“The idea of the wellness trust is to create a pool of money that can effectively address the social determinants that are making our families sick and the vast disparities in health and access based on which ZIP code you live in,” Jim Mangia, CEO of a network of 10 community clinics in south Los Angeles, told journalist Rob Waters.
I’d never heard of a “wellness trust” until I stumbled upon Mangia’s engaging Q&A with Waters, who blogs about health and science over at Forbes. Mangia is part of a coalition of labor and community groups trying to establish a wellness trust with funding obtained via a state law that mandates that a certain percentage of profit made by hospitals be spent on community benefits. Here’s Mangia:
“If you look at where the money is in healthcare, it’s with hospitals, health plans and insurance companies. So if you’re going to reorder the priorities of a healthcare system in a particular area, you have to use the resources of the system’s wealthiest elements. The issue is: Are these community benefit dollars actually being used for community benefits? I think some are and some aren’t. We’ve done research and know that cities and counties have some power to decide how those community benefits are spent. It’s through that process we think we can create this trust.”
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It seems pretty far-fetched that bringing a supermarket to a disadvantaged neighborhood could, in a matter of months, turn back the tide of obesity.
So I wasn’t exactly shocked by the study in Health Affairs (AHCJ members have free access) this week finding that the addition of a supermarket made little impact on nearby residents’ diet or weight gain. The authors compared two demographically similar Philadelphia neighborhoods. Both were considered food deserts, but one received a new 41,000-square-foot-supermarket in 2009. Six months later, the authors found no significant difference in body mass index or daily fruit and vegetable intake between residents of the two neighborhoods. (In the neighborhood with the new supermarket, most residents didn’t even adopt it as their main store.)
The link between food deserts and obesity has always been somewhat tenuous. For instance, having a nearby supermarket or grocery made no difference in the amount of fruits and vegetables people ate or the overall quality of their diets in one of the largest observational studies to date. More recently, researchers analyzed data from 97,678 adults in the California Health Interview Survey and found “no strong evidence that food outlets near homes are associated with dietary intake or BMI.” They figured it’s because most people go by car and don’t limit their shopping to nearby stores.
News outlets tended to cast the latest study as a policy fail for the Obama administration. Obama’s $400 million Healthy Food Financing Initiative is based on the idea that making fresh fruits and vegetables more accessible in underserved neighborhoods will help reverse diet-related health problems.
I’m not sure that a six-month pilot study on a single store is the final word. In a thorough report by Sarah Corapi at The News Hour, study author Steven Cummins says he remains convinced that better food stores are needed in many disadvantaged neighborhoods: Continue reading
It’s great that the rapid rise in youth obesity since the 1980s has started to level off. But there’s an unsettling trend hidden in the data: Progress has largely been limited to kids from more educated and higher income families, according to a recent analysis that got less news coverage than it should have.
Robert Putnam and colleagues at the Harvard Kennedy School compared outcomes by education and income using data from two nationally representative health surveys (the 1988–2010 National Health and Nutrition Examination Surveys and the 2003–2011 National Survey of Children’s Health).
Among teenage children of parents with a college degree, they found that the prevalence of obesity began to drop about 10 years ago, while it continued to climb among the teenagers of parents who have at most a high school degree. They found the same trend when they used estimates of family income, rather than education, to measure socioeconomic status. (The growing gap is not merely a reﬂection of racial or ethnic differences, they say, because it persisted even when they limited the analysis to non-Hispanic whites.)
Los Angeles Times reporter Melissa Healy raised an important point in her coverage: Continue reading
The idea that chronic stress can change how your body and brain work fascinated Dan Gorenstein, a radio reporter at Marketplace, and it sparked the idea for an affecting, memorable piece about poverty and health.
The report pivots on the story of a woman with a troubled past and a painful confession. How did Gorenstein find her, and persuade her to go public? How did he balance her interests with his potentially conflicting interest in pursuing a good story?
The piece also distills a lot of complicated research about chronic stress, decision making and health. But it remains a tight, fast-moving narrative. I talked to Gorenstein and got the inside story on how he did the reporting.
“For many patients, a prescription for housing or food is the most powerful one that a physician could write, with health effects far exceeding those of most medications.”
– from Housing as Health Care — New York’s Boundary-Crossing Experiment
Image by nouspique via flickr.
Housing First is a health care strategy based on the idea that secure, affordable housing is a necessary first step to care effectively for homeless people with chronic mental health and substance abuse problems. There is some evidence that this approach may, in some circumstances, even save taxpayers money (but probably not as much as is often claimed).
