Type in a ZIP code in this new atlas, and see how place shapes health

by Suzanne Bohan

July 18, 2018

For years, Dr. Amy Kind has been keenly aware that the neighborhoods in which her patients live often hinder their recovery. She described, for example, how worries over neighborhood safety deter home health care staff from visiting some of her low-income patients to check on their recovery. In one case, that lack of follow-up care meant a 78-year-old patient with mild dementia forgot to take his antibiotics to treat his pneumonia, and was readmitted three days after leaving the hospital.

Kind, an associate professor at the University of Wisconsin School of Medicine and Public Health, also described the futility of, say, diabetes education for patients who live in substandard housing that lacks adequate refrigeration in which to store insulin. Or how some people are too embarrassed to tell their doctors that they often can’t afford to heat their homes….

To read the rest of the column, visit its original posting site at the Center for Health Journalism.

Blog, Health disparities, Health equity

Access to credit and savings plays a key role in promoting health

by Suzanne Bohan

July 18, 2018

When Jennifer Bui, a resident of the low-income San Diego neighborhood of City Heights, turned 18, she started concentrating on her financial future.

“I was really interested in building my credit and building my financial power, in a way,” said Bui, now 19 and studying engineering and physics at Brown University in Rhode Island.

After watching her mother struggle with debt, she was determined take control of her finances. “It’s so heartbreaking to see my mom paying all of this interest,” Bui said. Her mother opened department store credit cards, but didn’t understand that the high interest rate accrues on the entire amount, if not paid in full. Occasionally she also forgot the due date, and got hit with late fees.

“It definitely stresses her out. She worries about it all the time, like how to pay them off,” Bui said.

Bui was leery of opening a credit card account, in part because of her mother’s experience. Then she learned of a new credit union in City Heights — a rare offering in an area with far more payday lenders, pawn shops and check-cashing outlets than bank branches.

It’s called Self-Help Federal Credit Union, and it opened in April 2017, largely through a $3 million loan and with $400,000 in grants from the California Endowment, the state’s largest health foundation…

To read the rest of the column, visit its original posting site at the Center for Health Journalism.

Health, Health disparities

Dishing out nutrition lessons during soccer practice

by Suzanne Bohan

February 24, 2018

A group of kids in South Los Angeles is getting a lesson in nutrition during a break in their “Soccer for Success” practice session.

“Who can tell me what is a grain?” asked a coach at a “Soccer for Success” session with young children last summer on a South Los Angeles playing field. “Wheat!” a young boy called out.

“Who knows the difference between a good wheat and a bad wheat?” she asked next. “One is a brown one and one is a white one.”

Several of the kids, mostly five- and six-year olds, called out white and then one said brown.

“You get a high five for that one,” the coach said. “The brown one is better. If you eat bread, if you eat pasta, if you want to eat anything the brown grain is better, OK?”

This young boy was sure he had the answer to a nutrition question asked during the “Soccer for Success” practice.

“So let’s recap, guys. Which one’s better, brown or white?” All the kids shouted “Brown!” in unison.

Not long after the grain training session was over, the youngsters got a snack that underscored the lesson.

The nutrition session was all part of the “Soccer for Success” program, which in South Los Angeles is run by the Brotherhood Crusade. It’s a sports-based child and youth development initiative, largely funded by foundations, with the goals of combating obesity, reducing youth violence, promoting healthier lifestyles and increasing family and youth engagement in the community.

But rather than just focus on physical activity – soccer – for losing weight, it also stresses eating fresh, quality foods instead of high-calorie, high-fat processed foods. Experts know that weight loss takes both increased activity and cutting back on rich foods with little nutritional value.

The nutrition segment I witnessed has a significant effect on the kids, said George Weaver, administrator with the Brotherhood Crusade. During the 90-minute soccer workout sessions, the coaches take two breaks to teach the children and youth about healthy eating. The topics change each week, covering nuts, grains, fruits, vegetables, etc.

The kids become inspired by what they learn, said Weaver. “In a lot of cases, our parents are participating in buying fresh fruits because their kids are saying, ‘No, no, no, we’ve got to buy this!’” and pushing their parents to make healthier purchases.

“They’re relaying this information to their parents,” he said.

George Weaver, with the Brotherhood Crusade, and I on a South LA soccer field during a "Soccer for Success" session.

