STARS and STRIPES 2017 Session Kick-Off

The 2017 STARS and STRIPES program launched on June 12th with an orientation session introducing students and parents to program instructors and staff. Ms. Mary Williams, Center for Healthy Communities (CHC) community outreach coordinator, opened the event and provided an overview of what all participants could expect over the summer and introduced the instructors and program assistants for the 2017 session.

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Dr. Crook speaking at STARS and STRIPES orientation session.

In welcoming the students, Dr.Errol Crook, Director and Principal Investigator for the CHC, encouraged the young people to take advantage of the opportunities ahead of them and support each other through the program and future challenges as they move on to college and into careers in the medical sciences. He stressed that the CHC focuses on health disparities and sees education and knowledge building as a key component of helping communities to develop their own capacity to advocate for equity and improvement.

Drawing on her experiences as an immigrant to the United States, Dr. Martha Arrieta, Director of Research Core, continued the theme of encouraging the STARS and STRIPES participants to take their futures into their own hands and to make the most of their participation in the program. She also challenged the group to remain curious; explaining that curiosity is the foundational principle of research. In asking the questions — specifically what, when, where, who, and why — researchers move forward in identifying problems and finding solutions.


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Mary Williams welcoming the STARS and STRIPES students.


After the greetings, Ms. Williams introduced the program assistants and instructors who intern explained the program of study for the summer:

  • Library Research
  • Biology, Anatomy, and Physiology
  • Computer Science
  • English
  • Algebra and Trigonometry
  • Health Disparity Studies and Terminology

Learn more about the STARS and STRIPES program.

Read previous articles about the program.

Defining Health Equity

In May 2017, the Robert Wood Johnson Foundation released a report titled “What is Health Equity? And What Difference Does a Definition Make?” with the purpose “stimulate discussion and promote greater consensus about the meaning of health equity and the implications for action within the Culture of Health Action Framework.” In doing so, the authors identify crucial elements to guide effective action. The way we define health equity is important as it reveals the values and beliefs that are used to make decisions, justify actions, and promote policies.

The document provides a general definition of health equity:

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.

In pointing out the importance of measurement for accountability, the authors added the following:

For the purposes of measurement, health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups.

With those definitions as a starting point the report offers :

  • Series of definitions for different audiences
  • Explanation of key concepts
  • Criteria for defining health equity
  • Discussion of steps to advancing health equity
  • Guiding principles
  • Glossary of terms often arising in health equity discussions

See a summary of the report.

Download the report, Braveman P, Arkin E, Orleans T, Proctor D, and Plough A. What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation, 2017.


CAB Member Profile: Mr. John Jones

The Sentinel Surveillance to Monitor Progress toward Health Equity project aims to develop and implement a surveillance system to capture the information necessary to monitor progress towards health equity for health disparate populations. One key element of this project is the engagement of community members through a Community Advisory Board (CAB).  Recently, Mr. John Jones, a member of the Trinity Gardens community and a member of the CAB, shared a little about his experiences with the CAB.

Tell us a little bit about yourself and your background.

I was born in Chatom, AL, but moved to Mobile in 1947. I first moved to Trinity Gardens in 1949. After high school, I spent four years in the Air Force. Living in South Dakota, I attended the School of Mines in Rapid City. After leaving the Air Force, I returned to Trinity Gardens, graduated from Bishop State.  I spent the next 28 years working for the railroad. I’m now retired and have time to do more in the community.

How did you become involved with the Community Advisory Board for the Sentinel Surveillance Project?

My pastor, Rev. Ulmer Marshall at Trinity Lutheran Church, was involved with the group. He had to step back from the commitment and asked me if I would attend in his place. I came to check it out. I wanted to see if it was something that I could really contribute to. I thought it was worthwhile so became a part of the group.

Why did you decide to become part of the CAB?

I wanted to share my life experience with the community and with the CAB. If I could contribute to something that would help someone improve their health, I wanted to do that.

Give us a few highlights of your time as a CAB member. Is there any one memory that stands out?

I would say the surveys that were taken. Particularly, I was instrumental in going to places and talking with business owners about the project about allowing the team to conduct surveys on their property. They were so congenial and open to helping. I was surprised. They will still ask how things are going and how they can help.

