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Babies are Dying in Rochester at Twice the National Average. Why?

Nov 7, 2014, 11:13 AM, Posted by Maria Hinojosa

Two medical professionals talk with a disabled child who sits on his mother's lap.

Rochester, N.Y., is the birthplace of Xerox, Bausch & Lomb, and Kodak, and home to two top-ranked research institutions, the University of Rochester and Rochester Institute of Technology. Nevertheless, babies die in this upstate New York city at a rate two times higher than the national average, and Rochester’s children of color are three times more likely than white infants to die before their first birthday. Why?

To come up with some answers, Futuro visited Rochester as part of its America by the Numbers series, made in partnership with Boston public TV station WGBH (check your local PBS and World Channel listings to see the series). We went knowing that the U.S. as a whole ranks 56th in the world for infant mortality, by far the lowest of any industrialized nation, despite the fact that we spend more on health care per capita than any other country, and the largest portion goes towards pregnancy and childbirth. This makes Rochester’s statistics even more tragic—an outlier in an outlier.

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What Baltimore Taught Us: On a Journey to Strengthen Families

Oct 31, 2014, 1:12 PM, Posted by Kristin Schubert

Young mother with her children.

Recently a team from the Foundation went to Baltimore to talk to families and community leaders, gaining their insights into an essential question for us: What can the Foundation do to strengthen the systems—health care, education, community—to create a web of support for families, one in which those at greatest risk can’t easily fall through?

What follows are my colleagues’ reflections on our time in Baltimore.

Martha Davis: I spoke with a Violence Interruptor, a Safe Streets employee who works to stop street violence. He is a 37-year-old man who has spent nearly half his life in jail, and has been shot 14 times. When I asked him how it is that he got to where he is today, he told me he came to the streets to learn how to “be a man,” but the birth of his children inspired him to want to be on the “side of peace." His was a life of violence and suffering, deep poverty, and racism; now he makes people feel safe and hopeful. He and the other Violence Interruptors are living proof that change is possible.

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Living Out Their Salad Days: Shaping Healthier Environments for Kids in the Nation’s Schools

Sep 2, 2014, 10:59 AM, Posted by Susan Dentzer

A school lunchroom full of hundreds of young children, happily slurping up ... salad.

If you’re someone who’s ever struggled to get kids to eat their vegetables, it sounds like an impossible dream.

But this is reality at Anne Frank Elementary School, the largest in Philadelphia, with 1,200 students from kindergarten through fifth grade. Serving salads was the brainchild of Anne Frank principal Mickey Komins, who had the salads brought in from a local high school cafeteria.

Along with the after-school Zumba and kickboxing classes that the school now sponsors for kids, parents, and staff, healthier food offerings are among the innovations that earned Anne Frank an award from the Alliance for a Healthier Generation. The Alliance, a Robert Wood Johnson Foundation grantee, is a nonprofit founded by the American Heart Association and the Clinton Foundation to help stem the tide of childhood obesity. It’s at the vanguard of a growing national movement to turn schools into healthier environments, and offer kids fundamental lifelong lessons about maintaining their health.

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How to Advance Minority Health? A Successful, Sustainable Effort to Promote Healthy Choices in Miami.

Apr 28, 2014, 1:00 PM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Lillian Rivera, RN, MSN, PhD, administrator/health officer for the Florida Department of Health in Miami-Dade County, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Rivera is an alumnus of the RWJF Executive Nurse Fellows program.

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In order to address this question, it is important to identify the areas within your jurisdiction where there are identified health disparities and to develop initiatives with those needs in mind.

Miami-Dade County in Florida is one of the few counties in the United States that is “minority majority,” meaning the minority makes up the majority of the population. More than two-thirds of the 2.5 million residents are Hispanic; 19 percent are Black; more than 51.2 percent are foreign-born and most of  them speak a language other than English at home (mostly Spanish and Creole);  19.4 percent live below poverty level; and 29.8 percent of the population  under age 65 (more than 700,000 individuals) is uninsured .

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Childhood Lead Exposure: Piling Disadvantage onto Some of the Country’s Most Vulnerable Kids

Nov 19, 2013, 9:00 AM

Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.

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Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?

Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.

We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.

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The Ripple Effect of Asthma Programming

Nov 1, 2013, 2:58 PM, Posted by Molly McKaughan

There was once a small boy. He was 5 years old, and he lived in a neighborhood of Washington, D.C., in an environment that was rife with potential triggers for asthma.

Back in 2006, we wrote about this boy in a report assessing the impact of one of our programs, Managing Pediatric Asthma.

JH, as we called him then, was enrolled in that program. And with good reason. He coughed and wheezed four days out of every seven, and had made four visits to the emergency department at Children’s National Medical Center in the previous year.

It’s been a long time since I’d thought about JH, but his compelling story came flooding back to me when I read a recent story in the Washington Post about an asthma clinic at this same hospital.  It teaches families of kids with asthma, kids like JH, how to manage the condition with medication, ultimately reducing the number of trips to the emergency room.

According to the Post article, “The clinic has had some success. ER visit rates for asthma have fallen by 40 percent, even as the prevalence of asthma continues to rise.”

Those hopeful results reminded me of JH and other kids just like him, and of RWJF’s important investment in pediatric asthma. The story demonstrates how one program can have such a ripple effect—making a big difference, not only in the life of one very small boy years ago, but in the lives of children with asthma living in Washington today.

