December 17, 2012

The Science of Eliminating Health Disparities


Link to the 2012 Health Disparities Summit


I'm checking-in at the 2012 Summit on the Science of Eliminating Health Disparities, which is focused on Building a Healthier Global Society by Integrating Science, Practice and Policy.  The summit has been rescheduled post super storm Sandy from December 17-19, 2012. 








November 21, 2012

Yes! New York City Matters





A NYC view overlooking Central Park from the Upper West Side. (2012)

I grew up in New York City. My fascination with local neighborhoods began when my mom and I would travel throughout Manhattan.  Her budget constraints offered a good fortune for long long walks on foot down city streets. In the cold we shared great times and hot chocolate with crowds during the Thanksgiving parade. I remember taking a pony ride and my first tennis lessons in Central Park.  My mom worked in Rockefeller Center and for 25 years on Madison Avenue, she took me to see my first Broadway show, we also had many days of window shopping


My family has lived here for five generations! New York City is a place where the power of social connection puts family and friends in close proximity for fun times.  I also love it when I bump into people I know when I'm on the bus or subway platform, in the gym, at a show or just moving around the City. It's amazing how often I unexpectedly see folks I know, there are kindred spirits here.

I also have wonderful memories of taking class trips and summer camp excursions to the Hayden Planetarium, Empire State Building, Carnegie Hall, Statue of Liberty, and Ellis Island which encourage my tenacious attempt to share my New York City point for view while moving about in search of intriguing, provocative and fun-filled opportunities that abound here. Whether I flip the pages of magazines, see online posts, hear about venues from friends and family or just wander, I know from the depths of my heart that New York City matters.

A place where diversity thrives and opportunities abound across life span.

Here's a short list of a few of my recent sightings:

  • There's lots to see and experience including exhibits at the United Nations. 
  • Just over from the Chelsea area of Hudson River Park evidence of success along The HighLine shows promise for The LowLine, a Delancy street undeground dream in progress.  The streets of the the Lower East Side, Union Square, Washington Square and the Village still move my creative soul whether it's writing time, listening to music or just taking a walk.
  • A unique mix of historical and contemporary experiences are within reach in museum settings. For example, a visit to New Museum could anchor exploration of the Bowery. The Metropolitan Museum of Art's famous Christmas Tree and Neapolitan Baroque Crèche offers glimpse a nativity scene to feed your imagination.  The Christmas Angels and Tree in Rockefeller Center are stunning!
  • I love love love the outdoors spaces including Central Park, Bryant Park, Prospect Park, Flushing Meadow, Cunningham Park/Alley Pond and Wave Hill au naturel New York City landscapes.  I hope to do the giraffe path (aka hike the Heights) one day soon.  Do you know the story of Seneca Village?
  • NY Waterway Ferry offers a daily boat ride schedule from Long Island City to Brooklyn's  DUMBO it's a connection worth exploring if not for the commute, for sightseening on this trip and  the other waterway destinations. (N.B. I've taken this trip on the East River Ferry).



NY Matters Photo Contest is sponsored by Vidicom and Citybuzz.

 A special note to native New Yorkers who work and live here.  Remember to take time to see why visitors have booked their travel.
  • As you commute, give yourself time to take another route to work so that you can see new places. 
  • Take a "visitor" weekend and go some where you (alone or with friends) have never been in New York City.
  • You have to be intentional, come up with your own a list of places to visit around town so you can be ready when you have time.
Whether you are visitor or have lived here all your life if you don't get lost or at least turned around once in a while then you are just not moving through enough of New York City.  NYC MTA has new apps and online tools that are helpful with navigation of the train and bus system along with useful tools to connect with art in the subway and/or follow the "Poetry in Motion" series


Young people should also be encouraged to explore the diverse, urban destinations as well as the lens that elders can offer of their great times around town. Here are a more pictures from my Instagram collection of my experiences including food and culture around New York City:



In this post I've selected public spaces, which are often public-private ventures that all can enjoy regardless of budget.  I'd like to be a selected winner in the New York City Buzz contest A few nights in the fine Affina hotel, a Broadway play, shopping at Bloomingdales, good food and museums are quite a winning combination. I will be following #citybuzzNYC and sharing my experiences on social media, while I hope for a win.
  

