Now Viewing: Disease Prevention and Health Promotion

Roadmaps Out of Fantasyland: RWJF’s Outbreaks Report and the National Health Preparedness Security Index

Jan 30, 2015, 5:47 PM, Posted by Susan Dentzer

“When you hear hoofbeats, think of horses, not zebras,” the late Theodore Woodward, a professor at the University of Maryland School of Medicine, cautioned his students in the 1940s. Woodward’s warning is still invoked to discourage doctors from making rare medical diagnoses for sick patients, when more common ones are usually the cause.

And while many Americans have worried about contracting Ebola—in viral terms, a kind of “zebra”—more commonplace microbial “horses,” such as influenza and measles viruses, continue to pose far greater threats. For instance, a large multistate measles outbreak has been traced to Disneyland theme parks in California—while this year’s strain of seasonal flu has turned out to be severe and widespread.

One obvious conclusion is that many microbes remain a harmful health menace, expected to kill hundreds of thousands of Americans this year. Another—speaking of Disneyland—is that much of America appears to live in a kind of fantasyland, thinking that it is protected against infectious disease.

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Diabetes: The Case for Considering Context

Jan 27, 2015, 9:00 AM, Posted by Tiffany Green

At Virginia Commonwealth University School of Medicine, Briana Mezuk, PhD, is an assistant professor in the Department of Family Medicine and Population Health, Division of Epidemiology; and Tiffany L. Green, PhD, is an assistant professor in the Department of Healthcare Policy and Research. Both are alumnae of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program.

Approximately 30 million U.S. adults currently have diabetes, and an additional 86 million have pre-diabetes. The incidence of diabetes has increased substantially over the past 30 years, including among children. Estimates place the direct and indirect costs of diabetes at a staggering $218 billion annually.1 Like many other diseases, disparities on the basis of race and income are apparent with diabetes. Non-Hispanic blacks, Hispanics, Native Americans, and socioeconomically disadvantaged groups are more likely to develop diabetes than non-Hispanic whites and socioeconomically advantaged groups. 

Despite the enormous economic and social costs associated with diabetes, it remains a struggle to apply what we know about diabetes prevention to communities at the highest risk. We have robust evidence from randomized controlled trials that changing health behaviors, including adopting a healthy diet and regular exercise routine and subsequent weight loss, will significantly lower the risk of diabetes. Unfortunately, these promising findings only appear to apply to the short-term. Even worse, results from community-based translation efforts have been much more modest than expected, and show only limited promise of reducing long-term diabetes risk. In response, leaders at the National Institutes of Health have noted that many efforts at translating clinical findings into community settings are “limited in scope and applicability, underemphasizing the value of context.”2

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The Imperative to Collaborate Across Disciplines to Make It Easier to be Healthy

Jan 12, 2015, 9:00 AM, Posted by Chevy Williams

Chevy Williams, PhD, MPH, is a fellow at Experience Institute, where she is learning and applying design thinking to social problems. Williams is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of Pennsylvania. 

Today, we can get access to just about anything in minutes or hours. Smartphones put a world of information literally at our fingertips. Within minutes, most of us can get food we want, entertainment we desire, even travel to another city. But seeing a doctor, an arguably more immediate need, is not so easy. Creating a Culture of Health requires our collective interdisciplinary expertise to make health and health care as accessible and user-friendly as other products and services we use on a regular basis.

Before I left academia, I heard the word “interdisciplinary” tossed around a lot, but I saw it practiced in very safe ways. Typical research teams of grants I was on or would review comprised researchers from only the social, psychological, and health and medical sciences.  As public health faculty, I’d hear statements like “Public health is inherently interdisciplinary.” This may be true since public health draws from multiple disciplines, but I couldn’t help but feel that such statements were more a reflection of inertia than anything else.

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The Best Defense is a Strong Offense: Strengthening Our Nation’s Outbreak Preparedness

Dec 22, 2014, 5:08 PM, Posted by Paul Kuehnert

In the shadow of this year’s Ebola outbreak, the Trust for America’s Health and the Robert Wood Johnson Foundation released a new report, Outbreaks: Protecting Americans from Infectious Diseases.

The report finds that while significant advances have been made in preparing for, responding to, and recovering from emergencies, gaps in preparedness remain and have been exacerbated as resources have been cut over time.

