How Smartphones Could Impact Public Health

(Chart via Pew.)Smartphone owners now outnumber regular cell phone owners for the first time, according to a new study.

From the March 3, 2012 article in the Boston Globe

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This smartphone proliferation has tremendous potential from a public health perspective. When Ispoke with Frank Moss at Bluefin Labs for the story, he described a day when doctors would simultaneously prescribe medicine with an app to help patients better monitor their care (you can read more of Moss’s ideas about mobile health in his New York Times op-ed). When you consider that smartphone penetration is already higher in African American and Latino communities (49 percent in each group vs. a national average of 46 percent) and that these two groups are historically disadvantaged when it comes to accessing health care (just browse the February headline roundup from the Kaiser Family Foundation for examples of these disparities), it would be revolutionary to begin targeting health care apps and devices to these populations.

When we consider looking that the gadgets being pushed into the marketplace to help us monitor our health (many of which I tried while reporting the story) we forget that they’re all targeting ”fairly affluent people,” says Jane Sarasohn-Kahn, a health economist who often blogs about public health at Health Populi. “When we look at the burden of chronic disease, it’s the African Americans and Latinos, the poor and less-educated, and very old or very young that don’t have access to healthy food or safe places. These populations have spent as much money on their mobile phones [as the rest of the country], but the platform technology hasn’t penetrated into poor urban areas.”

Sarasohn-Kahn hopes that Medicaid will start developing applications to target these populations, and points to the recent move by a former CDC scientist to develop an asthma inhaler outfitted with GPS and Wifi enabled sensors. When distributed in urban populations, the inhalers allow the doctors to better track their patients, and allow epidemiologists to learn more about the health of these groups. Right now, the smartphones are spreading at a rapid clip through the country. We just need to be smart enough to know how to help them nudge us all toward better health….

Black men survive longer in prison than out: study

From a 14 July 2011 Health News Today item

NEW YORK (Reuters Health) – Black men are half as likely to die at any given time if they’re in prison than if they aren’t, suggests a new study of North Carolina inmates.

The black prisoners seemed to be especially protected against alcohol- and drug-related deaths, as well as lethal accidents and certain chronic diseases.

But that pattern didn’t hold for white men, who on the whole were slightly more likely to die in prison than outside, according to findings published in Annals of Epidemiology.

Researchers say it’s not the first time a study has found lower death rates among certain groups of inmates — particularly disadvantaged people, who might get protection against violent injuries and murder.

“Ironically, prisons are often the only provider of medical care accessible by these underserved and vulnerable Americans,” said Hung-En Sung of the John Jay College of Criminal Justice in New York.

“Typically, prison-based care is more comprehensive than what inmates have received prior to their admission,” Sung, who wasn’t involved in the new study, told Reuters Health by email….

Blacks Readmitted to Hospital More Than Whites: Study

Blacks Readmitted to Hospital More Than Whites: Study
Return rates even higher for hospitals serving mostly minority patients, research shows

From the February 15, 2011 Health Day news item

TUESDAY, Feb. 15 (HealthDay News) — After leaving the hospital for treatment of three common conditions, older black people are more likely to be readmitted within 30 days than older white people, a new study finds.

Overall, older blacks have 13 percent greater odds of being readmitted to the hospital, recent research suggests, while patients treated at hospitals that primarily serve minority populations have 23 percent greater odds of readmission within 30 days.

“There are significant racial disparities in readmission rates in this country,” said the study’s lead author, Dr. Karen Joynt, a health policy fellow at the Harvard School of Public Health in Boston.

“We found that both race and site of care mattered. The next step is to find out why this disparity exists,” she said.

And, she noted, no matter what the race, about 20 percent of people discharged from the hospital are readmitted within 30 days, which suggests that there are gaps in care that need to be identified and addressed.

“Hospital discharge is a really vulnerable time. Going home from the hospital often requires medication changes, diet changes and lifestyle changes. Even in the best case scenario, one in five is being readmitted,” she said.

