U.S. Is Many Different Communities When it Comes to Health

The following excerpt comes from the November 1, 2017, article by Sternberg in US News and World Report.

The jigsaw puzzle of U.S. counties fits neatly together into a pleasing whole, displaying America as a land of many parts.

Within those parts, people in adjacent communities may have similar lifestyles and incomes. They may eat similar foods, enjoy the same music, picnic in the same parks and vacation at the same campgrounds or beaches.

But look more closely and you’ll find people living in neighboring communities often live very different lives. Residents in one county may suffer many more days of poor physical or mental health – or both – than those in the county next door. People in many communities even live longer than those in communities nearby, a pattern that extends nationwide.

Which is why community health assessments – including a new U.S. News ranking of the nation’s Healthiest Communities, to debut in March – are so valuable for identifying trouble spots and targeting remedies to where they’ll do the most good.

Think of them as diagnostic scans of what ails America, from soaring rates of obesity, hypertension, and diabetes to pervasive mental health problems and opioid abuse. The overlapping epidemics are having a profound impact nationwide. For the first time in nearly a century, life expectancy has begun to decline in major population groups, and not just in poor underprivileged neighborhoods. Death rates rose for white men, white women, and black men, and remained essentially unchanged for black women and Hispanic men and women.

“This is the first time we’ve really seen fairly marked decreases in life expectancy in key groups and not simply the socially disadvantaged,” says Dr. William Stead, chief strategy officer at Vanderbilt University Medical Center and McKesson Foundation professor of biomedical informatics.

In most measures of population health, the world’s richest country lags behind other developed countries, despite trillions spent each year on medical care.

“Waves of chronic disease are reaching historic rates,” says Tyler Norris, chief executive of the Well Being Trust, a $100-million nonprofit funded by Providence St. Joseph Health to help improve the nation’s mental and physical health. Chronic diseases not only reduce productivity, he says, they have driven health care costs so high that they are “unaffordable no matter who you are.”

Eighty percent of the growth in Medicare spending – now totaling nearly $650 billion a year – is due to chronic disease, says Kenneth Thorpe, of the Rollins School of Public Health at Emory University and chairman of the Partnership for Chronic Disease.

Tragically, this chronic-disease epidemic of diabetes, hypertension, heart disease, stroke, arthritis and other ailments is occurring against the backdrop of a revolution in medical care, one that ushered in countless innovations including antibiotics, blockbuster drugs, high-tech surgery and genetic medicine.

The roots of the problem run deep, anchored in national neglect of festering social problems and each community’s history, culture, economy, schools, hospitals, neighborhoods and sense of place. These so-called social determinants offer a way of assessing community health. They show that poor health and other social problems are more heavily concentrated in some neighborhoods than others, variations that may not be apparent when examined at the national or state levels.
Read the full article.


Food Security, Social Determinants of Health Lower Hospital Use

The following excerpt comes from the November 1, 2017, article by  Sara Heath on Patient EngagementHIT.

Implementing public programs to supplement food security in low-income patients can help reduce hospital use within that population, according to a study published in both BMC Geriatrics and Population Health Management. This data suggests that addressing the social determinants of health can directly improve health outcomes.

Currently, nearly one-third of senior patients live on income less than 200 percent of the poverty line, a fact which the Maryland-based research team said impacts that healthcare industry. Low-income patients have a higher propensity for utilizing hospitals and the emergency department.

Previous efforts to meet health needs include expanding access to primary care, but researchers added that caring for social needs is also essential for health improvement.

“Excess hospital utilization in this population was once believed to be preventable by improving health care access,” the research team said. “However, disparities exist among older adults who have health insurance through Medicare, and are not attributable to access to primary care providers.”

Previous research has suggested that 85 percent of patient health is determined by the social determinants of health, as opposed to genetic makeup or other health-related factors such as healthcare access.

The social determinants of health include social factors like housing, education level, and food security, among others.

The Supplemental Nutrition Assistance Program (SNAP) is one such program suitable for addressing food security. The federally-funded program has proven effective in expanding food access for low-income individuals, and shown that food access may be tied to health outcomes, the team posited.

“By targeting financial support toward food needs, SNAP can improve access to a higher quality diet for food insecure adults,” the researchers explained.

“There is evidence of reduced caloric intake, poorer dietary quality, and greater risk of hypoglycemia for low-income adults at the end of the month when funds run low,” the research team continued. “Therefore, greater SNAP benefits may facilitate chronic disease management for nutrition-sensitive conditions, which may account for evidence of reduced chronic disease hospital utilization.”