George Weaver, with the Brotherhood Crusade, and me on a South LA soccer field during a “Soccer for Success” session.

Each year, about 1,500 South Los Angeles children and youth will participate in the free soccer/healthy lifestyle program. And the fact that it’s free is essential, as few of the parents could afford to pay for it.

In addition to raising awareness among the young about healthful eating choices – lessons they’ll retain their entire lives – kids are also losing weight, Weaver said. One girl lost 13 pounds, he said, and a boy 10 pounds.

This two-minute video, called “How Celeste Amaya Lost Weight….While Having Fun!” tells the story of one girl’s weight loss after she joined the “Soccer for Success” program. That weight loss allayed her mother’s fear that she would develop diabetes.

And “Soccer for Success” goes even beyond the important goals of physical fitness and healthy eating, said Weaver. It’s also about building self-confidence, acquiring life skills and turning South LA schools and recreational centers into true community hubs.

The program is funded by the U.S. Soccer Foundation, the California Endowment and other foundations, as well as city and corporate donors. For more information visit www.ussoccerfoundation.org/our-programs/soccer-for-success.

Health, Health disparities

A new community garden springs up after land group adopts health perspective

by Suzanne Bohan

October 24, 2017

Alina Bokde, executive director of the LA Neighborhood Land Trust, stands in a community garden that’s the result of new thinking about the health aspect of her organization’s work.

Alina Bokde, executive director the Los Angeles Neighborhood Land Trust, wasn’t quite sure how a new push to view her organization’s work through a public health lens would work.

She’s been acquiring open space in urban areas for years, with an eye toward conserving land, providing recreation and helping to mitigate climate change. But having a direct and significant effect human health? That was harder to envision achieving with small plots of land.

But her group had joined with dozens of other nonprofits in a bold effort to finally lift South Los Angeles, a poor neighborhood with familiar urban social ills – crime, poverty, high disease rates – onto a new trajectory that results in longer, healthier lives for residents.

The organization funding this major South LA project, which is called “Building Healthy Communities” and will run tens of millions of dollars over a decade, asked the community’s nonprofits to agree on common goals and best practices to increase the odds of achieving real success. The request of the funder, the California Endowment, reflects an emerging practice in philanthropy called “collective impact.” It asks that the many nonprofits tackling social ills in a community join together more tightly to achieve lasting change.

The nation’s 1.4 million nonprofits typically develop independent approaches to solving major social problems. But they’re “often working at odds with each other and exponentially increasing the … resources required to make meaningful progress,” wrote two authors in the Stanford Social Innovation Review.₁

The newly-shared objective around health led to a surprising outcome for the LA Neighborhood Land Trust after it began looking for the human health potential of its work as well.

Armed with this new way of viewing the organization’s work, one of Bokde’s staff approached an LA community health clinic, Clinica Romero, and asked the director – who hadn’t worked before with the land trust – if the clinic would develop a curriculum and nutritional guide for its diabetic patients, using a wished-for community garden at a nearby park to teach these lessons. The clinic director said yes, and Bokde then went to the Kaiser Family Foundation, asking if it would award a $50,000 grant to build the garden and help fund the development of the material to teach the patients more healthful living habits. It also said yes.

In the spring of 2012 the new community garden opened, with 19 raised plots – nine of which are reserved for clinic patients and the rest set aside for the community. The plots were awarded by lottery and there’s a wait list. Gardeners pay $35 a year. The fenced-in area, with a shed and its thickly-growing gardens, is a peaceful oasis off a busy LA thoroughfare. The clinic patients attend classes there, where they learn ways to cook the fresh produce. They also learn the most nutritious ways to shop for food and to cook it.

Bokde is thrilled with the outcome. “I’ve become a convert,” she said. And at no point did she feel the collaboration toward improving community health was forced. “It was very natural.” Her organization is also working with another clinic to build and run a community garden at a South LA high school.

The Los Angeles Neighborhood Land Trust even changed its tagline to “Growing Healthier Communities Through Urban Parks & Gardens.” And the Land Trust Alliance, a national group, asked Bokde to speak at its October 2012 annual conference in Salt Lake City on the intersection between public health and open space acquisition. She got an enthusiastic response and the national group invited her back to speak on the topic this year.

A woman named Imelda leisurely watered her garden plot one evening last summer in a busy LA neighborhood.

