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Creative Communities Are Addressing Social Isolation

Jan 7, 2019, 3:00 PM, Posted by Maryjoan Ladden

Social connections are not just nice to have—they can significantly affect our health and well-being. Inspired by creative approaches abroad, communities across the United States are taking steps to reduce social isolation and increase residents’ sense of belonging.

A man walks over a snow covered lawn.

It’s only January and already, I’m counting down the days to spring when warm weather will arrive. The long, cold months of winter can be isolating—the snow and subzero temperatures make it difficult to get out and about. Winter is particularly tough for children who can’t go outside to play, and for newcomers from warmer climates who are not accustomed to the cold. For people who don’t have meaningful social connections, the cold weather season can exacerbate the isolation they face year-round.

Social isolation is a serious problem for many. It can lead to anxiety, depression, substance abuse, and even suicidal thoughts. Social isolation can impact our health in other ways too—by escalating unhealthy habits, stress, lack of sleep—and putting us at higher risk for coronary heart disease and stroke.

Fortunately, there are many creative ways in which communities across the United States are tackling social isolation and building a sense of community.

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Four Ways to Build Inclusive, Healthy Places for All

Jul 25, 2018, 11:00 AM, Posted by Sharon Roerty

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.

Healthy Places Swing Set

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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A Successful Model That Predicts and Prevents Violence

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.

Cardiff image

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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Can a Trash Can Reveal a Community’s Values?

Sep 21, 2017, 12:00 PM, Posted by Karabi Acharya

What can the U.S. learn from Copenhagen about use of 'placemaking' to foster healthier, more inclusive communities?

Bike-friendly Copenhagen street.

One of the most striking cultural symbols upon arriving in Copenhagen is the sheer number of cyclists navigating city streets—in fact bicycles outnumber cars!

But during my recent visit, it was the trash cans that actually caught my eye.

Just as in many U.S. cities, Copenhagen’s citizens can return used bottles and cans for cash. But, unlike other cities, Copenhagen’s trash cans are equipped with small “deposit” shelves on the outside to place recyclables. This provides an easier, safer, and more sanitary way of collecting discarded cans. Instead of digging through trash cans overflowing with smelly garbage and sharp glass, collectors can easily retrieve bottles and cans from these exterior shelves.

A small feature like this speaks volumes about how our public spaces can support social values like dignity and compassion.

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How Lessons From Abroad Are Uplifting Youth in the United States

Aug 23, 2017, 12:00 PM, Posted by Jennifer Ng'andu

Creative programs in Latin America are inspiring U.S. communities to pursue similar approaches that connect young adults to education and employment.

International Youth Foundation

Like many high school graduates in Brazil, Caroline was eager to find a job. She desperately needed money to continue her studies and pursue her dream of becoming an engineer. But two years after graduating, she was still unemployed. Caroline eventually managed to improve her job prospects in an unlikely way—through drawing, dance and breath work.

Intent on breaking free from a family history of women who weren’t able to get good jobs or finish high school, Caroline discovered a job training program run by Rede Cidadã (The Citizen Network). The non-profit organization connects youth to jobs and apprenticeships throughout Brazil, where the youth unemployment rate is nearly 25 percent.

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Innovations from Abroad Are Keeping Seniors Socially Connected

Apr 13, 2017, 10:00 AM, Posted by Susan Mende

From a dementia village to the next AirBnB for seniors, global entrepreneurs are searching for ways to improve the lives of a rapidly aging population. Their lessons can inform efforts right here in the United States where the elderly population is expected to more than double by 2060.

At a nursing home, a nurses' aide sits with a senior who is drinking a glass of water.

Through the plate glass window of the café where I sipped my coffee, I watched an older gentleman bend to pick something off the ground. He did this repeatedly: down and up, down and up. I learned that he did this every day for hours, picking up fallen leaves.

The man had dementia and lived in Hogewey, a community outside Amsterdam where older people with advanced dementia lead largely autonomous lives in familiar, welcoming surroundings. This particular gentleman liked to pick up leaves—and why not? It did him no harm; in fact, it gave him a little exercise, and he probably found the activity relaxing.

Hogewey is unique—a gated, village-like community where those with dementia live in small-group homes that look and feel like real homes, with people of similar backgrounds and experiences. Caregiving and other staff support them in everyday activities and blend into the environment, serving as grocery store clerks, hairdressers, bartenders, and neighbors.

