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2011-2012 Narrative Report

to

Kaiser Permanente, Inc.

on the

Kaiser Permanente Burch Minority Leadership Development Awards Program

Submitted by:

Barbara Krimgold and Marie Briones-Jones

Center for Advancing Health 2000 Florida Avenue, NW, Suite 210

Washington, DC 20006 (202) 387-2829

(202) 387-2857 (fax) www.cfah.org

bkrimgold@cfah.org

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Project Summary On September 7, 2011, the Center for Advancing Health (CFHA) received from Kaiser Foundation Hospitals, Inc. (Kaiser Permanente), in Oakland, California a $98,000 grant to launch and manage the Kaiser Permanente Burch Minority Leadership Awards Program (Kaiser Permanente Burch Leadership Awards). The program supports junior minority researchers with two-year leadership development awards. It was established to honor the service of Chris Burch, retired Executive Director of the National Association of Public Hospitals and Health Systems, to the cause of public hospitals and social justice. The Kaiser Permanente Burch Leadership Awards aim to enhance the voices and leadership development of minority researchers committed to improving service to the underserved and reducing health and healthcare inequalities by strengthening support for public hospitals and other safety net providers. It is also designed to develop and sustain a more diverse pool of leaders and experts with access to the federal, state and local health policy community. The program has an advisory committee which includes Dr. Winston Wong, Chris Burch, Bonnie Lefkowitz, Cara James, Barbara Krimgold, and Marie Briones Jones. In launching the Kaiser Permanente Burch Leadership Awards, six scholars were selected from among a diverse group of 100 minority scholars who have completed postdoctoral training in health disparities research under CFAH managed W.K. Kellogg Foundation funded programs: the Kellogg Health Scholars Program (KHSP), in particular its Multidisciplinary Track; Scholars in Health Disparities Research (one of KHSP’s two predecessor postdoctoral research training programs); and the predoctoral training program, Kellogg Fellows in Health Policy Research Program. These six scholar alumnae who were selected as the 2010-2012 Kaiser Permanent Burch Leadership Awardees are Drs. Angelica Herrera, Emma Sanchez-Vaznaugh, Shedra Amy Snipes, Mindi Spencer, Kalahn Taylor-Clark, and Naima Wong. The 2010-2012 program recipients have met twice during the course of their Awards Program. The first meeting, which occurred on Friday, June 3, 2011, has been reported on the 2011-2012 Narrative Report. The second meeting occurred on June 8, 2012, with Chris Burch and national program office (NPO) co-directors Barbara Krimgold and Marie Briones-Jones at the Hotel Palomar in Washington, DC. At the meeting, the recipients provided updates on research and presented the work and activities that they have pursued, funded under the program. Awardees expressed how important the KP Burch has played in their leadership development and hope that the program continues beyond the pilot phase. As the program closes its successful pilot phase, it is hoped that the Kaiser Permanente Burch Minority Leadership Awards program will be sustained in future years to continue to develop emerging minority leaders and to honor the outstanding legacy of Chris Burch. CFAH submits, together with this report, a request for continued funding to support the next cohorts of Kaiser Permanent Burch Leadership Awardees beginning in the fall of this year. Program Progress The six 2010-2012 Kaiser Permanente Burch Leadership Awardees, along with their current residence, current professional affiliation and research focus/interests, are:

Dr. Angelica P. Herrera, Assistant Professor, Health Administration and Policy Program, at University of Maryland-Baltimore County, Department of Sociology and Anthropology, with a joint appointment in the Center for Aging Studies. She recently completed a residential fellowship with the Health and Aging Policy Fellows Program (HAPF) through a placement with the Health Resources and Services Administration (HRSA) in the Office of Health Information Technology and Quality (OHITQ), and a liaison role to the Administration on Aging (AoA). Dr. Herrera’s primary objective is to examine the policies, costs, and organizational processes of various care

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coordination models in community health centers that link primary preventive care, mental health services, and home- and community-based services for chronically ill low-income, ethnic minority, and limited English proficient elderly.

Dr. Emma Sanchez-Vaznaugh Assistant Professor at San Francisco State University, Department of Health Education. She was recently appointed to the Institute of Medicine’s Committee on Physical Activity and Physical Education in the School Environment and just very recently received a 5-year K01 grant from the National Heart, Lung and Blood Instittute. Dr. Sanchez-Vaznaugh’s research focuses on the social, policy and environmental determinants of population health across the lifespan, with special attention to disparities across groups based on race/ethnicity, immigrant and socioeconomic position, and how such disparities may be prevented, mitigated and eliminated through program interventions and policies, including but not limited to federal, state and local health and social policies. Dr. Sanchez-Vaznaugh’ research-to policy efforts pay special attention to school environments and their influence on children’s health and health-related behavior.