The team looked at nearly 6,900 patients over the age of 65 who were dually eligible for Medicare and Medicaid between 2009 and 2012. Matching data about days spent in the hospital, healthcare costs, and emergency department visits with SNAP enrollment data showed that the program has an impact on healthcare.

SNAP benefits reduced the likelihood for hospitalization by 14 percent, and reduced the likelihood of each individual day in the hospital by 10 percent.

The program also reduced the likelihood of nursing home admissions by 23 percent, and reduced each additional day in the nursing home by 8 percent.

SNAP benefits had no statistically significant effect on ED utilization, but the researchers maintained that the results nonetheless showed great potential for SNAP in healthcare.

Specifically, the results proved that more than just increasing access to care can help reduce hospital and ED utilization.

“It is notable that all had access to both Medicare and Medicaid because policy makers have increased access to health care for low-income groups thinking that that alone would reduce high hospital utilization in low-income groups,” the researchers pointed out.

Read the full article.


Thinking about the Social Determinants of Health

Dr Crook EditedAt the end of November 2017, Dr. Errol Crook, Director of the Center for Healthy Communities and the Abraham Mitchell Chair of Internal Medicine at the USA College of Medicine, gave a presentation during Internal Medicine Grand Rounds on “The Social Determinants of Health: A Focus on Poverty.” Dr. Crook started by saying that he wanted to talk more about public health than focusing on one patient. Through the presentation, he explored:

  • Health equity and health disparities
  • Discussed socio-cultural determinants of health in the U.S. (and the world)
  • Reviewed the impact of poverty on health
  • Examined the importance of understanding how social factors may impact care of individual patients

Poverty in contextIn the discussion on poverty, Dr. Crook explained the importance of context and understanding that

  • Having an income does not remove the risk of poverty
  • Wealth and income are different as a person may have income but not the accumulated wealth to cover emergency expenses such as unforeseen health issues
  • People living in poverty usually work many hours and many jobs.

In other words, for people living in poverty or near it, health care and education costs are discretionary expenses. They have to decide between buying medication or seeking care and paying for gas to get to work.

With that background, he introduced two projects from the Center for Healthy Communities. First, The Impact of Labor Force/Labor Market Status On Access To Health Care with Dr. Kenneth Hudson as Principal Investigator explored the relationship between job types (good job, mediocre job, or bad job) and health. The study looked at a random sample of households in census tracts in Mobile, AL, with at least 50% of residents living at or below the federal poverty line. Dr. Hudson and his team found that

  • 91.5% of respondents were working
  • The majority of respondents were in bad jobs — those without health or retirement benefits and paying poverty wages
  • The participants spent a large percentage of income on basics such as rent and utilities
  • For those who did not acquire a job with health insurance or retirement benefits before the age of the 30, the most likely never would.

Dr. Crook also talked about the importance of data from The Sentinel Surveillance to Monitor Progress Towards Health Equity with Dr. Martha Arrieta as Principal Investigator. Given the difficulty of obtaining good information on the health status of individuals living in low-resource areas, the project used a sentinel surveillance approach to choose data collection sites that intersected with the daily lives of residents in three high poverty zip codes in Mobile, AL. The research produced a lot of information on the number of people below the age of 65 reporting having chronic diseases such as diabetes and high blood pressure. Dr. Crook emphasized that 68% of those responding to the survey felt that diabetes would result in severe complications regardless of what treatment or lifestyle changes a person underwent.

Dr. Crook closed his presentation by drawing together the threads of social factors, income and wealth disparities, employment status, and attitudes toward health into a single pattern focused on an individual patient and her health needs. He asked those attending to think about the patient’s future prospects based on what her educational and socio-economic status were. He encouraged those working in the clinics to think about these issues as they worked with individuals.

View Dr. Crook’s presentation online.

New Journal Focused on Community-Based Research and Practice

In 2017, Collaborations: A journal of Community-Based Research and Practice launched to offer a peer-reviewed, open access resource focused on community-university collaborations. As an academic journal, Collaborations  will publish information related to:

  • The initiation of grassroots change efforts
  • The ingredients necessary for effective partnerships
  • The challenges of sustaining change
  • The process of technology transfers/research-to-practice/policy
  • The use of action research to document the effects of school-university collaborations
  • The development of community resources to improve university coursework
  • Civic engagement through university-community partnerships
  • Public policy and practice-relevant knowledge generated through university-community collaborations

Collaborations is divided into three sections: Scholarly Research, University-Community Collaborations, and Reflections on Experiential Learning. It is sponsored by the University of Miami and Rutgers University.

