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Don’t know how to open up about your mental health? Lady Gaga’s mom has some advice.

Editor’s note: Cynthia Germanotta runs the Born This Way Foundation with her daughter Stefani, who performs as Lady Gaga. The nonprofit focuses on empowering youth to create a kinder, braver world and provides mental health resources.


Talking about mental health can be awkward, and intimidating, and just plain hard.

I know that personally, as someone who has struggled to talk about it in my own life — even with people that I know well and trust completely — and I know that from research on the topic. When Born This Way Foundation polled young people about this issue last year, we found that about 9 in 10 young people recognize it as a very important priority, but only about half actually talk about it with anyone — friends, healthcare professionals, and even their families.

See also: ‘You’re not alone’: Famous men are talking about mental health, and it could save lives

If we’re going to end the stigma around mental health once and for all — and do a better job of taking care of our own emotional wellness — that has to change. And that includes how we talk about it with our parents and within our own families.

I get a LOT of questions from parents and young people alike about how to do this, so — in honor of Mental Health Awareness month which is wrapping up next week — I thought I’d share my answers to some of the questions I get most often about mental health.

We don’t talk about mental health in my family. How do I even bring the subject up?

Mental health can be a taboo subject, even within the confines of our own homes. That’s starting to change, especially with parents or caregivers from younger generations, but you don’t have to wait for an adult you trust to bring it up. If you feel like you can’t open up to your parents or caregivers, try another family member, someone at school, or another person in your community. 

Like with most things, mental health and emotional wellness are topics that are easier to talk about when it’s not a crisis situation. So start small. Important conversations don’t always need to be Big Talks, they can begin as causal chats over the dining room table, while watching TV, or running errands. Put mental health into regular rotation as a conversation topic in your family so that if (and, for most of us, when) you or a loved one encounters a challenge it will be that much easier to talk about honestly and openly.

Not sure how to bring up the topic? Talk about reading this interesting article on Mashable!

I’ve been having a hard time and I want to see a mental health professional to get help, but I’m afraid of bringing this up with my parent or caregiver.

Asking for help can feel like the hardest part. We might be afraid of “disappointing” the people who love us or worried that we’ll be written off as “dramatic” or “not tough enough.” But remember that thinking like that has more to do with internalized stigma about mental health than how your parent or caregiver will actually react.

As a parent, I’m so thankful when my children are honest with me about how they’re feeling and what they need. It lets me do a better job of being their mom and supporting them! These conversations still aren’t always easy, but we’ve gotten better at them with time and practice.

As challenging as it may be to say the words, asking for help will be one of the best decisions that you ever make. And if the person you first open up to doesn’t react the way you need them to — don’t give up. You can and should still get help. (More on that below …)

I think my parent or caregiver might be struggling with a mental health issue. How can I help them?

It can be challenging to know how to help someone who is struggling with a mental health issue but we can all be the difference for someone in need — even the adults in our lives — and there are great resources out their to help us do it.

Sites like MakeItOk.org have helpful tips for what to say and trainings like Mental Health First Aid are an amazing way to learn how to step up in a situation like this. It’s an 8-hour course offered nationwide by the National Council for Behavioral Health that will teach you how to spot the signs that someone is experiencing a mental health challenge or crisis, and how to help them. We should all have these skills – it literally save lives.

(Interested in becoming a Mental Health First Aider? Be a part of our #BeKindBeTheDifference campaign.) 

I’ve tried talking to my parent or caregiver but they just don’t get it. What do I do?

Talk to someone else, and then another person if that doesn’t work out. Keep Talking.

Most parents and caregivers love their children and try as hard as they can to support them. But sometimes, they don’t get it right. It doesn’t mean they don’t care, it just means that for whatever reason — whether it’s a generational difference or their own biases or blind spots — they aren’t understanding what you’re trying to communicate or they don’t know how to respond in a helpful way.

But, even if it doesn’t feel like it at first, there are other places to turn — other family members (aunts, uncles, siblings, cousins, grandparents); friends’ parents; teachers, counselors, or other staff at your school; healthcare providers including your primary care doctor; neighbors; religious leaders; coaches; community center staff – the list goes on! There are also wonderful resources out there available online, over the phone, and via text. Here’s a list to get you started.

The important thing is to get help when you need it, even if it’s sometimes hard to find. And if your parent or caregiver isn’t able or willing to support you in that process, don’t give up. Someone out there is willing to listen and help.

WATCH: Michael Phelps discusses how he learned to overcome suicidal thoughts

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Article source: https://mashable.com/2018/05/26/how-to-talk-about-mental-health-lady-gagas-/

How a Tiny Kansas Town Rebooted Its Struggling Hospital into a Health Care Jewel

LAKIN, Kansas—No stoplight marks the entrance to Lakin, just a gas station, a Subway, and a Dollar General. On Main Street, a coffee shop owned by a Mennonite family stays open late once a week, but its storefront was the only one illuminated at 7 p.m. on a recent weeknight. According to one study, the 2,200 citizens of Lakin live in one of the ten most remote towns in the country. To reach it, you must drive through miles of straw-colored fields that stretch to the horizon in all directions. Ranches that aren’t growing corn or wheat have dikes drilling for natural gas or cows standing in feedlots of gray filth. During the winter, the air is so dry that the soil cracks, and the wind carries the inescapable stench of dust and manure.

