‘Connectivity’ as the Key to Healthy Communities

The following excerpt originally appeared in in an article by Shannon Firth in MedPage Today  on May 11, 2017 summarizing a panel discussion that had taken place on May 9, 2017.


Keeping people connected to resources necessary to maintain good health — not least of which is other people — is a vital but often neglected factor in modern healthcare, policy experts and scholars said here Tuesday.

Transportation is an “underappreciated” health problem, said Dayna Bowen Matthew, JD, a nonresident senior fellow at the Brookings Center for Health Policy, at a panel discussion hosted by the Brookings Institution on Tuesday.

She noted that interstate highways aren’t always a means of connecting people to each other and to resources: in cities, they create barriers as well.

A grid of superhighways can mean a person living in a city’s southeast quadrant must take two buses and time off from work to reach a well-intentioned “food solution” in the northwest quadrant.

“That community’s not connected,” said Bowen Matthew, who is also a professor at University of Colorado Law School and the Colorado School of Public Health, and author of Just Medicine: A Cure for Racial Inequality in American Health Care.

Those families across town from farmers’ markets and other fresh food resources will rely on the more accessible options instead, which may be fast food.

Tuesday’s discussion focused heavily on the social determinants of health — nonmedical factors that greatly influence a population’s health such as transportation, housing, access to food — but one thing unites these influences: connectivity.

Social Networks are Key

The National Health Service in England has a “district nurse,” an individual responsible for keeping watch over certain neighborhoods, explained, Stuart Butler, PhD, a senior fellow in economics for the Brookings Institution.

Growing up in England, Butler’s mother ran a post office, which was a key source of “intel” for the district nurse on the community residents’ well-being. If Butler’s mother hadn’t seen someone for a few days, the nurse would learn of this and ride her bicycle to the person’s home.

Decades later and an ocean away, Matt Brown, RN, a geriatric nurse navigator at Sibley Memorial Hospital in Washington, learned quickly about the importance of follow-up phone calls to ensure smooth transitions back to the community.

During his first such call as part of a senior-focused transition project, he spoke to a patient who had just returned home after being hospitalized for pneumonia.

In the course of the phone call, the patient reluctantly admitted he had fallen and couldn’t get up off the floor of his home. Brown convinced him to call 911, rather than wait for the patient’s wife to come home. When the ambulance arrived, Brown spoke with the emergency medical technicians to confirm his patient was okay.

To further reduce the risk of injuries, the Sibley Innovation Hub has offered a short training course focused on transitions after certain surgeries, which they are now supplementing with animated patient education videos.

Read the full 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.

Turning research into action

The following excerpt originally appeared in a blog article by Jillian West and Stephanie Chernitskiy on the Policies for Action Blog on May 16,. 2017.


Multivariate analysis. Face validity. Sampling bias. For researchers, these are everyday terms. For policymakers, advocates, and other stakeholders, they might as well be ancient Sumerian.

A lack of a shared language is one barrier to turning research into action, but it’s not the only one. A few weeks ago, we sat down with a group of local decision-makers to find out how we, as researchers, can more effectively ensure that our research contributes to real-world improvements in population health, well-being, and equity.

In our conversation, we weren’t surprised to hear that the budget is often the first—and largest—hurdle a policymaker must face when implementing evidence-based policy. If the funding is not there or the return on investment is unclear, the policy in question will likely fall flat.

Time constraints and limited bandwidth also get in the way. In small states, legislators are virtually on their own, with few or no staff to help track down relevant data. Additionally, online academic journals often come with paywalls and paid subscriptions, meaning that the necessary research is just out of reach.

As one decision-maker put it, “If your research is in a journal, I can’t get to it.”

Our decision-makers also spoke candidly about the framing challenges they face translating research into action.

Elected officials and other policymakers must tread carefully, balancing the needs of their constituency with the values of that constituency. No matter what, evidence doesn’t exist in a vacuum—partisanship, ideology, and belief systems matter too. One decision-maker characterized it like this:

“Most people know the evidence against smoking. But they may also harbor an ideology that government shouldn’t tell people what to do in their personal lives. There’s a significant challenge in explaining your evidence in light of these overarching lenses.”

Researchers who want to see their work bear fruit in a policy environment must understand these ideological contexts. If a policymaker has invited you to speak about your research, be sure you know what kind of environment they are navigating. Do local leaders embrace skin-in-the-game, market-driven policies, or are they looking to make a publicly funded means-tested program more effective? Or perhaps a decision-maker sees the value in a policy or practice change, but needs help making the case to other leaders in the community? Try to communicate your findings in a manner that avoids the traps of dueling ideologies. And remember, even researchers aren’t immune from ideological biases.

