Now Viewing: Health Disparities

Putting the Needs of the Community Front and Center

Dec 11, 2017, 8:00 AM, Posted by Paul Lindberg

In the rural Columbia Gorge Region of Oregon and Washington, promoting better health for all means asking what community members need, listening to what they say, and including their ideas in programs and services.

Columbia River, town of Hood River.

The Columbia Gorge Region where I live is a vast rural area larger than Connecticut but with a population of only 75,000. While many people here are doing well, others live in poverty, or have to drive long distances to get to a doctor’s office. In this land of fruit orchards, one in five people regularly run out of food.

Mandi Rae Pope was once one of those people. A few years ago, during a difficult pregnancy at the end of her husband’s graduate studies, Pope says she was “counting pennies out of a Mason jar to pay for gas.” She struggled with migraines, and they were getting worse. In the midst of all that, our local Women, Infants, and Children nutrition program gave her a prescription for Veggie Rx, a program we started to provide free fresh fruits and vegetables to people struggling with food insecurity. This was a top concern that community members had identified. By using Veggie Rx, Mandi Rae was able to provide fruit to her toddler son, and the more nutritious diet also helped tame her migraines. Grateful for the help, she wanted to pay if forward and expressed an interest in promoting the program.

View full post

In Rural America, Community-Driven Solutions Improve Health

Nov 15, 2017, 2:55 PM, Posted by Katrina Badger

There’s no one-size-fits-all solution to improving health. A lot is being done across the country to make rural places healthier and thriving, with state and national policies enabling local innovation.

Dirt road cuts through agricultural fields.

I grew up in southwestern Ohio, surrounded by woods, corn and soybean fields down the road from a small town. Although my childhood home fits what some might see as a stereotypical description of small town America, I never thought of it that way. Now, as a program officer at the Robert Wood Johnson Foundation (RWJF) working to promote healthy, equitable communities, I’ve had the opportunity to travel to a number of rural places and small town across the United States and see the vast diversity of these places and the people who live in them.

Encompassing about three quarters of our nation’s land and home to about 15 percent of the population, rural and small town America is not just one kind of place. It includes the Midwest like the area where I grew up, and nearby Appalachia. It’s also places like the Mississippi Delta and the “Black Belt” of fertile land in the South, unincorporated colonias and many places along the U.S.-Mexico border, remote and geographically isolated “frontier” areas across the West, and Native lands across the country.

View full post

Why Discrimination Is a Health Issue

Oct 24, 2017, 6:00 AM, Posted by David R. Williams

What does the pervasiveness of discrimination mean for health? Social scientist David Williams explains the physiological response to stress and why a good education or high-paying job doesn't necessarily protect from its effects. 

A patient sits in a doctor's office while a nurse looks over his chart.

Forty-one years after graduating from Yale University, Clyde Murphy—a renowned civil-rights attorney—died of a blood clot in his lungs. Soon afterward, his African-American classmates Ron Norwood and Jeff Palmer each succumbed to cancer.

In fact, more than 10 percent of African-Americans in the Yale class of 1970 had died—a mortality rate more than three times higher than that of their white classmates.

That’s stunning.

View full post

A Conversation on the Future of Health Equity Research

Jan 12, 2017, 4:43 PM, Posted by Tracy Orleans

In the past decade, the healthy equity research landscape has shifted from building the evidence to identifying solutions. David Williams and Paula Braveman share thoughts on the evolution of research with a look to the future.

Everyone deserves to live the healthiest life possible.

The latest National Academies of Science Engineering and Medicine report notes that compared to other fields of health research, health inequities is still a relatively new field that faces significant research and practical application challenges. The consensus report provides specific recommendations including: expanded health disparity indicators, longer-term studies, an examination of structural factors, and new research funding opportunities. RWJF’s Tracy Orleans talks with two of the nation’s leading experts on health equity and health disparities, Dr. David R. Williams and Dr. Paula Braveman, who share their thoughts on some of these issues and the evolution of research with a look to the future. 


