Housing and Health - Foundations Fund Research in CT to Examine Relationship

Housing and health are increasingly the focus of study, to better determine how one impacts and influences the other.  Foundations at the state and national level are among those devoting resources in Connecticut to seek answers that can ultimately guide future public policy. With a $125,000 grant from the Connecticut Health Foundation, the Open Communities Alliance will work to create better links between housing and health care and set the stage for a two-year pilot program to enable interested families of children with acute asthma to move to healthier neighborhoods.

The “Healthy Housing Vouchers” project aims to use housing policy to improve health outcomes for low-income families and reduce health disparities, tying together clinical and nonclinical factors that affect people’s well-being. 

The Open Communities Alliance project will create a streamlined process for low-income families of children with asthma to help them access affordable housing in healthier communities if they choose. It will include referrals, counseling on the impact of environmental conditions on health, help identifying potential rental locations, and assistance with security deposits, moving expenses, and supportive services as they adapt to a new community. The initial participants in the pilot program will be low-income families who receive government-funded housing vouchers and have children with acute asthma.

The Connecticut Health Foundation will also be providing a $100,000 grant to support Connecticut Voices for Children’s work to promote policies that advance health equity for children and families. The work will include conducting policy research, producing educational materials and analyses to inform policymakers about issues affecting children and families, bringing together state agencies and advocates through the Covering Connecticut’s Kids and Families Coalition, and participating in state-run councils to represent research-based policy solutions.

These projects are among  11 awarded a total of $535,000 - announced this month - by the Connecticut Health Foundation, based in Hartford.  It is the state’s largest independent health philanthropy dedicated to improving health outcomes for people of color.

Earlier this year, the Connecticut Data Collaborative and the Liberal Arts Action Lab were awarded a 500 Cities Data Challenge grant by the Urban Institute and the Robert Wood Johnson Foundation. The joint proposal was one of 10 selected from a large competitive pool of applications submitted by organizations from cities across the United States.

The one-year $148,000 grant will support local research and educational outreach on housing conditions, health outcomes, and neighborhood disparities in the capital city of Hartford.

The Connecticut Data Collaborative is a nonprofit organization focused on providing public access to data, creating an ecosystem of data users, and increasing data literacy. The Liberal Arts Action Lab, launched in early 2018 by Trinity College and Capital Community College, investigates problems posed by Hartford community partners, with teams of undergraduate students and faculty fellows who conduct semester-long research projects to strengthen the city.

The Urban Institute and the Robert Wood Johnson Foundation designed this challenge grant to encourage communities to delve into the 500 Cities open-access dataset, to design innovative solutions on social factors that influence health, and to guide local organizations on how to effectively use neighborhood-level data. The broader goal is to promote more comprehensive cross-collaborative approaches to foster a broader “Culture of Health” in urban areas.

CT is 5th Healthiest State in USA; MA Ranks 1st, New Data Shows

Connecticut is the fifth healthiest state in the nation, dropping from third a year ago, but remaining in the nation’s top 10, where it has been every year since 1993. Massachusetts, Hawaii, Vermont, Utah and Connecticut rank as the five healthiest states, while West Virginia, Alabama, Arkansas, Louisiana and Mississippi rank the least healthy.

The United Health Foundation ranked America's states based on a variety of health factors, such as rates of infectious diseases, obesity, physical inactivity, smoking and infant mortality, as well as air pollution levels and the availability of health care providers. The survey has been conducted annually for 28 years.

America’s Health Rankings was built upon the World Health Organization definition of health:“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

The model reflects that determinants of health directly influence health outcomes. A health outcomes category and four categories of health determinants are included in the model: behaviors, community & environment, policy and clinical care.

This is the first time Massachusetts has been named the healthiest state, ending Hawaii's five-year ranking at number one. Connecticut’s highest ranking was second, in both 2006 and 2008.

