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.

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.
–In males, none of the measures of exercise was associated with a decrease in violence-related behaviors, which could be because a larger proportion of males than females did not answer all of the survey questions…

The survey included questions on how often students exercised, how many sit-ups they did and the time of their longest run in the past four weeks as well as whether they played on an organized sports team in the past year.

Students also were asked if they had carried a weapon in the past 30 days or if they were in a physical fight or in a gang in the past year.

Nearly three-quarters of the respondents were Latino, and 19 percent were black. Fifty-six percent were female.

The findings — based on analyzing data from a 2008 survey completed by 1,312 students at four inner-city high schools in New York — were to be presented this week at the Pediatric Academic Societies annual meeting in Washington, DC.

Readers, do you have any experience with teenage girls and exercise and how they may have been influenced by daily activity? Please let us know.

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 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. Similarly, the blood pressure reductions were associated with a 40.4 percent and a 48.8 percent reduction, respectively, in the relative risk of stroke. Following the literature, we averaged the systolic and diastolic effects to arrive at an overall relative risk reduction of 32.2 percent in myocardial infarction and 44.6 percent in stroke associated with the blood pressure reductions…

In a population ages 55–64 that is evenly divided among men and women, the incidence of myocardial infarction is estimated to be about 11.4 per 1,000 person-years, and the incidence of stroke about 3.3 per 1,000 person-years. Using average attributable costs per case, the reductions in incidence were estimated to have saved $235,254 from blood pressure reductions over the thirty-six-month study period.

With each avoidable emergency department visit costing on average $474 in Massachusetts, we estimated total savings of about $1.4 million from the 2,851 reported emergency department visits avoided. These savings were much larger than the savings from blood pressure reduction. Thus, estimated savings from the use of mobile clinics were driven by the number of emergency department visits avoided.

Total mobile clinic savings were about $1.6 million from January 2010 through June 2012. Total operating expenditures during the same period were $1,222,886. Operating expenses included personnel salaries and benefits, vehicle operations and utilities costs, and mobile clinic administrative costs. The ratio of total savings to total expenditures, or return on investment, was thus 1.3.”

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:

“As you can see, Massachusetts is one of the most unequal states, and had one of the biggest increases in inequality. While state policies in a few areas help to mitigate some of the impact of this trend on health (e.g., health reform and in particular, Medicaid and Commonwealth Care), we know that having a low income is just about the worst thing for your health. Very troubling report for everyone, and particularly those of us who care about the health of the state.”

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. As he put it:

Those among us in the shadows—they do not speak, not loudly. They do not often vote. They do not contribute to political campaigns or PACs. They employ no lobbyists. They write no op-eds. We pass by their coin cups outstretched, as if invisible, on the corner as we head for Starbucks; and Congress may pass them by too, because they don’t vote, and, hey, campaigns cost money. And if those in power do not choose of their own free will to speak for them, the silence descends. Isaiah was born into the shadows of life. Leukemia could not overtake him, but the shadows could, and they did.

From his dual-perspective as a former pediatrician and a former government leader, Dr. Berwick’s argument reminds us that biological problems cannot be divorced from their societal context. From my perspective as a psychologist, I think Isaiah’s life also speaks to the power of our individual stories, not just to touch those around us, but to keep us alive.

Isaiah’s story makes clear that of all the inequities in our society, hopelessness may be the overriding one. I don’t mean to suggest that we can cure poverty or prejudice by making people feel hopeful, but I very much believe that by helping people feel that their lives have meaning we can keep them engaged in those fights. Even in the face of a challenging objective reality, whether that is a chronic illness diagnosis or a life of marginalization, our ability to find hope and meaning may be the best defense we have against despair and mortality. You can’t cure leukemia on your own, but you can cure hopelessness. That is because we are not only the main character in our lives, but we are also the narrator. We can take the events of our lives and weave them into a story that fosters the hope and meaning that are life-sustaining.

Let me be clear: I’m not advocating a simplistic rose-colored-glasses approach. In fact the scientific literature in my field suggests that the biggest boost we get from telling our stories may come from first acknowledging and exploring the negative before trying to find a seed of redemption. And in the face of inequality and illness it is appropriate to feel down. But hopelessness killed Isaiah and hopelessness is just a state of mind. I hope Dr. Berwick’s message will inspire not only good medical practice and devotion to curing society’s inequities. I hope it will also remind us that we each get to tell our own story and the way we choose to do so might save our lives.

Jonathan Adler, Ph.D. is an Assistant Professor of Psychology at Franklin W. Olin College of Engineering in Needham, Mass.

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:

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.

Robert Blendon, of the Harvard School of Public Health conducted the poll and this morning told WBUR: “…in a world where we’re so pleased with universal coverage, beneath the surface there are still people who think they’re being treated differently based on their insurance.”

A Snarky Tone And A Long Wait

“I felt I was treated like a second class citizen,” said Charlene Wallace, 61, who is on Medicare (due to disability and death benefit income, she earns $4 too much to qualify for MassHealth, she says). Wallace used to visit a clinic in Lowell for her Chronic Obstructive Pulmonary Disease (COPD), chronic bronchitis, high blood pressure, arthritis, restless leg syndrome and recent heart attack, for which she takes a total of 20 medications. “When I asked why I had to get a urine test every month, the nurse raised her voice and said ‘Because you have to, that’s why.’ You have an appointment at 11 and you’re there for three hours,” she said. “Even just to pick up a prescription, I’m there an hour and a half.”