At the one-third acre garden site in Los Angeles one August evening last summer, a woman named Imelda was calmly watering the tomatoes, carrots and chilies she grows for her family. (Gardeners with extra can sell at a farm stand at the garden on weekends.)

Her family loves the fresh produce, but she’s also enriched by the experience. Tending her garden “takes a little of the stress away,” Imelda said.

TAKEAWAY: When nonprofits working in the same community set shared overarching outcomes, such as reducing violence, improving health or economic revitalization, they can produce outstanding results.

—

John Kania and Mark Kramer. “Collective Impact.” Stanford Social Innovation Review, Winter 2011. www.ssireview.org/articles/entry/collective_impact

Health, Health disparities

Controlled burns spark hope on Yurok reservation

by Suzanne Bohan

August 24, 2015

This photo, taken in Feb. 2013, shows the thick undergrowth that’s blocking healthy growth of hazel on Yurok tribal lands in Northern California.

The forests on the Yurok tribal lands in Northern California look like weed-choked, overgrown gardens, as one tribal member described it.₁

After years of fire suppression – in an ecosystem that needs fire to regenerate – the forest is filled with underbrush that crowds out desirable plants used for basket making, medicines and food. And many of the vast meadows that once blanketed the hills are gone.

Before European contact, the Yurok’s forests were cleared of underbrush by periodic fires, allowing elk and other animals to move freely, and the Yurok used controlled burns to keep trees and bushes from encroaching into meadows, where important plants grew and animals grazed.

But over the past century timber companies began planting monocultures of conifers not only on clearcut forests but on former prairies.₁ The rest of the meadowland was lost and the forests became overrun with undergrowth due to state and federal government fire suppression policies.

The result: A reduction in game and in many plants species critical to the preservation of Yurok culture.

But Del Norte County and its adjacent tribal lands in 2010 joined a statewide, $1 billion community transformation initiative funded by the California Endowment, which seeks to leave 14 California communities far healthier in 10 years. One key lever of change in this initiative is to ask community members what they most want to change, rather than the outside funder dictating terms. And then organizing members into a strong force for change.

Skip Lowry, whose mother is Yurok, led a nine-month “listening campaign” among Yuroks and non-Indians living in and around the tribal lands, which surround the Klamath and Trinity rivers. At the end, the community chose prescribed burns as the chief priority for restoring peoples’ health.

That’s not surprising to Dr. Susan Cameron, a Navajo/Hispanic scholar who works in the education department at the Smithsonian’s National Museum of the American Indian in Washington, D.C. She said Native Americans’ sense of well being is intrinsically linked to the preservation of their culture and community.

“Health can only be rooted in your community. There’s no other way it can be,” Cameron said. And much of what children need to learn to keep the Yurok culture alive, she noted, comes from a healthy forest.

“Since time immemorial the Yurok community honored and obeyed natural rights, true ‘laws of the land,’ which our culture depended on for the continuation of the blood of our people,” noted Lowry in a July 2012 article in Yurok Today. “And only within that culture will we find the balance and harmony once again.”

The largest bushes are cut and hauled away in preparation for a controlled burn on five acres of Yurok tribal land.

The largest bushes are cut in preparation for a controlled burn on five acres of Yurok tribal land.

The organizing campaign, funded by the California Endowment, led to the creation of the Klamath-river Local Organizing Committee, or KLOC, in April 2012. In April 2013, the Yurok tribe will start a managed burn on five acres where overgrown

These hazel shoots are twisted and bent from too much nearby plant growth. They need to grow straight for basket making and many other uses. The controlled fire will clear out the unwanted bushes and allow the hazel shoots to grow unimpeded.

bushes have caused prized hazel plants to send out twisted and bent shoots in order to avoid other plants. The Yurok need straight shoots for a variety of ancient uses, including making baskets, baby rattles and eel traps.

In a few weeks, I’ll post photos of the burn in progress. Photos taken by Melissa Darnell, the lead community organizer for the initiative in Del Norte County and the Yurok tribal lands, in this post show the site before and after preparation for the burn.

TAKEAWAY: Native American cultures have always known that health is intrinsically linked to your community and surroundings, a reality gradually coming to light in Western cultures.