I have learned some things from the areas I’ve been in and the people I’ve talked with. I didn’t realize how many people don’t have insurance and don’t see a doctor until an emergency happens. I guess I saw it but didn’t see it.

What community needs are you most concerned about?

I’m mostly concerned about the lack of medical assistance available in my community. This includes a lack of education on illness, how do avoid different illnesses, and how to manage their disease if they to get sick. The lack of [health] education means people don’t take health seriously.

Over my life, I’ve watched people with diabetes who only had a torso when they were buried. Their limbs had been amputated. Also, people don’t know that they can lead a good life with Diabetes. Many think it is a death sentence. I’m seeing younger and younger people who say they have High Blood Pressure. Being retired, I now have the time to pay more attention to my surroundings.

In a project like this, we can see the problems and how people fall through the cracks. This work allows us to create a catch basin.

How do you see the sentinel surveillance project addressing these issues in the community?

Hopefully, improve the areas where the data has been collected. I like to think this project will address the issues. I have been asked how long are you going to collect data, when are you going to do something. If I didn’t believe in it, I wouldn’t be sitting here.

Have you ever been involved in research before, if so how is this similar or different?

No, I had no research experience before participating in this project.

What have you learned about research through this process?

I’ve learned that people are embarrassed to be honest about their health. I’ve learned that we can’t put people on the defensive when we talk to them about these issues and ask questions. I guess I’ve learned humility. I’ve never been known to have much patience. Now, I can look beyond a “fault” and understand how to help.

I’ve learned that some people can’t help themselves because they don’t know how. This has taught me to reach out and help them on their own terms.

Would you encourage others people in your life to participate in or be a part of leading/shaping research projects as a result of your involvement with Sentinel Surveillance?

Yes, I would but I would be cautious. You have to be careful of people who want to make a big name for themselves and are not really focused on helping the community.

HDRG Recap: “From Charity to Justice: Optimizing the Impact of Service Learning and Community Service”

The final Health Disparities Research Group (HDRG) meeting for the 2016-2017 academic year was held Friday, May 19th. Dr. Erik Goldschmidt, the Director of the Foley Community Service Center at Spring Hill College (Foley Center) was the presenter. Dr. Goldschmidt described the integral role community service plays in the mission of Spring Hill College and the ways in which the Foley Center advances community service efforts by supporting the volunteer work of nearly 50% of the student body each year.

The Foley Center administers service learning courses for many of the departments at Springhill. Service learning classes must provide students with opportunities for authentic interaction with community groups and the individuals they serve. Springhill strives to ensure that these authentic interactions result in student experiences that are characterized by substantial and sustained onsite service to local non-profit, direct-service organizations. This interaction focuses on building relationships which then become the vehicle for student development of self-knowledge, awareness of others, and systems thinking.

In addition, Dr. Goldschmidt discussed the Foley Center’s plans for future growth. A core principle driving the next phase of development is the goal of facilitating systemic engagement that advances beyond charitable work to justice oriented action. The College intends to support students as they work alongside partners to solve real-world problems. Ultimately the expectation is that there will be a “reciprocal learning process” that will improve the community while supporting students in their academic and spiritual journey.

The Foley Center is also exploring ways to bring community members on to the Spring Hill College campus for authentic interactions. One approach is “college exposure” days for students from area middle and high schools. More than a campus tour, the exposure day is designed for two way interaction between the 25 visiting students and approximately 70 faculty, staff and students involved with the group throughout the day. The day also provides for cooperative learning activities in the classes.

Another approach to bringing the community into the campus is a semester focus on one community partner. The partner organization’s leadership and staff can visit the campus, interact with students, and speak in various classes. The interaction includes asking, “what more could we be doing with you.”

Throughout his presentation, Dr. Goldschmidt stressed the potential for personal development of students of service learning, while reinforcing the need to authentically engage with partners with respect and humility.


Useful Resource: Find Summer Meals in Your Community

Find Summer Meals in Your Community is an interactive mapping tool to help families locate nutritious free meals for children and teens around the country. The resource, developed by the Department of Agriculture, works on tablets, smartphones, and other mobile devices without the need to download. Users can enter an address, city, state, or zip code to find up to 50 nearby locations. Information provided includes site addresses, hours of operation, contact information, and directions.

Visit Find Summer Meals in Your Community.


