How Do Community-based Field Workers View the Impact of Their Research Participation on Their Lives

An  article recently published in BMC Public Health explored the way community-based field workers viewed the impact of research participation on their lives. Authored by Christabelle S. Moyo, Joseph Francis and Pascal O. Bessong, the article — Perceptions of community-based field workers on the effect of a longitudinal biomedical research project on their sustainable livelihoods — reports findings of a study conducted with 16 individuals who had worked as community-based field workers in the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) South Africa which was initiated in 2009. Recruited from the community, the field workers were trained to collect data on childhood illnesses, vaccination history, feeding habits; and to collect biospecimens such as tool and urine following standard protocols that governed eight field sites in the project’s network.

To understand the way the field workers viewed the impact of their work in the lives, the researchers undertook a qualitative research project in January and February 2016. The methodology consisted of one-on-one interviews and focus group discussions with 16 former field workers and five community members who were not directly involved in the project. Benefits reported by the MAL-ED community-based field workers included:

  • Knowledge about child growth and malnutrition
  • Acquisition of knowledge & various skills
  • Knowledge about conducting research and data collection
  • Received financial benefits
  • Acquired physical assets
  • Experience working with children
  • Personal development
  • Social capital benefits (greater social network)
  • Understanding of water and sanitation issues

The article can be accessed from BMC Public Health.

Raising Awareness about Health Disparities and Health Equity

The 2017 theme for National Minority Health Month — Bridging Health Equity Across Communitieshighlights the importance of collaborating across sectors and communities to address health disparities and the social determinants of health in the efforts to achieve health equity. As a part of National Minority Health Month, the Office of Minority Health developed a website — in English and Spanish —  with various tools and resources:

  • Example social media posts
  • Graphics for use on websites, in newsletters, and on social media
  • Listing of related blog articles
  • Suggested Action Steps

The website also lists upcoming events:

Decisive action by communities can reduce health disparities and improve lives

From the article by Risa Lavizzo-Mourey and Victor Dzau on STAT

Our choices for good health depend on our choices for everything else in life: a good education, safe and decent housing, a secure job that allows us to support our families.

What happens when those choices don’t exist? Ask Alpha Whitaker.

Whitaker, a single mom in Indianapolis who put herself through college, had to turn down a dream job because she didn’t have a safe way to get to work. Her bus route ended 10 blocks from the job, and she would have had to walk through a dangerous neighborhood — twice — every day.

In choosing safety, Whitaker gave up a job with full health benefits, a 401(k) plan to help her save for her daughter’s education, and a salary that would have allowed her family to move to a safer neighborhood. These things — financial security, health insurance, education, and neighborhood — influence health.

Fortunately, Indianapolis is one of many US communities working to create better choices for their residents in transportation, public safety, and employment. In doing so, they are creating better choices for health as well.

On the surface, the link might not be obvious. But as “Communities in Action: Pathways to Health Equity,” a new report from the National Academy of Medicine’s Culture of Health program shows, health equity and equal opportunity are inextricably linked. The report, commissioned by the Robert Wood Johnson Foundation, defines health equity as the state in which everyone has a chance to attain their full health potential.

Americans today live shorter, sicker lives than people in other developed countries. Across America, health varies by income, education, race and ethnicity, geography, sexual identity, and disability status. We pay a high price for these health disparities in lost lives, wasted potential, and squandered resources. They also affect national security: Some 26 million young adults are unqualified to serve in the United States military because of persistent health problems, poor education, or convictions for a felony. The report estimates that racial health disparities are projected to cost health insurers $337 billion between 2009 and 2018.

“Communities in Action” spotlights how communities are working together to create pathways to health equity. By addressing factors well beyond access to health insurance, cities like Indianapolis, Buffalo, Minneapolis, San Antonio, and Los Angeles are seeding the conditions needed to enjoy full, healthy lives.

Take the Indianapolis Congregation Action Network (IndyCAN), a multiracial, multifaith group that took on limited access to bus routes. That transportation issue created barriers to good jobs and opportunity. Working with a variety of stakeholders, including the residents most affected, IndyCAN helped pass a regional transit referendum to triple bus service in Indianapolis, fuel economic development, and increase access to jobs. Because all residents understood that improved bus service would benefit everyone in the community in a range of ways, the referendum passed last November — with the Indianapolis Chamber of Commerce as a leading champion.