Dr. Shedra Amy Snipes, Assistant Professor within the Department of Biobehavioral Health at Pennsylvania State University. Dr. Snipes’ research focuses on the safety and well-being of migrant farmworkers, and the intersections between biology, culture, folk beliefs and health disparities research. Her field work has taken her to many worksites where she tests fieldworker exposure to pesticides and toxins. Her policy work has the objective of improving worker safety and protection, and assuring healthier outcomes for migrant farmworkers.

Dr. Mindi Spencer, Assistant Professor at the University of South Carolina Arnold School of Public Health, with a joint appointment in the Institute for Southern Studies. Dr. Spencer’s research focuses on how cultural and psychosocial factors influence quality of life in older adulthood. Her ultimate goal is to ensure that her research has relevance to long-term care (LTC) policy and late-life disability prevention, with a particular focus on improving health of elders and caregivers working with American Indian elders.

Dr. Kalahn Taylor-Clark, Director of Health Policy at the National Partnership for Women and Families. Previously, she was Research Director at the Engelberg Center for Health Care Reform, Brookings Institution. Dr. Taylor-Clark’s current research focuses on improving value in health care while reducing racial/ethnic and socio-economic health care disparities. She has gathered data on current health systems and is developing interventions to improve the value of health care provided, improve health outcomes and reduce health inequalities and inequities. She is also is a survey researcher who designs and fields public opinion surveys to explore and increase understanding of public support for health equity in all policies.

Dr. Naima Wong, Program Officer, Research and Evaluation, Robert Wood Johnson Foundation, Previously, she was Research Associate with the Georgia Health Policy Center in the Andrew Young School of Policy Studies at Georgia State University. Dr. Wong’s current research focuses on a diverse range of projects that includes providing local evaluation for a national cross-site initiative on environment and policy change to promote healthy eating and active living, conducting a health impact assessment (HIA) of a local military base closure redevelopment, and designing a national framework for implementing health in all policies (HiAP) in the US. She has been working with colleagues to promote understanding of HIA and HiAP.

The work and activities that these awardees have undertaken in the second year of their awards program are wide ranging as evidenced from their one year reports. See Attachments I, II, III, IV, V, and VI.

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Dissemination The NPO has established a Kaiser Permanente Burch Minority Leadership Awards Program web page on the CFAH web site, http://www.cfah.org/activities/kpburchprogram.cfm. The awardees’ work is funded under the program will be disseminated through routes such as publication

of articles, and presentations of their work through articles, and conference oral and poster presentations.

For instance, the 2010-2012 cohort of awardees presented in two panels at the 6th Conference of the

International Society for Equity in Health on Making Policy a Health Equity Building Process, at Cartagena

de Indias, Colombia, September 26-28, 2011. One panel is on Place, Migration, and Health. This panel

was moderated by Ms. Krimgold and the Kaiser Permanente Burch Minority Leadership Awardees

presenting include Drs. Sanchez-Vaznaugh and Snipes. The other panel on Implications of Health in All

Policies for the US was moderated by program advisor Bonnie Lefkowitz and Awardees presenting

include Drs. Herrera, Spencer, Taylor-Clark, and Wong.

Dr. Wong also presented at the 13th World Congress for Public Health on April 12-29, 2012, at Addis

Ababa, Ethiopia on a panel Mrs. Krimgold moderated. Dr. Wong presented “Health in All Policies in the

United States: A Case Study Using a Military Base Redevelopment to Understand Opportunities and

Implementation” at this conference.

KP Burch awardee Emma Sanchez-Vaznaugh is presenting at the October 27-31, 2012 APHA annual

meeting in San Francisco, CA.on obesity patterns among Latinos and Asians, with other KHSP alumnae

and Ms. Krimgold.

In addition, KP Burch advisory committee member Mrs. Bonnie Lefkowitz has organized (and will

moderate) a panel that has been accepted to present at the NIH/NIMHD November 2012 Science of

Eliminating Health Dipsarities Summit at National Harbor, MD, focused on “Health In All Policies: Why

Addressing Health Disparities Requires a Broad Range of Options.” Dr. Sanchez-Vaznaugh is one of the

panelists and will present on “Racial or ethnic childhood obesity disparities: are they evenly distributed

across geography?”