See the first issue of Collaborations.

Learn more about the journal.

Read the submission guidelines.

APHA Reflections: Lynette Parker

Lynette croppedFrom November 5 to 7, 2017,  members of the Center for Healthy Communities Research Core attended the American Public Health Association’s Annual Meeting and Expo in Atlanta, GA. Below, Ms. Lynette Parker, research assistant,  shares some thoughts on her first time attending the APHA meeting.

In general, what was your impression of the event?
APHA was huge. Choosing sessions to attend was difficult due to the diversity of subject matter and approaches. I ended up in sessions on community-based participatory research, violence, exercise, and big data. It was definitely a trove of information and learning.

Tell us about one session or activity that stood out to you?
A couple of things stand out to me. First, I attended a session titled “COmmunity voices: Community member perspectives on community-academic partnerships and CBPR.” Each of the presenters focused on the work of their partnerships and the findings from their research. The final presentation “Research Ethics in the Time of Crisis” really stood out to me as the presenter discussed the development of a Community Ethics Review Board in Flint, Michigan, following the water crisis.  In my opinion, the presentation — and work it is based on — offers an important example of how a marginalized community can have a voice in determining community direction and the research that is conducted within its boundaries.

A second experience was presenting the Research Core’s poster on its process for involving community members in the planning process for disseminating the findings of the Sentinel Surveillance Project. The conversations with others working on community-engaged projects were enlightening. I had a long conversation with a researcher from North Carolina who was doing work with Adverse Childhood Events in North Carolina. We talked about different ways of bringing community members more into projects so that they can help improve the research and interventions.

What are some lessons you learned at APHA?
I don’t know if it was a lesson learned or more of one reinforced, but the many sessions that I attended solidified the importance of community engagement in my mind. From a big data social media project to the Community Ethics Review Board to the improvement of an exercise intervention after user feedback, many of the sessions I attended pointed to the need to learning from those we are working with.

Is there anything else you would like to share about your experience?
APHA was very informative if a little overwhelming. It was good to get feedback on the work we are doing.

CHA Led Project: Learning about Nutrition and Gardening

IMG_1504On October 30th, Community Health Advocates (CHA) Bo and Sheena Williams hosted an event promoting gardening at the Taylor Park Community Center and Garden. The event started with a talk from Bo Williams on the history of gardening in the African American Community. This was followed by a lunch and a day in the garden. Children at the Taylor Park Center helped construct raised beds that are easily accessible for senior adults.

Learn more about the CHA program and activities.

HDRG Recap: Building Community Based Research through Community Coalitions

DannyEditedAt the November 2017, Health Disparities Research Group (HDRG) meeting, Danny Patterson, Coordinator, Collaborations and Partnerships, Gulf States Health Policy Center (GSHPC), shared about their experiences with coalition building to work for improving health outcomes. Working in 5 states (Alabama, Florida, Mississippi, Louisiana, and Texas) GSHPC united with community members, partner organizations, and service providers to form coalitions including 130 multi-sector community organizations in the states of Alabama (cities of Bayou La Batre, Mobile, Birmingham) and Mississippi (cities of Hattiesburg and Gulfport/Biloxi) and Louisiana via LSU in Baton Rouge. Coalition members represent a range of groups including faith-based organizations, government, education, primary care, mental health, housing, academia, public health, business, law enforcement, and other community-based organizations. GSHPC works with both local and national partners in their work. The work is supported by the National Institute of Minority Health Disparities.

With a focus on health policy research that leads to positive change, the coalition building process included three basic phases: member recruitment, development of strategic partnerships, and training of coalition members. Activities taking place throughout the process include community information meetings, coalition member recruitment, policy focus area identification, subject matter expert presentations, community forums/policy scans, literature reviews, community action plans (in development) and action plan implementation. The goal is to “empower communities and increase their capacity to improve health outcomes.”

The local coalition is currently working in 3 policy areas: health literacy, financial literacy, and educational literacy.  In terms of health literacy, the coalition is working on local practice or policy change by creating pathways for data sharing between Ozanam Charitable Pharmacy and Mobile Board of Health Clinics. The current research pilot, designed by the coalition, will recruit 50 diagnosed diabetes patients (as of November 6, 31 had been recruited). The two organizations serve mostly low-income and homeless individuals. The process under study will facilitate the sharing of information for the participating patients in order to provide more holistic care. To date, lack of transportation from the clinic to the pharmacy has been identified as one of the problems that will need to be addressed. The study will evaluate whether or not the increased communication between pharmacy and doctor translates into improved care and disease medication management for the patients.