October 29, 2012

More notes on hurricane survival


Autumn view of New York City.
photo by Katherine Ellington
Are you prepared for disaster? My notes on storm survival for Hurricane Irene Sandy are updated here considering some of the challenges for those living in the New York City area and in the multi-state path of the storm.  As we wait out the unpredictable, uncertain intentions of this storm:
  • Use your down time to share meaningfully with family, friends and neighbors too.  It’s an intense time so avoid conflict and drama — now is the time to work together.
  • Listen to news reports, but you can turn down the volume to find some peace throughout the day.
  • Check-in on family and friends while the lines are clear and working. Mobile phones and land lines may be inaccessible.

Hurricane severity is a mix of rains and ear-popping wind that may cause all kinds of unimaginable damage and harm not always obvious.  For example, the stress of the storm may raise blood pressure or a major power outage that last for days could also shut down our water supply because pumps (including gasoline) run on electricity.  Here a few suggestions:
  • Shower/bathe before the storm just in case the water goes. 
  • Put on/sleep in some comfortable clothes just in case you have to leave your house in a hurry. 
  • Don't skip meals. It's a good time to cook food from the freezer. 
  • Don't wander around; the calm before the storm is a dangerous time.

Here's a live look at Hurricane Sandy:
Please note that power outages and damages have to be reported to agencies to be resolved.  Utility companies don't know immediately unless you call in. Be prepared to contact:
  • Con Edison for power outages as well as lines down in your neighborhood.
  • Phone, cable and other utility companies should also be contacted directly by residents if there is trouble.
  • In New York City call 311 to report trouble and for help.

Other reading:
What to do during a hurricane is a guide from FEMA with up-to-date information.

Please share your storm survival ideas, reflections and/or comments.

August 22, 2012

Violence Prevention: A Life Saving Story



You can listen to my personal experience with gun violence (click play above) or read the story in my post on KevinMD.com.  In writing this post, I reached out to Dr. Carl Bell, a psychiatrist and national leading public health expert on violence prevention. He helped me think more about basic principles of violence prevention, which in his view involve:
  • rebuilding the neighborhoods and communities
  • providing adequate access to affordable, high quality health care
  • enabling supportive programs that build self-esteem and increasing social skills
  • reestablishing the adult protective shield for young people
  • minimizing the residual effects of trauma
In "Violence Prevention 101: Implications for Policy Development" Dr. Bell states that "these principles are interdependent and are key guiding principles for effecting large, systemic changes in health behavior."  

Furthermore, Dr. Bell also talks about the importance of collaboration because it takes the forces of combined leadership to engage with communities in search of solutions through policy and practice.   It also takes understanding the different kinds of violence and the root cause that are specific to geographic locations and local populations. Policy efforts can be shaped with compelling evidence and stories demonstrating the cost and life saving value of prevention and effective harm reduction strategies.

For example, the New York City neighborhood where I grew the "Peace is a Lifestyle" campaign to put an end to gun violence in the streets of New York City, which is among the most prevalent form of violence affecting the lives young people in already vulnerable communities.

Death Rates from Gun Homicides for Males (Aged 25-34)
City Limits chart using CDC data shows violence disproportionately affects young men of color, particularly in African American communities.


           
The landscape of violence moving across America is striking. Dr. William Petit's story of losing his family to a violent home invasion in a Connecticut suburb feels like Truman Capote's narrative where incomprehensible acts of violence, loss of life stun, enrage and numb.  When medical school Dean Dr. Steven Berk's The Anatomy of A Kidnapping opens his own telling of a late night gunpoint encounter it becomes more evident that violence is a pervasive and growing epidemic from Main Street to heart of the city.  It's an experience that trauma and emergency medical centers know too well, but a story for America to behold for better days ahead.

I've pledged with the Centers for Disease Control to educate others about the full scope of violence: it can be emotional, physical, and/or sexual in nature. You can also Veto Violence by clicking the link below:


References:

Bell CC. Violence prevention 101: Implications for policy development. In: Perspective on crime and justice: 2000–2001 Lecture Series. Vol. 5. Washington, DC: National Institute of Justice; 2002: 65–94 

Berk SL. Anatomy of a Kidnapping: A Doctor's Story. Lubbock, TX: Texas Tech Univ; 2012.

