Now Viewing: Social Determinants of Health

What Can We Do About Biases Baked Into Data?

Oct 31, 2022, 1:00 PM, Posted by George Hobor, Nicole Marwell

We believe that local data can help uncover inequities and inform decisions that support healthier communities. But what happens when the data we rely on fail to capture the social reality we imagine they do? Or when the data are flawed, incomplete—or worse, riddled with bias?

Robot Illustration

While data are critical in guiding policy and allocation decisions, it’s important to understand what data are and what data are not. Data are too often seen as objective, neutral, and accurate representations of reality. But the data points guiding our decisions are produced through human decision-making—and the bias and error that inherently comes with those decisions.

For example, while patient ratings and reviews of physicians can provide important insights, they are not an exact science and are subject to human bias on what to report and what to leave out. In fact, studies have found that patient reviews tend to be biased against physicians of color. This awareness of limitations and biases should inform decisions about how we use patient ratings as data. If we are not clear-eyed about these limitations and the conclusions that we can draw from these kinds of data, there will ultimately be consequences for healthcare organizations’ government reimbursement rates, decisions about salary and raises for individual physicians, diversity of the medical workforce, and ultimately health equity.

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Four Reasons We Need School Nurses Now More Than Ever

Sep 15, 2022, 10:45 AM, Posted by Robin Cogan

A relentless advocate for school nurses reflects on the central role they play in advancing health equity within schools and communities. 

A woman meets with a student during a sports physical.

The 2022-2023 school year will be the fourth marked by COVID. With schools facing unprecedented challenges, school nurses are preparing for a demanding year.

No one is more familiar with these challenges than Robin Cogan, MEd, RN, NCSN, FNASN, FAAN, who has spent more than two decades of her 35-year nursing career as a school nurse in Camden, New Jersey. She is New Jersey Director for the National Association of School Nurses and faculty at Rutgers University-Camden School of Nursing. Here, she discusses the essential role nurses play in advancing health equity in schools and communities as well as what they need in order to continue caring for children.

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Help Us Learn How to Close the Racial Wealth Gap

Jul 28, 2022, 11:00 AM, Posted by Alexandra Zisser, Mona Shah

It’s past time to close the racial wealth gap, which undermines health in families and communities affected by structural racism.

Illustration of Wealth Gap

Editor’s note: This funding opportunity is now closed.

Can your family withstand a difficult diagnosis, a missed paycheck, or a significant rent increase? For many families and communities, those financial shocks are impossible to weather and gravely impact health and wellbeing. A survey conducted this year found that two-third of Americans have put off care they or a family member need because of cost.

This is the result of the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black and Indigenous families and other communities of color of assets and resources that accumulate and transfer from one generation to the next. Today, the racial wealth gap is a chasm; previous research shows that, for each dollar of wealth held by White families, Indigenous families have about 8 cents, Black families have about 13 cents, and Latino families about 19 cents.

Our nation’s policies have limited wealth and opportunity, especially for Black, Indigenous and other communities of color. From the appropriation of millions of acres of Native American land, to the Emancipation Proclamation which freed slaves but did not establish a federal policy that Black people could own land, to the internment camps that cost Japanese Americans their homes and businesses, home and land ownership have been afforded only to some. Housing discrimination in many forms, including redlining and predatory lending, continues today.

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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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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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Relatives Raising Children: Why is it so Difficult?

Mar 24, 2022, 11:00 AM, Posted by Jennie Day-Burget

Child-welfare systems and policies shouldn't create so many unjust barriers for children growing up in nontraditional families.

Families face challenges illustration.

Life is harder than it has to be for families where grandparents or other relatives step up to care for children when their parents can't. Our family-supportive policies and systems were designed to serve “traditional families,” with services aimed at “parents” and foster families, not relatives who step up. These families face unnecessary barriers to getting the support children need to thrive. This is especially true among Black and American Indian families, who make up a disproportionate share of the 2.6 million families in the United States where children are growing up without parents in the home. The pandemic has made things worse. COVID-19 has robbed thousands of children of their parents and sent them into the care of relatives.

What happened to the Brown family of Baton Rouge, La., helps to tell the story of grandfamilies, also known as kinship families, which form when children are separated from parents through life events like death, illness, incarceration, or deportation. After a horrific onslaught of gun violence killed four members of their family, Robert and Claudia Brown took custody of three grandsons. They fought for 12 years to adopt the boys.

