Your Brain On Poverty: Low-Income Childhood Linked To Smaller Brain

Young children living in poverty appear to have smaller brain volumes in critical areas, according to researchers at Washington University School of Medicine. But poverty’s detrimental impact on brain development may be mediated by basic early interventions like compassionate parenting and caregiving, the report says.

(Digital Shotgun/flickr)

(Digital Shotgun/flickr)

Growing up poor is already known to be associated with a higher risk of “poor cognitive outcomes” and school performance, the researchers note. But what’s fairly new here is how outside economic forces play out in the development of a child’s brain. According to the study, published in JAMA Pediatrics Monday:

Poverty was associated with smaller white and cortical gray matter and hippocampal and amygdala volumes. The effects of poverty on hippocampal volume were mediated by caregiving support/hostility on the left and right, as well as stressful life events on the left.

The finding that exposure to poverty in early childhood materially impacts brain development at school age further underscores the importance of attention to the well-established deleterious effects of poverty on child development. Continue reading

Study: Teen Girls Who Exercise Have Lower Risk Of Violent Behavior

A few years back, an acquaintance told me that one of the few mandates he imposed on his daughter was that she play a sport regularly, whether she liked it or not. At the time, I thought it was a bit harsh. But now, with a ‘tween daughter of my own who is happiest curled up on a comfy chair reading, and sometimes needs a nudge to run around, I totally get it.

Girls need to move for so many reasons, among them, mental clarity, physical fitness and confidence, and simply to learn that their own bodies can bring them immense joy. Now, add another benefit to the list: it keeps them out of trouble.

(Rohan Reid/flickr)

(Rohan Reid/flickr)

Researchers from Columbia University in New York report that teenage girls from inner-city neighborhoods who exercised regularly were less likely to carry a gun and engage in violent behavior and activities.

Here are some of the findings, from the Columbia news release:

–Females who exercised more than 10 days in the last month had decreased odds of being in a gang.
–Those who did more than 20 sit-ups in the past four weeks had decreased odds of carrying a weapon or being in a gang.
–Females reporting running more than 20 minutes the last time they ran had decreased odds of carrying a weapon.
–Those who participated in team sports in the past year had decreased odds of carrying a weapon, being in a fight or being in a gang.
Continue reading

Study: Mobile Clinic Saves Money, Improves Health For Low-Income Patients

The Boston “Family Van” is an urban mobile health clinic that travels to some of the city’s poorest, medically underserved communities — Dorchester, Roxbury, East Boston, Hyde Park and Mattapan — caring for patients who have the highest rates of preventable illness, hospitalizations and avoidable emergency department visits. (Not surprisingly, these are also some of the neighborhoods hardest hit by the current flu epidemic.)

A program of Harvard Medical School, The Van is staffed by community health workers, and sometimes by doctors and nurses. Their goal is to bring medical care to the people rather than wait for the people to seek care (which may or may not happen, and if it does, may be dangerously delayed).

A patient treated by staff at Boston's Family Van

A patient, Geralyn Lynch, treated by staff at Boston’s Family Van in Dorchester, Mass. (Photo: Mim Adkins)

A recent study, published in the journal Health Affairs, found that the Family Van — with its neighborhood version of house calls — also saves money by preventing ER visits. Additionally, patients receiving care from The Van staff were able to reduce their blood pressure, researchers report.

The study, by researchers at Harvard Medical School, looked at data from 5,900 patients who made a total of 10,509 visits between 2010 and 2012.

Here’s more from the paper:

“The average reductions in systolic and diastolic blood pressure were associated with a 31.0 percent and a 33.3 percent reduction, respectively, in the relative risk of myocardial infarction. Continue reading

Report: Mass. Among Most Unequal States On Income Gap

Center On Budget and Policy Priorities

Here in Massachusetts we often crow about how great things are — our premier health care and education systems, for instance. But it’s worth noting that not everything is so hot, and some things are pretty miserable. Here’s some evidence: A new report by the Center on Budget and Policy Priorities has found that across all states the gap between the richest and poorest households are wide and growing. The states with the largest gaps: New Mexico, Arizona, California, Georgia, New York, Louisiana, Texas, Massachusetts, Illinois, and Mississippi.

According to a statement on the group’s website, the 2000′s were a “lost decade” for low and middle-income households:

“Prolonged growth in income inequality undermines the basic American belief that hard work should pay off,” said Elizabeth McNichol, co-author of the report and senior fellow at the Center. “Anyone who contributes to the nation’s economic growth should reap the benefits of that growth. But for decades now, those benefits have been skewed in favor of the wealthiest members of society.”

The long-standing trend of growing income inequality continued between the late 1990s and the mid-2000s.

Incomes fell by close to 6 percent among the bottom fifth of households, on average, while rising by 8.6 percent among the top fifth, during this period. Incomes grew even faster — 14 percent — among the top 5 percent of households. For the middle fifth of households, incomes grew by just 1.2 percent.