By category, Connecticut ranked fourth in Behaviors, fourth in Clinical Care, sixth in Policy, tenth in Health Outcomes and 15^th in Community & Environment.  Connecticut had the third lowest levels of infectious disease, fourth lowest prevalence of smoking and ninth lowest levels of obesity.

The Bay State won the honor in part due to having the lowest percentage of uninsured residents at just 2.7% of the population, plus a low prevalence of obesity and a high number of mental health providers.  Rhode Island moved from 14^th to 11^th; New York from 13^th to 10^th. 

This latest report shows that the nation's health overall is getting worse.  The nation's premature death rate -- the number of years of potential life lost before age 75 -- increased 3% since 2015.  That increase is driven in part by drug deaths, which increased 7% during that time, and cardiovascular deaths, which went up 2%.  Overall, the United States ranks 27th in terms of life expectancy in a comparison of 35 countries, according to the report. Long-term challenges remain — including infant mortality and low birthweight. Cardiovascular deaths and drug deaths also increased.

Connecticut’s strengths, according to the report, include the state’s low prevalence of smoking, low violent crime rate and low percentage of uninsured people.  The state’s greatest challenges include a high drug death rate, high levels of air pollution and a large disparity in health status by educational attainment.

The report also identified the following highlights:

• In the past year, primary care physicians increased 6%, from 197.8 to 209.4 per 100,000 population
• In the past two years, children in poverty increased 33%, from 12.3% to 16.3% of children
• In the past five years, cancer deaths decreased 3% ,from 179.0 to 173.7 deaths per 100,000 population
• In the past three years, drug deaths increased 67%, from 11.0 to 18.4 deaths per 100,000 population
• In the past five years, the percentage uninsured decreased 44%, from 9.9% to 5.5% of the population

Gender Identity in Schools Among Topics at Connecticut School Health Issues Conference

The keynote address “When Boys Will be Girls: Getting A Grip on Gender” will greet attendees – school nurses and school health officials from across Connecticut - attending the 38^th Annual School Health Conference on Thursday in Cromwell. “Critical Issues in School Health 2016,” a two-day conference, will have expert presentations on issues ranging from absenteeism to infectious diseases, food allergies to mental health.  But no issue has grown in attention and interest recently than how to respond to LGBT students in the school setting.

The conference is coordinated by the Connecticut chapter of the American Academy of Pediatrics with the assistance of the Association of School Nurses of Connecticut.  

The keynote will be given by Robin McHaelen, MSW, founder and executive director of True Colors, a Hartford-based non-profit organization that works with social service agencies, schools, organizations, and within communities to ensure that the needs of sexual and gender minority youth are both recognized and competently met. McHaelen is co-author of several books and articles on LGBT youth concerns, and has a national reputation as a thought leader in LGBT youth concerns, programs and interventions.

In her presentation, titled “When Pink and Blue Are Not Enough,” McHaelen offers suggestions on working with LGBT students, and seeks to increase “understanding, knowledge and cultural competency regarding LGBT students,” while identifying issues of “risk, challenge and strengths specific to LGBT youth.”  She also will point to “opportunities for intervention that will ensure appropriate care within a safe, affirming environment.”

Among the recommendations:  offer gender-neutral bathroom options, always use the patients’ chosen name and chosen gender pronouns, and “recognize that there are additional stressors (and that there may be significant feat on the part of) transgender patients.” 

McHaelen will be offering a similar presentation at the New England School Nurse Conference, to be held in late April in Mystic, hosted by the Association of School Nurses of Connecticut.  The president of the Association is Suzanne Levasseur, Supervisor of Health Services for the Westport Public Schools.  The New England affiliates include Massachusetts, Vermont, New Hampshire and Maine.  The conference theme is “Waves of Change, Oceans of Opportunity.”

