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.

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.


Synopsis
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.

 

Medical Research: Ensuring the Infrastructure of Hope

 

The following article originally appeared in the Med School Watercooler from the University of South Alabama College of Medicine.


By Selwyn M. Vickers, M.D., FACS; John V. Marymont, M.D., MBA; and Richard M. Myers, Ph.D.

Author information: Vickers, University of Alabama at Birmingham senior vice president of Medicine and dean of the School of Medicine, is a world-renowned surgeon, pancreatic cancer researcher and pioneer in health disparities research. Marymont, University of South Alabama vice president for medical affairs and dean of the College of Medicine, is a nationally known academic leader and orthopaedic surgeon. Myers, HudsonAlpha Institute for Biotechnology president and science director, is an internationally renowned genomics and genetics researcher who was a key contributor to the Human Genome Project.

Medical research means hope for millions of Americans and their families affected by a life-changing disease like Alzheimer’s, diabetes, cancer or heart disease — diseases that certainly have an impact in Alabama. As we look to the future, it is important for Congress to continue to fund the National Institutes of Health to provide for the critical infrastructure needed by our nation’s medical research enterprise.

Today, the physicians, scientists and patients at the UAB School of Medicine, USA College of Medicine and HudsonAlpha Institute for Biotechnology urge Congress to continue its commitment to sustained, robust growth in the NIH by creating a sustainable model for funding the NIH moving forward. Congress responded in a bipartisan and positive way to the extreme cuts proposed by the administration. Investment in scientific discovery is crucial to improve the health of patients, strengthen the economy in the near and long terms, and maintain the United States’ global pre-eminence in medical innovation.

The nation invests less than $100 per person annually for all of the research conducted and supported by the NIH, yet the return on investment has been spectacular for us all. The quality of life for millions of Americans has been improved by innovations in treatment, technology and care resulting from NIH-supported research across the country.

Because of NIH-funded research, the HIV transmission rate in the United States from infected mothers to their babies has fallen from 27 percent in 1990 to less than 1 percent in 2017. Childhood cancer patients with lymphocytic leukemia now have a five-year survival rate of 90 percent as a result of available treatments. People battling high cholesterol can take statins to manage their health. Vaccines have been developed to prevent hepatitis A, rotavirus and the human papillomavirus (HPV). The emerging field of genomics is the foundation for countless discoveries. While there is tremendous potential, advances in genomics have identified key factors in widespread, costly diseases such as Alzheimer’s and have provided prevention strategies for breast and other cancers.

The federal government, primarily through NIH, plays an irreplaceable role in supporting medical innovations by funding the research that serves as the foundation for these and other lifesaving advances. Given the uncertainty of discovery — the next important insight into a disease could come from a number of different avenues or organisms — industry relies on this investment to inform our fundamental understanding of medicine. This research is a springboard that speeds and makes possible the development of treatments and cures.

Physicians and scientists at U.S. medical schools and teaching hospitals such as the UAB and USA Schools of Medicine conduct more than half of all external research funded by NIH. Because of NIH support, these investigators are a force for translational discovery through their ongoing research of techniques such as deep brain stimulation, an important treatment for patients with Parkinson’s disease and other movement disorders; exploration of molecular changes that happen to the body during and after exercise; and design of cutting-edge clinical trials to advance discovery and new therapies.

The proposed cuts to NIH funding not only affect medical research, but they affect the very fabric of academic medical centers and nonprofit research institutes— institutions across the country employing faculty and staff to conduct this scientific research and provide the best possible care for patients. At UAB, USA and HudsonAlpha, less than 15 percent of funding comes from the state of Alabama. More than 25 percent of revenue comes from federal grants, including those from the NIH and U.S. Department of Health and Human Services. Removing or reducing that funding would be devastating for patients, researchers and works alike.

Forty-five of the nation’s 50 states have academic medical centers, each making large economic impacts, both in  its local and regional communities and in its state as a whole. UAB and USA are among the largest employers in Alabama.  

This kind of economic development has made the United States the world leader in medical research, but its stature may be slipping as other countries have been increasing their public investment in research. While Congress recently took important steps to help the NIH regain some of its lost purchasing power, flat — or even worse, reduced — future appropriations threaten to undermine these key efforts. Because research cannot be turned on and off like a spigot, there must be sustained and predictable NIH budget growth so that researchers can build on previous progress and investment.

Millions of Americans depend on medical research to provide hope in the face of potentially devastating diagnoses. The UAB and USA Schools of Medicine, HudsonAlpha, and the nation’s medical schools, teaching hospitals and nonprofit research institutions urge Congress to help us to maintain the infrastructure of hope.

Our patients — and all Americans — deserve it.

Because Social Science Is Necessary to Achieve Health Equity

The following article by Courtney Ferrell Aklin, Ph.D.(National Institute on Minority Health and Health Disparities (NIMHD) and Eliseo J. Pérez-Stable, M.D. (National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)) first appeared on the Why Social Science Blog? on April 25, 2017.