Read the full article.

Useful Resources: Health Literacy

Health Literacy is key to individuals being able to access, understand, and fully use health information and services. For this reason, the Agency for Healthcare Research and Quality (AHRQ) has developed a listing of tools and other resources to help healthcare professionals in “making information easier to understand and systems easier to navigate.” The resource list is divided into the following topics:

Visit the AHRQ website to learn more about the available Health Literacy Resources.

How med student loan burdens can deepen health disparities

The following article by Caleb Zimmerschied originally appeared on AMA Wire on April 27, 2017.


The high loan burden associated with medical school can discourage students from underrepresented minority groups or lower-income families from pursuing a career as a physician. This creates a ripple effect of widening health care disparities that disproportionately affect the accessibility of primary care physicians in underserved areas.

Adjusted for inflation, the average medical student graduated in 2014 with a loan burden 3.5 times greater than a medical student in 1978. By 2014, the average loan burden was over $170,000.

Higher interest rates and unsubsidized loans for graduate students mean that they pay off more per dollar owed than undergraduate students. The Association of American Medical Colleges (AAMC) estimates that, accounting for interest under the Pay As You Earn repayment program, a student with $180,000 in loan burdens could pay almost $380,000 in total repayment. During a three-year residency, the AAMC estimates that total repayment to reach nearly $450,000. This amount increases further if a student pursues a specialty care field.

Those kinds of figures may be enough to intimidate any bright student considering a career in medicine. But students in ethnic and racial minority groups that are underrepresented in medicine, and those from lower-income families, can be particularly daunted by the prospect of six-figure loan burdens. According to the most recent AAMC report, 18.2 percent of black high-school sophomores said they aspired to apply to medical school, but only 6.7 percent actually applied. For Hispanic high-school sophomores, 24.4 percent said they wanted to go to medical school but only 6.8 percent applied.

According to 2014 AAMC data, while 13 percent of the U.S. population was black, they only made up 4.1 percent of the physician workforce. Hispanics accounted for 18 percent of Americans, but only 4.4 percent of the physician workforce. This in turn likely contributes to the lack of physicians making direct efforts to serve these communities. According to research published in JAMA, despite making up less than 30 percent of the physician workforce in 2013, physicians from underserved groups are significantly more likely to see nonwhite patients, and “nonwhite physicians cared for 53.5 percent of minority and 70.4 percent of non-English-speaking patients.”

Additionally, the cost of medical school likely deters applicants from lower-income rural communities as well. This could contribute to the fact that while 20 percent of Americans live in rural areas, only 10 percent of physicians practice where people in rural communities can access them. With a shortage of about 4,000 primary care physicians, 77 percent of rural U.S. counties are designated as health professional shortage areas.

Read full article

Segregated Living Linked To Higher Blood Pressure Among Blacks

The following article by Carmen Heredia Rodriguez originally appeared on Kaiser Health News.


For African-Americans, the isolation of living in a racially segregated neighborhood may lead to an important health issue: higher blood pressure.

A study published Monday in JAMA Internal Medicine suggested blacks living in such areas experienced higher blood pressure than those living in more diverse communities. Moving to integrated areas was associated with a decrease in blood pressure, and those who permanently stayed in localities with low segregation saw their pressure fall on average nearly 6 points.

Kiarri Kershaw, assistant professor of preventive medicine at Northwestern University in Chicago and lead author of the study, said the findings reinforce the close relationship between social policy and community health outcomes.

“It lends credence to the notion that we should bring public health practitioners and health policy officials to the table to make these decisions,” she said. Researchers used data from a long-term study that has followed 2,280 African-Americans over the course of 25 years, checking in every three to seven years to track blood pressure.

Heart disease is the leading cause of death in the United States, and African-Americans are disproportionately affected by the condition. According to the American Heart Association, 46 percent of non-Hispanic black men and nearly 48 percent of non-Hispanic black women live with a form of heart disease, while about 36 percent of non-Hispanic white men and 32 percent of non-Hispanic white women do.

Georges Benjamin, executive director of the American Public Health Association, said the burden to address such disparities falls on society at large.

“It doesn’t just hurt African-Americans or people of color. This hurts everybody,” he said. “Because everyone pays not just in terms of humanity, but in terms of dollars.”

Doctors generally record two numbers for blood pressure: the diastolic pressure — the blood’s force inside the veins when the heart is at rest — and the systolic pressure, which gauges the blood’s force when the heart beats. Blood pressure is measured in millimeters of mercury, or mmHg (using mercury’s chemical element symbol), with systolic pressure reported first, such as 115 mmHg over 75 mmHg.