The region’s economy depends on the price of gas and oil, which plummeted in recent years. But there are pockets of industrial vitality, too. Seventeen miles east of Lakin, in Holcomb, where Truman Capote wrote In Cold Blood, smoke rises from the steel towers of the Tyson Fresh Meats plant. Tyson’s workers slaughter 6,000 head of cattle a day, making it one of the largest beef-packing plants in the world. East African refugees inspect beef beside immigrants from Burma, Mexico, and Ecuador. Those who don’t find jobs at the plant labor on the surrounding dairy farms and ranches. In short, this part of western Kansas is like a lot of rural America, right down to the struggling county hospital.

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Four years ago, Kearny County Hospital had to turn away patients because it didn’t have enough doctors to treat them. It was losing $100,000 a year in its maternity ward. County commissioners wanted to avoid the fate of other rural communities, which have lost 83 hospitals across the country in the past eight years. Often, the solution is to stop delivering babies. More than half the rural counties in the country no longer have a labor and delivery unit in their hospitals; in Kansas, nine rural obstetrics units have shut down in the past 10 years, and six more are planning to close soon, says Michael Kennedy, associate dean for rural health education at the University of Kansas School of Medicine.

But Kearny County went the other way.

Officials hired an innovative CEO who came up with a way to make their rural hospital appeal to talented young physicians who want to deliver babies in Third World countries. You can do that work right here in Kansas, Ben Anderson told his new recruits, by serving immigrants and refugees. Once the new doctors arrived, Anderson applied for grants to upgrade the hospital’s equipment and fly in a specialist to see women with high-risk pregnancies. The skilled doctors and luxurious birthing suites attracted immigrants from neighboring Garden City and wealthier patients from out of town, and the baby boom they created padded the hospital’s bottom line. KCH went from delivering 187 babies in 2014 to 327 in 2017. In the span of five years, Anderson has turned the hospital into the county’s largest employer, with a profitable maternity ward that draws patients from as much as two hours away for its superior care. “I think it’s a huge success story,” Kearny County Commissioner Shannon McCormick says. “When you’re alive and thriving and all your neighbors are not—you’re doing something good.”

The district’s Congressman is Roger Marshall, a Republican obstetrician who has said that some poor people “just don’t want healthcare.” But if the turnaround of Kearny County Hospital reveals anything, it’s that people really like good health care.

Anderson says the hospital now serves about 20,000 patients annually, up from roughly 10,000 patients in 2012, and generated $23.4 million in revenue last year. As hospitals in his corner of southwest Kansas continue to cut services, he’s looking to expand.

“We have a moral responsibility to provide good care,” he says, “even if we’re the only care.”

***

On a windy February morning, Anderson wore black-frame glasses and carried a thermos from Dartmouth, where he earned his master’s in healthcare delivery science, as he gave me a tour of the hospital. The walls of his office were covered in his handwriting: stick figures to illustrate the concepts of equity and equality, a pie chart to explain how the hospital is reimbursed for Medicare patients. His personal mission statement was scrawled in a back corner: “Honor God through loving diverse people and advocating for holistic healing, with special attention toward those who are most vulnerable.”

Anderson grew up poor in California, and remembers receiving medicine from a homeless shelter because he didn’t have insurance. Now 38, he says that experience, along with his Christian faith, drives his desire to care for others. “It’s a practical act of love,” he says.

We walked past the hospital waiting room, where a Bible, a copy of Methodist Life newspaper, and a Spanish-language phone book sat on a table near the front door. The halls were carpeted and quiet, muffling whatever emergencies might be unfolding behind closed doors. Anderson showed me one of the five spacious birthing suites, which each have a private bathroom, Jacuzzi tub, and fold-out couch. In one corner of the room was a $16,000 incubator, designed to transfer infants to the neonatal intensive care unit in Garden City, half an hour away. Down another hallway was the brightly-lit family clinic, where moms waited with their young children to see the same doctors who had delivered them. Outside, Anderson showed me the converted military trailer that handles the overflow from the clinic. This is where some of the area’s sickest moms see a specialist once a month.

Anderson and his wife, who grew up near Kansas City, have four children. She wanted to raise them in a rural Kansas town, and he was drawn to the refugee population near Kearny County. In 2009, they moved to Ashland, Kansas, about two hours southeast of Lakin. That’s where Anderson pioneered his recruiting strategy. He asked Todd Stephens, director of the international family medicine fellowship at Via Christi, a Catholic, nonprofit regional health system with a particular focus on serving the poor in Wichita, how he could hire one of his graduates. Stephens encouraged him to target candidates who were interested in missionary work overseas. He also warned Anderson that the doctors wouldn’t relocate one at time—good doctors don’t want to practice by themselves.

