Blog: National Partnership for Action
Posted on 9/19/2013 by Eric Yurkovich
Los Angeles is a city with many health disparities and where residents live often determines their health destiny. A recent study on health conditions in Los Angeles found that low-income communities such as South Los Angeles and Boyle Heights face disproportionate rates of obesity, asthma and violent crime. Geographic location is such an important determinant of health that a person born and raised in Watts can expect to die 12 years sooner than a person born and raised in Brentwood.
The city of Los Angeles’ new planning effort seeks to reduce the consistent gap in health outcomes by elevating “health equity” as a priority for the city. Los Angeles is among the first of cities nationwide to launch the creation of a Health and Wellness Chapter, a high-level policy vision of health that will be embedded in the City’s General Plan, which serves as the city’s planning constitution for long term management and development. Through this effort, the city is prioritizing community health and establishing policies to make Los Angeles a healthier place to live, work and play.
The Health and Wellness Chapter is an important recognition that health happens in communities. A Los Angeles resident who lives in quality housing in a safe community with good schools, open space and access to affordable, healthy food and good jobs has greater opportunities to thrive. Recently, LA’s Health and Wellness Chapter project team released the “Health Atlas”, which provides a data-driven snapshot of health in Los Angeles.
The Health Atlas [PDF | 163 MB] articulates the baseline health conditions in the city and provides a context for understanding how demographic conditions, social and economic factors, the physical environment, access to health care, and health behaviors contribute to the health of Los Angeles residents. The report maps and analyzes over 100 health indicators and identifies where health issues are concentrated, illustrating the opportunity to address health through better community design.
The maps and data will help guide the creation of a new Health and Wellness Chapter for the general plan. It will also be used to target community outreach, with a focus on vulnerable groups and the areas with the greatest health disparities to include their needs in planning for healthier communities.
A draft of the Health and Wellness Chapter will be available for public review in early 2014.
Learn more about the Health and Wellness Chapter .
Posted in: Health NPA Partners Promising Practices Health Disparities Prevention Health Equity Minority Health | Comments | Add a Comment | Comment Policy | Permalink
Posted on 9/18/2013 by Amirah Abdullah
A world free of disparities in health and health care, where all people are able to attain the highest level of health, may appear utopic. However, this is the vision of the Southeastern Health Equity Council (SHEC) for the states of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. These states are comprised of a diverse population, with some groups demonstrating an increased risk of adverse health outcomes, and many residing in rural locations that restrict access to care.
To achieve its vision of health equity, the SHEC is collecting and utilizing data to outline the challenges and opportunities facing the region. Data is a powerful tool that can illuminate issues, inform decisions, and portray the impacts of such decisions.
As an intern working with the SHEC, I have had the opportunity to contribute to their latest efforts to improve the health of the population by increasing awareness on state-level policies and practices related to health care access, healthy food choices, and cultural competency. From June through August 2013, I researched data in 12 domains using 19 indicators to help answer questions about the physical environment, food choices, health behaviors, diversity in the health care workforce, and health care coverage affect an individuals’ lifespan, with the intent to generate a regional health equity report card.
This report card, which will be available this fall, will present detailed data by race, ethnicity, gender, sexual orientation, urban/rural location, and disability, which will be used by the SHEC for the first time to inform local policy makers. It will allow a look at several domains across multiple demographic measures at the same time, to generate a much needed holistic response to resolving health disparity issues. The SHEC will emphasize health disparity indicators and gaps in existing data to illustrate the importance of collecting data from minority groups. The SHEC developed the report card using Healthy People 2020 goals (where available), year comparisons, and national comparisons to grade each indicator.
Although the SHEC region is known to have some of the poorest performing states in the nation, the data never cease to provide compelling evidence of unequal burdens of disease in our communities. The Southeast represents 19 percent of the total population in the country. Yet in 2010, this region accounted for 21 percent of heart disease mortality nationally, with factors such as obesity, diabetes, and hypertension affecting this population at a substantially higher rate than other areas of the country.