The NPO will also facilitate further dissemination of awardees’ accepted for publication articles in peer-reviewed journals through CFAH’s Health Behavior News Service (HBNS). HBNS is always on the lookout for the latest research on health disparities and population health and looks to Scholars and Fellows from programs managed by CFAH for original, health-related research that explores causes of and demonstrate interventions for health disparities. Announcement of the awardees’ publications and presentations will also be posted on the program’s web page and the KHSP monthly enewsletter, KConnection. Future Plans CFAH is submitting a continuation grant request with this 2011-2012 report to Kaiser Permanente. The request will fund from 2013 to 2018 an additional four cohort, with six awardees each, for a total of 24 minority leadership awardees. Upon receipt of funding, nomination and selection of the 2013-2015 cohort of nominees will commence immediately. CFAH will continue to disseminate the work of the awardees through various channels.

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Attachments 2011-2012 Awardees Reports: Attachment I: Dr. Angelica Herrera Attachment II: Dr. Emma Sanchez-Vaznaugh Attachment III: Dr. Mindi Spencer Attachment IV: Dr. Shedra Amy Snipes Attachment V: Dr. Kalahn Taylor-Clark Attachment VI: Dr. Naima Wong

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Attachment I: Angelica P. Herrera, DrPH, MPH July 27, 2012

Kaiser Permanente Burch Minority Leadership Development Awards Program Final Report

This month, I began a tenure-track faculty position in July 2012 at the University of Maryland, Baltimore County in the multi-disciplinary Heath Administration and Policy Program, in the Department of Sociology and Anthropology with a joint appointment in the Center for Aging Studies. Previously, I held an adjunct appointment at the University of California, Los Angeles in the School of Public Health and was concurrently completing a residential fellowship with the Health and Aging Policy Fellows Program (HAPF) through a placement with the Health Resources and Services Administration (HRSA) in the Office of Health Information Technology and Quality (OHITQ), and a liaison role to the Administration on Aging (AoA). Accomplishments in Year 1.

In Year 1, I completed extensive training in health policy and aging through participation in the Academy of Health’ Health Policy workshop, a 6-week training through the American Political Science Association, and quarterly retreats with the HAPF related to communicating our policy work, media interviewing skills, and networking. During this time, I quadrupled my professional network by meeting with numerous leaders involved in advancing the aging and social justice agenda on a national level. At HRSA, my principal objective was to enhance my knowledge about the function, regulation, financing, organization structure, and mission of HRSA and its Federally Qualified Community Health Centers (FQHCs). My second aim was to investigate current projects and initiatives at HRSA and AoA, both completed and underway that may directly impact the health of low-income, older ethnic minorities that rely heavily on the safety net provided by FQHCs. Thirdly, through interviews with key stakeholders and personal research, I sought to examine potential ways that HRSA could capitalize on provisions outlined in the Patient Protection and Affordable Care Act to enhance their capacity to increase the quality of effective health services to ethnic minority elderly patients. Several recommendations emerged, including: (i) improving the coordination of care and linkage to the aging services network, older adult evidence-based health promotion programs, and care transition programs; (ii) adjusting reimbursement systems to accommodate dual-eligible and patients with multiple chronic conditions; (iii) exploring innovative strategies to compensate FQHCs that foster community health and disease prevention that address the social determinants of health and promote aging in place; (iv) increasing training of primary care providers and community health team (e.g. promotoras) around geriatric care; (v) conducting data analysis of older adults at the patients and health center level to establish a baseline on their status, demographic concentration, service use, expenditures, and identify priorities; and (vi) instituting age-related quality metrics into health information technology systems to better track services, quality, health inequities, and health outcomes of older patients. My findings during this period have culminated into a policy narrative, invited for publication in the Journal of the American Geriatrics Society (JAGS), “The Role of Federally Qualified Community Health Centers in Reducing Health Disparities in Older Adults: Opportunities Following the Affordable Care Act”. I worked with my hometown organization, San Diego Southern Caregiver Resource Center, to submit formal testimony to the Senate Committee on Aging regarding our best practices in Latino

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Alzheimer’s care and support for their caregivers. As a concurrent Health and Aging Policy Fellow and Kaiser Burch Leadership recipient, I met with representatives from Senator Sanders office, and the HELP (Health, Education, Labor, and Pension) Committee discuss findings regarding inequalities in OAA services. In addition, I presented my findings on the performance of FQHCs in delivering quality diabetes care to older under/uninsured minorities to the Subcommittee on Primary Care and Aging and directly to the Assistant Secretary on Aging Kathy Greenlee in one of the first ever joint HRSA-AoA meetings. Accomplishments in Year 2.