This is just one example of what a community can do to promote health equity. “Communities in Action” explores many other efforts to curb violence, boost education, improve social connectedness, and expand access to healthy foods — all of which create the opportunity for healthier lives. Although their approaches differ, these community efforts consistently bring a shared vision for promoting health equity, building and harnessing community capacity, and involving many different sectors to enlist broad buy-in.

Read the full article.

Black History Month Sheds a Light on Racism as a Public Health Threat

From the article posted by Atif Kukaswadia on the PLOS Blogs: Public Health Perspectives:

Black History Month came and went all too quickly — while it gave our nation a spotlight for the accomplishments and contributions of the black community, it also reminded us to reflect and focus on the threats facing African-Americans all year around. Beyond the month of February, civil rights advocacy continues to address racial disparities in voting rights, education and criminal justice, but discrimination also impacts the black community in ways that aren’t typically seen as social issues. This is particularly true in public health and should be addressed by doctors and nurse practitioners.

Discrimination affects mental and physical health

Racism is detrimental to mental and physical health because repeated exposure causes a heightened sense of fear and anxiety regardless of whether victims experience physical violence or merely anticipate discriminatory behavior. The Southern Poverty Law Center reported more than 1,000 hate crimes in the month following the 2016 presidential election — 221 of which were logged as anti-black incidents. The past several years of media coverage on tragic cases of police brutality and alarming stop-and-frisk regulations shows us that many more cases often go unreported, and have profound negative impact on the health of African-Americans.

Long-term physical manifestations of discrimination include depression, high blood pressure, cardiovascular disease, breast cancer and premature death. One of America’s leading social epidemiologists, Nancy Krieger, points out that constant stress from racial profiling can give way to unhealthy coping mechanisms, like over- or undereating, retreating from personal relationships, unstable anger management, violence, and other lifestyle choices. These coping mechanisms exacerbate poorer health outcomes overtime, creating a cycle based in what Krieger terms “embodied inequality” — the idea that human bodies do not partition social and biological experiences.

Discrimination shapes health care

Indirect effects of racism in health care are often harder to see on the surface, but can create barriers to accessing quality care. These barriers can be identified through social determinants of health, which are “conditions in one’s environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not,” according to Healthy People 2020. Victims of racism are more vulnerable to the risks of living through social determinants that make it harder to seek medical care, like inadequate transportation, low income, poor health literacy, fewer educational opportunities, underemployment, and other systemic barriers.

Black communities have historically experienced more structural barriers to health care than white communities, which not only make it harder to seek treatment, but can also lead to poor outcomes even if treatment is accessed. A 2012 study from Johns Hopkins University found that many primary care doctors hold a subconscious bias toward their black patients, which undermines any positive outcomes of a medical visit. During visits with black patients, the study revealed that doctors tended to speak slower, use less positive tones, dominate conversations and spent less time addressing social aspects of the patients’ lives. Inadequate patient-doctor consultations can result in poor health literacy, which can lead patients to wait longer before seeking care for a health issue, and ultimately creates more urgent and expensive treatments long term.

Health Literacy Can Mitigate Racial Disparities

Mitigating the detrimental effects of racism — subconscious or not — is easier said than done, but begins with providers acknowledging that biases exist and are creating health disparities. While medical providers can work to eliminate attitudes that lead to discrimination, they can also participate in public policy and on-the-ground interactions with patients. On an administrative level, providers can employ more diverse staff members, and promote medical research for racial disparities in public health, and work to expand access to quality health care to African-American patients. One potential avenue for intervention is through increased health literacy but in order to promote health literacy among African Americans, nurses, social workers, and educators must collaborate to meet patients where they are, listen to their concerns, advocate for creative solutions, and train others in professional communities to do the same.

Read the full article.