Tracy Orleans: Nearly ten years ago you started work together on the RWJF Commission to Build a Healthier America. At the time, gaps in health between groups of people or communities were not news to health experts, but they were surprising to a lot of others. We’ve come a long way since then with a more explicit focus on health equity research. How do you view this shift?

 

David Williams: For a long time, researchers focused on documenting the health differences between populations. Those differences are now well-established and we’re able to point to more scientific evidence about why the gaps exist. For example, there’s a growing body of research around the effects of epigenetic aging, which shows that people who experience discrimination or other trauma are biologically older than people of the same chronological age. Science shows that their telomeres, which protect chromosomes from fraying, are shorter among both children and adults who are black, poor, or from unstable homes. This type of more explicit health equity research is a rapidly growing field.

View full post

The Impact of Climate Change on Health and Equity

Jun 22, 2016, 9:00 AM, Posted by Alonzo L. Plough

Tackling the daunting health effects of climate change requires community leaders from all sectors to work together to meet the needs of everyone, especially the most vulnerable.

A flooded town after a big storm.

It’s been nearly 10 years, but I still remember the deadly heatwave that hit California back in July 2006 and claimed hundreds of lives.

The blistering heat lasted for 10 days, with temperatures soaring as high as 119 degrees—the highest ever recorded in Los Angeles County. The number of heat-related deaths was estimated to be as high as 450 across nine counties, including Los Angeles County.

During the five years that I worked as director of emergency preparedness and response for the Los Angeles County Department of Health, we constantly battled the health effects of really hot days, wildfires and droughts.

These weather phenomena directly impact health—and they are all linked with global climate change. Just this past weekend, during a trip to Yosemite National Park, President Obama noted, “Climate change is no longer a threat—it’s a reality.”

The people at greatest risk of serious harm from these climate change-related events include children, the elderly, people with chronic health conditions, the economically marginalized and communities of color.

View full post

Shaking Up Systems To Achieve Health Equity

Mar 17, 2016, 10:00 AM, Posted by Catherine Malone, Dwayne Proctor

In order to achieve greater health equity in America, we need to co-create solutions aimed at transforming the many systems that influence where we live, learn, work and play.

A parent reads to a group of children.

Babies born in the shadow of Yankee Stadium are likely to be lifelong fans of the Bronx Bombers. They are also likely to live seven years less than a baby born a handful of subway stops south near Lincoln Center. The same is true in Las Vegas, where a baby born near The Strip is likely to live nine or 10 years less than someone born west of town.

When it comes to health across cities, zip codes are unequal and so are health outcomes. For example, ethnic minorities continue to experience higher rates of morbidity and mortality than whites. Among the 10 leading causes of mortality in the U.S. (e.g., heart disease, cancer or stroke), minority populations experience the highest rate of death.

We write often about the disparities between population groups and the day-to-day experiences of individuals who, for a myriad of reasons—systemic, geographic or financial—do not have the same opportunity to live as healthy a life as their fellow citizens. Our goal is greater health equity in America, a process that begins with including those most affected and co-creating solutions to improve the systems that negatively impact health. The end result should be decreased health disparities.

Here at the Foundation, we know that health disparities are more often caused by systems related to non-medical determinants of health, which is why we’ve specifically invested more than $457 million since 2014 toward eliminating these pervasive gaps in health outcomes.

View full post

What’s the Connection Between Residential Segregation and Health?

Mar 16, 2016, 7:00 AM, Posted by Donald F. Schwarz

Residential segregation is a fundamental cause of health disparities. We need to take steps that will reduce health risks caused by segregation and lead to more equitable, healthier communities.

Graphic illustration depicting residential segregation from 2016 County Health Rankings & Roadmaps.

For some, perhaps the mere mention of segregation suggests the past, a shameful historic moment we have moved beyond. But the truth is, residential segregation, especially the separation of whites and blacks or Hispanics in the same community, continues to have lasting implications for the well-being of people of color and the health of a community.