The Browns struggled through trauma, grief, and loss. They scrambled to pay lawyers while supporting three growing boys. They blew through retirement savings. They didn’t know about services or support that could have bolstered their mental health and financial security.

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How a Nurse Leader Took on the Social Determinants of Health

Mar 17, 2022, 11:45 AM, Posted by Najaf Ahmad

Trailblazing nurse and recently retired CEO of a community health center reflects on her legacy of providing care that prioritizes the social determinants of health.

Doctor and patient illustration.

Maria Gomez was 13 years old when she immigrated to the United States with her widowed mother to escape violent political turmoil in Colombia. They landed in Virginia on a snowy day with no boots, no coat, and not speaking a word of English. Together, they faced many challenges while navigating their new life. In spite of them, Maria’s gratitude and drive to give back led her to a nursing career. She ultimately joined a group of advocates in launching Mary’s Center to address gaps in access to healthcare and structural barriers that many immigrants face.

Today, Mary’s Center uses an integrated model of healthcare, education, and social services to serve patients at five clinics and two senior wellness centers in Washington, D.C. and Maryland. In 2012, President Obama presented Maria with the Presidential Citizens Medal, the second highest civilian honor in the United States.

After an illustrious career, Maria retired in December of 2021. She shared reflections on how she has led efforts to serve a diverse population and insights into the challenges our healthcare system and nation face. In this interview, Maria discusses how she shaped a system of care that aims to build trust with patients and provide integrated care that addresses more than medical needs.

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How Local Leaders Can Create Socially Connected Communities

Nov 1, 2021, 1:00 PM, Posted by Risa Wilkerson

Simple steps, guided by input from community members, can help reduce social isolation and improve health, well-being, and civic engagement.

Social Connection infographic.

What happens when young men and boys of color aren’t able to be themselves in any setting? 

In San Diego, refugees from East Africa commonly experience discrimination, racism, and Islamophobia. Young men and boys, in particular, describe how they have to act one way in school, another way with friends outside of school, and another at home. It is important for the community to find ways to improve social connections, increase opportunities, and build resilience, since their social isolation can lead to unhealthy behaviors that put their health and futures at risk.

Social isolation—the lack of significant social connections interpersonally and within a community—is a “deeply consequential” public health crisis, according to U.S. Surgeon General Vivek Murthy. He noted how “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness.”

Indeed, the health risks of social isolation have been compared to those of smoking and obesity, and it is linked to depression, impaired immunity, increased suicidal tendencies, and increased risk of death. 

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New Narratives of Hope This Black History Month–And Beyond

Feb 9, 2021, 12:00 AM, Posted by Dwayne Proctor

More than 50 years after the civil rights movement we still have a lot to do to reduce discrimination and increase health equity. Dwayne Proctor reflects on the role of stories in the search for solutions.

An older student plays around with a younger student in a school auditorium.

Author’s note, February 2021: My post below was first published in February 2018. Over the past harrowing year, the issues it explores have become even more urgent, as the murder of George Floyd triggered a racial reckoning during a global pandemic that has hit communities of color hardest. In the midst of it all, systemic racism continues to take a brutal toll. The death of Dr. Susan Moore, who called out the racism she was experiencing as a patient, is just one example. Moore’s death, and those of Clyde Murphy and Shalon Irving, which I wrote about in my blog, are painful reminders of the cost of letting such racism continue. In the words of RWJF Trustee Dr. David Williams: “The first thing we have to do is acknowledge that the everyday racial discrimination embedded in our culture is sickening and killing African-Americans, and make a new commitment to make America a healthier place for all.”

One of my earliest and most vivid childhood memories is watching from my bedroom window as my city burned in the riots that erupted after Dr. Martin Luther King Jr.’s assassination 50 years ago.  

The next afternoon, my mother brought me to the playground at my school in Southeast Washington, D.C., which somehow was untouched. As she pushed me in a swing, she asked if I understood what had happened the day before and who Dr. King was.

“Yes,” I said. “He was working to make things better for Negroes like you.”

My mother, whose skin is several tones darker than mine, stared at me in surprise. Somehow, even at 4 years old, I had learned to observe differences in complexion.

That is particularly interesting to me now, as I eventually came to believe that “race” is a social construct.

Of course racism and discrimination exist. They are deeply embedded in America’s history and culture—but so too is the struggle against them.

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