Anderson took that recruiting model with him to Lakin in 2013. Over the next two years, he hired six new medical providers, and began coordinating recruiting efforts with hospitals in five other counties. He was especially interested in family medicine doctors who were trained in obstetrics, because in rural America, it’s more affordable to hire someone who can treat all patients than to hire specialists. Family medicine physicians can also get help repaying their medical school loans if they work in rural, underserved areas. Via Christi has one of the strongest family-medicine obstetrics training programs in the country. Anderson kept hiring their graduates, and then made sure his hospital had the equipment to back up their skills.

First, he had to address the hospital’s high rate of complicated births. In 2014, he asked Lisette Jacobson, an associate professor at the University of Kansas School of Medicine-Wichita, to help him apply for a grant from the Children’s Miracle Network of Kansas. She examined the data and discovered that most of the women with what are known as complicated pregnancies were overweight, obese or had family members who had been diagnosed with diabetes or heart disease. This is partly a function of living in rural America, Jacobson says, where people tend to drink and smoke more, weigh more, and have less access to medical care and healthy food. Many of the women also had gestational diabetes—which is associated with preeclampsia, drives up C-section rates, and can threaten the life of the baby and mother. Latino women are at higher risk for gestational diabetes, and they make up the majority of KCH’s pregnant patients. The hospital’s gestational diabetes rate was twice the national average.

These statistics helped convince the Children’s Miracle Network to give Kearny County the $250,000 grant. Much of the money was used to install an infant security system, which prevents strangers from stealing newborns from their cribs. (Kearny County had not experienced such a kidnapping, but the security has become standard after rare abductions in other states made headlines in the 1990s.) The rest of the funds were used to upgrade the birthing suites and buy obstetrical equipment. Next, Anderson and Jacobson met with officials from Via Christi Health. They explained that southwest Kansas did not have any maternal-fetal medicine specialists to care for pregnant women with gestational diabetes and other risky complications. Via Christi offered to fly one of its specialists, Dr. Michael Wolfe, the 240 miles from Wichita to Kearny County once a month. Wolfe spends each visit examining 20 expectant mothers with high-risk pregnancies. His makeshift office is now the only maternal-fetal medicine clinic along the 519 miles between Denver and Wichita. Wolfe uses a 4D ultrasound machine—which shows moving, three-dimensional images of the fetus—that the hospital purchased with $70,000 worth of local donations. He also consults with the family medicine doctors in Kearny County—some of whom he trained during residency—on how best to care for their vulnerable patients.

Jacobson is now looking for funds to start a diabetes prevention program and hire breastfeeding experts to help the women who deliver at Kearny County remain healthy before and after they give birth. The hospital also received a separate grant to build community greenhouses and a walking trail—all of which should help improve the health of overweight patients.

“I think this is a model that can be replicated in other states,” Jacobson says of her partnership with the hospital.

The key, in her view, is collaborating with private health systems and the state health department, and making sure the local community supports the project from the beginning. When Jacobson discovered why so many women were having complicated pregnancies, she shared her findings with the people in Lakin, and explained how she would tackle the problem. Then she formed focus groups to ask women what they wanted— such as support with diet and exercise during pregnancy. People became invested in the project. They showed up for prenatal appointments and saw how better healthcare would affect their families. When it came time to raise money for an ultrasound machine, the banks and feedlots pitched in tens of thousands of dollars. “You’re not alone out there,” Jacobson says of struggling rural hospitals. “There are a lot of people that care about what you’re doing.”

Anderson, Wolfe and Jacobson’s work is part of a partnership called Pioneer Baby, designed to improve the health of reproductive-age women and their families throughout the region. They have already seen some success. Two years ago, 28 percent of the babies born at Kearny County were “large for gestational age,” a condition caused by gestational diabetes. Now that rate is 16 percent. If it goes down to 10 percent, Anderson says, the hospital will rival its urban neighbors.

Pioneer Baby helps ease the financial strain that prompts many rural hospitals to shut down their maternity wards. There are fixed costs for staffing such units 24 hours a day—including on-call doctors and nurse anesthetists-—and many hospitals simply don’t deliver enough babies to cover those costs. Anderson has figured out how to stay afloat with a mix of Medicaid, private insurance, federal funds and grants.

Only 14 percent of the women who deliver at the hospital live in Kearny County. The rest are evenly split between two groups: residents of neighboring Finney County—where the Tyson plant is located, and most of the immigrants live—and women from 14 other counties in the region. Some of the immigrants have private insurance through their jobs. Others have Medicaid, which reimburses in advance for prenatal visits, even if it doesn’t cover the full cost of labor and delivery. If a patient is uninsured, a state grant reimburses the hospital $61,000 annually for that lost revenue. No one is turned away because of their inability to pay, and the sheer volume of births helps keep the doors open.

The patients who drive to Lakin from one or two hours away are motivated by different factors. At least half of them have nowhere else to go: there’s a doctor shortage in their counties, and their hospitals have cut back on delivery services. But others have heard the doctors at Kearny County are good and the birthing suites are comfortable. These women tend to have private insurance, and their premiums offset the cost of serving people who are insured. Last year, the obstetrics unit turned a $400,000 profit.

