Category Archives: Health & Society Scholars
At Virginia Commonwealth University School of Medicine, Briana Mezuk, PhD, is an assistant professor in the Department of Family Medicine and Population Health, Division of Epidemiology; and Tiffany L. Green, PhD, is an assistant professor in the Department of Healthcare Policy and Research. Both are alumnae of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program.
Approximately 30 million U.S. adults currently have diabetes, and an additional 86 million have pre-diabetes. The incidence of diabetes has increased substantially over the past 30 years, including among children. Estimates place the direct and indirect costs of diabetes at a staggering $218 billion annually.1 Like many other diseases, disparities on the basis of race and income are apparent with diabetes. Non-Hispanic blacks, Hispanics, Native Americans, and socioeconomically disadvantaged groups are more likely to develop diabetes than non-Hispanic whites and socioeconomically advantaged groups.
Despite the enormous economic and social costs associated with diabetes, it remains a struggle to apply what we know about diabetes prevention to communities at the highest risk. We have robust evidence from randomized controlled trials that changing health behaviors, including adopting a healthy diet and regular exercise routine and subsequent weight loss, will significantly lower the risk of diabetes. Unfortunately, these promising findings only appear to apply to the short-term. Even worse, results from community-based translation efforts have been much more modest than expected, and show only limited promise of reducing long-term diabetes risk. In response, leaders at the National Institutes of Health have noted that many efforts at translating clinical findings into community settings are “limited in scope and applicability, underemphasizing the value of context.”2
Amani M. Nuru-Jeter, PhD, is an associate professor of community health and human development, and epidemiology at the University of California, Berkeley School of Public Health, and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. Her research focuses on racial health disparities.
Eric Garner’s death and the failure to indict NYPD Officer Daniel Pantaleo have had a profound effect on communities throughout the United States. But it’s not just Eric Garner. This, and similar cases including Michael Brown, Tamir Rice, Trayvon Martin, and Oscar Grant, have put race relations front and center in the national debate.
I’m tired of it, this stops today...every time you see me you want to harass me, you want to stop me...please just leave me alone” –Eric Garner
These last words from Eric Garner are not that different from what we hear in our work with African American women in the San Francisco Bay area:
Today, we can get access to just about anything in minutes or hours. Smartphones put a world of information literally at our fingertips. Within minutes, most of us can get food we want, entertainment we desire, even travel to another city. But seeing a doctor, an arguably more immediate need, is not so easy. Creating a Culture of Health requires our collective interdisciplinary expertise to make health and health care as accessible and user-friendly as other products and services we use on a regular basis.
Before I left academia, I heard the word “interdisciplinary” tossed around a lot, but I saw it practiced in very safe ways. Typical research teams of grants I was on or would review comprised researchers from only the social, psychological, and health and medical sciences. As public health faculty, I’d hear statements like “Public health is inherently interdisciplinary.” This may be true since public health draws from multiple disciplines, but I couldn’t help but feel that such statements were more a reflection of inertia than anything else.
Understanding Microcultures of Health: It’s Time for a ‘Deep Dive’ into Culture & Social Networks to Produce Lasting Health Change
Jason M. Fletcher, PhD, is associate professor at the La Follette School of Public Affairs, Department of Sociology, Department of Agricultural and Applied Economics, and Department of Population Health Sciences at the University of Wisconsin-Madison. He is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program at Columbia University, where he researched the intersection of health and social networks.
While an important priority for improving health and health care in the United States is in focusing on broad notions, such as creating a Culture of Health, there is also a need to consider targeted approaches that make use of the structure of relationships that influence health. Most people consider only a small number of social contacts when discussing important matters. Even though our Facebook friends number in the hundreds or thousands, the number with whom we share close and regular geographic or social space is considerably smaller. Network science is leading the way in uncovering what our microcultures look like and how they operate; these findings should be put to further use to improve population health.