Lesbian, gay, bisexual, and transgender students are the targets of bullying, harrassment, and disproportionately high discipline rates at school, researchers have pointed out. But without consistently collected, reliable, large-scale sources of data, it's difficult to track the extent of those problems or the effectiveness of proposed solutions, a group of researchers at Indiana University said in a briefing paper released this week.

Expanding existing federal surveys on youth safety and well-being to include more questions about gender identity and sexual orientation could provide a clearer picture, according to the researchers, noting that “if you don’t measure it, you can’t improve it.”  They suggest addressing the data gap by adding discipline and harassment items to existing health surveys that currently include measures of sexual orientation and gender identity, such as the Youth Risk Behavior Survey, collected by the Centers for Disease Control and Prevention.

“Although these measures provide more specific information about sexual orientation and in some cases gender identity, they do not provide sufficient information about the specific negative outcomes experienced by LGBT students,” the research paper points out.  They conclude: “the availability of data documenting the experiences of LGBT students is a civil rights concern, and the expansion of data collection efforts to include sexual orientation and gender identity is a critical next step in ensuring the rights of LGBT and all students to participation and protection in school.”

The mission of the Association of School Nurses of Connecticut is to support, assist and enhance the practice of professional school nurses in their development and implementation of comprehensive school health services that promotes students' health and academic success.  The Connecticut Chapter of the American Academy of Pediatrics has over 600 active members committed to both improving the health and safety of Connecticut's children and supporting those who provide care to these children.

Connecticut Leads the Nation in Preventative Health Care

Among the nation’s 34 most populous states, the rate of preventive health care visits was higher in Connecticut than any state in the nation.  Data released this month from the Centers for Disease Control and Prevention National Center for Health Statistics also found that the rate of preventive care visits to primary care physicians, among the 34 most populous states, exceeded the national rate in Connecticut more than elsewhere. Preventive care visits such as general medical examinations, prenatal visits, and well-baby visits give physicians and other health professionals the opportunity to screen for diseases or conditions, as well as to promote healthy behaviors that may delay or prevent these conditions and reduce subsequent use of emergency or inpatient care.

In this report, the rate of preventive care visits to office-based physicians is examined by state, patient demographics, and physician specialty. Estimates are based on data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to office-based physicians.

Overall, preventive care visit rates were higher for children under age 18 years (73.2 per 100 persons) and for those aged 65 and over (81.1 per 100 persons) than for adults aged 18–44 (53.2 per 100 persons) and 45–64 (51.8 per 100 persons).  The preventive care visit rates for women aged 18–44 (87.1 per 100 women) and 45–64 (60.5 per 100 women) exceeded the rates for men in those age groups (18.5 and 42.5 per 100 men, respectively).

The rate of preventive care visits in the 34 most populous states ranged from 33.1 visits per 100 persons in Arkansas to 120 visits per 100 persons in Connecticut.  Among those 34 states, the rate of preventive care visits was lower than the national rate in 11 states (Arkansas, Indiana, Iowa, Michigan, Missouri, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, and Washington).  The national average was 61.4 visits per 100 persons.  The data is from 2012, the most recent year available from the National Ambulatory Medical Care Survey.

In 2012, 35.7 preventive care visits were made to primary care physicians for every 100 persons across the United States.  In Connecticut, primary care physician preventative care visits were made 59.3 times per 100 people, the highest percentage in the nation.  In Massachusetts, the rate was 53.1, in Colorado 51.7, in Florida 48.7 in Georgia 43.3, in Texas 42.8 and in Maryland 42.2.  Overall, 58.2 percent of preventive care visits were made to primary care physicians, according to the CDC data.  Primary care physicians include office-based physicians in the specialties of family or general medicine, internal medicine, and pediatrics.

The female rate (76.6 visits per 100 females) of preventative care visits exceeded the male rate (45.4 visits per 100 males) by 69 percent. The percentage of preventive care visits to primary care physicians, however, made by males (76.3%) exceeded those made by females (48.0%). The data suggests that women tend to make their preventative care visits to physicians other than their primary care physician, with the report’s summary suggestion. this “may be related to gynecological or obstetric care for women.”