Project #1. Quality of Diabetes Care Among Older Black and Latinos in FQHCs To further inform the quality of elder patient care in the safety net, I worked with colleagues at HRSA to analyze the 2009 Patient Survey to identify patient- and system-level factors that influence the quality of and access to recommended preventive clinical services in the safety net, such as diabetes care and cancer screening, among diverse older adults in FQHCs. With full sponsorship by this Kaiser fellowship, I presented this at the American Society on Aging conference in March of 2012, as a late-breaking poster, titled Quality of diabetes care among older Black and Latino patients in Federally Qualified Community Health Centers, in the Multicultural Health and Aging section. The major findings of that study were as follows: Receiving education and information on diabetes from providers and support staff, informational follow-up calls, and formal/informal education increases patients’ chances of having annual (a) eye exams and (b) HbA1c tests. Having any form of health insurance was significantly associated with receipt of eye exams. Compared with uninsured patient, dual-eligible (Medicaid + Medicare) patients are: 7 times more likely to have an eye exam, 4 times more likely to have an annual HbA1c blood exam, 4 times more likely to have an annual foot exam. Patients under insulin PLUS oral medication treatment for their diabetes were twice as likely to receive an annual eye and foot exam as those on no medication. Patients needing assistance with Activities of Daily Living (ADLs) were twice as likely to have had a foot exam in the previous year. Overweight /obese patients were twice as likely to report having an annual HbA1c test as normal weight patients. Female patients are less likely than males to receive an annual HbA1c blood test or eye exam. African-American patients were twice as likely as non-Hispanic Whites to have a foot exam in the previous year. Implications of the study to policy and practice change were discussed at a roundtable at the same meeting. Project #2. Older Americans Act, Caregiver Services for Minority Elderly With funding from NIMHD, I worked with colleagues at the University of Texas and AoA staff to analyze data from the 2009 National Survey of Title III Older Americans Act services to assess the intensity, quality, and effectiveness of these services (e.g. case management, caregiver services, homemaker services) to older ethnic minorities. This was the first time that AoA made this data publicly available. Findings from this analysis are now complete and written up in a manuscript, which was has been accepted with minor revisions to Home Health Care Services Quarterly, peer-reviewed journal. The paper is co-authored with Rebecca George, Jacqueline Angel, Kyriakos Markides, and Fernando Torres-Gil. The paper, titled Effectiveness and Reach of Older Americans Act Caregiver Services to Latino and African Americans. Gerontological Society of American annual meeting, San Diego, California in November 2012. In addition, I am working with transportation and aging national expert, Dr Richard Maratolli, on a paper evaluating OAA transportation data to assess the reach of these services to ethnically diverse elderly.

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Project #3. Latino Family Caregiver Diabetes Intervention. Using funds from Kaiser, I attended the Summer Institute for Behavioral Interventions on Aging at John Hopkins School of Nursing, which covered a range of topics, from the development, implementation, and evaluation of interventions for older adults, the role of theory, measurement issues, cost analysis, recruitment and retention, design and analysis considerations, ethical issues, diffusion of innovations, and effective grant writing for interventions. I am finally actively pursuing funding to pilot test the first-ever diabetes home-based brief training program, El Encuentro, that I designed for Latino family caregivers who care for frail, dependent elderly relatives with type 2 diabetes This program has great potential to become evidence-based, cost-effective, and reimbursable by Medicare, and ultimately offered through FQHCs, the aging services network, or home health agencies. Additionally, I am attending the Qualitative Research Summer Institute at the University of North Carolina’s Odum Institute from July 29 to August 2, 2012, (covered by Kaiser funds) to enhance my knowledge of mixed methods, which I intend to integrate into the evaluation of the diabetes pilot feasibility study. I have used this time to foster partnerships, such as with the National Nurses Hispanic Association and Vida Senior Centers, the DC area’s largest network of senior centers serving Latino elderly, both expected to serve as critical partners on this project. Project #4. Evaluation of Local Health Department Resources and Services for Seniors (ELHDRS) During this period, I have also contributed to the completion of the project, Evaluation Local Health Department Resources and Services for Seniors (ELHDRS), a RWJF study. I am the lead author on the Policy Brief, entitled “Partnering for Senior Health Promotion and Protection in California’s Eroding Public Health Infrastructure” with co-authors Dawn M. Jacobson, Sue Holtby, Nicole Lordi, Steve P. Wallace, and Hector P. Rodriguez. This policy note reports results from a survey of senior managers within California’s Local Health Departments (LHDs) and Area Agencies on Aging. It finds that in spite of growing demand for senior health services, two-thirds of LHDs and AAA’s experienced budget cuts in the 2010-2011 fiscal year, while nearly 40% faced staffing reductions. Budgetary and personnel reductions compromised LHDs ability to serve seniors in a number of critical areas, including the investigation of health and environmental hazards, the enforcement of public health laws, the implementation of health promotion programs, and quality improvement activities. With no end in site to California’s budget crisis, we recommended that local public health system stakeholders reexamine the distribution of responsibilities, eliminate redundancy in overlapping areas, and pinpoint gaps in services. LHDs may also benefit from streamlining and coordinating service delivery with system partners through written formal agreements with AAA’s, and cross-agency sharing of provider and consumer electronic information systems. An e-newsletter and copy of the Policy Brief is scheduled for dissemination to over 11,000 legislators, policymakers, and health professionals in California and nationally.

