Neighborhood Health Networks

Many of you may know my friend and colleague Sheila Ryan, Ph.D., R.N., F.A.A.N. Sheila is a Professor, Charlotte Peck Leinemann and Distinguished Alumni Endowed Chair, and Director of International Programs at the University of Nebraska Medical Center College of Nursing. Sheila has served as President of NLN and as an executive officer for AACN. Sheila is a member of the Institute of Medicine and a fellow in the American Academy of Nursing and has served on many programs and committees for the past two decades.  Sheila has been a nursing dean for 22 years at two universities and has board service with IHI, IBHI and RJW/IOM committees.  Sheila is presently Chair of the Board of AIHA, American International Healthcare Alliance. 

Sheila has been working on the idea of neighborhood health networks as a  potentially powerful tool to serve disadvantaged populations right where they live. Here is an outline of the neighborhood health networks concept, by Jo Ellen Kerner and Sheila Ryan.

 

Barbara Ross Lee D.O.

books from people we know or will hear from at our summit...

6 books all recently published have come to our attention, as follows....be sure and add to this list: 1. r.williams, "Eliminating Healthcare Disparities in America", Humana Press (2007)
2. D Satcher and R Pamies, "Multicultural Medicine and Health Disparities", McGraw Hill, (2006)
3. B Smedley, A Stith, and A Nelson, (Editors), Unequal Treatment, "Confronting Social and Ethnic Disparities in Health Care", National Academies Press (2003)
4. Norma and Wm. Anderson,"Autobiographies of a Black Couple of the Greatest Generation", (2004).
5. D Wilson with C. Spitzer, "Wilson's Way - Win Don't Whine" (2009) Go to www.booksurge.com>
6. L Grouse, "Cable Hell - The Birth and Death of Medical Television" (2011), Barrenger Publishing.

The first three on the list are the go to texts for excellent overview of health disparities.....the latter three are the personal stories of people involved at the core of the struggle for justice and equality (#4 and #5), and in #6, how an amazingly promising educational innovation/intervention can be effectively destroyed by excessive commercialism.

a simple way to read all the material on the blog...

The Index published yesterday is aimed at helping readers get to specific essays/comments on the blog thus far. However, if one wishes to approach it another way, the following may help some readers: scroll down from the front page to the bottom of the page, where you will see in the lower right hand corner the words "Older Posts"; click on "Older Posts", and scroll down that page until you get to the bottom and you see "Older Posts"; again, click on "Older Posts" and scroll down till you pass the first post dated 4/27/10 and under which you will see "Newer Posts" and "Home". From there, by reversing the process and scrolling back up, one can review the posts in the order in which they were posted.

Index to existing major contributions to the Blog (June,2010-June 1, 2011)

INDEX CONTINUED.....FROM "ARCHIVES"
3. Entry from 7/14/10 by Dr. William Straub - describes a new proposed model to develop a Senior physician corps made up of retired physicians willing to work to fill the anticipated primary care workforce gap in community health clinics and elsewhere.
4. Entries posted on 8/24/10, from Dr. John Geyman, a former Chair of Family Medicine at the University of Washington School of Medicine, who is a prolific and persistent author on health care reform and on disparities; he describes first the disparities currently extant in cancer in the USA and secondly his belief that the health reform act is doomed to failure and the reasons why.
5. Entries of 8/27/10 and 8/31/10 describing the careful analyses of Dennis Andrulis, Brian Smedley and others of the Affordable Care Act (the health reform law) passed a year ago. The reader will find the link to the website of the Joint Policy Center where the report is available in full. An update report is planned for the MLKjr Health Equity Summit this August.