On the eve of the report’s release, I spoke with Jeffrey Levi, PhD, executive director of the Trust for America’s Health to get his thoughts on today’s preparedness landscape—think, Ebola—what to do about shrinking budgets and growing infectious disease threats, and where to go from here.

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Ebola as an Instrument of Discrimination

Nov 21, 2014, 1:00 PM, Posted by Allison Aiello

Jennifer Schroeder, Stephanie M. DeLong, Shannon Heintz, Maya Nadimpalli, Jennifer Yourkavitch, and Allison Aiello, PhD, MS, professor at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This blog was developed under the guidance of Aiello’s social epidemiology seminar course.

Ebola is an infectious disease that the world has seen before in more moderate outbreaks in Africa. As the devastating Ebola outbreak in West Africa has taken a global turn, fear, misinformation and long-standing stigma and discrimination have acted as major contributors to the epidemic and response. Stigma is a mark upon someone, whether visible or invisible, that society judgmentally acts upon. Ebola has become a significant source of stigma among West Africans and the Western world.

In many ways, the source of this discrimination can be traced back to the legacy of colonialism and the western approach to infectious disease response in Africa. The history of foreign humanitarian aid has sometimes dismissed cultural traditions and beliefs. As a consequence, trust in westerners has eroded and has been compounded by a disconnect between western humanitarian aid approaches and a lack of overall infrastructure investment on the part of African national health systems. This is apparent in the Ebola epidemic in West Africa. Some don’t actually think that Ebola exists; instead they believe that it is a hoax carried out by the Western world. All of these factors are facilitating the rapid spread of the disease.

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Is Louisville, Kentucky, the New Face of Asthma Healthography?

Nov 17, 2014, 11:00 AM, Posted by Meredith Barrett

Leaders in Louisville, Kentucky, know first-hand that where you live and work affects your health and well-being. During a special session at the American Public Health Association’s meeting this week in New Orleans, we explore how the air quality in Louisville neighborhoods impacts the health, economy and overall vibrancy of the community. And we’ll highlight how Louisville is the poster child for tackling tough issues like asthma head-on, top-down and bottom-up, through data and collaboration among individual residents, corporate execs, community organizers and public leaders. 

Asthma attacks are sneaky, expensive and debilitating, yet almost entirely preventable.

Asthma is one of the most common and costly chronic diseases in the United States, affecting more than 8 percent of the U.S. population. Despite decades of research and the development of effective treatments, rates of morbidity have not declined and health care costs reach more than $50 billion a year. Asthma also leads to more than 13 million missed days of school and 10 million missed days of work, negatively affecting educational achievement, employee productivity and regional business growth. But the most frustrating part is that a large proportion of these hefty impacts could be avoided with improvements in self-management, community policy and advances in digital health care.

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Connected Health Approaches to Improve the Health of Veterans

Nov 12, 2014, 1:00 PM, Posted by Mitesh Patel

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

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Teen Take Heart

Nov 5, 2014, 11:00 AM, Posted by Steven Palazzo

Steven J. Palazzo, PhD, MN, RN, CNE, is an assistant professor in the College of Nursing at Seattle University, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013 – 2016. ) His research focuses on evaluating the effectiveness of the Teen Take Heart program in mitigating cardiovascular risk factors in at-risk high school students.

Difficult problems demand innovative solutions. Teen Take Heart (TTH) is a program I’ve worked to develop, in partnership with The Hope Heart Institute and with support from the RWJF Nurse Faulty Scholars Program, to address locally a problem we face nationally: an alarming increase in obesity and other modifiable cardiovascular risk factors among teenagers. The problem is substantial and costly in both economic and human terms. We developed TTH as a solution that could, if it proves effective in trials that begin this fall in my native Washington state, be translated to communities across the country.

The State of Obesity: Better Policies for a Healthier America, released recently by the Trust for America’s Health and RWJF, makes it clear that as a nation we are not winning the battle on obesity. The report reveals that a staggering 31.8 percent of children in the United States are overweight or obese and only 25 percent get the recommended 60 minutes of daily physical activity. The report also finds that only 5 percent of school districts nationwide have a wellness program that meets the physical education time requirement.