CAB Member Profile: Leevones Fisher

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Mrs. Leevones Fisher speaking at the CHC Community-Engagement forum in January 2017.

The Sentinel Surveillance to Monitor Progress toward Health Equity project aims to develop and implement a surveillance system to capture the information necessary to monitor progress towards health equity for health disparate populations. One key element of this project is the engagement of community members through a Community Advisory Board (CAB). Recently, Mrs. Leevones Fisher, a community activist and member of the CAB, shared a little about her reasons for participating in the CAB and the importance of continued investment in research.

Tell us a little bit about yourself and your background.

I grew up in the Trinity Gardens community of Mobile, AL. My family of nine consisted of mom, dad, and six siblings. After attending school at Trinity Lutheran School and graduating from Trinity Gardens High School, I did undergraduate studies at Talladega College where I majored in chemistry with a minor in math. After receiving my degree, I moved to Atlanta, GA, to teach school for five years. I returned to Mobile when my mother fell ill with cancer. I started working in Alabama, married and had one son. I’ve been in Mobile ever since.

I stared the Bay Area Women Coalition (BAWC)  in 1997 in response to the many problems with crime in the neighborhood. My brother had been murdered. The children of friends had been murdered. Crime in our community was bad at that time with police and service workers afraid to come into the neighborhood. As a result of the organizations advocacy and focus on improved housing, the crime rate has gone down. We’ve constructed 50 new homes and build two affordable housing subdivisions – with one made up of apartments for seniors. We’ve also renovated or repaired over 400 houses and are currently working with community gardens to improve access to healthy food.

How did you become involved with the Community Advisory Board for the Sentinel Surveillance Project?

It all started when I attended a workshop at Bishop State Community College 10 years ago. Dr. Crook and Dr. Arrieta came to the workshop to talk about health. I talked to them about health and how the university needs to be more involved with the community. The relationships shouldn’t be a one-way thing.

Why did you decide to become part of the CAB?

One reason I joined the CAB is I wanted to give my opinion on the neighborhood and what is happening as a community member. Being a apart of the group provided an opportunity to see things improve and grow; and I wanted to monitor the growth of the impact the project would have on the community.

Give us a few highlights of your time as a CAB member. Is there any one memory that stands out?

One thing that stands out is when I got the chance to go to the national conference and meet others from across the country and share during the poster session. It was an eye-opening experience to find out that so many people were interested in what we are doing.

What community needs are you most concerned about?

Health is a big concern, especially women’s health. Most of the women in our community are the heads of households and they are not in good health. When we don’t take care of ourselves, it means that we are not taking good care of our family.

How do you see the sentinel surveillance project addressing these issues in the community?

Poor housing is a big issue. But, I’ve learned that health is also one of the main issues. Poor housing and poor health go together. If people are not healthy, they don’t care about the housing part. They are just trying to get well. Health helps housing and housing helps health. The two go together. Poor health means that you can’t keep up your house.

Have you ever been involved in research before, if so how is this similar or different?

Yes has been involved in research before this project. I did a lot with with the College of Business, Dr. Semon Chang. He had us go door to door to do an assessment of the community, a housing assessment. With Dr. Ken Hudson, we tried to figure out why the housing and health issues were such a detriment in the neighborhood. Both surveys were done because we had gone out to find the information we needed to make a change on the housing issue. The impact was we learned that poor housing had an impact on health conditions. This led to trying to find out what could be done about health conditions.

What have you learned about research through this process?

It has to continue. When you start looking at one thing, you find something else that has to be addressed. We need to continue investing in research to address issues in the community with people. Housing work led to health research, and we learned that it is big and needs to be narrowed down to certain areas. There are so many issues with health, which is very different than housing. So we must continue researching to understand the issues and how they work together and how they can be addressed.

Has the experience changed the way you consider or approach research in other areas of your life?

Yes… keep researching looking at every facet from infancy to old age. Pick an age and you can research and find out so many fascinating facts about that age. Whether it is finance or spiritual needs,  there is so much that can be researched. I used to think of research as trying to find a cure for cancer or something. But, it is multifaceted.

Would you encourage others people in your life to participate in or be a part of leading/shaping research projects as a result of your involvement with Sentinel Surveillance?