The federal prescription drug program called 340B helps the hospital care for needy mothers in other ways—giving them car seats and clothing, helping them rid their homes of bed bugs or buy groceries. The 340B program allows certain hospitals to buy drugs at a steep discount and then be reimbursed for those costs by Medicare. Kearny County uses a portion of the $1.64 million it receives through the program to help pregnant women—particularly those who are uninsured. “If Medicaid isn’t covering the cost of OB, that money has to come from somewhere,” says Diane Calmus, government affairs and policy manager for the nonprofit National Rural Health Association. “And 340B is an important source of that for a lot of hospitals.” The program has recently come under fire from the Trump administration, which slashed $1.6 billion from its budget this year.

Given such financial and political constraints, Anderson’s success is a rare bright spot in the industry. “If we could replicate Benjamin Anderson—having somebody with the skill set that he has is a big piece of the picture,” Calmus says.

***

Fatha Hasan keeps a framed photo of the doctor who delivered her 6-month-old son on the wall of her Garden City home. An Ethiopian refugee, Hasan immigrated to Kansas last February to join her husband. They already had two children, one of whom was born via C-section. Hasan wanted to avoid surgery with her third baby, but doctors at a Garden City clinic told her she would have to have a C-section. So she went to Kearny County.

Dr. Lane Olson gave her a choice: She could attempt a vaginal birth, but there was a small chance her uterus could rupture and both she and the baby could die. He might have to perform an emergency C-section. Despite these dangers, the American College of Obstetricians and Gynecologists recommends vaginal births after C-sections as long as emergency intervention is available. Olson was willing to give it a try. “He was kind to her. He encouraged her and helped her a lot,” says Ifrah Ahmed, a friend of Hasan’s who translated for her during a recent interview. “He helped her build her morale.” And Olson was right. Hasan spent just one night in the hospital to give birth last November and did not need a C-section.

Olson, 32, moved to Lakin three years ago in part because he wanted to help patients like Hasan. He had done a fellowship at a mission hospital in Rwanda and wanted to keep working internationally. He’s now one of five family medicine doctors—along with a physician’s assistant—who handle deliveries at KCH, and Anderson plans to add two more doctors this fall.

Erin Keeley, a 27-year-old physician’s assistant, is fluent in Spanish and has befriended many of the local refugees. She’s counseled a first-time mom from Somalia about the safest way to deliver her baby after female genital mutilation, and listened sympathetically to a woman, pregnant with her third child, who had to leave her two older daughters behind in Cuba. “There’s just a sense of medicine as mission here,” Keeley says.

And that mission changes the way patients are treated. Some women told me they feel more welcome in Lakin than they do in Garden City hospitals and clinics. They don’t have to sit for hours in the waiting room, and if they are uninsured, it’s easier to get service. “They don’t make the patients feel like you’re the outsider,”Ahmed says. “More like, ‘How can I help you? What can I do for you?’”

A few weeks before Trump was elected, federal authorities thwarted a plot by a small, anti-Muslim militia group to bomb an apartment complex in Garden City where many Somali immigrants live. By contrast, doctors at Kearny County have befriended their Somali patients, and offer to pray with women during labor, a practice that both Muslim refugees and Christian patients appreciate. “They’re very God-centered people,” Ahmed says. “Especially refugees that have been through a lot in life … it makes an impact and shows them that there is good in the world.”

The doctors also receive substantial perks: 10 weeks paid time off a year, which allows them to travel internationally, and the chance to practice their skills. On a typical day, every family doctor will deliver a baby, see patients in the emergency room and clinic, perform a minor surgery and check on patients in the hospital and nursing home.

Dr. Drew Miller, 38, grew up 40 miles away and has been working at Kearny County Hospital for nearly eight years. After doing his training in Kansas City, the transition back to a rural area was tough. “A small town can feel very isolated and clique-y,” he says. “Those first couple of years, it was very lonely.”

Some locals think the young doctors are only in Lakin to pay off their medical school loans. Older patients complain that they can no longer see the same family doctor every time they need medical care—and the doctor they do see might be their children’s age. Such resentments can make it difficult for newcomers to make friends outside of work. Yet Miller says he’s grown to love Lakin and plans to stay.

As the hospital continues to grow, Kearny County is looking for ways to expand its staff and possibly open a clinic closer to the Tyson plant. Anderson is working with an architect to design a master plan for the hospital that would include more birthing suites. Olson says the next big challenge is recruiting and retaining nurses to work exclusively in the obstetrics unit. Doctors can’t stay with patients through hours and hours of labor, so well-trained nurses must fill that role.

Meanwhile, Fatha Hasan keeps bringing her son to see Olson, and recommends him to friends and neighbors. “She’s praying that God gives Olson a long life to live,” Ahmed says.

Lisa Rab is a journalist in Charlotte, N.C. Her work has appeared in Mother Jones and The Village Voice, among other outlets. Reach her at lisayrab@gmail.com.

More from POLITICO Magazine

Article source: https://www.politico.com/magazine/story/2018/05/26/kansas-hospital-rural-healthcare-218407

Fear and failure: How Ebola sparked a global health revolution

Updated 9:41 AM ET, Sat May 26, 2018

Chat with us in Facebook Messenger. Find out what’s happening in the world as it unfolds.