Index to existing major contributions to the Blog (June,2010-June 1, 2011)

INDEX to materials on the blog, its Archives Section (to be found by clicking on "Archives" on the Right side of the Home Page),and The Planned Segments section (to be found by clicking on "Planned Segments" under "Home" listed in the upper right hand corner of the home page).
TO BE FOUND UNDER "PLANNED SEGMENTS:
1. introductory comments to each of the ten separate planned seminars or segments;
2. included in "first seminar" is a commentary on Dr. Howard Koh's NEJM (September 2010)article on Healthy People 2010 and his foreshadowing of Health People 2020;
3. included in the "second seminar" entitled "Health Care in the American Grain" is a discussion of the need to identify a set of Foundational American Values against which to measure our health care system/systems and a trial balloon of four such basic american values, along with some relevant references.
4. the "third" through the "tenth seminars" cover the following - disease-specific disparities, diversity and socio-economic factors in disparities, challenges to health workforce development, health information technology, new and anticipated technological breakthroughs, multicultural-integrative-complementary care, health as a team game/new models, America and its interactions with the world.
TO BE FOUND UNDER "ARCHIVES"
1. Entry of 6/14/10 by Mary Woolley, "Health Equity - Getting Beyond Hope". The CEO of Reseaqrch!America speaks out about the relationship of Hope to our fundamental values and our unique american capacity to deliver innovations that work.
2. Entry of 6/16/10 by University of Michigan scholars, Carmen Green and Gilbert Omenn; an essy "Unequal Burdens and Unheard Voices: Minority Aging"
TO BE CONTINUED ON NEXT BLOG POST...

Further Preparatory Stuff

As we approach the Ides of June, when Co-Editor Barbara Ross-Lee will take over the direction of this blog in her role as the Co-Leader for Program Development for the Augus 22-23, 2011 Summit, there are a few more introductory and preparatory observations/comments to be made for the potential reader. First, I should point out that by scrolling down continuously through this and the several blogs that follow, you will find included in those few blogs from August, 2010, material that is relevant to a section of the program that Dr. Ross-Lee will want to be discussing in more detail, because it is a part of the planned agenda for the Summit. I will, in a separate blog, identify the subjects of what can be found on the blog either in the archives or in the items listed under Home to the right of the top of the blog; in this way, one can find particular items of interest from the first blog May through August of 2010.

Expanding the range of expertise!!!......

For reasons that have only been dimly perceived by me, I have felt the need to subscribe for more than twenty years to two major policy journals. The first subscription is natural for me....HEALTH AFFAIRS.....and we discussed yesterday that journal's decision to expand it's range of interest to include environmental challenges, which are clearly meant to include socio-economic and cultural matters. We discussed yesterday some of the health disparities-relevant articles to be found in the most recent issue of HEALTH AFFAIRS, the theme for which is "Environmental Challenges for Health". Perhaps as a commentary on how boring is my life, last night I happened upon a recent issue of that other major policy to which I have longn subscribed, but have rarely read, FOREIGN AFFAIRS. The november/December 2010 issue blares out it's theme on the cover......"THE WORLD AHEAD". Fresh from the stimulation of reading HEALTH AFFAIRS' maiden environmental challenges issue, I was emboldened to look in detail at this special issue, which is clearly aimed at examining the future of our world through a dozen articles, and a closing special list of "must-read books".
The twelve articles' titles as listed on the front cover are instructive by the absence of any significant interface with the contents of the HEALTH AFFAIRS' special them issue on environmental challenges for health. On closer inspection, however, four of the articles offered some potential overlap with health matters: "Clean Energy's Future"; "The Education Gap"; "Feeding the World"; and "The Demographic Implosion". Of the many books recommended by a collection of experts, only one seemed to be directly relevant to health and health care in general and health disparities in particular, and that cam from Judith Rodin, the President of the Rockefeller Foundation, who discussed "Thinking in Systems" by Donella H. Meadows, published by Chelsea Green (2008). Dr Rodin concludes her review as follows, "Presented in a clear and concise manner, the book makes evident that in order to succeed in the world ahead,prediction, control, andsiloed analysis must be transformed into a framework in which complexities are embraced,silos broken,and partnerships welcomed. Doing so will not be easy, but as Meadows notes,only then can we 'use our insights to make a difference in ourselves and in our world'." I could not help but guess that this last words might be a useful closing commentary for our upcoming Summit on Health Equity.