During the question and answer phase of the HDRG meeting, Danny stressed the importance of transparency and open dialogue to build the coalition. Such an approach — a willingness to give a little while building something greater — helps develop the relationships needed to develop a healthy and impactful coalition.

Along with projects related to policy, the GSHPC coalition focuses on building community-based leadership capacity. This capacity is critical for sustainable once funding for the projects are over. The built capacity for local leaders to continue the policy work is essential for continued progress toward health equity.

Learn more about the Gulf States Health Policy Center.
Learn more about the Health Disparities Research Group.

APHA Reflections: Marcellus Hudson

Marcellus APHA_smallFrom November 5 to 7, 2017,  members of the Center for Healthy Communities Research Core attended the American Public Health Association’s Annual Meeting and Expo in Atlanta, GA. Below, Mr. Marcellus Hudson, research technician III,  shares some thoughts on his first time attending the APHA meeting.

In general, what was your impression of the event?
I  was impressed by the number of people in attendance. I felt welcomed in the first session I attended. I, also, felt like everything was organized.

Tell us about one session or activity that stood out to you?
The session that stood out to me was the Black Caucus of Health Workers. This session stood out because I wasn’t aware of an organization that focuses on recognizing the health care needs of Blacks in America. They explained their organization’s history and why it was formed. I was told that it was one of APHA’s oldest organizations.

What are some lessons you learned at APHA?
I learned the difference between the Public Health field and Medical field. I understand that the Public Health field is focused more on populations while the Medical field is focused more on individuals. I  learned about effectively using social media to engage your audience by utilizing tools like HootSuite and Buffer.

Is there anything else you would like to share about your experience?
It was an amazing experience and I look forward to next year’s!


CHA Led Event: 6th Annual Rainbow Cancer Walk-a-Thon

event_editedOn October 27, 2017, Revelation Missionary Baptist Church held its 6th Annual Rainbow Cancer Walk-a-Thon. Started by Community Health Advocate Mrs. Gloria Carter, the event offers an opportunity for participants to memorialize the lives lost to cancer, celebrate cancer survivors, and learn more about different forms of cancer. After opening in prayer, Walk-a-Thon participants walked around the church’s life center.
Cancer education was provided by representatives of the Mitchell Cancer Institute. Mobile’s Azalea Trail Maids came out to show their support.

Heart Health Disparities Take Toll on African-Americans

The following excerpt comes from the article by Will Boggs published October 23, 2017,  on Reuters.

African-Americans have worse cardiovascular health and more deaths from heart disease than other groups, at least partly from less effective disease prevention and management efforts, according to a scientific statement from the American Heart Association (AHA).

”While African Americans are more likely to experience many cardiovascular diseases, in particular strokes and heart failure, they are also more likely to die from cardiovascular diseases,” Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago told Reuters Health by email.

Because African Americans develop nearly all cardiovascular diseases – heart attack, stroke, and heart failure – at a relatively young age, she continued, “higher rates of death may arise from the length of time that African Americans live with these conditions.”

“Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” she said.

Traditional cardiovascular risk factors – high blood pressure, diabetes, obesity, and atherosclerosis – are more common and start at earlier ages among African Americans, Carnethon and colleagues report in the journal Circulation.

Unfortunately, not much has changed since 2005 when a special issue of Circulation pointed out disparities in the rates of cardiovascular disease, disease management, and outcomes for African-Americans.

Many of the differences arise from unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong, the research team writes.

African Americans also have higher rates of certain health conditions that predispose to cardiovascular disease – such as chronic kidney disease, sickle cell disease/sickle cell trait, and HIV, for example.

Genetic differences between African-Americans and other ethnic groups appear to explain only a small part of the disparity in cardiovascular disease rates and outcomes.

Finding strategies that reach younger African-Americans and men with disease prevention messages remains a significant challenge, Carnethon’s team notes.

“Cardiovascular diseases are preventable with healthy lifestyles,” she said. “Unfortunately, many African-Americans do not have equal access to the resources needed to lead healthy lifestyles, specifically access to healthy foods, safe spaces for physical activity, and peaceful homes and communities that promote restorative sleep.”
Read the full article.