Because readmissions are so common, reducing the rate of readmission is a focus in health-care policy. Previous studies have suggested that racial disparities may play a role in readmission rates, but the evidence was inconclusive, according to background information in Joynt’s study.

Using national Medicare data that included more than 3 million hospital discharges for heart attack, congestive heart failure and pneumonia, the researchers compared the rate of readmissions for blacks and for whites. To conform with other research, the researchers considered any non-black patients as white, which means that Hispanics, Asians and Native Americans were placed in the white category for this study.

The researchers also looked at the data by hospital, and whether or not a hospital was primarily a minority-serving hospital.

Of the 3 million plus discharges, 276,681 (8.7 percent) were for black patients, and 2,886,330 (91.3 percent) were for white patients. About 40 percent of the black patients and 6 percent of white patients received care at hospitals that primarily served minorities.

The average age of the patients was mid-70s to early 80s, depending on the condition. There were slightly more women included in this study than men.

Overall, readmission rates were 24.8 percent for blacks and 22.6 percent for whites, which means black patients have 13 percent greater odds of readmission within 30 days after discharge, according to the study.

Among those who had been admitted for heart attack, black patients from minority-serving hospitals had the highest readmission rates — 26.4 percent, according to the study. That translated to 35 percent greater odds of readmission for this group.

The results of the study are published in the Feb. 16 issue of the Journal of the American Medical Association.***

Joynt said this study wasn’t able to tease out the reasons that these disparities exist, but said that less access to transitional care may play a role. She said that other research has shown that good follow-up care after a hospital discharge can make a difference in readmission rates.

“The biggest take-away from this study is that currently, hospital readmission is a major problem in the U.S., and we need better solutions to help prevent readmission,” said the co-author of an editorial in the same issue of the journal, Dr. Adrian Hernandez, an associate professor of medicine at Duke University School of Medicine in Durham, N.C.

“This was an excellent study that raises important questions. How can we get a process in place that strengthens the support received after discharge? How do we get resources that will enable hospitals to reach beyond their doors to provide services and support to vulnerable populations?” he said.

SOURCES: Karen Joynt, M.D., M.P.H., health policy fellow, Harvard School of Public Health, and cardiology fellow, Brigham and Women’s Hospital, Boston; Adrian Hernandez, M.D., M.H.S., associate professor, medicine, Duke University School of Medicine, Durham, N.C.; Feb. 16, 2011, Journal of the American Medical Association***

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Webinar: Black American Health: Law as a Social Determinant of Health

Webinar: Black American Health: Law as a Social Determinant of Health

Information and registration for this free webinar may be found at https://www2.gotomeeting.com/register/363063002

Excerpt

 

Social determinants of health are the key factors in the health status gap between blacks and whites. Social determinants of health are the social, economic and political forces under which people live that affect their health.  Social determinants include wealth/income, education, physical environment, health care, housing, employment, stress and racism/discrimination. In fact, for blacks racism is a key factor. Accumulating evidence strongly suggests that exposure to racial discrimination, and the related economic adversity and social disadvantages, may be a chronic source of trauma in Black communities  that negatively influences mental and physical health outcomes.  These effects may be exacerbated for Black children  who may be impacted by exposure to racial discrimination directly and indirectly via the negative influence of racial discrimination on parent and community support and functioning.  Using a life-course framework, we will examine how exposure to racial discrimination in childhood can shape child and adult health, particularly the likelihood of chronic disease in adulthood. The law is a factor in every social determinant of  health and particularly in racial discrimination.  The webinar will discuss the role of laws and legal structures as a strategy for reducing health disparities. **Racial Inequality: A Risk Factor for Health Disparities in African American Communities”. Dr. Kathy Sanders-Phillips **Law as a Social Determinant of Health Dr. Vernellia Randall The Webinars are organized by Professor Vernellia R. Randall at The University of Dayton (randall@udayton.edu).