Living in an America in which all populations have an equal opportunity to live long, healthy, and productive lives is the vision of the National Institute on Minority Health and Health Disparities. As we bring National Minority Health Month to a close, it is important to remember that not all groups have obtained health equity. Racial and ethnic minorities, rural residents, people with disadvantaged socioeconomic resources and sexual and gender minorities carry a disproportionate burden of illness and disease. The search to determine the best way to reduce health disparities and to achieve health equity remains challenging for all of us.

The potential to live longer and healthier lives is greater than ever before with the emergence of medical and technical advances in healthcare and the adoption of healthier lifestyles. Despite these advances, health disparities continue to persist. A health disparity, defined as a health difference that adversely affects disadvantaged populations, based on one or more health outcomes, results from a series of complex and interrelated factors. To truly reduce and ultimately eliminate health disparities a framework must be applied that can address the multifaceted underlying causes of the disparity.

The social sciences have provided the very frameworks necessary for understanding the complexity of health disparities. Health, which is at the center of health disparities, is a combination of interactions among biological pathways, individual behavior, social interactions, physical or built environment, and the intersections with the health care system. Research to date shows that the development and maintenance of disease cannot be explained solely by genes and biological mechanisms. Behavioral and social factors are just as crucial to understanding the trajectory of health disparities as those contributed by biology. Important research questions such as adherence to treatment regimens, patient and clinician racial/ethnicity or gender match and its effects on health outcomes, and the interaction of chronic stress and health behaviors in development of disease are all derived out of social science theory.

The examination of where we work, live, and play, also known as the social determinants of health (SDOH) has taken a prominent role as a contributor to differences in health outcomes for health disparity populations. SDOH sit at the intersection of where social science theory and research methodology are applied to the practice of public health. Given the public health concern that continues to arise as health disparities persist, despite a myriad of targeted interventions to address them, NIMHD is committed to ensuring that all factors contributing to the etiology of health disparities are recognized.

Read the full article.

Medicaid Helps Schools Help Children

From the report by Jessica Schubel on the Center on Budget and Policy Priorities website:

Medicaid provides affordable and comprehensive health coverage to over 30 million children, improving their health and their families’ financial well-being.[1] In addition to the immediate health and financial benefits that Medicaid provides, children covered by Medicaid experience long-term health and economic gains as adults.[2] Many children receive Medicaid-covered health care not only at the doctor’s office, but also often at school.

For students with disabilities, schools must provide medical services that are necessary for them to get an education as part of their special education plans, and Medicaid pays for these services for eligible children. And Medicaid’s role in schools goes beyond special education, as it also pays for health services that all children need, such as vision and dental screenings, when they are provided in schools to Medicaid-eligible children. Schools can also help enroll eligible but unenrolled children in Medicaid or the Children’s Health Insurance Program (CHIP), and connect them to other health care services and providers. Medicaid also helps schools by reducing special education and other healthcare-related costs, freeing up funding in state and school budgets to help advance other education initiatives.

Read the full report to learn more about

  • Leveraging Medicaid for special education
  • Helping kids stay healthy and succeed academically
  • Connecting kids to coverage

As Some Holdout States Revisit Medicaid Expansion, New Data Show It Pays Off

From the article by Shefali Luthra on Kaiser Health News:

Although the GOP-controlled Congress is pledging its continued interest — despite stalls and snags — to dismantle Obamacare, some “red state” legislatures are changing course and showing a newfound interest in embracing the health law’s Medicaid expansion.

And a study out Wednesday in Health Affairs adds to these discussions, percolating in places such as Kansas, Georgia, Virginia, North Carolina and Maine. Thirty-one states plus the District of Columbia already opted to pursue the expansion, which provided federal funding to broaden eligibility to include most low-income adults with incomes up to 138 percent of the federal poverty level (about $16,000 for an individual).

Researchers analyzed data from the National Association of State Budget Officers for fiscal years 2010 to 2015 to assess the fiscal effects of expansion’s first two years.

Their findings address arguments put forth by some GOP lawmakers, who say the expansion will add to the nation’s budget deficit and saddle states with additional coverage costs, forcing them to skimp on other budget priorities like education or transportation.

The researchers concluded that when states expanded eligibility for the low-income health insurance program they did see larger health care expenditures — but those costs were covered with federal funding. In addition, expansion states didn’t have to skimp on other policy priorities — such as environment, housing and other public health initiatives — to make ends meet.

“This is a potential big benefit, not only to people who get coverage, but to state economies,” said Benjamin Sommers, an associate professor of health policy and economics at Harvard University’s public health school, and the study’s first author.

This finding — that states expanding Medicaid didn’t encounter unforeseen budget problems — shouldn’t be surprising.