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Highlights

Appointed to the

Institute of Medicine

committee on Physical

Activity and Physical

Education in the school

environment.

Awarded a 5-year K01

Mentored Career

Development grant from

the National Heart Lung

and Blood Institute.

Invited to help plan the

national childhood

obesity conference for

2013.

Attachment II: Emma V. Sanchez-Vaznaugh, ScD, MPH San Francisco State University, Department of Health Education

Research Focus

Dr. Sanchez-Vaznaugh’s research seeks to generate sound evidence to inform program interventions and policies, with the goal of improving population health, reducing health disparities and addressing the needs of poor and underserved populations. Her research focuses on the social, policy and environmental determinants of population health, racial/ethnic, socioeconomic disparities, immigrant health and how disparities may be eliminated through program interventions and policies at the federal, state and local levels.

Accomplishments

Over the past two years, the Kaiser Permanente’s Burch award supported Dr. Sanchez-Vaznaugh’s development as a leader, enabling her to reach critical milestones; the most significant ones follow: Research-to-policy (and practice) connections: The Institute of Medicine appointed Dr. Sanchez to serve on the Committee on

Physical Activity and Physical Education in the school environment (2012-2013).

She was invited to participate as a workgroup member of the Basic and Applied Research track to plan part of the 2013 Childhood Obesity Conference. This is a national conference conducted every two years.

Additionally, Dr. Sanchez-Vaznaugh met with the following professionals to strengthen her research-to-policy connections: Charlotte Pratt (National Institutes of Health, Heart, Lung and Blood Institute), Mary Story, Healthy Eating Research, Robert Wood Johnson Foundation (RWJF), Amelie Ramirez, DrPH Salud America! RWJF, Pat Crawford, University of California Berkeley, and Jerry Davis, Chair, Geography Department, San Francisco State University.

Publications (published and under review). Dr. Sanchez-Vaznaugh authored or co-authored four papers. Details regarding these studies are provided below: Sanchez-Vaznaugh, EV., et al. Physical education policy compliance and

children’s physical fitness. (2012). Am Journal of Preventive Medicine. May; 42(5):452-9. Sanchez, B.N., Sanchez-Vaznaugh, EV., et al. Differential associations between the food

environment near schools and childhood overweight across race/ethnicity, gender, and grade. American Journal of Epidemiology. (2012) Jun 15; 175 (12):1284-93.

Acevedo-Garcia, D. Sanchez-Vaznaugh, EV., et al. Integrating social epidemiology into immigrant health research: A cross-national framework. (2012) Social Science and Medicine.

Sanchez-Vaznaugh, EV., et al. Compliance with physical education policy and Latino Children’s fitness: the majority do not benefit. American Journal of Preventive Medicine. Under Review.

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Conference presentations (partial list). She presented her work at the following conferences: Sanchez-Vaznaugh, EV. Childhood obesity and racial/ethnic disparities: attention to the causes

of the causes. Latina Researchers Conference. City University of New York. New York City, NY. April 27, 2012.

Sanchez-Vaznaugh, EV. Socioeconomic status and food policy as determinants of obesity: health equity insights from diverse immigrants to the United States. 6th International conference of the Society for Equity in Health. Cartagena, Colombia. September 27, 2011.

Sanchez-Vaznaugh, EV. Is participation in the national school lunch program associated with children's body weight? Society for the Advancement of Chicanos and Native Americans in Science's annual conference. San Jose, CA. October 28, 2011.