In a much-cited 2009 study in Seattle, researchers analyzed medical and law enforcement costs for 91 people given supportive housing and found that costs dropped to about half the level seen among 35 comparable homeless people on a waiting list.
Cities from coast to coast are ramping up efforts to provide housing as a health care solution. Reporters who keep an eye on this trend won’t be lacking for stories to pursue. There’s a lot of money at stake, for one thing. And, despite all the potential for helping people, it’s questionable whether all these projects will really save money, especially if they house more than just the heaviest repeat users of emergency rooms and jail cells. Other aspects of the Housing First model are bound to stir controversy (more on this below). Continue reading
It’s easy to blame disadvantaged people for engaging in behaviors that put them at risk for developing diabetes.
Rhiannon Meyers, a reporter at The (Corpus Christi, Texas) Caller-Times, says that “Over and over again, I heard doctors blame our region’s high rates of diabetes and related complications on noncompliant patients unwilling to make the necessary changes to get healthy,” while she was reporting “Cost of Diabetes.”
But Meyers delved deeper and found there were environmental and social forces that contribute to higher rates of unhealthy behavior and illness. In the latest “Shared Wisdom,” she explains: Continue reading
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The greatest public health problem is not heart disease. It’s not cancer. And it’s not mental health.
It’s inequality. That’s according to a Canadian health policy analyst quoted by André Picard in a notable series in the Toronto-based newspaper The Globe and Mail.
The Globe‘s Wealth Paradox series, published over two weeks in November, explores how Canada’s increasing wealth gap is reshaping society and putting future generations at a disadvantage. The Globe being a business newspaper, the series makes a business case for taking the threat seriously. It’s full of story ideas that can be transposed onto U.S. turf.
Picard’s piece, Wealth begets health: Why universal medical care only goes so far, dug into the heavy health impact of income inequality despite Canada’s longstanding provision of medical care to all: Continue reading
Dozens of news stories over the past year have reported on the disturbing data showing that Americans are dying younger than people in other wealthy countries and falling behind in many other measures of population health.
But much of the reporting I’ve seen shies away from covering a crucial part of the story: How social inequality may be the most important reason why the health status of Americans is failing to keep up with progress elsewhere.
Being born into poverty, growing up with curtailed opportunities for education and employment, living in a disadvantaged neighborhood – these social determinants of health are like the cards you’re dealt in a game of poker. It’s hard to win if the deck is stacked against you.
Researchers in sociology and public health have developed a fair amount of evidence that social status (typically measured by income or education) may be the most significant shaper of health, disability and lifespan at the population level. In the picture that is emerging, social status acts through a complicated chain of cause-and-effect. Education equips people with knowledge and skills to adopt healthy behaviors. It improves the chances of securing a job with healthy working conditions, higher wages, and being able to afford housing in a neighborhood secure from violence and pollution. The job security and higher income that tend to come with more education provide a buffer from chronic stress – a corrosive force that undermines health among lesser educated, lower income people. Research consistently shows that more education gives people a greater sense of personal control. Positive beliefs about personal control have a profound impact on how people approach life, make decisions about risky behavior, and cope with illness. Continue reading
Conan Murat, one of Alaska’s first dental health aide therapists, provides a first-person perspective on providing oral health care to his fellow Native Alaskans on the isolated Yukon-Kuskokwim delta in this month’s issue of Health Affairs.
One of the perks of belonging to the Association of Health Care Journalists is free access to online versions of a number of useful journals. Health Affairs is one of those and the November issue is dedicated to the theme of “Redesigning the Health Care Workforce.”
In one piece, “How to Close the Physician Gap,” the authors suggest that registered nurses and pharmacists could help address the disparity between the demand for primary care services and the number of physicians available to provide the care. Another looks at meeting growing health care needs through the wider use of nurse practitioners and physician assistants.
But Murat’s piece weighs in on another health care workforce issue that touches the lives of millions of Americans: the shortage of dental providers. Continue reading
In rural areas, the federal Centers for Medicare & Medicaid Services designates more than 1,300 hospitals as being “critical access hospitals.” So designated, these facilities get a bit more in reimbursements to ensure that Americans outside of cities and suburbs can get the care they need without having to travel too far. In August, a report from the Office of Inspector General of the federal Department of Health and Human Services recommended that 80 percent of these facilities be decertified.
When he learned of the report, David Wahlberg, a health/medicine reporter for the Wisconsin State Journal, interviewed administrators at critical access hospitals in Wisconsin and found that the administrators believed closing these hospitals would have a detrimental effect on care for Medicare patients. Continue reading