In 45 states and the District of Columbia, gaps between the richest and the poorest households widened during this period and narrowed in none. Average incomes grew more quickly among the top fifth of households than among the bottom fifth in most states.

“For low- and middle-income families, the 2000s were a lost decade of falling incomes and economic insecurity,” said Doug Hall, co-author of the report and Director of the Economic Analysis and Research Network (EARN) at the Economic Policy Institute.

“That’s not only harmful to these families, but it also threatens our future economic growth.”

How does this relate to health care? Quite directly, says Nancy Turnbull, Senior Lecturer on Health Policy and Associate Dean for Educational Programs at the Harvard School of Public Health: Continue reading

Essay: Patient’s Death Highlights Medicine’s Promise, Failure


By Jonathan Adler, Ph.D.
Guest Contributor

A new class of doctors entered the world this spring: medical school graduates, who will join the legions of caretakers we turn to for insight and comfort and rescue. Among the most elite of this new group of caretakers are those who graduated from Harvard Medical School in May. Their graduation speaker was Dr. Donald Berwick, the former Administrator of the Centers for Medicare and Medicaid Services. His speech, reprinted in a recent issue of the Journal of the American Medical Association, eloquently highlighted both the “glory of biomedical care” and its blind side. Dr. Berwick dedicated his address “To Isaiah,” as he told the story of one of his patients from many years ago whose life and death touched him and stands as a call to action for what the medical profession ought to be about.

Dr. Berwick met Isaiah when he was 15 years old, a rough kid from a rough neighborhood, living with his mother, his brothers, and his mother’s ten foster children in a third-floor walk-up in Roxbury. Isaiah had a bad case of leukemia and a worse case of despair. As Dr. Berwick put it, in the sanctity of his clinic at Children’s Hospital, “the glory of biomedical care came to Isaiah’s service” and over time Isaiah was cured of leukemia. But years later, Isaiah was found convulsing on a street corner, brain dead as the result of uncontrolled diabetes. He never came out of this state and died two years later, at age 39. As Dr. Berwick said, “Isaiah, my patient. Cured of leukemia. Killed by hopelessness.”

Dr. Berwick gleans two lessons from the sad story of Isaiah. First and foremost, doctors must vociferously attend to their patients’ illnesses, no matter who their patients are. And second, that doctors must also seek to cure the injustice that Dr. Berwick believes was the true cause of Isaiah’s death. Continue reading

What If Our Health Care System Kept Us Healthy?

Rebecca Onie is the cofounder of Health Leads, the Boston nonprofit that helps doctors “prescribe” basic necessities (housing, food, heat in winter) to low-income patients, in addition to just medications.

In her recent TEDMed talk, she asks some radical question: What if our health care system actually kept us healthy? What if doctors could truly prescribe solutions, not just drugs? What if ER waiting rooms around the country weren’t just places to watch the clock and read old copies of Good Housekeeping, but rather, were transformed into service-oriented, patient-centered hubs where, in a brutal New England winter, a family could go and a volunteer could help that family get the heat turned back on? Listen to Rebecca’s talk and get inspired:

Sick (And Poor) In Massachusetts: Longer Waits, Less Satisfied Patients

(Harvard School of Public Health/WBUR/Blue Cross Blue Shield of Massachusetts Foundation/Robert Wood Johnson Foundation)

Brecah Bollinger, a 42-year-old mother of three in Quincy, requires a lot of medical treatment. But, she says, she often feels like a critical element is missing from her health care: the caring part.

Diagnosed with an immune system disorder, sarcoidosis, Bollinger has near-constant joint pain, trouble breathing, deafness in one ear and a slew of other symptoms that prevent her from holding a job, she says.

She’s on MassHealth, the state’s subsidized Medicaid program for low-income residents. But Bollinger says that as soon as she steps into the doctor’s office, she enters a world in which she feels inferior — rushed, ignored and discounted at each step. “I call it assembly-line health care,” she says. Doctors have abruptly stopped her from talking by putting a hand in her face, suggested she’s addicted to painkillers and left her alone in an exam room in the middle of a medical history, seemingly too busy to take her myriad symptoms seriously, she says. Although Bollinger reports that she was assigned a primary care doctor five years ago, she’s never seen her: that doctor’s schedule is always full. So Bollinger says she just takes whichever provider happens to be free.

“I’m treated horribly,” she says. “I want my doctor to be thorough even if it takes more than five minutes. Frankly, I’m embarrassed to be on MassHealth — they think, ‘Oh, you’re poor, you must be a drug addict.’ Or, like, ‘Your insurance doesn’t pay me enough to be thorough.’ ”

Despite nearly universal health insurance coverage in Massachusetts, which has clearly helped residents, mainly the poor, gain access to medical care, disparities persist.

Bollinger says she has a friend with renal cell cancer who is covered by private insurance and experiences health care in an entirely different, more humane manner. “She has Blue Cross and they treat her like a queen,” Bollinger says. “They pay for her transportation, and her primary care doctor, on days off, calls her just to check in.”