(CNN)It is what fear sounds like.

Article source: https://www.cnn.com/2018/05/26/health/ebola-outbreaks-west-africa-congo-revolution-mckenzie-intl/index.html

What’s the Answer to the Shortage of Mental Health Care Providers?

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Population Health: The ‘North Star’ of the Triple Aim

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Article source: https://www.usnews.com/news/healthiest-communities/articles/2018-05-25/a-decade-later-triple-aim-health-care-framework-offers-lessons-promise

Single-Payer Health Care in California: Here’s What It Would Take

About half that sum could come from existing Medicare and Medicaid dollars, according to the analysis. What employees and employers currently spend would cover another $100 billion to $150 billion. But the remaining $50 billion to $100 billion would require new taxes — such as a 15 percent payroll tax on earned income.

A separate analysis put the bill’s cost at $331 million, accounting for savings achieved through efficiencies and preventive care, among other things. Whatever the figure, even supporters concede that it would require a higher sales tax and increased taxes on large businesses.

Ardent proponents, like the California Nurses Association, are undeterred. “It really is about the political will,” said Catherine Kennedy, a longtime nurse who lives in Carmichael, outside of Sacramento. “We can find the money.”

‘Single payer’ has no single definition.

Democrats overwhelmingly favor single-payer plans in polls, but the phrase means different things to different people. To some, “single payer” is just a way of saying coverage for everyone. To others, it means eliminating the profit motive from health care. Or it represents simplicity — an end to paperwork, deductibles, co-payments and preapprovals.

“I do support a single-payer system,” said Steven Cohen, a retired engineer, who lives with his wife, Terri, a retired schoolteacher, in Valencia. Even though he is on Medicare, Mr. Cohen, 71, said a recent switch in his medication for rheumatoid arthritis caused his out-of-pocket drug costs to rise sharply. The insurance and pharmaceutical industries now have too much clout, he said.

When asked if he would still support single-payer if it meant higher taxes, however, Mr. Cohen said no: “Raising taxes to offset the cost of health insurance is not the best approach.” And he is unwilling to trade his Medicare coverage for a state-based version, “unless it changes for the better.”

A nationwide Kaiser Permanente survey last September found similar sentiments. A majority favored the idea of a single-payer national health plan. But when those surveyed were told that the role of employers in health care would be ended, that governmental control would grow, or that people would have to trade in their existing coverage, support fell below 40 percent.

Article source: https://www.nytimes.com/2018/05/25/business/economy/california-single-payer.html

Diverse, Bike-friendly Cities Have Happier Residents : Shots – NPR

A cyclist by Lake Michigan shore in Chicago. Biking to work is associated with higher levels of well-being.

Amanda Hall/Robert Harding/Getty Images


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A cyclist by Lake Michigan shore in Chicago. Biking to work is associated with higher levels of well-being.

Amanda Hall/Robert Harding/Getty Images

Every year, Gallup and Sharecare rank U.S. cities for well-being, based on how residents feel about living in their communities, and their health, finances, social ties and sense of purpose. Perhaps unsurprisingly, places like Naples, Fla., and Boulder, Col., tend to top the list, while Southern and Midwestern towns including Canton, Ohio, and Fort Smith, Ark., often come in last. But what hard data underpin the differences between these communities?

A study published Wednesday takes a step toward teasing out which attributes might contribute to well-being in communities around the country.

A Yale-led team of researchers has identified 12 community factors independently related to well-being. The factors included some obvious ones, such as higher levels of education and income, as well as some surprises, including a higher percentage of black residents, a higher percentage of bicycle commuters, and better access to preventive care, such as mammograms. The results appear in the journal PLOS ONE.

Well-being has been associated with longer life expectancy and better health outcomes. Previous studies have also shown that where someone lives can improve or diminish well-being.

Life Expectancy Can Vary By 20 Years Depending On Where You Live

For this study, the researchers compared two types of data: well-being data, gleaned from the Gallup-Sharecare Well-Being Index, based on surveying more than 300,000 Americans; and community attributes that researchers suspected would influence well-being drawn from the Robert Wood Johnson Foundation County Health Rankings, as well as other sources. This data included county-level information on high school graduation rates, percent of children in poverty, and the number of preventable hospital stays, among other things.

Using a statistical model, researchers whittled down more than 75 community attributes to determine which stood out.

Many of the potential factors are highly correlated with one another — for example, lower median income is correlated with lower education and less access to healthy food. Researchers wanted to figure out which characteristics measurably affected well-being independent of those other factors.

To the researchers’ surprise, they discovered that just 12 factors related to demographics, clinical care, social and economic factors, and the physical environment explained over 90 percent of the variation in well-being across the country.

“That’s higher than I would have expected,” says Brita Roy, assistant professor of medicine at the Yale School of Medicine and lead author of the study.

In what Roy called an unexpected but notable result, her team found that communities with higher percentages of black residents reported higher levels of well-being.

“Having something that shows greater diversity is actually better for all of us I think is a really important finding,” Roy says.