I would. I would like for them to be a part of it not just because they are receiving something; but, because they want to see a different in their community. We need to research how this could happen. I think of President Kennedy saying, “Ask not what your country can do for you – ask what you can do for your country.” This always resonated in my mind because most people when asked to participate in research want something in return.

Any final thoughts on research.

We need to keep the ball rolling because I don’t think the need for research will ever end.


Useful Resource: Peer City Tool and 500 Cities Data

The following comes from an article posted on the site Community Commons titled ‘Peer City Tool and 500 Cities Data: Mapping Trends and Challenges Among Peer Cities’.

The Federal Reserve Bank of Chicago (FRBC) recently introduced the Peer City Identification Tool. The tool identifies peer or “sister” cities that are experiencing similar trends and challenges in equity, economics, and resiliency. It’s meant to provide policymakers, community advocates, and practitioners with context on how their city compares to similar cities. However, it does not mean the cities are the same, but simply highlights cities that are experiencing similar trends and challenges.

The tool was born out of a multi-year study by the FRBC to gather economic and social data on post-industrial cities across the Midwest and Northeast. As opposed to simply publishing a report, the FRBC decided to develop a mapping tool. Today, the tool provides city-level data from 300 cities across the country. Cities with available data have a median population of roughly 100,000.

Since it’s a comparison tool, leaders can see how their own assets and liabilities compare to similar cities in their region and across the country, especially among those with similar histories and challenges. Though the cities may have regional or cultural differences, their shared economic and demographic characteristics have important policy implications for decision makers and planners looking for success stories.  It’s a unique opportunity to share and learn best practices for addressing challenges at the community level.

…With the recent release of the 500 Cities Project data, policymakers and advocates now have access to updated city and tract-level data for chronic disease risk factors, health outcomes, and clinical preventive services. It’s a collaboration between the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the CDC Foundation.

The Peer Identification Tool data gives a snapshot on a variety of social and economic factors among peer cities, like economic resiliency. However, to give an even more robust snapshot, 500 Cities data can be used to explore a variety of health conditions and outcomes.

For example, struggling with unemployment, precarious employment, or poverty can be a factor in higher rates of mental health issues. To explore, 500 Cities data can be brought in to compare the percentage of adults with poor mental health among these sister cities who are experiencing poorer social and economic outcomes. It’s important to note that the base city will have different sister cities in each category, though there may be some overlap.

Read the full article.
Explore the Peer City Identification Tool.
Explore the 500 Cities Project.

Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults

The following comes from a Commonwealth Fund summary of research first published in Health Affairs Web.

Low-income adults in Arkansas and Kentucky who obtained coverage under the Affordable Care Act’s Medicaid expansion had better access to primary care and preventive health services, lower out-of-pocket costs, improved medication compliance, and improved self-reported health status than did low-income adults in Texas, which did not expand Medicaid. Among adults with chronic conditions, ACA coverage was associated with better disease management and medication compliance and a significant increase in self-reported health status.

The Issue
Congress is currently weighing the future of the Affordable Care Act. Since becoming law, the ACA has helped more than 20 million Americans enroll in health insurance coverage, and national studies have noted improvements in coverage, consumer satisfaction, and access to care. In this Commonwealth Fund–supported study, researchers compared Kentucky, which expanded Medicaid as prescribed by the ACA; Arkansas, which obtained a waiver to use federal Medicaid funds available through the ACA to purchase private marketplace insurance for low-income adults; and Texas, which did not expand Medicaid coverage. Looking at these three states, the authors assessed ongoing changes in health care use and self-reported health among low-income adults, including those with chronic conditions, after three full years of the ACA’s coverage expansions.

Key Findings

  • By the end of 2016, the uninsured rate in Arkansas and Kentucky—the two expansion states—had dropped by more than 20 percentage points compared to Texas, the nonexpansion state. In 2016, the uninsured rate was 7.4 percent in Kentucky, 11.7 percent in Arkansas, and 28.2 percent in Texas.
  • Low-income adults in Kentucky and Arkansas who gained coverage experienced a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket costs, and a 23-point increase in the share of those who reported they were in “excellent” health.
  • Results were similarly positive for people with chronic illnesses who gained coverage because of the ACA. Low-income patients with diabetes, heart disease, hypertension, and stroke who gained coverage were 56 points more likely to report having regular care for their condition than were chronically ill adults in Texas, 51 points less likely than those in Texas to skip medications because of the cost, and 20 points more likely to report being in excellent health.