The Center for Healthy Communities Thanks Dr. Hattie Myles

On Friday, March 31, 2017, Dr. Hattie Myles is retiring from her role as the Assistant Dean for Student Affairs and Educational Enrichment at the University of South Alabama College of Medicine.  Over her long tenure with the University, Dr. Myles has led many critical initiatives. The Center for Healthy Communities (CHC) is particularly thankful to Dr. Myles for her service as Co-Core Director of the Community Outreach Core for the Center for Healthy Communities’ Center of Excellence in Health Disparities. For over 10 years Dr. Myles has spearheaded the CHC’s Pipeline Program which has encouraged, supported, trained, and mentored high school and undergraduate students from health disparate communities as they have pursued college preparation, undergraduate and graduate education, and career paths in the biomedical professions. She has made a tremendous impact on the lives of countless students. We are proud of all she has accomplished and wish her the best in her well-deserved retirement.

The College of Medicine is hosting a retirement reception for Dr. Myles on Friday, March 31, 2017, from 3 to 5 p.m. at the Terrace on the second floor of the USA Student Center.

To learn more about the many ways Dr. Myles contributed to the USA community read the article posted by the Med School Watercooler on March 23.

Health Care Outcomes in States Influenced by Coverage, Disparities

From the article by Kimberly Leonard in US News:

Enjoying longer, healthier lives than the average American, and with strong medical coverage and access to care, Hawaiians rank No. 1 in the country for health care, according to the U.S. News analysis of federal data supporting the Best States rankings. But Hawaii has more than a mild climate and residents who share a proclivity for outdoor activities to contribute to its success. The state had a significant head start: a four-decade jump on health care reform.

“It was a really wonderful exciting time and one that’s kind of forgotten by the rest of America,” says Dr. Jack Lewin, who oversaw the state’s implementation of the Prepaid Health Care Act as health agency director.

As a result of the law’s passage, Hawaii became the first state in the country to implement a nearly universal health care system for its residents, enforcing a mandate for all employers whose employees work a minimum of 20 hours a week. The model, originally proposed by President Richard Nixon, would later become the inspiration for Hillary Clinton’s unsuccessful attempts at national health care reforms in her role as first lady in the 1990s.

Though never implemented nationally, the law in Hawaii, as well as measures in other states that have been particularly proactive, provides strong evidence that increasing access to health care coverage has contributed to wellness, according to the data compiled for Best States.

In Hawaii, residents have steady access to preventive care such as screenings and doctor visits, and are among the least likely to report that they skipped needed medical care because of cost. Mortality rates are the lowest in the country, giving Hawaiians the longest life expectancy in the U.S. Their obesity and infant mortality rates also are among the lowest in the country.

Experts say the Hawaiian experience helps give credence to those who say health care coverage is fundamental to reforming the American health care system, noting that people who are uninsured often skip needed testing, care or medicines because of concerns about cost.

“There is a large body of research showing that people who have health insurance are likely to access care and to get appropriate care like cancer screenings, and that leads to ultimately better health outcomes,” says Rachel Garfield, associate director for the program on Medicaid and the Uninsured at the Kaiser Family Foundation, which studies health care.

The U.S. News rankings examine not only how well residents are, but whether they can access medical care and how good that care is. Each of these three components is given equal weight for a final score. The results appear to suggest some parallels across states that tend to be more engaged.

“Higher performing states have huge efforts over time to reform or improve their health care system, and government plays a very important leadership in that,” says Douglas McCarthy, senior research director of the Commonwealth Fund, a foundation that releases studies on health care issues. “The stakeholders are very engaged and created a culture of collaboration. It’s really about bringing everyone to the table.”

Read the full article.

Understanding Poverty

 

In late 2016, Busted: America’s Poverty Myths is a five part series from On the Media exploring the way poverty is portrayed in the United States and the realities that people face. The episodes include (descriptions come from On the Media):

  • The Poverty TourWelfare advocate Jack Frech has taken reporters on “poverty tours” of Athens County, Ohio, for years. But has media attention made any difference in the lives of the Appalachian poor?
  • Who Deserves to be Poor? — The notion that poverty stems from a lack of will power and a poor work ethic is as old as America. Why that needs to be dispelled.
  • When the Safety Net Doesn’t Catch You — Government assistance in the United States helps millions out of poverty, but often the most needy fall through the cracks.
  • Breaking News Consumer’s Handbook: Poverty in America Edition — When reporting on poverty, the media fall into familiar traps. How to steer clear of stereotypes and seek insight.

