the nation.  

A row of homes are under construction.

The house that Robert and Celeste Bridgeford bought in Curry County, Oregon over a decade ago wasn’t just old. It was dangerous. Water damage and thin walls wracked by decades of severe storms unleashed wide swaths of mold. The damaged floors put the whole family at risk of falling, especially Robert, disabled years ago by a work injury. “We had always planned to replace the house, but... then...life happened,” says Celeste.

The Bridgeford family—like a third of Curry County’s residents—lives in a prefab house that is manufactured in a factory and then transported to the site. About 40 percent of the prefab housing in Curry County is substandard. With little industry in the area, many families struggled to find work and couldn’t afford to fix or replace their homes.

This all started changing in 2013 when community groups, non-profits and public agencies joined to propose a pilot project for the state of Oregon. This project would, for the first time, provide low cost loans or other funds to help prefab home-owners repair or replace their homes.

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Data, Meet Curiosity: Finding Bright Spots in Appalachia

Apr 1, 2015, 9:20 AM, Posted by David Krol

There are so many opportunities to connect the wealth of data we have at our fingertips and to start asking new questions. David Krol tells his story about how he took this approach to find bright spots in Appalachia.

A misty scene of trees and sky.

If you close your eyes and picture Appalachia, what do you see? The images that often arose first in my mind were those from LIFE Magazine’s 1964 photo essay on the war on poverty. Photojournalist John Dominis gave the nation a face to the plight of Appalachian communities in Eastern Kentucky, and poverty and economic hardship have long been central to an outsider’s understanding of the region ever since. But through my work at the Foundation, I knew this narrative was only one part of the region’s rich and diverse story. I knew there was a different story to be told, and so I wanted to shine a light on these bright spots that demonstrate how health can flourish across Appalachia.

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Expanding Horizons for Rural Young Men of Color

Sep 8, 2014, 1:55 PM, Posted by Maisha Simmons

An older student assists a younger student in school.

When we first began the Forward Promise initiative, we envisioned building the capacity and impact of organizations across the country working with boys and young men of color from every type of community and background. We wanted to identify and support a cohort of grantees that were diverse in their approach, in their geography, and in the racial, ethnic and cultural experiences of the young people that they supported. Once we began doing this work, it didn’t take long to realize we were falling short.

The simple truth is that the majority of organizations who applied for Forward Promise that had demonstrated success and were ready to expand were located in major cities. Few applicants were in the rural beltway that stretches across the Southern United States, from Alabama to Arizona. It would be easy to assume that there weren’t many young men of color there or that there was not much innovation or capacity to support young men of color in that region. But you know what they say about assumptions ...

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The Country Doctor: Study Anticipates a Disappearing Breed that Doesn’t Bode Well for Rural America

Nov 7, 2013, 9:00 AM

Rural counties throughout the United States may be hardest hit by the country’s anticipated shortage of primary care physicians (PCPs), according to a new study from the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Rural Health Research Center at the University of Washington School of Medicine.

Researchers point to several factors that have implications for rural counties:  PCPs deliver the majority of health care in those areas; a substantial percentage of primary care providers in the United States are approaching retirement age at the same time that fewer new medical school graduates are opting for primary care specialties; and demand for health care services is expected to increase as the population ages and millions gain health insurance coverage as a result of the Affordable Care Act.

The study, which used data from the American Medical Association and the American Osteopathic Association 2005 Physician Masterfiles, found a higher percentage of PCPs near retirement in rural counties than in urban ones, with the percentage increasing as the degree of rurality increased. (Physicians 56 or older in 2005 were considered to be near retirement and were the primary focus of analysis.) The 184 counties in the top 10 percent of near-retirement PCPs were characterized by lower population density and lower socioeconomic status, as measured by low education, low employment, and persistent poverty.

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Fresh Fruit, Broken Bodies

Oct 30, 2013, 9:00 AM, Posted by Seth Holmes

Seth M. Holmes, PhD, MD, is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program and an assistant professor of public health and medical anthropology at the University of California, Berkeley. The following is an excerpt from his recently published book, Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States.

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“The first Triqui picker whom I met when I visited the Skagit Valley was Abelino, a thirty-five-year-old father of four. He, his wife, Abelina, and their children lived together in a small shack near me in the labor camp farthest from the main road. During one conversation over homemade tacos in his shack, Abelino explained in Spanish why Triqui people have to leave their hometowns in Mexico.