August 14, 2012

a global haiku



I spent time with scholar, poet and activist Sonia Sanchez during the International Conference on Health in the African Diaspora — ICHAD 2012 in Baltimore, Maryland last month. Thomas LaVeist, Ph.D., conference chairman and director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health in Baltimore said that the ICHAD vision was borne from his eye-opening experiences in Salvador da Bahia, Brazil. He wanted to find more ways for the more than 160 million Afro descendants across the Western hemisphere to move from surviving to thriving by considering pathways for health and healing through an interdisciplinary lens including public health, history and with the evidence of research that can also inform policy and practice in the future. LaVeist called on Sanchez to open the dialogue. 

On her arrival, Sonia and I made a 4th of July trip to a nearby Whole Foods Market.  I thought she wanted more ripe fruits and a selection from the vegetarian food bar. I offered to go for her, but she insisted on going together.  It was phenomenal to watch folks respond to Sonia, she greeted people with open arms.  While in line our cashier kept a steady gaze on Sonia while also trying to focus on the preceding customer.  By the time our turn came at the register the awestruck cashier was visibly flustered. When we got just outside the exit door the cashier ran from her station to Sonia with tear-filled eyes. She said, “I knew it was you. I just had to come and thank you for your work. Your words have made all the difference in my life especially in the hard times when it seemed I had no where to turn. I honor you. I just couldn’t let you go without speaking.”  Sonia listened and a few others gathered to share in the moment.




I’m still thinking these excursions are about shopping when on our next trip to back to Whole Foods Market the following day, we bumped into actor Antonio Bandera who was in line buying lunch. Sonia then spotted the soulful singer-songwriter Me'shell Ndegeocello who sings "Fool of Me" in the movie Love Jones.  There was spirited impromtu community celebration at the front door of the store. We then moved on to the aisle of the hot food bar this time Sanchez was spotted by a manager and a small crowd quickly huddled around. As I watched this unfold, it came to me that Sonia was opening up her space for people to share in.  She was moving through an agenda of connection and community engagement.  She was taking time to hear about what was going with people’s lives. Sanchez was checking-in on the pulse of the community.  She was doing the same when I caught up with her again on a panel at the Harlem Book Fair earlier this summer.


Her reading selections and reflections during ICHAD 2012 came from Does Your House Have Lions? (Beacon Press, 1997) an epic poem focused on the healing narrative of her brother’s battle with AIDS.  Sanchez is clear about the work we must take on as individuals and communities for healing.  She asks the question “What does it mean to be human?”  She calls on us to examine our biases, shed stereotypes, shatter stigma and pull out the roots of the disease killing us all, silence.  In this book, Sanchez offers a community of voices for balm.

brother’s voice

i linger in stethoscopes and thermometers at Lenox Hill
i have entered the hospital to test
the cough and the temperature making me ill
i have entered the hospital to rest
and all i have discovered is unrest
the doctors says happily it is not pneumonia or cancer
the doctor says my temperature is like a trickster

In spending time with Sanchez I wanted to know more of her genius and life as an artist, scholar and as a black woman, she is the first professor to develop and teach a seminar on African American women’s literature.  Sonia Sanchez has published sixteen books including I’m Black When I’m Singing, I’m Blue When I Ain’t and other plays (Duke University Press, 2010).  Sanchez taught for 22 years at Temple University, she pioneered the Black studies program at San Francisco State and is a co-founder of the Black Arts movement.  She has made impressions within the minds and hearts of the global African diaspora and beyond for more than half a century.

Sanchez offered me valuable lessons in the healing practice of storytelling that begins with open arms and listening closely. She also has me thinking about a haiku life.

The morning sunlight
A day break call in real time
to hear nature’s song
                                             —Katherine Ellington

June 28, 2012

Here We Go




The arc of the moral universe is long, but it bends toward justice. 
                                                  — Dr. Martin Luther King, Jr.  