 

Sentinel Communities: Mobile, Alabama

The Sentinel Communities project — a part of the Robert Wood Johnson Foundation’s Culture of Health Initiative — will track health outcomes in 30 cities to understand

  • Local health care landscape
  • How challenges can be addressed in areas with different geographic and historic landscapes
  • How communities make progress or address barriers in improving population health.

The Sentinel Communities were chosen to reflect the nation’s diversity in terms of demographics, geography, and approaches to health. The following, drawn from the first report about Mobile, AL., provide some context for health issues in city.

 

  • In addition to an overall 25% poverty rate for Mobile, significant income inequality exists between black and white residents, with black households earning about half the median income as white ones.
  • While educational attainment has increased among white residents, the percentage of black residents with a bachelor’s degree or higher declined between 2010 and 2014.
  • Despite progress, Mobile residents have a lower life expectancy and higher rates of teen pregnancy, obesity, smoking, and uninsurance than the national average.
  • Even with the introduction of a new Regional Care Organization that may improve insurance coverage for residents, Mobile remains a federally designated health care shortage area.

 

See the full report for charts on indicators such as income, teen pregnancy, mortality, and educational attainment as well as some of the initiatives currently in place to address health issues.

 

Introducing the Language Access Portal

From the article by Kelli Carrington on NIMHD Insights:

Many of us know what it’s like to feel overwhelmed during a doctor’s visit by information about health conditions, medicines, and behavior recommendations. For patients who don’t speak or understand English fluently, the situation can be more than overwhelming—it can be dangerous. Patients with limited English proficiency (LEP) are nearly three times more likely to have an adverse medical outcome.1

Language is one of the most significant barriers to health literacy, the ability to understand the basic health information needed to make good health decisions. Patients who lack health literacy are often unable to read or understand written health information or to speak with their healthcare providers about their symptoms or concerns. These patients are less likely to follow important health recommendations or be able to give informed consent.2

According to the U.S. Census Bureau, more than 1 in 5 U.S. residents don’t speak English at home. Of that group, about 4 in 10, or 25 million people, have limited English proficiency.3 Many people with limited proficiency also live in households where no one speaks English well, meaning there isn’t a translator readily available to accompany them to doctor’s visits.

The National Institute on Minority Health and Health Disparities (NIMHD) is committed to addressing these language barriers and to improving the health literacy and lives of everyone living in America. We’re excited to announce a new tool, the Language Access Portal, as a resource for the NIMHD research community, public and community health professionals, healthcare providers, and others who work with health disparity populations with LEP. The portal improves access to cross-cultural and linguistically appropriate health information produced by the National Institutes of Health (NIH), NIMHD, and other federal agencies.

The Language Access Portal pulls together health resources from across NIH in selected languages, particularly those languages spoken by populations experiencing significant health disparities. As we launch, the portal includes information in Spanish, Hindi, Tagalog, Korean, and Vietnamese. The portal currently has language resources for the following areas where health disparities have been identified:

Read the full article.

Highlights from the Commonwealth Fund Scorecard on State Health System Performance

From the Commonwealth Fund:

The 2017 edition of the Commonwealth Fund Scorecard on State Health System Performance finds that nearly all state health systems improved on a broad array of health indicators between 2013 and 2015. During this period, which coincides with implementation of the Affordable Care Act’s major coverage expansions, uninsured rates dropped and more people were able to access needed care, particularly those in states that expanded their Medicaid programs. On a less positive note, between 2011–12 and 2013–14, premature death rates rose slightly following a long decline. The Scorecard points to a constant give-and-take in efforts to improve health and health care, reminding us that there is still more to be done.

According to the 2017 scorecard, Alabama’s performance relative to the baseline score set in 2013 included:

  • Drop from 39 to 47 in overall performance.
  • Drop from 27 to 34 in terms of access Dropped from 36 to 42 in terms of prevention and treatment
  • Remain at 41 in terms of avoidable hospital use and cost
  • Drop from 41 to 45 in terms of healthy lives

See the full Alabama scorecard.