These “small worlds” of influence are known to have substantial impacts on health—as shown by numerous careful, gold-standard empirical studies. College freshman who are randomly assigned a roommate who binge drinks are more likely to binge drink, themselves. Adults whose spouses stop smoking through a clinical intervention are themselves much more likely to stop smoking. These positive and negative impacts on health spread not through broad culture but through the “microcultures” of close social ties.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts this year. As we usher in 2015, we take a look back at our ten most-read 2014 posts.
Why Do Deaths from Drugs Like Oxycodone Occur in Different Neighborhoods than Deaths from Heroin? This in-depth look at the role neighborhoods play in shaping substance abuse patterns was written by RWJF Health & Society Scholars program alumna Magdalena Cerdá, PhD, MPH. She compares neighborhoods that have more fatal overdoses of opiate-based painkillers to neighborhoods in which heroin and cocaine overdoses are more likely to occur, identifying characteristics of each. Her piece generated a larger audience than any other post published on this Blog this year, with more than 22,000 visits.
How Stress Makes Us Sick was written by RWJF Health & Society Scholar Keely Muscatell, PhD. A social neuroscientist and psychoneuroimmunologist, Muscatell shares her research into the physical manifestations of stress, its relationship to inflammation, and ways people may be able to reframe their responses to stress in order to alleviate the physical reactions it can cause. Understanding how stress makes us sick, she blogs, “is of extreme importance to the health and longevity of our nation.”
Misfortune at Birth, which drew the third-largest audience among the posts published on this Blog in 2014, asks whether some premature babies are simply born in the wrong place. It reports on nurse-led research that finds seven in ten black infants with very low birth weights have the misfortune of being born in hospitals with lower nurse staffing ratios and work environments than other hospitals. The blog post was written by Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, based on their study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative.
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar and an assistant professor at Johns Hopkins University. On this first Universal Coverage Day, Saloner examines holes in access to care that remain after the Affordable Care Act. His post is cross-posted with the Leonard Davis Institute of Health Economics blog.
The United States is the last remaining rich country in the world where a large percentage of the population lacks health insurance coverage. This situation is being improved under the Affordable Care Act (ACA), with recent estimates showing that from early 2013 to mid-2014 the uninsured rate dropped from 19 percent of adults to 14 percent. The uninsured rate will no doubt continue to fall in 2015, but the problem of the uninsured will not go away with the ACA. It will not go away even if all 50 states expand Medicaid for poor adults, and will not go away if the U.S. Supreme Court rules against the plaintiffs in a pending challenge to the power of the administration to provide subsidies in the federally facilitated insurance exchanges.
In its 2012 baseline estimate, the Congressional Budget Office (CBO) projected that by 2022 the ACA might cut the number of uninsured by half, but would still leave behind 30 million people without insurance. This projection assumed full implementation of the ACA provisions. We don’t yet have a clear sense of how much larger that number will be with incomplete implementation of the core ACA coverage provisions, but even an optimistic assessment is that tens of millions of Americans will continue to spend periods of time without health insurance.
Who does the ACA leave behind? By design, the ACA excludes undocumented immigrants, a group that numbers around 11 million today. Some undocumented immigrants purchase private insurance, receive coverage from an employer, or participate in public programs funded with non-federal dollars, but the majority have no insurance. Undocumented immigrants are prohibited from enrolling in Medicaid, receiving subsidies, and purchasing coverage on the exchanges. Although President Obama recently signed an executive order protecting many undocumented immigrants from immediate deportation, the ACA exclusion will continue in the foreseeable future, barring an act of Congress.
Jennifer Schroeder, Stephanie M. DeLong, Shannon Heintz, Maya Nadimpalli, Jennifer Yourkavitch, and Allison Aiello, PhD, MS, professor at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This blog was developed under the guidance of Aiello’s social epidemiology seminar course.
Ebola is an infectious disease that the world has seen before in more moderate outbreaks in Africa. As the devastating Ebola outbreak in West Africa has taken a global turn, fear, misinformation and long-standing stigma and discrimination have acted as major contributors to the epidemic and response. Stigma is a mark upon someone, whether visible or invisible, that society judgmentally acts upon. Ebola has become a significant source of stigma among West Africans and the Western world.