Outside the U.S. Supreme Court (March 2012)

Today! The U.S. Supreme Court is set to rule on the Patient Protection and Affordable Care Act signed by President Obama on March 23, 2010. Here's a brief overview:



  
Watching and waiting....

Today #SCOTUS tomorrow health_____  and society ______ 
You fill in the blanks.



June 20, 2012

A Woman’s Worth


In 1920 the 19th Amendment to the U.S. Constitution was ratified giving women the right to vote and it was unsuccessfully challenged a year later.  Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on race, color, religion, sex and national origin now has recent amendments including the Lily Ledbetter Fair Pay Act of 2009.
Today marks the 40th Anniversary of Title IX, The Education Amendments of 1972 another hallmark for girls and women across America. Meanwhile the Paycheck Fairness Act (S. 3220), that would extend the reach of the Equal Pay Act of 1963 and the Fair Labor Standards Act to close the gap male–female income disparity in the United States, has failed to pass the U.S. Senate. This is a story of generational as well generative progress. 
The Best Countries To Be A Woman — and the WorstNew York Times article describes Canada's successful top ranking for “... policy mix giving women access to health care and opportunities and protecting them against violence made it more egalitarian than some European nations and the United States.”
The June 2012 issue of JAMA features an original contribution from a group of researchers led by Dr. Reshma Jagsi on gender differences in the salaries of physicians who lead major NIH endeavors at leading medical institutions across the the United States.  The results indicate a $12,194 paycheck differential favoring men, a shortfall for women. These disparities are often characterized through comparisons in productivity, which some conclude is justifiable.  The roots of this dilemma should be considered more closely. While  negotiation skills are a must for women in the professional workforce, systemic  disparities should be examined and addressed.
It’s worth noting that women’s paychecks are more likely to support children and families. The remarkable rise of women through the ranks of business, academia or medicine has some common stumps that can be overcome with leadership and fortitude for the future.  Educational achievement as well as economic opportunity represent significant pathways for progress among girls and women.  Our success is the success of our nation with diversity and inclusion at it’s heart as well as prosperity.

May 28, 2012

Reflective Practice Notes: #FSLT12 #MOOC



My first massive open online course (mooc) has started.  The 2012 First Steps into Learning and Teaching in Higher Education (#FSLT12) is a diverse group of medical educators engaged in a collaborative environment. My experience as a learner in medical education awakens my pursuit for a career in academic medical education.  My strength as innovator shapes my motivation for this platform as a beginning. The profession of medical education has formidable and complex challenges to address in healthcare, this holds around the wold.  I see my futurist position in Geoffry Moore’s Crossing the Chasm based on diffusion of innovations theory from Everett Rogers.
My academic progress has come with a considerable investment in independent self-directed learning. I have experience in the development of peer-to-peer learning modules in medical education through webinar experiences for physicians-in-training.  In these brief online settings, interactive involvement supports a short-lecture format with a move from discussion to dialogue to enhance learning and experiential connectedness. For example, a “Learning Well Webinar” planned for premedical and preclinical medical students about the strategies for learning the basic science curriculum was developed in collaboration with medical students, premedical students and a faculty member based on innovative approaches.  My efforts began with online book discussion webinars for physicians' storytelling.
Professional Standards Framework
In considering the framework of professional values this models is based on respect of peer learning adding a diverse learning community to medical education. Open registration and enrollment aims at equal opportunity for learners. The aims and objectives of the “Learning Well Webinar” offer an innovative approach to higher education learning.  The model was limited in “evidence-informed approaches and the outcomes from research, scholarship and continuing professional development” because it was new, but does fully recognise the implications for future professional practice.
I blog and write for reflective practice in medicine and life. A reflective practice on teaching and learning will be a new endeavor that’s staring in the very early stages of my professional development.  Using Brookfield’s lens of autobiography, I see my unique experience in developing peer-to-peer webinar modules as valuable, where credibility has been maintained with the support of faculty and the power of space beyond institutional walls enabling authentic encounters for learning. In Educating Physicians—A Call for Reform of Medical School and Residency Cooke, Irby and O’Brien describe four goals for medical education: standardization and individualization; integration; habits of inquiry and improvement as well as formation of professional identity.  Reflective practice provides support for evidence of personalized competency throughout the unique trajectory of training and career advancement.  