 

Hurricane Sandy Recovery: By the Numbers

Nov 19, 2012, 11:17 AM

As the recovery efforts continue in the aftermath of Hurricane Sandy, NewPublicHealth is following the work of local and state health departments in the areas affected by the storm as they help their citizens regroup, recover and build community resilience. 

Three weeks after the storm the New York City Health Department has meaningful storm-related health use data that is valuable for both current health services delivery and future disaster planning:

  • Emergency room visits for both mental and physical health concerns in New York City dropped on the day of the storm but have now returned to typical levels.  
  • There was a brief increase in cases of hypothermia immediately after the storm but no sustained increase since then.  
  • There is a continuing modest increase in visits for prescription medicine refills.
  • There has not been an increase in injuries or illnesses overall.  
  • There has been a modest increase in asthma emergencies in the Rockaway section of New York, which was especially hard hit by flooding and storm debris during the period immediately following the storm, but rates seem to have returned to baseline. According to the health department, the increases likely were caused by people living in cold temperatures, using their stoves to heat their homes, dust from storm clean-up and reduced access to prescription medication for some people during the first days of the storm.  

 

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Mindfulness and Yoga for Disadvantaged Urban Youth

Jun 11, 2012, 1:00 PM, Posted by Tamar Mendelson

Tamar Mendelson, PhD, is an assistant professor at the Johns Hopkins Bloomberg School of Public Health, and an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006). Her research interests include the development of prevention and intervention strategies for reducing mental health problems, with a focus on underserved urban populations. 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. Mendelson is a member of the program’s 2nd cohort.

Anyone who's ever spread a yoga mat across a floor will tell you that it's about more than flexibility. One of many benefits of yoga is that it helps those who practice it deal with stress in their lives. An emerging body of research points to the conclusion that yoga can have a stress-relieving effect.

One problem with the research base is that it's mostly focused on adults. But grown-ups aren’t the only ones who deal with stress in their lives. Children face it as well, and they often do it without the same resources—emotional, financial and otherwise—that adults have.

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Housing, Neighborhoods and Health Disparities

Jan 5, 2012, 1:00 PM, Posted by Corina Graif

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Corina Graif, PhD, RWJF Health & Society Scholar at the University of Michigan, Ann Arbor.

In the New Year I hope that our thinking about housing policy will more systematically incorporate the expanding evidence and relevance of housing conditions for population health and health care policy. Many aspects of internal housing conditions are known to affect health. For instance, heating, ventilation, mold and lead are linked to cardiovascular health, excess mortality, asthma, disability, intellectual functioning, ADHD [Attention Deficit Hyperactivity Disorder] and delinquent behavior.

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We are also learning more and more about the health relevance of various characteristics of the physical environment surrounding one’s residence. For example noise, spatial proximity to vegetation, to grocery shops and to highways, and other sources of air pollution are linked to cardiovascular, mental health, obesity, asthma and allergic effects. Limited but important evidence also exists on the health implications of the socio-spatial context of housing. For instance, fear of crime, crowding, neighborhood disadvantage, social exclusion, and residents’ social exchange are linked to cardiovascular and mental health, obesity, diabetes and low birth weight.

In my dissertation work and related projects, I ask questions about the spatial context of neighborhood effects to investigate how the urban geography of inequality and cumulative spatial disadvantage shape the health and well-being of the inner-city poor. I analyze residential mobility data from the Moving to Opportunity Experiment in Los Angeles, New York, Boston, Baltimore, and Chicago together with data from PHDCN [Project on Human Development in Chicago Neighborhoods], and a large collection of data based on Census and other administrative records over several years.

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Moving to Better Health

Nov 1, 2011, 12:00 PM, Posted by Greg Duncan

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At different points in time, each of us has spent a blissful sabbatical year at the Russell Sage Foundation and living on the Upper East Side of Manhattan – just a few blocks from Central Park to the west and Weill Cornell Medical College to the east, with a Food Emporium right in the basement of our apartment building. Among the other striking things about the Upper East Side is how healthy people are – only 8.4 percent of residents were obese in 2003-07, the lowest rate in all of New York City. Yet just a five or ten minute ride north on the 6 train takes you to East Harlem, where nearly 30 percent of residents are obese (Black and Macinko, 2010).

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These sorts of massive disparities across neighborhoods in health outcomes have generated long-standing concern that living in a disadvantaged neighborhood environment might causally contribute to adverse health outcomes, and so doubly-disadvantage poor families who are already at elevated risk for adverse health due to their own low incomes. Common hypotheses for why neighborhood of residence might contribute to obesity and closely related health problems such as diabetes include differential access to grocery stores that sell healthy foods, opportunities for physical activity, or medical treatment. Neighborhoods could also systematically differ with respect to social norms around health-related behaviors, or in terms of levels of psychological stress due to differences across areas in rates of crime and violence.

Empirically isolating the causal effects of neighborhood environments on health has been challenging for social scientists and medical researchers because most families have at least some degree of choice over where they live. Suppose we observe two observationally equivalent people, one living in a distressed area and the other in a more affluent area, with different health outcomes. Is the observed difference in health due to something about the neighborhood environments in which the two people are living, or instead to hard-to-measure characteristics of the two people that are related to their residential choices and directly related to health as well?

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