In many ways, the source of this discrimination can be traced back to the legacy of colonialism and the western approach to infectious disease response in Africa. The history of foreign humanitarian aid has sometimes dismissed cultural traditions and beliefs. As a consequence, trust in westerners has eroded and has been compounded by a disconnect between western humanitarian aid approaches and a lack of overall infrastructure investment on the part of African national health systems. This is apparent in the Ebola epidemic in West Africa. Some don’t actually think that Ebola exists; instead they believe that it is a hoax carried out by the Western world. All of these factors are facilitating the rapid spread of the disease.
Meredith Barrett, PhD, is vice president of science and research at Propeller Health, a health technology company working to reduce the burden of asthma and chronic obstructive pulmonary disease (COPD). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), Berkeley and UC, San Francisco. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.
Leaders in Louisville, Kentucky, know first-hand that where you live and work affects your health and well-being. During a special session at the American Public Health Association’s meeting this week in New Orleans, we explore how the air quality in Louisville neighborhoods impacts the health, economy and overall vibrancy of the community. And we’ll highlight how Louisville is the poster child for tackling tough issues like asthma head-on, top-down and bottom-up, through data and collaboration among individual residents, corporate execs, community organizers and public leaders.
Asthma attacks are sneaky, expensive and debilitating, yet almost entirely preventable.
Asthma is one of the most common and costly chronic diseases in the United States, affecting more than 8 percent of the U.S. population. Despite decades of research and the development of effective treatments, rates of morbidity have not declined and health care costs reach more than $50 billion a year. Asthma also leads to more than 13 million missed days of school and 10 million missed days of work, negatively affecting educational achievement, employee productivity and regional business growth. But the most frustrating part is that a large proportion of these hefty impacts could be avoided with improvements in self-management, community policy and advances in digital health care.
RWJF Scholars in the News: EpiPens in schools, suicide prevention, financial incentives for wellness, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:
A study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH, shows that keeping supplies of epinephrine, commonly known as EpiPens, in schools saves lives, Health Day reports. Epinephrine injections are given in response to life-threatening allergic reactions to food or to insect stings. Gupta’s study found that epinephrine was administered to 35 children and three adults in Chicago public schools during the 2012-13 school year. “We were surprised to see that of those who received the epinephrine, more than half of the reactions were first-time incidents,” Gupta said. “Many children are trying foods for the first time at school, and therefore it is critical that schools are prepared for a possible anaphylactic reaction.” Forty-one states have laws recommending schools stock epinephrine, according to the article.
Matt Wray, PhD, MA, an RWJF Health & Society Scholars program alumnus, writes in Medical Xpress that when it comes to preventing suicides, it’s important to focus some attention on how a person seeks to end his or her life. According to the article, suicide-prevention research has shown that when people who have begun to act on suicidal impulses find that access to their chosen method is blocked, many do not seek out other means. “Most people don’t have a backup plan,” Wray writes. “So when their initial attempt is stalled, the destructive impulse often passes. Moreover, contrary to what many believe, people who attempt suicide more than once are rare. Less than 10 percent of those who survive an attempt ever end up dying by suicide.”
Tova Walsh, PhD, MSW, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar at the University of Wisconsin in Madison. Her research focuses on the role expectant and new fathers play in the health and well-being of their partners and children, and the influence of parenthood on men's health and well-being. Walsh has used interview, focus group and survey data to examine the experiences of service members returning to family life after deployment.
On Veterans Day, we honor the service and sacrifice of U.S. military veterans. Recognizing that it is not just the individual who serves our country, but his or her entire family, we honor, too, our military families, whose support is essential for our servicemen and women to carry out their duties.
When a service member deploys, partners, children and other family members re-organize their lives to accommodate the physical absence of a loved one. They live each day bearing the burden of separation. When their deployed loved one returns home, they share not only in the joy of long-awaited reunion, but also in the joy and challenges of the extended process of the veteran’s reintegration to home, family and community. The youngest members of our military families are least able to understand or express the impact of these experiences, and yet are deeply affected by these transitions and the accompanying shifts in emotions on the part of the adults who they depend upon for care, love and security.