In many U.S. counties and cities, neighborhoods with little diversity are the daily reality. When neighborhoods are segregated, so too are schools, public services, jobs and other kinds of opportunities that affect health. We know that in communities where there are more opportunities for everyone, there is better health.

The 2016 County Health Rankings released today provide a chance for every community to take a hard look at whether everyone living there has opportunity for health and well-being. The Rankings look at many interconnected factors that influence community health including education, jobs, smoking, physical inactivity and access to health care. This year, we added a new measure on residential segregation to help communities see where disparities may cluster because some neighborhoods or areas have been cut off from opportunities and investments that fuel good health. 

View full post

What Can Communities Do Now for Health Equity?

Jan 28, 2016, 1:21 PM, Posted by Joe Marx

The Culture of Health Prize communities demonstrate that there's no single formula to address health equity locally, but there are key lessons we can all learn from their success.

2015 RWJF Culture of Health Prize video

Our annual RWJF Culture of Health Prize honors and elevates communities across the United States that are making great strides in their journey toward better health. 

A scan of the 2015 winners reveals something we’ve seen in previous years: There is no single blueprint. Even when solving common problems, these Prize communities innovate in their own ways. Each brings fresh ideas to the forefront and offers a unique perspective on how to holistically address our nation’s most complex health issues. So it makes sense to turn to them to answer the question that is at the heart of our work today: How can communities come together to create places where health can happen – for everyone?

We ask that question a lot and sometimes our answers can be pretty lofty: work together across sectors, think about health broadly, and so on. While all true, communities looking to take action sometimes ask us to, well, be a bit more specific. What can we do tomorrow? Where do we start

Here, we dive in to look at how the 2015 Culture of Health communities approached that Prize-winning question. 

View full post

Removing Barriers and Creating Opportunities for Young Men of Color

Jan 5, 2016, 10:00 AM, Posted by Maisha Simmons

A new toolkit is here to help us understand how to collectively build a path toward a healthy and productive adulthood for young men of color.

A Latino men's group poses in front of a colorful banner.

Trayvon Martin. Manuel Diaz. Rexdale Henry. Michael Brown. Some names may be more familiar to you than others. But all share a common fate of life lost too soon.

What happens when you hear their names? Do you think about the circumstances that prematurely ended their lives? Or do you regret losing the chance to benefit from the great contributions they could have made?

It's clear that young men of color face daunting barriers to health that directly impact their potential to succeed and thrive. Access to a series of supports and conditions specifically designed to address these barriers can dramatically change their life course trajectory. That is why the Robert Wood Johnson Foundation launched our Forward Promise initiative a few years ago.

As part of this work, the big question we are always asking ourselves is what would it look like for every young man of color to grow up in a Culture of Health? We know for example that there would need to be positive school environments, access to role models, job training, support to understand and heal from trauma in their lives, and pathways to college and career, to start.

View full post

Closing Health Gaps: The Oklahoma Example

Dec 7, 2015, 8:00 AM, Posted by Andrea Ducas

With the right data to inform priorities, and a powerful commitment to equity, places like Tulsa, Okla., are making progress to close health gaps.

Adult and child reading a book in the classroom.

What would your ideal future look like? For me and my colleagues at the Foundation, it would be one where everyone has the opportunity to live the healthiest life they can.

An unfortunate reality in this country, however, is that while we continue to realize substantial gains in health, the things that help people become and stay healthy are not evenly distributed across states or even metropolitan areas. Access to healthy foods, opportunities for exercise, good-paying jobs, good schools, and high quality health care services may be readily available in one area, and difficult to come by or nonexistent in another just a few miles away.

Sometimes the differences are particularly stark: In some communities, two children growing up just a short subway or car ride apart could be separated by a 10-year difference in life expectancy.

So how do we square this reality with the Culture of Health we’re working hard with others to build? An important first step is recognizing those disparities and what’s driving them, and ensuring that people in communities across America have strategies – and the data – they can use to proactively close health gaps.

Let’s use Oklahoma, and within it the city of Tulsa, as an example.

View full post