See the full summary.
See the original article.


Attitudes for Designing Population Health Interventions

In this video from,  Dr. Moon S. Chen, Jr., professor of hematology and oncology at UC Davis Comprehensive Cancer Center and principal investigator of The National Center for Reducing Asian American Cancer Health Disparities, responds to the question , “What are some important considerations in designing health interventions for minority populations?” As a part of his answer, Dr. Chen discusses the attitude of humility and the need to work with the community instead of on the community.

Medicaid’s Role in Providing Access to Preventive Care for Adults

The following excerpt is from a Data Note by Leighton Ku, Julia Paradise, and Victoria Thompson published by the Kaiser Family Foundation published on May 17, 2017.

Medicaid, the nation’s public health insurance program for people with low income, covers 74 million Americans today, including millions of low-income adults. The Affordable Care Act (ACA) expanded Medicaid to nonelderly adults with income up to 138% of the federal poverty level (FPL), and, in the 32 states (including DC) that implemented the expansion, more than 11 million adults have gained Medicaid as a result. Chronic illness is prevalent in the adult Medicaid population. Preventive care, including immunizations and regular screenings that permit early detection and treatment of chronic conditions, improves the prospects for better health outcomes. This Data Note focuses on Medicaid’s role in providing access to preventive care for low-income adults.

Why is preventive care for adult Medicaid Enrollees Important?

Adults in Medicaid have high rates of preventable and controllable conditions. Nearly one-third (30%) of non-elderly adult Medicaid beneficiaries report that they are in only fair or poor health – roughly double the percentage of low-income privately insured and uninsured adults who report fair or poor  health (Figure 1). Medicaid adults also have significantly higher rates of chronic conditions and risky health behaviors that may be amenable to preventive care. One in 10 adult enrollees has a diagnosed mental illness; 7 in 10 are overweight or obese, and almost 1 in 3 smoke tobacco.

Preventive care can reduce disease and avoidable use of high-cost services. Increased access to screening for diabetes, cancer, depression, and o ther chronic conditions, and counseling to address behavioral risk factors, have the potential to reduce disease and prevent exacerbations of conditions that can be medically managed. Improved health may reduce the use of avoidable hospital and other high-cost care, and reduce Medicaid spending. For example, smoking can cause heart disease and other chronic illnesses that one study estimated may be responsible for more than $75 billion in Medicaid costs. Medicaid coverage of smoking cessation services, including quit lines and medications, has the potential to mitigate both the health and cost impacts of smoking. Obesity, a major driver of preventable chronic illness and health care costs, affects about two-thirds of low-income adults. Findings from one study indicate that severe obesity in adults cost state Medicaid programs almost $8 billion in 2013, suggesting that “effective treatment for severe obesity should be part of each state’s strategy to mitigate rising obesity-related costs.”

What Preventive Services Does Medicaid Cover for Adults?

Coverage of most adult preventive services has historically been optional for states. Medicaid coverage of preventive services for children has long been strong, as states must cover comprehensive preventive services at no cost for children in Medicaid under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. In contrast, historically, coverage of adult preventive care has been largely optional for states, with some exceptions – states must cover pregnancy-related care and family planning services without cost-sharing. In addition, within federal guidelines, states can charge adults cost-sharing for preventive services.

The ACA expanded coverage of adult preventive care. An important thrust of the ACA was an emphasis on preventive care. In particular, the ACA included recommended preventive services without patient cost-sharing as one of the 10 “essential health benefits” (EHBs) that most health plans are now required to cover. The required preventive services are based on the recommendations of independent, expert clinical panels and include, for adults: 1) screening and counseling services (e.g., cancer screening, diet counseling); 2) routine immunizations; and 3) preventive services for women. The EHB requirement applies to Medicaid benefits for adults who are newly eligible due to the ACA expansion, but not “traditional” Medicaid adults, for whom most preventive services are optional for states and can require cost-sharing within federal guidelines. To incentivize states to cover the EHB preventive services for all Medicaid adults, the ACA provided for a one percentage point increase in the federal Medicaid match rate for these services in states that opt to cover all of them without cost-sharing.

Read the full data note.