Maybe a welfare state isn't so bad after all....

The New York Times Magazine discusses how the Netherlands moves beyond universal health care to provide early life support, safe housing, and family-friendly policies. Apparently living in a so-called "welfare state" is not be so bad! Read the article to learn more about how the Dutch government works with other institutions to promote health, and whether or not such policies could be incorporated in the United States.

"[There is] something that seems to be overlooked when Americans dismiss European-style social-welfare systems: they are not necessarily state-run or state-financed. Rather, these societies have chosen to combine the various entities that play a role in social well-being — individuals, corporations, government, nongovernmental entities like unions and churches — in different ways, in an effort to balance individual freedom and overall social security." One Dutchman noted: "My American friends say they live in the best country in the world, and in a lot of ways they are right. But they always have to worry: ‘What happens to my family if I have a heart attack? What happens when I turn 65 or 70?’ America is the land of the free. But I think we are freer.” (Read full post)

Beyond Health Care

"The Robert Wood Johnson Foundation’s Commission to Build a Healthier America has just released a new report: Beyond Health Care. At a time when all eyes are trained on the debate over providing access to medical care for all Americans, the report looks beyond health care, to the health of the population. As it turns out our health—public health—has less to do with health insurance than one might think."

- Maggie Mahar "Taking Note: A Century Foundation Group Blog" April 07, 2009

Apologies for the late posting. While it still misses out on maternal leave, early childhood, and tends to focus some on health behaviors, it makes a good start in dissociating health from health care. It is a critical report which, without active dissemination, will most likely fall by the wayside while pundits continue to debate health care, hog flus, and housing finance. Tell everyone you know. (Read full post)

Together, We Make Better Decisions

For advocates of population health, its often difficult to get an audience to see in the same scale (e.g. long-term consequences of unequal societies) when discussing health. More specifically, it is difficult for some to grasp that something good for society will ultimately be good for oneself. Environmental advocates deal with the same problem (often with the same implications)!

A New York Times Magazine article entitled, "Why Isn't the Brain Green?" describes what some social and behavioral researchers have discovered about the way people think and make decisions (arguably a "rediscovery" of things we used to know before the advent of Modernity).

A key finding is when people discuss issues and come to a consensus as a group, they are more willing to take short-term sacrifices for long term gain. Also, being identified as a group and being physically located at the same table increases participation appreciably. Importantly, researchers acknowledge that there is no such thing as true preference. That is, information and perspectives presented as a group naturally affects what an individual values.

The article also discusses the principles of "frames" and "nudges" as tools to help guide people into making decisions that are in their best interest and in the best interest of the community. When queried about the potential coerciveness of these tools, in addition to the necessity of choice, researchers noted first:

“Remember when New York tried to enforce its jaywalking laws?” “You can’t enforce stuff that people don’t believe should be done.”

But more critically:
“I think you have to take it as a given that whatever we do, whether it’s what we currently do or what we plan to do, has some value judgment built into it.”

It is a large step to hear scientists acknowledging the limits of science in decision-making and realizing the essential need for broader human input. At the very least, when decisions are made they should reflect what is truly desired by the people. And, that, according to this and other research, is a good decision.
(Read full post)

Use the economic stimulus to raise our I.Q.!

Nicholas Kristof of the New York Times writes about how social determinants lower the I.Q. of children living in poverty and thus contributes to a collective drain on our intellectual resources . A researcher cited in the column notes, "“Bad environments suppress children’s I.Q.’s,”and Kristof concludes, "The implication of this new research on intelligence is that the economic-stimulus package should also be an intellectual-stimulus program. By my calculation, if we were to push early childhood education and bolster schools in poor neighborhoods, we just might be able to raise the United States collective I.Q. by as much as one billion points. That should be a no-brainer." Read the full column here. (Read full post)

Does the stress of poverty cause the "acheivement gap"?

In a study published this week in the Proceedings of the National Academy of Sciences, scientists from Cornell University found that the reduced capacity of the working memories of the poor is almost certainly the result of stress affecting the way that brains develop during childhood. In other words, the chronic stress of long-term poverty seems to be responsible for the "achievement gap" that contributes to poverty passing from one generation to the next. This article in this week's Economist refers to the Marmot studies and notes, "The main reason poor people are stressed is that they are at the bottom of the social heap as well as the financial one... So, it may not be necessary to look any further than their place in the pecking order to explain what Dr Evans and Dr Schamberg have discovered in their research into the children of the poor." (Yes, the Economist actually printed that!) The study authors showed that the relationship between childhood poverty and reduced working memory was mediated through chronic stress in childhood, measured through "allostatic load" -- a "biological marker of cumulative wear and tear on the body that is caused by the mobilization of multiple physiological systems in response to chronic environmental demands." If you're up for it, you can find the full text of the original research article here. (Read full post)

Inequality is Unhealthy

PHF's own Stephen Bezruchka recently paid a visit to Democracy Now! In a segment especially pertinent during this time of recession, Stephen explains how inequalities in wealth have contributed to America's poor health outcomes. As President Obama tries to "fix" both our health care and economic systems, what would you suggest he do to help America make a comeback as a contender in the Health Olympics?