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Q&A with Pau Gasol: The NBA All-Star's Health Advocacy Off-the-Court

Apr 20, 2015, 9:29 AM, Posted by Merlin Chowkwanyun

It may be NBA playoffs season, but the Gasol brothers are committed to promoting child health year round. RWJF Health & Society Scholar Merlin Chowkwanyun recently sat down with the Chicago Bulls' center to learn about his passion for health advocacy and how he's working to build a Culture of Health in the U.S. and abroad.

Image credit: Joe Murphy (NBAE/Getty)

Since moving to the Chicago Bulls last summer, NBA star Pau Gasol has been having one of the most sensational seasons of his basketball career. A two-time champion with the Los Angeles Lakers, the new Bulls starting center is entering the playoffs as the league leader in double doubles, averaging about 18 points and 12 rebounds per game. In February, he and his younger brother Marc Gasol (of the Memphis Grizzlies) made NBA history as the first siblings to start in the annual All-Star Game: Pau for the East team, Marc for the West.

The two have been equally active off the court. In 2013, after years of work with various philanthropic associations, Pau and Marc formed the Gasol Foundation. It focuses on child health and works towards "a world where all children will enter adulthood physically and mentally equipped to live successful, healthy and productive lives." The Foundation recently launched outreach projects in two areas with severe socioeconomic disadvantage. Vida! Health & Wellness in Boyle Heights (Los Angeles) provides parents and children with instruction in physical activity, physiology, and fitness; healthy cooking and eating; and psychological wellness. L'Esport Suma in South Badalona (Catalonia, Spain) uses sports to promote human development and social cohesion among participants. It is run in conjunction with Casal dels Infants, a long-standing NGO in the region.

Pau has always been a very visible 7-foot presence—literally and figuratively—in Memphis, Los Angeles, and now Chicago, the three cities where he has played. Among other things, that included visiting patients and working with the Children's Hospital Los Angeles and St. Jude Children's Research Hospital, and around the world, raising awareness of refugees' plight as a UNICEF ambassador. In 2012, the NBA recognized these and many other efforts with its J. Walter Kennedy Citizenship Award, given to only one player a season. He recently was named one of ten finalists for the NBA's Community Assist Award, and fans can vote for him on Facebook, Twitter, or Instagram by typing #NBACommunityAssist and #PauGasol. 

Each year, Robert Wood Johnson Foundation Health & Society Scholars at the University of Wisconsin-Madison's site complete a "'knowledge exchange" project designed to foster communication among the general public, academic researchers, and population health practitioners. As someone who grew up in Los Angeles, I cheered for Pau during his seven seasons with the Lakers but admired him just as much for what he did beyond the game. For my project this year, I wanted to interview Pau about his and Marc's plans because it seemed the Gasol Foundation's goals dovetailed with those of RWJF's Culture of Health initiative in many respects.

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Field Notes: What Cuba Can Teach Us about Building a Culture of Health

Jan 29, 2015, 9:54 AM, Posted by Maryjoan Ladden, Susan Mende

Ever since President Obama announced the restoration of diplomatic ties between the United States and Cuba, there’s been growing excitement over the potential for new opportunities for tourism, as well as technology and business exchanges. Most people assume that the flow will be one-sided, with the United States providing expertise and investment to help Cuba’s struggling economy and decaying infrastructure.

That assumption would be wrong. America can—and already has—learned a lot from Cuba. At RWJF, we support MEDICC, an organization that strives to use lessons gleaned from Cuba’s health care system to improve outcomes in four medically underserved communities in the United States—South Los Angeles; Oakland, Calif.; Albuquerque, N.M.; and the Bronx, N.Y. Even with very limited resources, Cuba has universal medical and dental care and provides preventive strategies and primary care at the neighborhood level, resulting in enviable health outcomes. Cuba has a low infant mortality rate and the lowest HIV rate in the Americas, for example—with a fraction of the budget spent in the United States.

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Nurses are Awesome, Say it Loud and Proud!

Jul 15, 2013, 10:00 AM, Posted by Timothy Landers

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*Gennit is not her real name but the story is true.  Her mom gave us permission (from the row behind us) to use this story and photo.  Hopefully, this counts as her “What I did over summer vacation” essay when school starts.

I’m sitting on the plane with Gennit, a 13-year old girl who was born in Ethiopia, but now lives in Atlanta with her brother and parents.  Gennit is a nice and articulate 13-year girl, and we chatted during the 13-hour flight about our experiences in Ethiopia.

She had a lot of things to say, and I noticed that she was somewhat soft-spoken making it difficult to hear her at times.  I asked her about my observation that many Ethiopian girls and women speak softly and what she thought about that.

Gennit told me she thought is was more “ladylike” to speak softly and, in Ethiopia, children are taught that it is wrong for a girl to talk loudly.

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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.