Researchers found residential segregation was associated with changes in systolic blood pressure, which is tied to adverse cardiovascular events, such as a heart attack. The findings did not show any changes in diastolic blood pressure.

The scientists also collected data on a variety of other social indicators including level of education, poverty and marriage status. They ranked the level of segregation in participants’ neighborhoods as “low,” “medium” and “high” based on the number of African-Americans in the larger area.

When compared to African-Americans living in highly segregated locations, participants living in medium-segregation neighborhoods recorded blood pressure that was on average 1.33 mmHg lower. Those residing in low-segregation areas were an average 1.19 mmHg lower.

Blood pressure for black residents who permanently moved into medium segregation locations decreased on average 3.94 mmHg. African-Americans who stayed in low-segregation locales saw an average decrease of 5.71 mmHg.

Read the full article.

Next HDRG Meeting

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 May 19 at 1:00 pm in Bio-medical Library Room 222-A.  Dr. Erik Goldschmidt,  Director of the Foley Community Service Center at Springhill College, will share about their work in his presentation “From Charity to Justice: Optimizing the Impact of Service-Learning & Community Service”.

Please join us for the final HDRG meeting of this academic year.

 

“Erase the Stigma by Breaking the Silence”

The following blog piece was written by Dr. Bobbi Holt-Ragler. She is a Community Health Advocate (CHA) with the Center for Healthy Communities-Center of Excellence for Health Disparities. She uses her skills as an educator and nurse to raise awareness about health issues that plague her community. Her contributions to the Center and her community are always appreciated.


Recently, we have been saturated with media coverage of acts of assault and vicious acts of violence committed on innocent people. Also, live streaming of suicide has become a common trend.  One may draw the conclusion that such actions by some of these individuals committing the crime may have been the result of a mental health issue. While we may not be certain of this fact; however, it raises many questions. Such as, were there any red flags or warning signs that were missed by family members and loved ones?  Also, were there any attempts made to obtain professional help; was professional help offered or made available to them?  Some of these questions may never be answered and will forever remain a mystery.

As a responsible citizen, we can no longer keep silent to the issues of mental health, but we must take action to raise the awareness of the problem.

Our nation has been in crisis for quite some time regarding mental health.  According to the 2017 Mental Health Report, there are over 40 million people that are struggling with a mental health problem; however, only half of these individuals receive the needed treatment.  In addition, the number of mental health professionals has decreased, and the number of teen suicide rate has increased.

Why is this so?  We can conclude that the stigmas regarding mental illness still exist.  Also, less attention has been given to the problem and there is a lack of available resources. Can we continue in silence? The answer is no.  If mental health is openly discussed as other health conditions such as heart disease and diabetes, perhaps more attention will be given to management and treatment of the problem. We advocate the importance of saving lives and the need to know CPR for heart attack, know your numbers for your blood pressure, and how to recognize a stroke with F.A.S.T.  So, why can’t we advocate for more education on mental health and encourage more community education on the recognition of signs and symptoms of a mental health crisis?  This approach may help to erase the stigma and offer an opportunity to learn more about how to access community resources.  

The media has drawn attention to the need for open dialog on mental health.  What we are witnessing daily on social media will require each of us to step out of the silence mode and talk more to heighten the awareness of the fact that there is more work to be done with our mental health system.

African American Health — The latest from the CDC

The May 2017 edition of Vital Signs released by the Centers for Disease Control and Prevention (CDC) focuses on both improvements and concerns in the health of African Americans. The report states:

  • The death rate for African Americans decreased 25% from 1999 to 2015.
  • African Americans ages 18-49 are 2 times as likely to die from heart disease than whites.
  • African Americans ages 35-64 years are 50% more likely to have high blood pressure than whites.

View the May 2017 Vital Signs online.

Download a PDF.

 

Useful Resource: Diabetes Resources for African Americans and People of African Ancestry

The National Diabetes Education Program (NDEP) of the Centers for Disease Control and Prevention has created a listing of resources specifically designed for African Americans and people of African Ancestry. These resources include:

Diabetes Prevention

  • Road to Health Toolkit — Use the flipchart, guides, posters, and other resources in the toolkit to talk to people in your community about how they can prevent or delay type 2 diabetes. Find training resources to help you use the toolkit and start a community outreach program.
  • Step by Step –This music CD with three original songs helps people move more. It also has a bonus music video.
  • Choose More than 50 Ways to Prevent Type 2 Diabetes Tip Sheet — Help African Americans at risk for type 2 diabetes find ways to move more, make healthy food choices, and track their progress with making lifestyle changes to lower their risk.

Diabetes Management

See the NDEP website for the full listing of diabetes resources.