Addressing Minority Health Disparities in Richmond: Results from a Health Needs Assessment of a Southside Community

Background: Evidence shows the effectiveness of integrating community health workers (CHWs) into care models serving high-risk patients to reduce emergency department (ED) use, increase primary care use, and address adverse social determinants of health (SDH). The Southwood Resource Center, part of a network of clinics established by Richmond City Health Department, utilizes CHWs to address disparities affecting underserved populations through primary care referrals and additional resource linkages. Local student-volunteers in partnership with CHWs conducted a community needs assessment to identify patient resource gaps, aid in design and implementation of SDH interventions, and examine the relationship between chronic disease management and ED use reductions. Methods: English and Spanish-language surveys were conducted during patient visits to the SRC, in addition to other settings to facilitate representative sampling. A total of 134 responses were received, with Blacks (34%) and Hispanic/Latinos (65%) well represented. Results: Significant social determinants identified by the needs assessment included housing stability, and transportation and food access. Respondents indicated need for support managing chronic conditions including heart disease, diabetes, mental health and asthma. 1 in 3 respondents (31%) reported using the ED for primary care, and nearly 2 in 3 (66%) reported not having a family doctor. Barriers to health care included cost (35.6%), insurance status (50.4%) and transportation access (29.6%). Conclusions: CHWs play an important role in identifying community strengths and resource gaps and linking patients to additional resources. Opportunities for service improvements include bilingual care coordination, chronic care management, health insurance navigation, food subsistence resources, and transportation support.https://scholarscompass.vcu.edu/gradposters/1104/thumbnail.jp

Wellness from Diabetes: Community Health and Diabetes Assessment

The Republic of the Marshall Islands (RMI) is highly prevalent in type 2 diabetes mellitus (T2DM) with a prevalence rate of 37.37%, the highest in the world. T2DM dominates Majuro, the country’s capital, as a leading cause of mortality and morbidity, despite efforts of health care workers, local community organizations, and government. Income and education are social determinants of health. The correlations between good health and high income, and between good health and high education level, are positive. However, there is a continuous growth of T2DM incidence and prevalence on Majuro. Therefore, we hypothesized that there is no significant difference between healthful dietary and exercise practices of two groups of people on Majuro, RMI: those with high income and high education levels, and those with low income and low education levels. Community-based research conducted on Majuro helped test our hypothesis and gain knowledge of necessary steps to reverse this epidemic. During beginning stages of our research, related literature on diabetes, social determinants of health, and research methods were reviewed. To acquire qualitative data, focus group discussions (FGDs) and key informant interviews (KIIs) were conducted. FGDs were held with people grouped according to profession (health, education, community). With the KIIs, key members deeply involved or active in the community were interviewed one-on-one. The bulk of our quantitative data will be gathered by surveys on basic demographics, economics, and health-related perceptions. In collaboration with the Ministry of Health and local organizations, 400 surveys will be administered in Marshallese and English, and collected

An Assessment of Funding and Other Capacity Needs for Health Equity Programming Within State-Level Chronic Disease Programs

Background: Chronic diseases are an important contributor to morbidity and mortality among racial/ethnic minority, low-income, and other under-resourced populations. Given that state health departments (and their chronic disease programs) play a significant role in providing population and preventive health services, their capacity to promote health equity is an important consideration in national efforts to address chronic diseases. The purpose of this study was to examine capacity needs of state chronic disease programs with respect to promoting health equity. Methods: In 2015, the National Association of Chronic Disease Directors (NACDD) conducted a survey of its members that work within a state chronic disease division (CDD) or the larger state health department. The survey was structured to provide information on major funding sources for chronic diseases, the extent to which key funders required a focus on health equity, dedicated staffing for health equity, and training and technical assistance needs of practitioners to support health equity integration in chronic disease programming. All data were analyzed using SPSS 19.0. Findings: A total of 147 chronic disease directors and practitioners responded to the survey from 43 states, the District of Columbia and three of the U.S. Affiliated Territories and Commonwealths. Forty-two percent (N=25) of the 59 directors of state, territorial and tribal chronic disease programs at the time of the study responded. Only 52% of respondents believed their CDD adequately addressed health inequities. Among the 70 respondents who did not know or did not believe their health departments adequately addressed health inequities, barriers identified include insufficient funding (62%), inadequate training (54%), and health inequities not being a priority (22%). Respondents also identified opportunities to strengthen funding requirements to address health disparities Conclusions: Overall, the data highlight some opportunities to enhance the capacity of state CDDs to promote health equity, such as through more direct funding requirements for health equity integration, staff training, increased funding, and specialized technical assistance. Because the response rate was less than 100%, we cannot generalize the findings to every state chronic disease program. However, the responses are relatable to their collective experience

