Supportive Housing Can Help End the Homeless-to-Jail Cycle

Jun 23, 2022, 11:00 AM, Posted by Erin Hagan

The best way to break the harmful homelessness-jail cycle? Keep people housed, first; then quickly provide the supportive services they need to thrive.

Hands holding a cardboard house.

Maria* is finally starting to feel at home. After living on the streets for eight years and a brief stint in a halfway house, she now has a permanent home in the Sanderson Apartments in south Denver. “I love my life, and I love myself, and I love my family,” she said, beaming. “And I found myself, found out who I am, where I belong.” The Denver Supportive Housing Social Impact Bond Initiative (Denver SIB) helped her find this stability.

There are many common myths about how to end homelessness. At RWJF’s Evidence for Action program, we wanted to test what truly works. We funded Sarah Gillespie and Dr. Devlin Hanson at the Urban Institute to conduct an evaluation of the Denver SIB program.

What we learned is that supportive housing has several benefits. It can help end the homelessness-to-jail cycle, free up public resources for other priorities, and ultimately, it creates stability for people experiencing homelessness.

Supportive housing seems to be especially beneficial for people with frequent interactions with the criminal justice system, and leads to better health outcomes for individuals and communities. In fact, the Robert Wood Johnson Foundation has included reducing incarceration among 35 illustrative measures to track progress toward building a Culture of Health in America

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Three Policy Lessons to Advance Health Equity During an Ever-Evolving Pandemic

Jun 16, 2022, 11:00 AM, Posted by Jacquelynn Y. Orr

Many COVID policies and practices exacerbated longstanding health disparities. Here’s how we can change that going forward.

Capital Building

Since Omicron first appeared here in December 2021, the United States has had a 63 percent higher COVID death rate than other high-income nations. We also continue to experience deep disparities by race and ethnicity for risk of infection, hospitalization, and death from COVID. Even though federal agencies issued guidelines on how to stay safe, it was our local and state responses that explain many of the differences in health outcomes.

We turned to researchers working with Systems for Action, Policies for Action, and Evidence for Action, all signature research programs of the Robert Wood Johnson Foundation, to find evidence-based answers within policies, practices, and data to help explain these disparities. The questions included: Which responses worked best during the pandemic for our population as a whole and for communities at greatest risk? And how can we respond to future large-scale national emergencies in ways that better protect the health of vulnerable people and communities?

Here are three important lessons that emerged:

1. Pandemic Response Policies Must Protect People at Greatest Risk

While rapid policy responses to COVID (from physical distancing to temporary paid leave) were meant to protect the general public, many of these policies left out groups most vulnerable to the health and economic consequences of COVID-19. For instance, the federal Families First Coronavirus Response Act excluded some 60 million workers, including health care providers and first responders who could not stay at home or practice measures such as physical distancing.

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Necessary Conversations: Talking Frankly About Race

Jun 9, 2022, 11:00 AM, Posted by Alonzo L. Plough

Engaging in honest dialogue about race sometimes means lowering our defenses and acknowledging our feelings so we can walk together toward racial equity. 

Illustration of a group talking. Illustration by Amir Khadar

The opening of the Tops Friendly Market in East Buffalo was a triumph of community activism, a victory for residents who struggled for years against food apartheid. In a neighborhood that had long lacked a full-service supermarket, the store became a symbol of local empowerment in one of the nation’s most segregated cities.

This segregation is a contributing factor in why White people in Buffalo have a longer life expectancy than their Black neighbors living on the East Side. To counter these conditions, residents persevered in efforts to shape a healthier, more equitable neighborhood—residents like 67-year-old Church Deacon Heyward Patterson. Deacon Patterson volunteered at a soup kitchen and even drove his neighbors to Tops Friendly Market to access nutritious food when they didn't have transportation of their own. He was murdered while helping load groceries into someone's car.

The murder of Deacon Patterson and others sparked outrage across the nation. But when the initial shock fades away, we need to look harder at the role of racist systems and structures that endure in the United States and how they contribute to unbridled violence and lives that are cut short.

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What We Learn from Taking the Public’s Pulse

Jun 7, 2022, 11:00 AM, Posted by Carolyn Miller

Findings from a national survey underscore the need to continue educating people about the root causes of inequities and how racism affects health. 