It’s tough enough being sick, but when you’re sick and poor, you’re far more likely to experience long waits and care that leaves you unsatisfied and feeling discriminated against because you’re on Medicaid or other public insurance.

In our poll, Sick in Massachusetts, we asked residents who said they had a serious illness, medical condition, injury or disability requiring a lot of medical care, or spent at least one night in the hospital within the last year about their experiences. We found that sick people with lower incomes (under $25,000) are significantly less likely than middle-income (from $25,000 to $74,999) and higher-income folks (over $75,000) to say they are very satisfied with their care. And more than one-fourth of the lower-income sick report that they were treated worse than others because of their insurance status, a significantly higher proportion than for middle-income (13%) and higher-income (2%) sick. Continue reading

Study Suggests One-Third Of Homeless in U.S. Are Obese

(Deadly Sirius/flickr)

The so-called “hunger-obesity paradox” is one of the many sad truths of urban poverty. Though the poor in general and the homeless in particular are often perceived to be malnourished and underweight, it turns out that obesity is equally pervasive — no matter where you live.

In a new study, researchers at Oxford University and Harvard Medical School found that “obesity is just as common among the homeless as it is among the general non-homeless population.” Here’s the news release:

The study, to be published in a forthcoming issue of the Journal of Urban Health, suggests this could be because cheap foods that are instantly satisfying often contain a high level of fats and sugars. Another reason could be that bodies experiencing chronic food shortages adapt by storing fat reserves.

Researchers examined the body mass index (BMI) data of 5,632 homeless men and women in Boston, and found that nearly one-third of them were obese. They used the medical electronic records at 80 hospital and shelter sites for the homeless in Boston, using data from the Boston Health Care for the Homeless Program– one of the largest adult homeless study populations reported to date. They found that just 1.6% of the homeless in this sample could be classed as ‘underweight’. Morbid obesity – where people are 50%-100% above their ideal body weight – was three times more common with 5.6% of homeless adults classed as morbidly obese. Continue reading

What The Rich U.S. Health System Can Learn From The Poor

A trio of superstar health innovators have a message for the broken U.S health care system: broaden the definition of health to include basic life necessities, bring care to where people live and study how it’s done in poor countries where you can’t always rely on expensive tests and drugs to make people better.

The persuasive new report on “re-aligning health with care” is written by Harvard doctors Paul Farmer (co-founder of the medical nonprofit Partners in Health) and Heidi Behforouz (executive director of the Prevention And Access To Care And Treatment [PACT] program) and Rebecca Onie, CEO of the nonprofit Health Leads. In it, they argue that with some rethinking, the U.S. can deliver better care at a lower price.

They lay out the central problem here:

The health care system is in crisis, driven chiefly by escalating costs, suboptimal health outcomes, scarce primary care resources, and rising poverty. At the same time…a growing number of health providers around the globe have learned to deliver high-quality health care at low cost. Now we need to align our resources in the United States to bring this knowledge fully to bear in saving dollars and lives.

Sounds great, but how to do it? The key, they write in the Summer 2012 edition of the Stanford Social Innovation Review is to change the way we view the “product” of health care, the places it’s delivered and the providers who dole out patient care. Continue reading

Perspective: Poverty, Health And Forced Eviction In The Slums Of Bangladesh

By Venita Subramanian and Maria A. May
Guest Contributors

(Note: Venita and Maria live and work in Dhaka, Bangladesh at BRAC, a poverty alleviation organization. Maria passes through Korail every day on her way to work. This piece represents our personal views, though draws on observations of our colleagues and the information we’ve been able to find in local sources.)

On April 4, one of the largest forceful slum evictions in Bangladesh’s history took place in Dhaka’s Korail bustee. Households, schools and shops within twenty meters of the road were bulldozed, with approximately 3,500 individuals affected.

“Our water supply was cut off and we have no place to go,” explained one of the affected women.

“The way the whole process was carried out was very inhumane. We received an announcement on April 3rd and the next morning, the eviction began. We were given just one night to dismantle our homes, gather our belongings and relocate ourselves. Where will we go?” said another victim.

Local shops and bazaars, the main sources of food for the community, were closed.

Many non-profit organizations, including BRAC, provide health services within the slums. Bangladesh’s recent successes in improving women’s health demonstrate that despite significant challenges, innovative, low-cost strategies can have a major impact. Under normal conditions, workers at BRAC’s health program are concerned that slum-dwellers may miss out on the continuum of care because of high rates of migration, both within slums and from slum to village. The recent demolition of Korail exacerbates this challenge for regular programming and introduces new challenges. The network of communication between field-based community health workers and residents is also disrupted, creating a rift in access to basic primary health services, including maternal and child health services.

Korail slum sits alongside Gulshan Lake. Its 30,000 residents are threatened by eviction (April 5). Photo by Ishtiaque Hussain

Few can boil their water, lacking money for fuel or wood to burn, and the few existing latrines often empty directly into the lake. The combination of crowding and unsanitary conditions creates the perfect environment for an outbreak of diarrheal disease. Continue reading