A health equity report card could not come at a more opportune time, with the ongoing national discourse about health care access and reducing the costs of health care. In spotlighting the disparities in the Southeastern region of the country, we create a unique opportunity to educate local and national policy makers, and generate discourse that can influence health outcomes in the region for the better.
We can effectively point policy makers toward decisions that improve healthy food choices, enhance health care access and promote well-being. We also create the opportunity to specify populations and issues that merit the attention of state and local policy makers and communities. Over time, we have a real opportunity to look back in time and ask – “did we make the grade?”
The development of the SHEC health equity report card is an exciting first step in making this vision a reality. However, it is important to remember that we must all play our parts in making the states in the Southeast a healthier place to live.
How do you grade progress on health disparities indicators in your state or region? Let us know by commenting below.
Posted in: Minority Populations NPA Partners Promising Practices Health Disparities Federal Prevention Data & Statistics Health Equity Minority Health | Comments | Add a Comment | Comment Policy | Permalink
Posted on 9/10/2013 by Alice Dalton
How do we create interventions that can encourage all members of society to be more physically active and eat better diets? It’s a knotty question with many different factors to be considered. One basic element is where the interventions are. We’re pretty sure that good neighborhood design, with well-located resources, can reduce health disparities associated with poverty. However, an intervention is less likely to improve minority health if it’s not accessible to those most in need. I investigated this using the English ‘Healthy Towns’ communities, a group of ethnically diverse towns and cities, including neighborhoods in London, experiencing poverty and ill health. The government had funded health promoting infrastructure in these places. I tested a technique for spatial equity analysis to help us understand what infrastructure was put where, for whom and why.
This technique can be used to identify resource gaps and suggest locations where interventions should be located to address health disparities. The process is relatively straightforward, but you need to be thorough when collecting your evidence. It’s not just a case of drawing, say, a one mile circle around existing play parks and claiming that children living in these areas are well-provided for and those outside aren’t. For example, some locations have more children living there, therefore a higher demand. Or, parks may be plentiful but underused because of their poor quality or poor access. These considerations are crucial for directing infrastructure and other interventions to where they’re needed most.
Overall, this work indicated that spatial equity analysis can be useful as the first step in future evaluations for health interventions, especially when it’s too early to measure direct health impacts. In the case of the ‘Healthy Towns’ program, we found that interventions were generally well-located in areas of highest population need, as determined by program managers. This is a good start, but we’ll need to wait to see if the aims – to make people more active and healthier eaters – will be met.
You can read the full article here .
Posted in: NPA Partners Promising Practices Health Disparities Prevention Health Equity Research & Evaluation | Comments | Add a Comment | Comment Policy | Permalink
Smartphone and mobile apps: An important solution to increasing participation and engagement of minority and underserved communities
Posted on 8/22/2013 by Regina Greer- Smith, MPH FACHE
These are exciting times. Today, technology allows us to advance knowledge and empower members of underserved communities with information at rapid speed and with minimal cost. Considering the use of smartphone and mobile apps may be an important solution to increasing participation and engagement of minority and underserved communities in patient-centered outcomes research and comparative effectiveness research. Patient-centered outcomes research involves research that brings both the patient and providers together for shared decision-making for better outcomes and determining the costs and benefits of one course of treatment over another.
According to the Pew Internet and American Life Project , minorities (along with young adults) are leading consumers of health information via mobile platforms. African Americans and Latinos are more likely to own a mobile phone than whites and outpace whites in mobile app use. African Americans are using Twitter to share information, especially about neighborhood events. This information should be leveraged by researchers to use mobile apps and smartphone technology in research engagement with minorities and underserved communities.
Taking the concept a step further, creating apps that deliver education and information from trusted members of communities – such as ministers, physicians and researchers – could increase wider participation because of the trust and relationships that are already in place.
As an example, an innovative research project to engage African American women in research is now underway. Women stay connected using a smartphone app to learn about breast cancer, receive messages about the importance of participation in clinical trials and connect with researchers who they select to work with.