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We’ve come to expect a flood of polling around election time, conducted or commissioned by universities, media outlets, partisans, and others. So why would a foundation invest in putting a poll into the field? On what topic? And when? RWJF’s Research, Evaluation, and Learning (REL) team supports various surveys and polls to gain insight into the public’s opinion on a range of topics from health to systemic racism to the effects of COVID-19 on day-to-day life. Findings can help philanthropy, policymakers, and stakeholders better gauge public awareness of a problem and support for a particular policy intervention, reveal shifting attitudes and shed light on whether people think systems change can advance health and equity.

Carolyn Miller, REL Senior Program Officer talks with Anita Chandra, a Vice President at RAND, on what we can learn from one of the Foundation's numerous survey efforts—the months-long RWJF/RAND COVID-19 survey and how it can inform policy solutions designed to address structural racism and improve health and prosperity.

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Strengthening Public Health Authority is Critical to a Healthy, Equitable Future

Jun 3, 2022, 1:45 PM, Posted by Monica Hobbs Vinluan, Sarah de Guia

What happens when elected officials use preemption to usurp public health authority, and what can be done about it?

Strengthening Public Health illustration.

This post is the second in a blog series that explores how preemption has served as a double-edged sword in either supporting or undermining efforts to advance health equity. We explore how some states have limited public health authority and what must be done to rebuild a public health infrastructure that centers equity.

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A Community Vision of Mental Health

May 19, 2022, 12:00 AM

Centering the community in making its own decisions, confronting a long legacy of trauma and violence, and honoring genuine emotion are among the pathways to mental health that many residents of Palm Beach County are embracing.

In Palm Beach County, Florida residents are tackling neighborhood challenges together. Teamwork and a commitment to inclusiveness and civic participation helped the county earn an RWJF Culture of Health prize.

Six communities that comprise the Healthier Together place-based initiative are asking local people what they care most about. Their questions sometimes surface surprising answers. Many residents say they want to focus on mental health and that “feeling whole in mind, body, and spirit” is what really matters to them. But the way they think about mental health often differs from the way a clinical provider considers it. “It’s not a traditional definition, it’s their definition,” said Jeanette Gordon, whose Healthier Neighbors Project in Riviera Beach and northern West Palm Beach is all about fostering engagement, empowerment, and balance.

Organizing a multi-generational street cleanup may not at first blush seem deeply connected to mental health, but the Healthier Lake Worth Beach community saw it as a natural fit. “They wanted to create the conditions where their kids could thrive,” explained Pat McNamara, CEO of Palm Health Foundation, which funds Healthier Together. And what could be better for emotional wellbeing than that? Under the umbrella of mental health, Palm Beach County communities are activating other priorities as well, each one identified by those who live there—including gaining access to healthy foods, confronting the root causes of trauma and violence, and creating opportunities for youth.

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Nurses Can’t Care for Us if We Don’t Care for Them

May 9, 2022, 10:00 AM, Posted by Beth Toner

After two years of a pandemic, nurses are more stressed and burned out than ever, and too many are leaving the profession. What are the systemic changes needed to truly support them? 

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I confess I have felt ambivalent about Nurses Week since 2011, my first year as a second-career registered nurse. Back then, in addition to a full-time communications job, I was working weekends in a long-term care facility. Despite having no experience other than clinical rotations just nine months before, I had been given a short orientation that I essentially had to structure myself; I was then thrown onto a skilled nursing floor with 15 residents during the day and 32 residents at night—most of them unable to walk on their own, some with dementia, and all with at least one chronic condition. I was hanging tube feeds, flushing central lines, and dressing stage IV pressure ulcers, all while trying to keep everyone safe and happy.

My colleagues and I received many tributes during Nurses Week—a message from the administrator, posters and food in the break room, giveaways. Don’t get me wrong; the gestures and the sentiment were lovely. But what I wanted more than encouraging emails and pizza was help. What I wanted was permission to say “I’m scared and could use some more support,” but nursing culture there—and in many places, still—was “sink or swim.” Not long after, I decided to “swim” out of long-term care, rather than make an error that would cost me my license or, worse yet, a resident his or her life.