Sanchez-Vaznaugh, EV. Environmental and policy approaches: can they really prevent childhood obesity? Stanford University. Palo Alto, CA. February 9, 2011.

New Awards. Dr. Sanchez-Vaznaugh was recently awarded a 5 year Mentored Career Development Award from the National Heart Lung and Blood Institute to pursue further training on nutrition and physical activity and to conduct research on the multilevel environmental influences on childhood obesity disparities. The Kaiser Permanente’s Burch award was instrumental in supporting Dr. Sanchez-Vaznaugh over the last two years to accomplish the above activities, crucial for her future success as a minority investigator.

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Attachment III:

Mindi Spencer, PhD

University of South Carolina

Biographical Sketch Dr. Spencer is currently an Assistant Professor in the Arnold School of Public Health at the University of

South Carolina, with a joint appointment in the Institute for Southern Studies. Her research focuses on

how psychosocial and structural factors influence quality of life in older adulthood. Recently, she

has been working to better understand how the health of American Indian elders has been

affected by their forced relocation to boarding schools during childhood. The KP Burch Award

enabled her to explore how research and advocacy is being used to inform long-term care (LTC)

policy and late-life disability prevention in Tribal communities.

Background

American Indians experience some of the highest physical disability rates of any U.S.

racial/ethnic group.

Disability, coupled with

historical trauma and an

unprecedented aging of the

population, will require the

coordinated provision of

holistic LTC services in

Indian Country. It is critical

that researchers work with

policymakers to emphasize

the integral role played by

LTC in providing

comprehensive health care

across the life span and

reducing health disparities.

Professional Development Activities Supported by the 2010-2012 KP Burch Leadership

Award

Intensive training in health policy at the AcademyHealth Health Policy Orientation in

Washington, D.C.

Increased involvement in the National Academy on an Aging Society, the policy arm of the

Gerontological Society of America

Attended the Indian Health Service Conference on Long-term Care in Indian Country

o Developed an understanding of the implications of the Patient Protection and

Affordable Care Act and the Indian Health Care Improvement Act on the future of

LTC in Indian Country

o Continued participation in follow-up webinars; invited graduate students to these

sessions as part of a new research lab at the University of South Carolina which is

dedicated to American Indian health

o Met an important contact – Dave Baldridge, Executive Director for the International

Association for Indigenous Aging – who continues to be both a friend and mentor

Model adapted from Kemper, 2003

The Indirect Role of Research

in the Development of Health

Policies for American Indian

and Alaskan Native Elders

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Participated in the 6th

meeting of the International Society for Equity in Health in Cartagena,

Colombia o Presented to an international audience on the unique ways that the “Health in All

Policies” model operates in Indian Country using a historical perspective

o Developed expertise in the importance of moving in the direction of Tribal control

over health services (i.e., the “638 Tribes”); working to create a white paper for

dissemination to Tribes

Joined the National Congress of American Indians and attended their 68th

Annual

Convention

o Attended the Elder Subcommittee and increased knowledge of the most current

policy issues

o Interacted with DHHS Elder Care Initiative LTC grant recipients (“best practices”

Tribes)

Continued development of a personal research agenda focused on LTC and American Indian

elders

o Currently analyzing data on 505 American Indian elders with Dr. Turner Goins, a

colleague from Oregon State University, on the long-term health effects of forced

relocation to boarding schools

o Contributed to a competitive grant proposal for a tenure-track hire in Native

American Studies at the University of South Carolina, which was subsequently

funded through the Office of the Provost

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Attachment IV: Shedra Amy Snipes, Ph.D. 2011-2012 Report Dr. Shedra Amy Snipes, Assistant Professor of Biobehavioral Health at Pennsylvania State University, is a bio-cultural anthropologist and health disparities scholar who uses ethnography, community-based research, biological markers to explore the health of Mexican immigrant farmworkers. Dr. Snipes’ research methods are unique – she bravely takes on the life and lifestyle of a migrant farmworker in order to understand dynamic social, environmental, and cultural factors associated with farmworkers’ health. Specifically, Dr. Snipes undergoes routine exposure to pesticides, works 12-hour shifts in orchards and fields, endures occupational injuries, and witnesses limited access to healthcare. Using this approach, Dr. Snipes is able to gather a rich dataset that is strengthened by biological risk assessment (saliva and urine) of farmworkers’ chemical exposures. Moreover, she is able to document issues associated with migration, injustice and workforce policy regulation among farmworkers and their families. Dr. Snipes’ ultimate goal is to form high-quality interventions that reduce farmworker occupational risks, as well as inform policies about occupational safety regulation. Dr. Snipes’ specific policy interests include regulatory activity of the Environmental Protection Agency (EPA) around worker protection, as well as policies of the Department of Labor (DOL) and the Occupational Safety and Health Administration (OSHA) for hazard prevention. The policy implications of her work suggest that: (1) Hazard prevention efforts of the EPA and OSHA should be revised and updated to mandate culturally-appropriate pesticide and injury training; (2) Personal protective equipment (PPE) guidelines are heavily ignored by owners, thus increased monitoring and enforcement is needed; and (3) Pay by yield increase likelihood of injuries because farmworkers are pressured to work quickly with high yield. Moreover, yield income may discourage safe behaviors such as use of PPE. Wage policies that encourage hourly, or contract payment may reduce likelihood of work-related hazards associated with rapid work. Dr. Snipes’ activities during her fellowship period include:

Beginning August 2011, Dr. Snipes began working with key staff of the National Agricultural Workers Survey (NAWS) – a DOL survey – to informally aid DOL staff in the addition of health-related questions for the 2012/2013 questionnaire. She attended a meeting in Burlingame, CA with a small set of scholars, and DOL staff to talk about items that might be missing from the knowledge-bank of farmworker health. This meeting was especially important for her development in health policy advocacy for farmworkers, since the NAWS is the only national survey of agricultural workers. Moreover, the addition of health-related questions to the NAWS survey will provide critically valuable information regarding the health of farmworkers in the United States, as we currently have little data apart from local evidence on the current landscape of health access, injury and pesticide exposure.

After attending this networking meeting with NAWS staff, she was able to gain use of an exciting dataset that remained unanalyzed by DOL staff. From September 2011 to June 2012, she codes, organizes and analyzes the national dataset of occupational injuries experienced by a subset of the nation’s farmworker population. In addition, she explored injury narratives of over 380 farmworkers, linking their stories to primary data on healthcare access, treatment outcome, and insurance status. A paper describing important contextual factors including migration status, documentation status, access of safety equipment, and intervention is forthcoming.

Dr. Snipes also spent her tenure as a Kaiser Permanente Burch Scholar attending national and

international conferences. First, Dr. Snipes presented her research at the International Society for Equity (ISEqH) in Health international conference with others in her award cohort. Dr. Snipes also became a member of the inaugural class of the American Academy of Health Behavior

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(AAHB)’s Junior Scholar Program. Under the mentorship of Dr. Collins Airhihenbuwa, Dr. Snipes engaged in a 12-month mentoring program structured through AAHB and The Kellogg Health Scholars Program, and completed two scholarly products.

Dr. Snipes was awarded a research grant aimed to develop and pilot-test feasibility and fidelity markers of a novel, evidence-based pesticide safety intervention for farmworkers. This grant was written in partnership with farmworker family advocates, Texas Migrant Council Migrant Head Start Program located along the Texas-Mexico Border, which serves nearly 3,500 farmworker families.

Upon noting that the literature was absent of intervention theoretical models that guide

researchers through the development of culturally-appropriate health frames, Dr. Snipes coined the “’Head-Hand-Heart’ Practical Guidelines for Culturally Sound Interventions”. The publication of this guideline is in its final editing stages, and will be submitted for publication in October 2012.