“Expansion is basically free” to the states, agreed Massachusetts Institute of Technology economist Jonathan Gruber, one of Obamacare’s architects who worked with Sommers to systematically compare the budgets of all 50 states to examine Medicaid expansion’s impact. “That’s the big insight,” he said. “There’s no sort of hidden downside.”

And that may be part of what’s fueling this renewed interest, said Edwin Park, vice president for health policy at the left-leaning Center for Budget and Policy Priorities. These states are seeing the federal windfall their neighbors received while trying to navigate public health concerns like opioid addiction, he said. They “are looking at how their neighbors or expansion states have done, and see the benefits,” Park said. “The primary argument against the expansion on the state level has been it’s going to break the bank. The research demonstrates that’s not the case.”

But a caveat: The data used in this analysis reflected only years during which the federal government picked up 100 percent of the tab for expanding Medicaid eligibility and therefore could overestimate the benefit to state budgets. That’s because in 2017 that federal support begins to taper off, and by 2020 states have to pay 10 percent of the expansion costs themselves.

Read the full article.

This one chart shows how far behind the US lags in healthcare

From the article by Christopher Ingraham on the World Economic Forum Website:

Is the money we’re spending on health care keeping us alive?

On a certain level, that’s the big test of any health-care system — and the United States is failing.

According to chart below, U.S. life expectancy continues to lag far behind other developed countries, despite spending way more on medical treatments aimed at keeping us alive.

US Healthcare lagsThe chart, courtesy of Oxford economist Max Roser, plots per-capita health-care spending against life expectancy for the world’s wealthiest countries over the past 40-plus years. Each country gets one line, which plots its trajectory on those measures over time.

Looking at the chart, two things become clear: As Roser notes, the big takeaway is that, in wealthy countries, more spending on health leads to a longer life expectancy.

But there’s a secondary finding: Not all health-care spending is created equal. In the United States, the inflation-adjusted per-capita annual health spending has exploded from 1970, when it was less than $500 a year, to 2014, when it was about $9,000 a year.

That’s $2,000 more per person per year than the second highest-spending country on the chart, Switzerland. But despite that big spending, growth in American life expectancy has been anemic. Essentially, we spend a lot of money but haven’t seen much in the way of life expectancy gains because of it.

Read the full article.

Competencies Needed for Community-Engaged Dissemination and Implementation Research

An article recently published in Translational Behavioral Medicine proposes a conceptual framework for assessing a researcher’s readiness to engage in dissemination and implementation research with community stakeholders. The authors, all affiliated with the North Carolina Clinical and Translational Sciences Institute, started with a table that included community engagement principles as defined by NIH, potential domains areas for competencies, and potential competencies. Through a process of development, evaluation, and refinement, the researchers developed a list of 40 competencies for community-engaged dissemination and implementation (CEDI) research that fit within 9 domains.  These domains were:

  • Perceived value of CE in D&I research: The researcher’s attitude toward the potential for enhancing D&I research processes and outcomes through community engagement
  • Introspection and openness: The researcher’s willingness and/or ability to examine their own preconceptions and to be receptive of others’ beliefs and opinions
  • Knowledge of community characteristics: The researcher’s willingness and/or ability to learn about the community’s characteristics and prior experiences
  • Appreciation for stakeholder’s experience with and attitudes toward research: The researcher’s willingness and/or ability to assess how the community’s research attitudes and experiences may affect the partnership
  • Preparing the partnership for collaborative decision-making: The researcher’s willingness and/or ability to organize the partnership in a way that facilitate dialogues, collective decision-making, and coordinated action
  • Collaborative planning for the research design and goals: The researcher’s willingness and/or ability to adapt to the attitudes and needs of community stakeholders when defining the research process
  • Communication effectiveness: The researchers’ willingness and/or ability to clearly present ideas, listen to community partners, and work through issues
  • Equitable distribution of resources and credit: The researcher’s willingness and/or ability to share resources for conducting the research and credit for outcomes of the research
  • Sustaining the partnership: The researcher’s willingness and/or ability to invest in a long-term relationship with community stakeholders

The individual competencies associated with each of these domains provide specific actions and/or attitudes to help assess readiness to undertake CEDI research. The authors describe this framework as a “first step toward development of a readiness assessment for researchers interested in conducting CEDI.”

The article is available from Translational Behavioral Medicine.

Upcoming HDRG Meetings

The Health Disparities Research Group (HDRG) is a multidisciplinary assembly of faculty, students, staff, and community representatives with a vision “to become an integral facilitator in eliminating health disparities through partnerships with our community.” Held the 3rd Friday of each month throughout the academic year, the meetings provide an opportunity to share research and cultivate a positive atmosphere for community-engagement in addressing health disparities.

The next meeting is April 21 at 1:00 pm in Bio-medical Library Room 222-A. Dr. C. Kenneth Hudson will provide an update on the project “The Impact of Labor Force/Labor Market Status On Access To Health Care”.

In May, Dr. Erick Goldschmidt, Director of the Spring Hill College Foley Center for Community Service, will share about their work.