(Read full post)

Happy, Happy, Joy, Joy

The results of a new well-being survey were recently released. Gallup, in partnership with with Healthways and America's Health Insurance Plans, conducted the survey. The top three states: Utah, Hawaii and Wyoming. The bottom three: Mississippi, Kentucky and West Virginia. Rankings by congressional district are also available. The story and nifty map feature are found here. (Read full post)

Place Matters

One of the most frequently presented arguments against systematic changes is that of individual agency. An initial response to this may be that, ideally yes, an individual has the potential to overcome any sort of adversity present in her or his life. Unfortunately, a large and ever growing body of evidence is showing that policy- (and ideology-) induced inequalities and disparities are stacking the deck against most individuals and especially individuals of certain populations. One of the most compelling manifestations of this is racial minorities that live in concentrated geographies (e.g. that are affected by deliberate and incidental housing, zoning, and economic policies). Below begins a list of damning evidence...

(check back for updates, feel free to post other studies through comments)

Zenk SN, et al. “Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit.” American Journal of Public Health. 2005; 95:660-667.

Summary of findings:
Statistically significant increases in distance to supermarkets were found in poorer neighborhoods when there were medium and high percentages of African Americans. Contrarily, distances to supermarkets were relatively consistent regardless of income for neighborhoods with low percentages of African American. The disparity of access between low percentage A.A. and high percentage A.A. poor neighborhoods were extreme, with an average of 1.10 to 1.15 miles greater distances to supermarkets.

Interpretation:
It's much harder to make the "healthy choices" in a poor African American neighborhood than in white neighborhoods. Why is this? Implicated, intertwined, and reinforcing factors include historically racist / exclusionary zoning policies ("redlining"), poverty dispersal or urban renewal factors, resultant deterioration in social environment, lack of political will or power, lack of employment/economic power, loss of tax base.
(Read full post)

An Inspiring Evening

Tonight the Population Health Forum was thrilled to be the guests of Meaningful Movies, a weekly community event organized by Wallingford Neighbors for Peace and Justice (link to their website)! We were able to screen a segment of the film Unnatural Causes... Is Inequality Making Us Sick? with over one hundred attendees. We had wonderful, engaging, and inspiring conversations after the film. Here are some helpful links for those who attended and want to learn more (or those who missed the event!)


Unnatural Causes Website: Summary of the series, video clips of each segment, toolkits for action in your community, and much, much more.

Several people asked about the graphs we displayed that showed where the U.S. stands compared to the rest of the world in terms of income inequality, health care spending, child poverty rates, and life expectancy (i.e. the "Health Olympics"!). The graphs were also from the Unnatural Causes website, but a direct link is here. They also have several other interactive activities and resources you should take a look at.

Thanks for a wonderful evening!
(Read full post)

Let Them Eat Soup

It is easy to understand that wealth in America is unevenly distributed among the few and many, however, it can be difficult to comprehend the magnitude of this income inequality. To help us comprehend the the income disparity in the United States the Working Group on Extreme Inequality developed the following video.

(Read full post)

Health care technology -- not the savior everyone perceives it to be!

In the New York Times Health Blog Well, Tara Parker writes about the need for both patients and physicians to move away from the framework that the most expensive and latest treatments are "best." She notes that technology has played a "surprisingly" small role in improving health outcomes - only 1 in 160,000 Americans have had their lives extended or saved because of recent improvements in health care technology. "The real gains in health, experts say, have come from lifestyle changes like smoking cessation and seat-belt use or from public health improvements like vaccination, a cleaner water supply and increasing access to primary care." Hopefully this is one more step towards getting the word out!
Read the full article here. (Read full post)

Population Health in the "deeper conversation"

An event we all might be interested in, a gathering of people we need to tell our values to:

WHAT: "Deepening the Conversation: Equity, Race and Social Justice in Our Region"
WHEN: MARCH 2, 2009: 6:00pm - 7:30pm
WHERE: UW Parrington Hall, Forum
This forum will provide an opportunity for University of Washington students, staff, and faculty to deepen the conversation around race, equity, and social justice issues. As current and future policymakers, leaders, teachers, and advocates, it is important for us to examine our role in addressing problematic social conditions. The Evans School Civic Engagement for the 21st Century Project and the Partnership for Cultural Diversity student interest group are collaborating with the Dean’s Office to host a panel discussion with:

* Ron Sims, King County Executive
* Greg Nickels, City of Seattle Mayor
* Dr. Sheila Edwards-Lange, UW Vice President for Minority Affairs and Vice Provost for Diversity
* Norman B. Rice, former City of Seattle Mayor and current director of the Civic Engagement for the 21st Century Project
(Read full post)

A budget to reduce inequality?