Keeping up with the literature and the experts

One of the reasons that IAMMM plans to continue this blog and other educational venues throughout the year between our first and second annual MLKjr Health Equity Summits, is that no single meeting can cover every relevant subject and issue. The May 2011 issue of the journal Health Affairs, which is totally dedicated to environmental challenges for health, is a case in point. In her introductory comment, entitled "Embarking on a New Course: Environmental Health Coverage", editor Susan Dentzer, recognizing the stimulus provided by a supportive Kresge Foundation grant, introduces this major commitment to the most wide-ranging, complex and challenging of all the various threats to our population's health. She begins by saying, "Our nation's approach to health and health care is so famously siloed that we've long neglected the obvious: The environment plays a role in nearly 85 percent of all disease."
She concludes as follows, "Authors in this issue propose major policy changes, including updating the Toxic Substances Control Act and removing incentives for producing unhealthy food. Requiring state and federal 'health impact assessments' in a 'health in all policies' approach would seem a reasonable starting point." Several of the published articles touch upon the health disparities dimensions of the envirnmental health problems, particularly that authored by Rachel Morello-Frosch et al, "Cumulative Effects on Racial and Ethnic Minorities" and another on "Unique Vulnerabilities of Children" byP. Landgren and L. Goldman.
It is clear that much of the health disparities problem resides in the area covered within this ground-breaking issue and those of us committed to analyzing health policies as they relate to disparities must take note of and follow carefully what this impoprtant health policy journal has put on its major "To-Do List". This is yet another reason why we are fortunate in having Susan Dentzer pllaying such a prominent role in our Summit and its outcomes.

Innovative Examples...an initial listing...

The following are some examples that have come to our attention over the past year or so, placed here to stimulate readers to add other promising activities and to alert them to these efforts such that you can pursue any that interest you in further detail. Here are some which could be of use in our program evolution for the August 22/23, 2011 Summit: State universal coverage programs...Hawaii, Vermont, Michigan; state based programs that are having an impact...South Carolina..(ray greenberg/ med. Univ. Of S.C.), MD/Univ. MD (Claudia Bacquet); programs with a regional reach - WAMI, univ of wash educational collaboration; univ. Of Colorado Native American Center Telecommunications-based public health (Spero Manson, Director); public health educational organizational innovations - Texas A & M School of Rural Public Health, Ciro Sumaya (Founding Dean Emeritus), NEOCOM community based medic an and public health school (Jay Gershen, President.......), striking example of new health education community model involving nurse educative training Native American community leaders in public health...a new model that seems to work...Sheila Ryan and JoAnn Koerner).

A pre-season (ie pre-re-awakening of HDP Blog) example!