I’m not telling you this so you’ll feel sorry for me; I’m telling you this because I have come to realize that I wasn’t alone in feeling frightened and overwhelmed on the job. Almost anyone who takes their nursing responsibilities as seriously as they should has felt that way at one point or another. And now, this Nurses Week, with two years of this awful pandemic under our belts, nurses—particularly those on the front lines—are feeling more stressed and burned out than ever; many are leaving the profession.

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What Nurses Can Teach Us About Health Equity

May 5, 2022, 1:00 PM, Posted by Nacole Riccaboni

I talked to a fellow nurse about inequities in healthcare settings, our own experiences with bias, and the importance of acknowledging and confronting the harms associated with structural racism.

Nurses wearing masks.

In Manhattan’s financial district, the average resident can expect to live until the age of 85. In East Harlem, life expectancy is only 76 years. Ten stops on the subway and a nine-year drop. That’s what Jasmine Travers, a nurse and New York University assistant professor, told me when we talked about the importance of digging out the root causes of health disparities.

As Black women in the nursing profession, both of us understand the need to “get real” about structural racism because we’ve seen how it plays out at the patient’s bedside and in our own professional lives. In fact, Jasmine left hands-on nursing to pursue research into the policies, practices, and structures that impede good outcomes. Talking about the realities of racism isn’t easy, but being uncomfortable isn’t an excuse to avoid tough conversations. The goal is not to accuse or shame anyone, but rather to shine light on enduring inequities, the forces that perpetuate them, and the ways we can heal the damage they do.

As an example, Jasmine described differences in how hospital staff sometimes approach pain control. The immediate response to a White patient’s complaint tends to be “let’s see how we can ease the pain.” But patients of color face more scrutiny. Too often, the first question a healthcare provider asks is, “what’s really going on here?”—the assumption being that pill-seeking behavior needs to be ruled out before considering the use of pain meds.

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Good Things Happen When Nurses Lead

May 2, 2022, 11:00 AM, Posted by Najaf Ahmad

A retired nurse CEO says we need nurses in government, on the boards of for-profits, and mentoring the next generation given their powerful role in influencing people, policies, and systems.

Mentor the Next Generation of Nursing illustration.

Maria Gomez has had her finger on the pulse of our healthcare system and the people it serves throughout her storied, 30+ year career running a community health center that serves a low-income, immigrant community in greater Washington, D.C. Maria entered the United States at age 13, started Mary’s Center after becoming a nurse, and helped grow it into a powerhouse serving 60,000 people each year. Mary’s Center helped pioneer an integrated model of healthcare, education and social services to put people on a path to good health, stability and economic independence. In 2012, President Obama presented Maria with the Presidential Citizens Medal. She retired in late 2021. Here, in the second part of a two-part interview, she reflects on the challenges facing our healthcare system, how nurses can continue leading efforts to meet them, and what we can learn from the pandemic.

What are the greatest challenges facing our healthcare system?

Today, it’s all about the numbers—the number of patients you see and the number of minutes it takes. Because that’s how you get paid. To transform lives, we need to change how we address patient needs. Providers can’t do it all in 15 minutes. Some are so overwhelmed by the numerous demands on them that they’ve grown numb to what their patients are feeling. Too many smart, incredibly passionate people who devote themselves to healthcare have become disheartened, burned out, and are even leaving the workforce. This is the most discouraged I’ve seen providers in my career.

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Understanding the Link Between Affordable Housing and Structural Racism

Apr 21, 2022, 10:00 AM, Posted by Rev. Eric Dobson

Creating inclusive communities requires more than fair housing laws. We need enforcement to end residential segregation and the disinvestment that shortchanges so many communities of color.

Understanding the Link Between Affordable Housing and Structural Racism

To this day, I still choke up when I remember the moment, two decades ago, that changed my life. As part of the Martin Luther King Day of Service, I had volunteered to help feed some folks who were homeless. At the end of the afternoon, I turned to one of the women who ran the sponsoring program, and said, “That was great, I look forward to doing this again next year.”

She paused, looked directly at me, and said quietly, “We do this every week.”

In those words, I suddenly heard a calling. My Dad was a church pastor and I had always expected to follow his path. But now I wondered, “Am I going to preach about this, or am I going to actually do it?” And so I signed up to work among people who were living mostly on the streets. Some struggled with mental illness or substance use, others had been forced from family homes because of their sexual identities. All were poor and most were Black or Brown. I learned to listen, not judge, and to think more broadly about how poverty and race intersect.

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