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In New Book, RWJF Scholar Explores Effects of Genetics on Environmental Science

Nov 4, 2014, 9:00 AM

Sara Shostak, PhD, MPH, is an associate professor of sociology at Brandeis University and author of Exposed Science: Genes, the Environment, and the Politics of Population Health. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006). 

Human Capital Blog: Your book, Exposed Science, won two awards from the American Sociological Association: the Eliot Freidson Outstanding Publication Award from the Medical Sociology Section and the Robert K. Merton Book Award from the section on Science, Knowledge, and Technology (SKAT). Congratulations! What do these awards mean for you and your work?

Sara Shostak: Thank you! I am deeply honored that Exposed Science won those awards. This kind of recognition from one’s colleagues is tremendously meaningful on a personal level, especially as there are many scholars in these sections whose work has inspired me for years.  

More broadly, the dual awards signal something important about the connection between these two domains of inquiry—medical sociology and the sociology of science. That is, science and the politics of science are important foci of analysis for sociologists concerned with population health. The conditions under which scientists do their research—the political economy of knowledge production—is a critical context for what we do and do not know about human health and illness.  

Population health researchers often observe that in the United States, health disparities research tends to focus on differences between racial and ethnic groups, while in the United Kingdom the focus tends to be on variations by social class (or what U.S. researchers more often call socioeconomic status). Scholars of science, knowledge, and technology can help us understand how and why these differences emerged, and with what consequences. My book raises questions also about how any of these determinants get operationalized in laboratory-based research. All of these aspects of how science is done have direct implications for public policy, as well.

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Preventing Elder Falls Before they Happen

Nov 3, 2014, 1:55 PM

Deaths and injuries from falls in people older than age 65 have doubled in the last decade. Last year, 24,000 older people died after a fall and more than two million sustained severe injuries—which can often lead to permanent disability. To find ways to prevent those falls and the injuries, deaths and costs that come with them, earlier this year the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute (PCORI) joined forces on the Falls Injuries Prevention Partnership, which will fund clinical trials at ten U.S. centers over the next five years.

The trials include some implementation of proven fall prevention strategies at the ten research sites. NIH researchers say a key goal is to help change physician behavior about fall prevention, because recent education efforts through conventional medical education channels and other methods have not been very effective.

“With this trial, we will be able to evaluate interventions on a comprehensive and very large scale,” said Richard J. Hodes, MD, director of the National Institute on Aging, which is a division of NIH. “This study will focus on people at increased risk for injuries from falls, the specific care plans that should be implemented—including interventions tailored to individual patients—and how physicians and others in health care and in the community can be involved.”

Each person in the trial will be assessed for their risk of falling, and receive either the current standard of care—information about preventing falls—or individualized care plans first shared with the trial participant’s primary care physician for review, modification and approval. They will include proven fall risk reduction interventions that can be implemented by the research team, physicians and other health care providers, caregivers and community-based organizations.

The trial directors hope to enroll 6,000 adults age 75 and older who have one or more risk factors for falls. The first year of the study is a pilot phase; if the go-ahead is given by NIH and PCORI to proceed with the study after that, enrollment for the full trial will start in June 2015, with participants followed for up to three years. The main goals of the trial are reductions in serious injuries from falls.

“With active input from patients and other stakeholders from the very beginning of this study, we think we can have a major impact, changing practice to make a real difference in the lives of older people,” says PCORI Executive Director Joe Selby, MD, MPH.

The ten trial sites and regions they serve are:

  • Essentia Health, Duluth, Minnesota (Midwest)
  • HealthCare Partners, Torrance, California (Southern California)
  • Johns Hopkins Medicine, Baltimore (Mid-Atlantic)
  • Mount Sinai Health System, New York City (Northeast)
  • Partners HealthCare, Waltham, Massachusetts (Northeast)
  • Reliant Medical Group, Worcester, Massachusetts (Northeast)
  • University of Iowa Health Alliance, Iowa City (Midwest)
  • University of Pittsburgh Medical Center (Mid-Atlantic)
  • University of Texas Medical Branch, Galveston Health (Southwest)
  • University of Michigan, Ann Arbor (Midwest)

Data management and analysis will be coordinated by the Yale School of Public Health.

>>Bonus Links:

This commentary originally appeared on the RWJF New Public Health blog.