Each day, between now and "opening day" for this health disparities blog, I hope to provide examples of why our organization decided there was a pressing need for it's August 22/23 MLKjr Health Equity Summit and a continuing educational effort through each year between subsequent Summits. The health policy blog is envisioned as a potentially useful venue to keep abreast of this complex and ever-changing societal effort to reduce health disparities. Illustrative examples are a good tool to appreciate why we think this is true.
Today's example has to do with the pressing need to address the issue of growing and perhaps reshaping the health care workforce over the coming decade if we are to have any reasonable chance of delivering excellent and cost effective health care to over 32 million currently unisured citizens. In the Jan. 20, 2011 issue of the New England Journal of Medicine, the editors published a cluster of short reports dealing with nursing education and practice. The first article, entitled "broadening the Scope of NursinG Practice"' by J A Fairman and others, summarizes the evidence that Advanced Practice Nurses, working indepently or in teams with physicians and other health professionals, can provide excellent primary care in a significantly cost-effective manner. After describing the traditional obstacles to such an expansion of nurse practice and pointing out that already 17 states allow such independent practice by qualified nurses, they conclude as follows, "Fighting the expansion of nurse practitioners' scope of practice is no longer a defensible strategy. The challenge will be for all health care professionals to embrace these changes and come together to improve US health care."
A major new Institute of Medicicine report provides a major foundation for the evidence and opinions above. One policy implication here is that the 33 remaing states which do not allow independent practice for nurses, should address that issue. But, there remains the question that there remains a dramatic nursing shortage in the USA.
A second relevant article in the same issue of the NEJM, "Nurses for the Future" by Linda Aiken, addresses that complex problem of an insufficienr supply cominG from the nursing educational pipeline. Dr.Aiken cites the impressive expansion in recent year of so-called retail clinics, staffed primarily by APRNs and that the supply os newly- minted APRNs is insufficienr to meet the anticipated demands. AIken argues that by shifting all nurse preparation program to the baccalaureate level via collaborative efforts involving community colleges and baccalaureate level institutions, tahr problems of nurse shortfal can be met. She argues that " public funding for nursing education must be used to steer the change in basic nursing education, just as public funding for patient care steers change in health care delivery." she goes on to identify existing educational public funding that can be used to address these changes. Aiken's ideas open up an area of innovative thinking about one of the most important issues (ie how to expand the health workforce) facing us right now and suggests to that there are certain workforce data that should be added to our growing list of evaluative benchmarks to check on as we follow progress in reducing health disparities over the coming decade.

Introducing samples of health disparities policy issues.

The goal of this blog is to highlight relevant disparities issues, progress in the reduction (or lack thereof) of health disparities in America and globally, and to identify innovative approaches to addressing those disparities associated with unnecessary societal burden of disease. IAMMM expects to focus on the issues surrounding the existence of health disparities through the lenses of those suffering from them, until health disparities are no longer a major societal challenge. To prepare the new reader of our blog for the upcoming commentaries from some of the major contributors to the august 22/23 Summit on Health Equity, let me enumerate here some of the major themes the will be covered. Our program will give attention to the following issues: a review of the past decade and more of the nature and dimensions of health disparities; an examination of the health disparities' reduction goals of Healthy People - 2020; a review of plans for adjustment to the health clinical care workforce to accomodate coverage of an expanded population; a review of progress and plans for meeting existing and projected research needs in health disparities; innovations and initiatives in public health, prevention and health promotion; innovations and trends in meeting the complex needs of acute and chronic clinical care and the changing demography of an aging population; the cost-effectiveness of integrative (complementary) medicine and health care with relation to health disparities reduction; the impact of social/economic status on health status and disparities; analysis of the Health Reform Act and it's potential impact and relevance to the reduction of our national disease burden through health disparities reduction; health information technology and it's potential impact on improving quality and efficiency in the health care delivery systems; and finally, some models of innovative approaches in the US and globally tha deserve our attention as we look to future strategies for improvement. More to come from those hard at work on the development of the August Summit!

Announcing the re-emergence of the health disparities policy blog

The parent organization of this blog has now announced the First Annual Martin Luther King jr Center for Health Equity Summit, scheduled for august 22/23, 2011 in Washington DC at the Willard Hotel. Program details and registration information will be posted shortly on this blog and on the IAMMM website shortly. The program is being planned by experts in the various areas relevant to health disparities policy, and we shall be publishing notes from these individuals, beginning in the first week of June, concerning the the issues and questions they expect to address at the August meeting. We hope that readers will chip in with their own relevant insights and opinions and questions, such that presenters will be able to include your ideas and concerns in their remarks. The edited blog archives will include the give and take as well as the major points ultimately presented at the summit itself.
Each day until these contributions by our program leaders start appearing, we will be adding policy relevant information that we think will illustrate the kinds of issues that we think will come forth through the blog venue and we look forward to the commentary of our readers.