Research by Carol Graham at the Brookings Institution and others has shown high levels of optimism within the black community, which could account for the correlation in the paper.

But percentage of black residents is not the same as an overall measure of diversity, says Anita Chandra, director of RAND Justice, Infrastructure, and Environment. A better measure of diversity is diversity exposure, which calculates how one ethnic or racial group is situated and exposed to all the other groups in a community.

Another unexpected finding was the connection between well-being and the percentage of residents commuting by bicycle. People living in places where they could commute to work by bike reported feelings of satisfaction and fulfillment.

This could be because places with bike-friendly infrastructure might also support other types of policies that improve living in that area. Or it could be that commuting by bike improves physical health, which in turn improves a sense of well-being; a study in Heart this week showed walking or cycling to work cut the risk of dying from heart disease or stroke by 30 percent.

#ScootersBehavingBadly: U.S. Cities Race To Keep Up With Small Vehicle Shares

The researchers hope their findings could lead to future research and even policy applications.

“We are starting to move in the direction of trying to understand at the community level how we can actually work to improve well being for all members of the community,” says Roy.

The study had limitations. It was cross-sectional, meaning researchers used one snapshot in time to see what was linked together, rather than using data over time. “We can’t prove causality at this point,” Roy says. “We don’t know if we improve these twelve factors, will we actually lead to improved well-being. But it certainly provides us with a first step in understanding what perhaps we should test.”

The study also didn’t include psychosocial data, such as levels of trust in community, trust in government and social cohesion. Those data weren’t available.

Chandra says this study serves as a call for collecting more and better information to help us grasp the full picture of what impacts wellness. “We collect a lot of data, but we still have these gaps in our understanding of community and individual well-being,” Chandra says.

She says in addition to surveys that measure an individual’s sense of well-being, like the Gallup-Sharecare index, researchers need to gather information on larger scale community and civic well-being to bring everything together.

“That’s really where policy makers and practitioners can make decisions about resource allocation and where to put time and investment and policies in place,” she says.

Nevertheless, she says this study is another important piece of the puzzle in understanding what drives overall health.

“There are things that communities can do that make it more possible for people to feel more positive about their community,” she says. “And some of these things are very much in our control.”

Dana Bate is a health and science reporter living in Philadelphia. You can follow her on Twitter: @danabate.

Article source: https://www.npr.org/sections/health-shots/2018/05/23/613762326/where-you-live-affects-your-happiness-and-health-but-how-exactly

The politics and policy of racism in American health care

Michigan legislators recently voted in favor of Senate Bill 897, a law that requires Medicaid beneficiaries to work at least 29 hours per week or risk losing their health insurance. Though the bill contained exemptions for a range of subgroups, its work requirements were projected to apply to 700,000 people, and more than 100,000 of those were likely to lose health coverage.

If the legislation had passed as the Senate intended, its effects would have been racially lopsided. This is because the bill provided an exemption for residents of counties with high unemployment rates, without any similar relief for residents of cities with high unemployment. As a result, Medicaid beneficiaries living in high-poverty, mostly black cities like Detroit and Flint would have been required to work, while those living in mostly white rural counties would not.

Recently, in a marked change of direction, Republican Sen. Mike Shirkey (the bill’s sponsor) disclosed that the controversial race-based exemption would be dropped. Nevertheless, Shirkey refused to acknowledge that race mattered. Instead, he claimed that the “administrative nightmare” of tracking county unemployment rates on a monthly basis was untenable, while maintaining that allegations of racism were “ridiculous.”

The only thing that is ridiculous is Shirkey’s denial. Michigan’s initial attempt to pass a racially biased policy is no anomaly. Racism is deeply rooted in the past and present of the American health care system. The United States is a deadly, difficult and disempowering place for people of color, and health care policy plays a chief role in sustaining this state of affairs.

We’d have to go as far back as slavery to fully grasp the racial history of US health care, but I’ll start at a much more proximate place: 1946. On August 13 of that year, President Harry Truman signed the Hill-Burton Act (then known as the Hospital Survey and Construction Act). Hill-Burton was the first significant federal intervention into the domain of health care, and it was nothing short of pathbreaking. In 1948, nearly a quarter of all US counties had no hospital at all, and many more had a very limited supply of hospital beds. To address this problem, Hill-Burton provided hospital construction grants to communities that could demonstrate need and feasibility. As a result, the supply and utilization of public hospitals grew precipitously over the next 25 years.

But the benefits of this boom did not accrue equally to all Americans. In exchange for supporting the bipartisan Hill-Burton Act, Southern (segregationist) Democrats demanded that preexisting practices of racial segregation remain intact. Hill-Burton also gave rural areas priority consideration in the disbursement of funds, a move that concentrated the program’s resources most heavily in the South. Finally, Hill-Burton delegated the responsibility for assessing health needs to the states. Consequently, local (openly white supremacist) power structures tightly controlled the process of identifying disadvantaged communities.

Hill-Burton, the first substantial inroads the US government made into health care, was designed to reinforce segregation, while enriching and empowering local political actors who were zealously invested in oppressing black people.