Building Interprofessional Global Health Infrastructure at a University and Health System: Navigating Challenges and Scaling Successes

Mission: Global Jefferson will create sustainable programs of global distinction through collaboration that position Jefferson as a local and international destination and resource for education, research, and clinical activities. Global Jefferson is supported by the Associate Provost for Global Affairs, part of the Office of the Provost. Global activity at Jefferson includes: Global Health Initiatives Committee (GHIC) Service Learning Global Research & Exchange between institutions Pre-clinical, translational, clinical, and applied research Poster presented at: 8th Annual Global Health Conference of the Consortium of Universities for Global Health (CUGH)https://jdc.jefferson.edu/globalhealthposters/1000/thumbnail.jp

Can Changing Your Environment Change Your Health? Examining Public Housing Relocation and Cardiovascular Disease Risk

Cardiovascular disease is the leading cause of premature death in the United States today, and vulnerable populations may be more susceptible to this disease risk. Relocating into a new neighborhood may affect one’s cardiovascular disease risk. Through a socio-ecological framework, this study sought to determine whether changes in one’s interior and exterior built environment had a significant effect on cardiovascular disease risk in Atlanta’s relocated public housing population. Using pre- and post-relocation data from a questionnaire delivered to public housing residents, and built environment assessments from before and after demolition neighborhoods, the results showed residents were significantly more satisfied with their new neighborhoods and residences. However, while the interior built environment improved significantly after relocation, the exterior built environment declined significantly. Further, neither overall health nor cardiovascular disease risk improved significantly after relocation. These results corroborate findings in other public housing research that shows that many former public housing residents do not perceive an improvement in their health after relocation

Organ Donation Ethics: Are Donors Autonomous within Collective Networks?

Can and will a person become an organ donor? Before such an altruistic act will occur, there is the ethic behind the action. There is an internalization of an ethic that the person agrees or disagrees with organ donation, no matter the variant. There is a large sense of agency and responsibility over the integrity of one’s body. We do care what our “network” thinks about our personally held norms of living donation and sanctity of the body. I present the position that understanding of the norms of living organ donation requires an examination of the personal social “network” surrounding the potential donor. Networks rely on connection which may lead to deliberate consensus building (or a reason to conform in order to limit disharmony). But I argue, even when there is a supportive social environment supporting a particular bioethical value, there will be some level of network level engagement with others in this process (for better or for worse)

Rhode Island’s Health Equity Zones: Addressing Local Problems with Local Solutions

The Rhode Island Department of Health (RIDOH) describes the strategies and infrastructure it has developed to fund its placed-based initiatives to address the social determinants of health to eliminate health disparities. Using a data driven and community-led approach, RIDOH funded 10 local collaboratives, each with its own, geographically-defined “Health Equity Zone,” or “HEZ,” and, to support the collaboratives, created a new “Health Equity Institute,” a “HEZ Team” of 9 seasoned project managers, and direct lines of communications between these assets and the Office of the Director of Health

Severity of Scope Versus Altruism: Working Against Organ Donation’s Realization of Goals- An Essay

The number of incidences of End Stage Renal Disease (ESRD) supports the case that it is a public health emergency. The burden is often quantified by rates, leaving many people cold and unresponsive, leading to, as Nordgren and Morris McDonnell (2011) state, “the diminishing identifiably of a large number of victims” snarled in the scope-severity paradox. The subject may identify with the disease or illness, but who are these ill-fated others? It must go beyond recognition that there is an ESRD problem at hand. “Strength in numbers” hurts---according to scope-severity paradox and its close kin, scope insensitivity. There appears to be less of an incentive to upset rational choice and side with emotion if enlarging health awareness is required to turn the tide of disease. But I argue that this emotive will more likely activate a collective empathy if an ESRD patient that needs a kidney is personally known to us