In 2012, the NAMCS survey sample size was increased fivefold to allow for state-level estimates in the 34 most populous states for the first time.

Hartford’s Health & Fitness Ranks #12 Among Nation’s Top 50 Metro Regions

Apparently, Hartford is in better shape than many of us may have thought. In fact, a national analysis by the American College of Sports Medicine (ACSM), with support from the Anthem Blue Cross and Blue Shield Foundation, ranks the metropolitan statistical area (MSA) of Hartford-West Hartford-East Hartford as 12th in the nation in the annual American Fitness Index™ (AFI) report. The 2014 AFI data report, “Health and Community Fitness Status of the 50 Largest Metropolitan Areas,” reflects a composite of preventive health behaviors, levels of chronic disease conditions, and community resources and policies that support physical activity.

In the 2014 report metropolitan Hartford received a score of 63.8 (out of 100 possible points) to earn the overall #12 ranking. Hartford ranked #7 in Community Health and #17 in Personal Health, according to the data analysis.

Leading the rankings is the Washington, D.C., metro area with a score of 77.3, followed by Minneapolis-St. Paul, Portland, Denver, San Francisco, San Jose, Seattle, San Diego, Boston Sacramento and Salt Lake City.

Researchers analyzed the data from the U.S. Census, the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), The Trust for the Public Land City Park Facts and other existing research data in order to give a scientific, accurate snapshot of the health and fitness status at a metropolitan level.

The data regarding Hartford-West Hartford-East Hartford indicate that 78 percent engaged in physical activity or exercise within the past 30 days, 35 percent eat two pieces of fruit per day, and 14 percent eat 3 or more vegetables per day. Just over 15 percent of the population are smokers. Overall, 60 percent are described as being in “excellent or very good health,” although 36 percent indicate they had days when their “mental health was not good” during the past month.

Among the “areas of excellence” cited for Hartford-West Hartford-East Hartford are a higher percent bicycling or walking to work, more farmers’ markets per capita, more golf courses and tennis courts per capita and a higher percent eating two or more fruits per day.

ACSM worked with the Indiana University School of Family Medicine and a panel of 26 health and physical activity experts on the methodology of the AFI data report. The 2014 edition uses revised methods from the first six full-edition reports released from 2008 to 2013.

New variables, including each community’s Walk Score ranking, have been added or modified and some variables have been removed to improve and enhance the 2014 data report.

“The AFI data report is a snapshot of the state of health in the community and an evaluation of the infrastructure, community assets and policies that encourage healthy and fit lifestyles. These measures directly affect quality of life in our country’s urban areas,” said Walter Thompson, Ph.D., FACSM, chair of the AFI Advisory Board.

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 50,000 international, national and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

Health Analysis Ranks Tolland, Middlesex, Fairfield Counties At Top of List

If you’re looking for the healthiest counties in Connecticut, look no further than Tolland and Middlesex Counties.  According to a report released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Connecticut’s eight counties vary across a range of health categories and indices. In the report’s analysis of health outcomes, the order of ranking was Tolland, Fairfield, Middlesex, Litchfield, New London, Hartford, Windham, and New Haven.

The report – County Health Rankings & Roadmaps - also includes a ranking by Health Factors, which finds a slightly altered order:  Middlesex, Tolland, Litchfield, Fairfield, New London, Hartford, New Haven, and Windham. Factors included in the analysis are health behaviors, clinical care, social & economic factors, and physical environment.

The Rankings look at a variety of measures that affect health such as the rate of people dying before age 75, high school graduation rates, unemployment, limited access to healthy foods, air and water quality, income, and rates of smoking, obesity and teen births.

The report relies on a robust set of data and analysis that allows counties to see what it is that is making residents sick or healthy and how they compare to other counties in the same state. A dynamic, interactive website shows the rank of the health of nearly every county in the nation and illustrates “that much of what affects health occurs outside of the doctor’s office.”