In Oaxaca, there’s no work for us. There’s no work. There’s nothing. When there’s no money, you don’t know what to do. And shoes, you can’t get any. A shoe like this [pointing to his tennis shoes] costs about 300 Mexican pesos. You have to work two weeks to buy a pair of shoes. A pair of pants costs 300 Mexican pesos. It’s difficult. We come here and it is a little better, but you still suffer in the work. Moving to another place is also difficult. Coming here with the family and moving around to different places, we suffer. The children miss their classes and don’t learn well. Because of this, we want to stay here only for a season with [legal immigration] permission and let the children study in Mexico. Do we have to migrate to survive? Yes, we do.

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Influencing Young Doctors

Aug 21, 2013, 1:00 PM

The news media has recently covered some innovative programs that are influencing the choices and attitudes of the next generation of doctors.

American Medical News reports on the Buddy Program, which pairs first-year medical students with early-stage Alzheimer’s patients and their caregivers. The program empowers patients, and also serves as a valuable learning tool for the students, heightening “their sensitivity and empathy toward people with the disease.” The program was developed at the Northwestern University Alzheimer’s Disease Center in Chicago; Boston University, Dartmouth College, and Washington University have replicated it.

NPR reports on a program at the University of Missouri School of Medicine that is encouraging more young doctors to pursue primary care in rural areas. During the summers, the school has been sending medical students to work alongside country doctors. While school officials caution they can’t be sure about the reasons, they have discovered that students who took part in the summer program were more likely to become primary care doctors who practice family medicine.  Some 46 percent of participants are choosing to work in the country after completing their medical training.

Read more about the Buddy Program in American Medical News.
Read more about the University of Missouri’s summer in the country program on NPR.org.

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

"My Definition of Diversity Was Altered When I Had the Opportunity to Experience Life Differently"

Jun 21, 2013, 9:00 AM, Posted by Cindy Anderson

Cindy Anderson, PhD, RN, WHNP-BC, FAHA, FAAN, is a professor and associate dean for research at the College of Nursing & Professional Disciplines, University of North Dakota. A Robert Wood Johnson Nurse Faculty Scholar, she received a Bachelor of Science degree in Nursing from Salem State College, and both a Master of Science degree in parent-child nursing and a PhD in physiology from the University of North Dakota. This is part of a series of posts looking at diversity in the health care workforce.

I was born and raised in the Boston area which we always referred to as the “melting pot.”  My grandparents emigrated from Eastern Europe and I grew up hearing stories of the “Old Country” which included both fond memories and atrocities that drove them to leave their homes and find a better way of life in America. As a second-generation American, I have always embraced the common and unique perspectives of others from a variety of backgrounds.

I began my career as an Air Force nurse, advancing my opportunity to engage with others from varied backgrounds and cultures. In the course of my career, I found myself stationed at the Grand Forks Air Force Base in North Dakota. My initial perceptions were based upon the stereotype that North Dakota was a rural, isolated state with little diversity. My misperceptions were quickly reversed when I had a chance to engage with the community. My awareness and respect for the unique diversity of rural North Dakota has steadily grown over the last three decades which I have been fortunate to spend in this great state.

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Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds

Jun 19, 2013, 9:00 AM

From 2006 to 2008, 158 of the country’s 759 residency sponsoring institutions and teaching sites did not produce any primary care graduates, according to a study published online last week by Academic Medicine. Less than one-quarter of medical school graduates entered primary care during those years.

The study also found that physician shortages in rural and underserved areas persist; only 4.8 percent of 2006-2008 graduates practice in rural areas. Nearly 200 institutions produced no rural physicians, more than half produced no Health Service Corps graduates, and 283 produced no physicians practicing at Federally Qualified Health Centers or Rural Health Clinics.

Graduate medical education (GME) distribution is uneven, the researchers found, and provides more support to subspecialty programs than to primary care programs. The top 20 primary care producing institutions (where 41 percent of graduates were in primary care) received $292 million in total Medicare GME payments, while the bottom 20 (where only 6.4 percent of graduates were in primary care) received $842 million in these funds.

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A Personal Mission: Bridging the Oral Health Care Gap

May 2, 2013, 12:00 PM, Posted by Monique Trice

Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. 

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

  • Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
  • According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
  • Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

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Oral Health: Putting Teeth Into the Health Care System

Aug 22, 2012, 9:00 AM

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

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