Developing mobile apps to include education and resources about the benefits of participating in patient-centered outcomes research and topics of interest to minority populations could increase their participation and involvement. Consider the possibilities for raising awareness and advancing health equity in research through mobile apps:
Developers and researchers must be aware that patients, caregivers and other community stakeholders are key partners in the development of mobile apps, because mobile apps are being developed for their use to enable and increase their participation – and not solely for the use of the researcher as a recruitment vehicle.
In January, 2013, Regina Greer-Smith, along with a team of healthcare professionals, formed The Midwest /Partners Patient Engagement Cluster , (MPPEC) resulting from involvement with The Patient-Centered Outcomes Research Institute (PCORI), a non-profit organization created from the Patient Protection and Affordable Care Act in October 2012. MPPEC’s mission is to engage patients and researchers in patient-centered outcomes research (PCOR) and comparative effectiveness research (CER).
Posted in: Health Minority Populations NPA Partners Promising Practices Health Disparities Prevention African American Health Care Health Equity Hispanic/Latino Minority Health Research & Evaluation | Comments | Add a Comment | Comment Policy | Permalink
Posted on 8/21/2013 by Robin Whittemore
Minority adults are at a disproportionate risk for developing type 2 diabetes, a challenging illness to manage that is a leading cause of morbidity and mortality in the U.S. Evidence indicates that lifestyle change programs, which incorporate healthy eating, physical activity and modest weight loss, can prevent or delay the development of type 2 diabetes. Yet, access to diabetes prevention programs is limited, particularly among minority and low-income adults.
To help address the issues with access to diabetes prevention programs, we designed a study to link existing community resources—public housing communities and a homecare agency— to minority and low-income adults at-risk for type 2 diabetes. Public housing communities provide housing at reduced rental costs for families of low socioeconomic status. We chose this setting because these communities often have the space and personnel to support a community-based program. The homecare agency consists of nurses who monitor and implement healthcare in a home environment, and are trusted health professionals in public housing communities.
We worked collaboratively with homecare nurses and residents of public housing to modify a diabetes prevention program to meet the needs of the community (e.g., low health literacy, family focused, culturally relevant, limited resources). We then evaluated the effect of a six-month diabetes prevention program provided by homecare nurses compared to a one-month enhanced standard care condition. Community health workers assisted nurses in the delivery of the programs.
The 67 participants were primarily female (79%), racial and ethnic minorities (76% non-white), had a high school education (72%), were unemployed (73%), unpartnered (83%), with an average age of 40 years, and an average of three children. Approximately half of the sample had elevated depressive symptoms (51%). Thus, our program reached adults with multiple health risks.
Homecare nurses were able to implement the program as intended; however, attendance at classes was sub-optimal, particularly with the six-month program. We did not see any difference between groups on any health outcomes, possibly because both groups received a similar program. What was promising was that there were significant improvements in health behaviors in both groups. Participants increased fruit and vegetable intake, low-fat eating, meal planning and improved nutrition behavior and physical activity. Participants decreased sugar drink intake, unhealthy snacking and triglycerides. They also reported improved stress management and decreased depressive symptoms. We did not see significant changes in BMI, glucose, cholesterol or blood pressure.
These findings suggest that brief diabetes prevention programs can dramatically improve the health behaviors of a high-risk, vulnerable population. Collaborating with a homecare agency and key stakeholders, and providing the program by homecare nurses was highly acceptable to nurses and participants, and offers a feasible and potentially sustainable way to improve access to diabetes prevention programs. Future dissemination and evaluation of health promotion programs for residents of public housing communities are urgently needed.
This study was funded by the Robert Wood Johnson Foundation .
Posted in: Health Minority Populations NPA Partners Promising Practices Health Disparities Prevention Diabetes Health Care Health Equity Minority Health | Comments (1) | Add a Comment | Comment Policy | Permalink
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The NPA works to achieve health equity -- the highest level of health for all people. This blog is a venue for professionals from all fields and sectors to share their thoughts on pressing issues, news and events pertaining to health equity. Follow and participate in this candid discussion.
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