It examines25 factors that influence health, including rates of childhood poverty, rates of smoking, obesity levels, teen birth rates, access to physicians and dentists, rates of high school graduation and college attendance, access to healthy foods, levels of physical inactivity, and percentages of children living in single parent households.

The data has been used to garner support among government agencies, healthcare providers, community organizations, business leaders, policymakers, and the public for local health improvement initiatives. The website’s Action Center offers access to free personalized assistance to places that need guidance on what steps to take to make their communities healthier places to live, learn, work, and play.

This year’s Rankings show significant new national trends:

• Child poverty rates have not improved since 2000, with more than one in five children living in poverty.
• Violent crime has decreased by almost 50 percent over the past two decades.
• The counties where people don’t live as long and don’t feel as well mentally or physically have the highest rates of smoking, teen births, and physical inactivity, as well as more preventable hospital stays.
• Teen birth rates are more than twice as high in the least healthy counties than in the healthiest counties.
• Access to health care remains an important factor and this year, the Rankings include residents’ access to dentists, as well as primary care doctors. Residents living in healthier counties are 1.4 times more likely to have access to a doctor and dentist than those in the least healthy counties.

The County Health Roadmap, which accompany the rankings, are designed to help bring people together from all walks of life to look at the many factors that influence health, focus on strategies that work, learn from other communities so as not to reinvent the wheel, and make changes that will have a lasting impact on health.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health  care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change.

The University of Wisconsin Population Health Institute is the focal point within the University of Wisconsin School of Medicine and Public Health for translating public health and health policy research into practice.

CT Among Leaders in Heart Health; States Vary Significantly Study Finds

If  heart health matters to you and you live in New England – especially Vermont or Connecticut - you’re in good company.  Americans’ cardiovascular health varies greatly from state to state, according to new research in the Journal of the American Heart Association (JAHA) - the first study to assess cardiovascular health at the state level. Among the findings:  people living in the New England states – including Connecticut – generally reported having among the highest percentage with “ideal cardiovascular health.”  Only the District of Columbia had better across-the-board numbers.  Among the findings:

• The percentage of the population with ideal cardiovascular health varies from 1.2 in Oklahoma to 6.9 in Washington, D.C.
• The percentage of the population reporting ideal cardiovascular health — defined as having optimal levels of all seven factors — was lowest in Oklahoma, West Virginia, and Mississippi.
• Ideal cardiovascular health was highest in Washington, D.C. (6.9), Vermont (5.5), Connecticut (5.5), Virginia (5.0), Massachusetts (4.6), Maine (4.5), and New Hampshire (4.5).

Overall, in the nationwide study funded by the Centers for Disease Control (CDC):

• About 3 percent of the total U.S. population reported having ideal heart health.
• About 10 percent of the total population reported having poor cardiovascular health, with two or less heart-health factors at optimal levels.

Researchers collected information on the American Heart Association’s seven major heart-health factors: blood pressure, total cholesterol, smoking, body mass index, diabetes, physical activity, and fruit and vegetable consumption. (used as a proxy measure in the study for a healthy diet.)

“Since the CDC is funding state heart disease and stroke prevention programs, we thought it would be helpful to have cardiovascular health information on the state level,” said Jing Fang, M.D., M.S., an epidemiologist with the CDC’s Division for Heart Disease and Stroke Prevention.  “Americans reported having on average more than four of the seven risk factors for heart disease,” Fang said. “We also found large disparities by age, sex, race/ethnicity and levels of education.”

Using 2009 data from the Behavioral Risk Factor Surveillance System – a telephone survey was conducted of more than 350,000 people in the 50 states and Washington, D.C. The report, in December 2012, could help state officials set goals to reduce risk of heart attack and stroke and improve cardiovascular health.

The American Heart Association goal is, by the year 2020, to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.