—

1. Community plan catches fire: KLOC, Tribe partner to come up with 10-year cultural burn program. Yurok Today, July 2012. www.yuroktribe.org/documents/2012_july.pdf

Blog, Health disparities

Life Expectancy in Las Vegas

by Suzanne Bohan

March 6, 2015

Courtesy the City of Las Vegas

The Las Vegas Review-Journal ran a story on life expectancy by neighborhood in the glittering city. Like most every other community, it varies dramatically by neighborhood, with the gap as much as 16 years at either end of the nine-mile stretch between the downtown Strip and suburban Henderson. The study was funded in part with money from the Robert Wood Johnson Foundation, which is doing pioneering work in providing communities with hard data on their health status, and showing how conditions in peoples’ neighborhoods play such a strong role in life expectancy.

Here’s the full article, by Steven Moore, which came out on March 5, 2015:

www.reviewjournal.com/trending/silver-state/here-s-how-long-you-ll-live-based-your-vegas-zip-code

Blog, Health, Health disparities

Low-crime neighborhoods promote mental health in older Latinos

by Suzanne Bohan

December 9, 2014

This is from a new study out of the University of Illinois. It’s long known that bad neighborhoods raise stress, but this one quantifies the effect, and in terms of depression. It’s not hard to understand that staying cooped up inside, and feeling fearful leaving your house, would bring on depression. Next step, as the researcher says, is investing in neighborhoods to promote residents’ health (and for residents to start organizing to bring in these improvements):

Older Latinos living in the U.S. who perceive their neighborhoods as safer and more walkable are less likely to develop severe depressive symptoms, and the effect may be long term, a new study suggests.

Researchers examined links between the onset of depressive symptoms in 570 older Latino adults and various characteristics of the Greater Los Angeles neighborhoods they lived in, including crime, the availability and quality of sidewalks, traffic safety and aesthetics.

Participants ranged in age from 60 to 90, and 351 of them screened positive for low levels of depression at the outset of the study. When participants were rescreened 12 and 24 months later, a total of 19 (5.4 percent) of those with depression showed elevated symptoms.

However, people who perceived their neighborhoods as low in criminal activity and more walkable were less likely to develop severe depression, according to lead author Rosalba Hernandez, a professor of social work at the University of Illinois.

“Many times we look at individual-level factors or things within the individual’s family that contribute to mental health, but here we’re seeing it’s beyond that – it’s the neighborhood and other macro-systems that can impact psychological well-being,” Hernandez said.

“If there are neighborhood factors that decrease depressive symptoms, how do we figure out what those factors are and make appropriate investments, so we can have individuals who are psychologically well and environments that are flourishing?”

For the full story see: http://news.illinois.edu/news/14/1208walkability_RosalbaHernandez.html

Blog, Health disparities

Feeling in control? It could add years to your life.

by Suzanne Bohan

February 17, 2014

Margie Lachman, a professor of psychology at Brandeis University, led a recent study on one’s sense of control and life expectancy.

I’ve long wondered if outlook could change one’s life expectancy odds, since part of what accounts for discrepancies in life spans relates to a sense of control. That’s why those higher on the social ladder live longer, even if those just below them on the rung have safe homes, good food, medical care, etc. More control means less stress, better health.

So a new study caught my eye. It reported that for a certain population (those with less than a college degree), a sense of control did indeed influence life spans.

“Health and longevity are not just due to health care access,” said Margie Lachman, a professor of psychology and director of the Lifespan Initiative on Healthy Aging at Brandeis University, who led the study. “Attitudes make a difference. How you construe your circumstances and challenges determine whether you take action or give up, or feel stressed or motivated.” Her comments appeared in a Health Day article, published by the National Institutes of Health.

Lachman and her colleagues looked at data from more than 6,100 U.S. residents who turned in health surveys from 1994 to 1996. They then looked at what happened to them by 2009, and found nearly 600 had died.

As other research has shown, the odds of dying was higher among those who had lower levels of education. But the researchers found that feeling a sense of control counteracted the increased risk.

The study, which was funded by the NIH, appeared online Feb. 3 in the journal Health Psychology.

So what accounts for the difference? “People with a high and low sense of control will see the same situation differently, perhaps as a challenge versus a threat,” Lachman said.

Shevaun Neupert, an associate professor of psychology at North Carolina State University, lauded the study for showing that being poor or uneducated doesn’t need to translate into feeling helpless.