Can it be true? Obama's new budget proposes steps toward reducing inequalities:

NY Times: Obama's Budget Plan Sweeps Away Reagan Ideas. (Feb. 26, 2009).

I suppose time will tell what will truly come from this, but for a moment I want to celebrate the fact that the executive branch is talking about income inequalities in this country. What a change!

Here's a link to the actual document Inheriting a Legacy of Misplaced Priorities, from the FY 2010 President's Budget on the White House's OMB page, which includes the following (music to our ears):

"By 2004, the wealthiest 10 percent of households held 70 percent of total wealth, and the combined net worth of the top 1 percent of families was larger than that of the bottom 90 percent. In fact, the top 1 percent took home more than 22 percent of total national income, up from 10 percent in 1980...And these disparities are felt far beyond one’s bank statement as several studies have found a direct correlation between health outcomes and personal income." [Emphasis Added]
(Read full post)

Hunger and the Weakness of the Social Fabric of America

As the economic crisis intensifies, weaknesses in the social fabric of the United States will be come increasingly apparent. One of these holes appears at the intersection of wealth disparity, employment, racism, physical communities, and food insecurity. An amazing panel discussion hosted by the Center for American Progress entitled “All You Can Eat? How Hungry is America in Good Times versus Recession?” took place on February 6, 2009.


The main thrust of the talk is on food programs, but speakers prodigiously bridge concerns of hypocrisy, stresses, and stigma of social support programs; health impacts of community, housing, and wealth disparities; the insensibility of focusing on downstream issues such as healthy choices and obesity; the importance of early childhood wellness; the cost savings of universalizing means-testing programs; and the true incentives of social equalization programs.

Panelists include Joel Berg, director of the NYC Coalition Against Hunger (NYCCAH) and author of All You Can Eat? How Hungry is America; Judith Bell, President of PolicyLink who studies disparities of access to food in poor and minority communities; and Jim Weill, president of the Food Research and Action Center (FRAC).

Excerpt from Joel Berg on the admonitions of those who advocate changes in the food preparation habits of poor, overweight Americans:

“I remind them that we’ve lectured low-income people that they should be working, and now only 10% of the people in poverty are on public assistance in America. They are working 2, 3, 4 jobs. They don’t have nannies for their kids. And now we’re saying they should spend 5 hours to cook their beans to be responsible.”

Most importantly, the panelists discuss the real possibility of and propose solutions to eliminate hunger and disparities during this opportune time.

---

On an unrelated note, two perspectives on of the Horatio Alger Myth (or, “pulling yourself up by your bootstraps”) in the United States:

A Political Science Perspective: The Horatio Alger Myth in the American Political Mind

A Literary Perspective: Gimme A Break! Mark Twain Lampoons the Horatio Alger Myth

(Read full post)

From the Producer of Unnatural Causes

Opinion piece by Larry Adelman in the SF Bay Guardian summarizing the current state (and stakes) of population health in the US pretty succinctly... (Read full post)

view from the retreat

Here are some incredibly energetic and creative minds at work. We are taking baby steps, but they can lead to innovation, incredible change and better health for all. Stephen

(Read full post)

Inaugural Population Health Forum Retreat

On February 15, 2009, 9 members of the Population Health Forum met to energize around action steps toward continuing the mission and goals of the PHF. We heard about the history of the PHF and present day constitution of the group. After sharing our own unique pathways to and interests in understanding population health, we collectively came to concrete understandings of the issues behind the forum’s mission and goals.

As steps toward action, we brainstormed about potential audiences we hope to reach with our messages about population health and started to develop lists of allies we hope to connect with as we move forward in spreading the word about population health disparities. Finally, we outlined digital and non-digital mediums for which we hope utilize as we begin a new phase of outreach and growth for PHF. We will create a blog that can help intra-PHF communication and self-education. We hope that in the near future, the blog and other digital technologies can be employed PHF in unique ways to ‘spread the word’. We also began to develop an outreach plan for community events for awareness and action raising around issues of population health. We will report on our research and action items for new directions at the next PHF meeting, March 3rd, 2009.

Overall, the meeting successfully engaged new members of the forum behind the mission and goals of the organization. We are inspired, excited, hopeful and enthusiastic. We are ready to move forward.

- Tegan Callahan (Read full post)

Welcome to the Population Health Movement!

While we are indebted to the many individual and collective purveyors of health and equality throughout the ages, today we recognize the beginning of a new chapter in the Population Health Movement.

A key component in building the Movement will be to share thoughts and ideas, arguments and apologies, comments and criticisms, articles and studies in an effort to not only build our knowledge and test our ability to reveal the unity of health, equality, and community to the world, but also to use these explorations to attract kindred spirits in a common cause.

This blog will serve as that crucible in which our plowshares will be molded and from whose sparks our allies will be guided. (Read full post)