Lest we think that all that racism stuff is behind us, let’s consider the present. Race rears its head in nearly every nook and cranny of the contemporary health policy landscape. Public opinion on the Affordable Care Act is profoundly racialized, in part because race-based evaluations of President Obama have “spilled over” into the arena of health care. Relatedly, there are gaping racial chasms in attitudes toward Medicaid expansion that diverge across states.

These rifts affect whether states expand the program. Two scholars from the University of Chicago recently found that states’ decisions about Medicaid expansion are “positively related to white opinion and do not respond to nonwhite support levels.” This has real consequences for people of color: Black and Latino people make up 48 percent of all Americans who fall into the “coverage gap” created by the states that refuse to expand Medicaid. Higher uninsured rates among these groups impede progress toward reducing yawning inequities in health outcomes ranging from maternal mortality to cancer to AIDS.

Medicaid work requirements build on this bedrock of racial inequality. There is persistent and well-documented racial discrimination in the low-wage labor market. One study found that an equally qualified African American is half as likely to receive a callback for an entry-level job compared to their white counterpart. When racial discrimination in hiring prevails, work requirements necessarily place a disproportionate burden on people of color.

Another significant barrier to employment is having a criminal record. But again, because of racism in the criminal justice system, black Americans are significantly more likely to have been incarcerated. This proves burdensome in the job market, even after people have paid their supposed “debt” to society.

Looking further down the line to when jobs are available and employers are willing to hire black folks, getting to those jobs can pose another significant challenge. Transportation infrastructure in communities of color is limited and often crumbling, so making it to work is no small feat. Though work requirements are race-neutral on their face, the tiniest glimpse into the skewed racial realities of navigating the labor market exposes them as discriminatory.

If all of the things I have said above are true, then perhaps people of color should flood the polls, the streets, and any other venue necessary to make their voices heard. Indeed, many of them have and will continue to fight for political change. Unfortunately, health policy itself can undermine those efforts. Policy and politics are linked. When policy is designed or administered in ways that are discriminatory, stingy, or unreliable, then the people meant to benefit from such policy are disempowered.

I wrote a book about the political effects of Medicaid. The black beneficiaries that I interviewed for my research would often (without prompting) relay stories of racial discrimination in Medicaid bureaucracies. One black woman from Michigan summed it up this way: “if you’re white and you have Medicaid … you are looked upon with more sympathy. … It’s ‘she’s going through a hard time right now.’ … If it’s us … we are looking for a hand out … and we are treated as such.”

Echoing this, a black woman from Georgia described the racial dynamics of Medicaid saying, “in that [Medicaid] office we’re in the bottom … all the way down there.”

These were common sentiments, and they did not just make beneficiaries feel bad, they made them distrust the government and sometimes caused them to disengage from politics.

Most broadly, the very structure of health policy in America undermines democracy. The patchwork of state Medicaid policies that emerge in the fragmented US political system has starkly different effects on the political participation of Medicaid beneficiaries in different locales. In some states, policy expansions boost rates of voting. In other states, policy retrenchment depresses political activity. Since places with large numbers of African Americans are less likely to expand Medicaid, these patterns do not bode well for political equality or democracy.

Nearly every aspect of the US health care system is shot through with racism. The latest debacle in Michigan is part and parcel of this larger reality. Reversing the biased policy that was originally proposed by the state Senate does not erase the enduring reality of race in America.

Achieving even a semblance of health equity in the United States requires both an unflinchingly reckoning with these facts and a more serious commitment to change than we have ever seen before. Such a commitment demands that we turn a skeptical eye toward waivers that purport to bring expansion while ushering in work requirements, drug testing, and other punitive policies. Not only are these waivers likely to exacerbate racial disparities in access to care, but they threaten to undermine our democracy.

With Medicaid facing persistent attacks and the entire social safety net under assault, broad and wide democratic engagement is vitally important, and pushing back against racially biased health policy is more essential than ever.

Jamila Michener is an assistant professor of government at Cornell University. She is a faculty affiliate of the Center for the Study of Inequality, the American Studies Program, and the Africana Studies Department.

Article source: https://www.vox.com/polyarchy/2018/5/24/17389742/american-health-care-racism

Health Insurance Coverage For Healthy Groceries? More Food-Based Interventions May Be Coming

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Health insurance plans cover a variety of medical procedures, prescriptions and provider visits. A recent change in how some plans interpret health-related insurance benefits may see more plans offering food-based benefits, including meals and healthy groceries.

Hippocrates, of the eponymous Oath, famously wrote “Let food be thy medicine.” A little over a decade ago, the editor of the British Medical Journal lamented, “Although many patients are convinced of the importance of food in both causing and relieving their problems, many doctors’ knowledge of nutrition is rudimentary.” Fortunately, food as prevention-based medicine is gaining traction across the country, with some seeing the paradigm already shifting.

The federal government recently gave the go-ahead for Medicare Advantage plans to broaden the scope of supplemental, “health-related benefits” for individuals. The Centers for Medicare Medicaid Services (CMS) has signaled that they will consider approving insurance plans with additional benefits that “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

The scope of these new “health-related benefits” is considerably broad. Insurers are readying their 2019 plans to incorporate this new definition, and it remains to be seen what these benefits will include. Kaiser Health News reports that insurers might include “air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals.”