“The idea that someone with low education can have high levels of perceived control and outlive their peers with the same education is a powerful finding,” she stated in the Health Day article.

Blog, Health disparities, Health equity

Deadly Discrimination

by Suzanne Bohan

February 9, 2014

David Williams, a Harvard University professor with an expertise on the health effects of racism.

Beware of the small slights in life. Over a lifetime they add up to major loss of health, physical and mental, warns David R. Williams, a professor of public health, sociology and African and African-American studies at Harvard University.

For decades Williams has studied the connection between racism and diminished health. Recently his work percolated up in the news as he’s giving a few talks this week, at the invitation of Canadian health experts eager to close the gap between black and white populations there.

Worldwide, life expectancies are all strongly linked to socioeconomic status – job rank, income and education level. Minority populations typically end up on the lower end of the spectrum, and many nations are working to reduce those life span differences, which reach up to 20 years.

Between 1990 and 2008, the United States began making headway in its quest end the difference, with the most educated blacks gaining 6.7 years in life expectancy. But they still lag in lifespan behind their white counterparts, and Williams points to racism, or what he calls “microaggressions,” as the key hidden factor.

To quantify the effects of racism, Williams developed three statistical tools: The Major Experiences of Discrimination, Everyday Discrimination, and Heightened Vigilance scales.

Everyday discrimination, Williams found, extracts the greatest toll. Black Americans often report poor service in retail outlets or being followed as though they’ll shoplift, being passed over for important positions or promotions, and less attentive treatment from health care professionals, among countless slights. (The Tumblr site, http://microaggressions.tumblr.com, has numerous first-hand examples.)

Among the health ramifications: Greater risk of developing heart disease, depression, and premature delivery, as well as the buildup of abdominal fat, itself linked to diabetes, high blood pressure, and stroke.

Awareness starts the cure, Williams asserts. In a recent article in the (Halifax) Chronicle Herald, he advised pausing before subconsciously categorizing somebody based on the most common traits used to discriminate — race, gender and age. Instead, he suggested making a conscious effort to focus on the person as a unique individual.

1) Harvard prof coming to HRM for talks on racism’s effect on health; The Chronicle Herald, Clare Mellor, staff reporter. February 7, 2014.

Suzanne Bohan

Blog, Health disparities

Lifespans for Rural Americans Lagging Behind Urban Counterparts

by Suzanne Bohan

February 1, 2014

Credit: U.S. Dept. of Transportation

Living in a bucolic rural area may seem like a good prescription for health, but new data shows that rural Americans are paying a price in shortened life expectancy for living in America’s hinterlands. In part it’s because only 17 percent of Americans live in rural areas, and they don’t have quite the advocacy voice of the 83 percent living in urban and suburban areas.

Overall, U.S. life expectancy increased during the past 40 years, from 70.8 years in 1970 to 78.7 years in 2010. But researchers teasing apart those numbers found a disturbing trend – rural residents reaped far smaller gains in lengthened lives than their urban counterparts, and the gap keeps slightly widening. While there’s long been some gap between country residents and city dwellers, in 1971 the rural-urban gap was only 0.4 years. By 2000 that rose to 2 years.

A number of factors likely explain the disparity, said the study’s lead author Gopal K. Singh, Ph.D., of the U.S. Health Resources and Services Administration. “When compared to urban areas, rural areas have higher rates of both smoking and lung cancer, along with obesity, yet reduced access to health care services. Additionally, rural residents have a lower median family income, higher poverty rate and fewer have college degrees.

Reference:

Gopal K. Singh, Mohammad Siahpush. Widening Rural–Urban Disparities in Life Expectancy, U.S., 1969–2009. American Journal of Preventive Medicine, 2014; 46 (2): e19 DOI: 10.1016/j.amepre.2013.10.017

By Suzanne Bohan

Type in a ZIP code in this new atlas, and see how place shapes health

Access to credit and savings plays a key role in promoting health

Dishing out nutrition lessons during soccer practice

A new community garden springs up after land group adopts health perspective

Controlled burns spark hope on Yurok reservation

Life Expectancy in Las Vegas

Low-crime neighborhoods promote mental health in older Latinos

Feeling in control? It could add years to your life.

Deadly Discrimination

Lifespans for Rural Americans Lagging Behind Urban Counterparts

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