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Attachment V: Kalahn Taylor-Clark 2011-2012 Report Framing Equity in Health Reform Health reform legislation promises to provide broader access to health care services, while lowering overall costs to the system, with a secondary goal of improving the quality of care and outcomes for patients. Still, health reform has an opportunity to reach beyond access and quality of care to improve well-being for the population through policies extending beyond the health care system. Thus, building a movement to improve America's health will require advancing a Health in All Policies approach. Several mechanisms can leverage support for such an approach: 1) data to assess equitable distribution of resources will be key in several areas, including, labor, health care, social services, and education, among others; 2) framing issues of equity will be key to garnering public support for strengthening the impact of health reform; and, 3) continuous assessment of strategic opportunities to affect health through reform activities will be key to sustaining policies to improve health. Activities for the Burch Leadership Award I hope to advance strategic thinking to enhance Health in All Policies through policy initiatives outlined in the Accountable Care Act. To do this, I have been developing a dossier of research that supports the 3 aforementioned areas. With the funds from the Burch Award I have identified several conferences of import to building out my research agenda. In fall 2011, I attended two conferences, the ISEQH meeting in Cartagena, Colombia, in which I presented research on enhancing data to support HiAP initiatives (October 2011). I also attended the Asian Pacific Islander forum on incorporating equity in health reform in Oakland, CA (September 2011). There I was able to liaison with health policy makers from the Congressional Tri-Caucus to build relationships on the issues, while seeking opportunities to engage discussions of including HiAP in health reform agendas. This experience allowed me to forge working relationships with leaders in the National Association of Public Hospitals, as well, with whom I am currently exploring ways to bring patient and community engagement into hospital systems. As I have encountered several personal obstacles to utilizing the resources provided through Burch this year, I look forward to using the remaining resources to attend two more conferences in March 2013 in San Francisco, CA. On March 20-23, I have submitted an abstract to present work on community engagement in health care. This work explicates the efforts of my organization, The National Partnership for Women and Families, to improve the health of the country’s most vulnerable populations through linking social and community resources to health care services. I look forward to sharing this work at an academic conference, as it will be imperative to bridge the gap between research and policy activity on the ground if we are to create real inroads to improve health equity. I will also attend a conference, Diversity Rx (March 10-12), which I hope will expand my network of disparity and health equity scholars in order to engage work with them from the purview of my organization’s goals to incorporate social determinants as a means to achieve better health care and health outcomes. I have been deeply grateful for the experience of being a Burch Scholar, and I do hope that this program continues in honor of Chris Burch’s legacy.

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Attachment VI: Naima T. Wong 2011-2012 Report When I received the Chris Burch Minority Leadership Award from Kaiser Permanente in 2010, I was a research associate at the Georgia Health Policy Center housed within Georgia State University. I was working with a team on a project that was different than any other the Center had conducted. Much of the reason was because it was connected to a budding field in the US, health impact assessment (HIA). HIA is a method or series of deliberate steps taken to inform a policy decision or development of a program using evidence. When applying the method, a few assumptions are fundamental, including that target of the HIA is a pending decision, those that will be affected by the decision are engaged authenticallly, and implications of health disparities are considered in the analysis. Our team conducted a rapid HIA as part of a larger effort to understand health in all policies (HiAP), an approach to policy development that operates from a multiple determinants of health perspective where health is an outcome under consideration in sectors seemingly unrelated to health at face value. We worked with the CDC to explore the practice of HiAP among federal agencies and used a case study to implement HiAP at the local level. In the case study, specifically, we engaged stakeholders in the 400+ acre Ft. McPherson base redeveloppment that was mandated by the 2005 base realignment and closure act (BRAC). The local stakeholders included residents from communities surrounding the base, the City of Atlanta, and a state appointed local redevelopment authority whose board was comprised with representation from elected officials, major Atlanta-based businesses (e.g., Georgia Power), and the board of regents. These stakeholders helped us to identify where the BRAC process and local decision-making would allow for HiAP. One such opportunity was to conduct a rapid HIA to inform the zoning blueprint and subsequent code that would be developed from the plan. We were successful on many measures including the incorporation of zoning for a grocery store in an area of Atlanta that is currently a food desert, inclusion of increased space designated for recreation, and redesigned connectivity between major amenities to both encourage active transport and optimize access to forthcoming amenities on the base for residents in the surrounding economically divested neighborhoods. During my time on the project, I used the Chris Burch award to attend AcademyHealth's well regarded Policy Orientation training. I have no doubt that this traning helped to inform our exploration of HiAP among federal agencies. In addition, using the award, I was able to participate in the HIA of the Americas workshop, an inimate convening of thought leaders and practitioners of HIA. This meeting helped broaden my understanding of the current issues and allowed me to establish connections with major players in the field. I was also priveledged to present my HIA and HiAP work at two international conferences, the International Society for Equity in Health in Cartagena, Columbia and the 13th World Congress for Public Health in Addis Abbaba, Ethiopia. These meetings further expanded the reach of the HIA and HiAP concepts; ideas that I believe are critical in addressing social determinants of health and promoting health equity. In February 2012, I transitioned from the Georgia Health Policy Center to become a research and evaluation program officer at the Robert Wood Johnson Foundation (RWJF). I've been able to continue my contribution to HIA by overseeing an ongoing evaluation of the Human Impact Project, RWJF's effort to build the field of HIA in the US. This award has allowed me to come full circle--beginning as a novice HIA practitioner, to an advocate of the method through dissemination, to being in position to help a growing field learn what works. I do not believe this is the end of the circle nor the end of the benefits the award will provide. My personal, more modest hope is that my work embodies what was intended. My grander hope is that the combined contribution of the awardees does not end with the first cohort and continues to amplify Chris Burch's legacy.