The new supplemental benefits might induce more beneficiaries to switch from traditional Medicare to Medicare Advantage, despite CMS’ caution to the contrary. Unlike the traditional government Medicare program, Medicare Advantage program is run via private insurers offering CMS-approved plans. Given the inclusion of the word “Medicare” in Medicare Advantage, the similarities in name between the two programs may be confusing to some beneficiaries.

Time will tell how successful these additional “health-related benefits” will be at improving health outcomes or driving down the costs of healthcare. As Kaiser Health News noted, some consumer advocates warn that the extra benefits in Medicare Advantage could come at the detriment of individuals on traditional Medicare.  The decision to enroll in Medicare or Medicare Advantage can have ramifications for the beneficiary, including coverage limitations regarding providers and hospitals. Additional money for groceries should not come at the expense of a plan that more appropriately meets an individual’s healthcare coverage needs. Even so, two aspects of the “health-related benefits” program are particularly exciting.

First, the new plans could lead to new data available for health quality researchers, which would increase the body of knowledge regarding evidence-based interventions around food and health.  Given that the parameters of the “health-related” food benefits are undetermined, they might be specifically tailored to meet the needs of particular health conditions, like heart disease or diabetes. The variety of potential interventions could provide ample room for researchers to determine what interventions have the greatest impact for individuals and the healthcare system overall.

Data regarding costs and health outcomes gleaned from the new plans might be in line with a recent Health Affairs study, in which participants in a food program experienced a statistically significant decrease in overall medical spending. Those in a medically-tailored meal program not only had a 16% decrease in overall medical spending but also reduced emergency department visits, inpatient hospital admissions, and emergency transports.

Second, many Medicare Advantage insurers also operate individual and group plans. If these extra benefits in Medicare Advantage are successful in reducing costs and advancing beneficiaries’ health, more plans could offer similar benefits. In doing so, insurers could be incentivized to increase their use of food as a preventative tool to improve health or food as medicine, providing individuals with medically-tailored meals to meet the nutritional needs of particular disease processes.

While the details of the new Medicare Advantage plans are still undetermined, one hopes they build on the existing evidence regarding successful interventions. Food-based interventions in the healthcare system are only set to grow to stem rising healthcare costs and improve individual and community health. The new plans could be a step in the right direction for insurers, and the basis for future pilots or studies to build evidence for further food-related health interventions to lower costs and improve health outcomes.

Article source: https://www.forbes.com/sites/tommytobin/2018/05/24/health-insurance/

After Trump attacks, Americans hold on to health insurance

More than a year after President Donald Trump took office, the percentage of Americans without health insurance is almost exactly the same as it was at the end of the Obama administration, according to a new, authoritative CDC report.

In 2017, 29.3 million people were uninsured, only a slight increase from the 2016 levels of 28.6 million, the study from the Centers for Disease Control and Prevention found. That’s an uninsured rate of 9.1 percent versus 9 percent.

Trump has made multiple promises to undo the Affordable Care Act (ACA), also known as Obamacare. Critics warned that repealing the act, one of President Barack Obama’s signature pieces of legislation, would lead to hikes in the number of uninsured.

“When we win on Nov. 8 and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare,” Trump told a campaign rally in Valley Forge, Pennsylvania, on Nov. 1, 2016. “Have to do it.”

But it was not to be. After several efforts, the legislative attempt to undo Obamacare fell apart in the Senate. Republicans, however, were able to take a few chunks out of it, including repealing the so-called individual mandate, which requires Americans to keep coverage or be fined.

That change doesn’t go into effect until 2019, so we haven’t yet seen the impact of people being able to opt out of coverage without tax penalties on the rates of the uninsured and on premiums covering potentially smaller pools.

In November, the Congressional Budget Office revised earlier estimates, predicting that repealing the individual mandate would lead to 13 million more Americans losing their coverage over the following 10 years, and premiums going up 10 percent. At the same time, the federal government would save $338 billion.

The new CDC report also contained a few warning signs.

The uninsured rate rose among middle-class adults, who don’t qualify for subsidized coverage under the ACA, to 8.2 percent.

The rate also rose significantly in states that didn’t use the ACA’s Medicaid expansion, averaging at 19 percent compared to the 9 percent uninsured in states that did expand low-income coverage.

Theresa Granger, a clinical assistant nursing professor at USC’s Suzanne Dworak-Peck School of Social Work, said that even if Republicans try again and get more rollbacks, she doesn’t expect the health insurance market “will fail per se.”

“Obamacare has opened the market so that more insurance companies have the opportunity to compete,” Granger told NBC News. “What we have now is more of an open market. Americans have more choices about their insurance. If Obamacare is dismantled, Americans will still have insurance available to them, but their options may be more limited and the cost to purchase insurance might change.”

Article source: https://www.nbcnews.com/business/consumer/after-trump-attacks-americans-hold-health-insurance-n876506