N.B. I'm also reading about mooc skepticism as Joshua Kim shares his "7 Concerns"at Inside Higher Ed.
References
  • Cooke M, Irby DM, O’Brien BC. Educating Physicians—A Call for Reform of Medical School and Residency. San Francisco, CA: Jossey-Bass; 2010.
  • Kies S, Martinsek, A. Improving first-year medical student performance with individualized learning strategies. Journal of International Medical Science Educators 2010 March; 20(1). 
  • Moore GA. Crossing the Chasm: Marketing and Selling High-Tech Products to Mainstream Customers. rev ed. New York: Harperbusiness; 1999.

May 14, 2012

An Open Mind On Obesity



Twitter poetics by Elizabeth Alexander





My tweet in response to reading a New York Times opinion by Alice Randall

At a time when 2 out 3 Americans are overweight, a story about black women and fat has gone viral. Perceptions about what women see in the mirror, feel about their bodies  and others tell them about beauty is not sufficient for health. The opinion that "many black women are fat because we want to be" may nurture bias that can hinder health care for those who are overweight or facing obesity. Just like cancers and cardiovascular disease there are striking disparities in health for minorities especially vulnerable are black women. Growing diversity in America creates an opportunity for research as well as dialogue to help us understand differences with sensitivity. The U.S. Department of Health & Human Services has identified focus areas revealing significant disparities in health access and outcomes among racial and ethnic minorities that need be addressed with interventions found within health systems beyond, but not excluding the patient-doctor relationship.


I grew up among five generations of black women who worked hard and laughed often to live long lives.  My great-grandmother was a midwife in South Carolina. Many of the  black women in my life have battled and overcome all sorts of illness including obesity.  Black women and men often face health challenges with diagnoses occurring at later more serious stages of disease leading to more preventable deaths than expected. This is true over life course and is the hallmark of health disparities. For example, among black women health doesn’t follow wealth as it should, education and socio-economic achievement does not improve our odds against infant mortality, the causes are considered unnatural.
I invite the author of the story who is a novelist along with others to consider a more imaginative context shaping unhealthy environments making healthier eating and physical activity a dilemma instead of a matter of habit. The rich storytelling in Toni Cade Bambara’s The Salt Eaters where the cost of healing is considered with this question:  "Are you sure, sweetheart, that you want to be well?… Just so's you're sure, sweetheart, and ready to be healed, cause wholeness is no trifling matter. A lot of weight when you're well." This question invites an individual response in the context of a community where healing (beyond cure) is matter of transformative relationships, support and structures for health and well-being.  

If you want to go quickly, go alone. If you want to go far, go together.  — African Proverb

Those who strive to lose weight with a combination of healthier eating and more physical activity may find challenges where the physical environment is out of shape for health. For example, there's a connection between obesity and food deserts, it's a complex disease of ill nutrition as well as poverty for some. This is an indication that obesity requires us to move beyond stigmas, dispel myths and open our minds to consider matters of research, policy and practice in health care and beyond along with individual lifestyle choices. The Institute of Medicine (IOM) has just released “Accelerating Obesity Prevention” a consensus report with actionable items, calling on all heath providers to consider:
“Adopting standards of practice (evidence-based or consensus guidelines) for prevention, screening, diagnosis, and treatment of overweight and obesity to help children, adolescents, and adults achieve and maintain a healthy weight, avoid obesity-related complications, and reduce the psychosocial consequences of obesity. Health care providers also should advocate, on behalf of their patients, for improved physical activity and diet opportunities in their patients’ communities.”
IOM report staff study directory Dr. Lynn Parker says “we and our committee members also are concerned about the lack of curriculum in medical schools on nutrition and physical activity for patients and the community.” 
The Institute of Medicine Infographic "Obesity: Complex But Conquerable"
The upcoming four-part documentary "The Weight of the Nation" offers a view of obesity as a complex, out of control, unaddressed rampant epidemic across America.  This is a conversation worth having whether or not you are a patient or health professional, overweight or not,  we should all weigh-in and be moved to take on the problem as a nation with dignity and respect.

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