Indeed, according to our poll, half of the lower-income sick said they had to wait longer for an appointment than they thought reasonable, a significantly higher proportion than for middle-income (32%) and higher-income (27%) sick. The poll was conducted by the Harvard School of Public Health, the Blue Cross Blue Shield of Massachusetts Foundation and WBUR.

What the poll, which surveys 500 “sick” residents of Massachusetts, shows overall is that despite widespread insurance coverage here, patients still experience serious problems related to the cost and quality of care. The poll found that about one third of sick adults report that the cost of their medical care has caused a “very serious” or “somewhat serious” financial problem for their family; and one in seven sick adults say there was a time in the past year they couldn’t get the medical care they needed, either because they couldn’t afford it or their insurer didn’t cover it.

Collection Agency Blues

Bonnie McGhee says the quality of her care is fine, but even on Medicare, she can’t pay for everything she needs. At age 67, she’s got severe, “brittle” diabetes, neuropathy, acid reflux and heart problems. Medicare pays 80% of her drug costs, but she still has a hard time paying the other 20%, she said, and has already stopped taking certain medications to save money. Two years ago, she was admitted to Cape Cod Hospital six times due to extreme spikes in her blood sugar levels and other problems related to the diabetes. She still owes about $2,000 for those visits. “The collection agency keeps writing me.”

To pay for her insulin, McGhee works summers as a parking lot attendant in Provincetown — 10 hours a day, four days a week. “Physically it’s hard,” she says. “I get very tired easily — I have neuropathy in my legs, so I don’t walk right. I can do this job because I can sit in a booth.”

Nancy Turnbull, an associate dean at the Harvard School of Public Health, and not involved in the poll, said she thinks the survey shows the effects of insurance coverage expansions in the state because “there are very few significant differences between lower and higher income people [when it comes to] access, financial barriers to care and almost every other measure.”

But,” she says, “while insurance coverage reduces disparities in care for lower income people, it doesn’t eliminate them. So it’s not surprising that there are still differences in the survey. Lower income people are more likely to be in limited network plans, and so have less choice of doctors and hospitals. Rising co-payments and deductibles lead people with less income to delay care, get sicker and then need appointments more urgently, appointments that might be hard to obtain in a timely way. They could be more likely to live in areas that have worse access to care than in richer areas. Poorer people encounter bias and prejudice in the health care system — against the poor, against people who have Medicaid, against people of color (who are more likely to have lower incomes). So while insurance is tremendously important, it does not equalize the health care system for lower income people.”

You can view the report, Sick in Massachusetts, here and the detailed results here. And here’s this morning’s WBUR interview with Blendon, who conducted the poll.

The Blue Cross Blue Shield of Massachusetts Foundation, the Harvard School of Public Health (HSPH) and WBUR worked in partnership to produce “Sick in Massachusetts.” The Foundation commissioned and funded the HSPH poll. An independent research firm, SSRS, conducted the telephone interviews and provided WBUR with the names of poll participants. WBUR met with the partners to review the poll questions and analyze the results. WBUR shared story scripts with Robert Blendon at HSPH for fact checking purposes. WBUR, using internal editing procedures, decided how to frame and expand on issues raised by the poll results.

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.

The study authors also compared the BMI of the US homeless adults with 5,555 non-homeless adults, using data from the National Health and Nutrition Examination Survey. They found that obesity amongst the homeless (32.3%) was almost as high as among the general population (33.7%). The mean BMI among homeless adults was 28.4 kg/m2 compared with 28.6 kg/m2 among the general non-homeless population. However, homeless women had a significantly higher percentage of obesity (42.8%) than non-homeless women (35.3%).

The study suggests that factors associated with being homeless, such as a largely sedentary lifestyle, sleep debt, and stress may also contribute to the high prevalence of obesity. The research paper expresses caution about what the precise risk factors and causes of obesity in the homeless might be. However, it offers a range of hypotheses and suggests this could be a ripe area for future research.

Lead study author, Katherine Koh, who carried out the research at the University of Oxford but is now at Harvard Medical School, said: ‘The recently described “hunger-obesity paradox”, which describes the co-existence of hunger and obesity in the same person, may help explain these findings. The rise of obesity among populations that lack regular access to food has recently been documented in developing countries and certain low-income populations. This research shows that this paradox may affect homeless people as well. Obesity among the homeless population could be due to the tendency to buy cheap, low-nutrient dense but highly caloric foods in the setting of limited resources. Another factor could be the physiological changes that occur in the body in the face of inconsistent food intake.’

Co-author Paul Montgomery, Professor of Psycho-Social Interventions at the University of Oxford, said: ‘To our knowledge, this is the first study to rigorously evaluate whether obesity is a problem among the homeless in the U.S. as very little research has been done in this area. This study highlights the importance of the quality, as well as the quantity, of food that the homeless are consuming. Interventions aimed at reducing obesity in the homeless, such as improving nutritional standards in shelters or educational efforts at clinical sites, should be considered in the light of these findings.’

This study supports other academic literature in the United States that demonstrates that the highest prevalence of obesity now exists in low-income groups. The study concludes that although being underweight has traditionally been associated with homelessness, obesity may have replaced underweight as the new malnutrition of the homeless.

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.

Health Includes Basic Needs

The authors cite a 2007 study at Johns Hopkins Medical Center in which 98 percent of pediatric residents said that referring well-child patients for help with basic needs could improve the children’s health. “But how many of those residents routinely screened their patients for food sufficiency? Only 11 percent.” The moral: Health care is much bigger than just prescribing medicine. This is the founding principle of Rebecca Onie’s Health Leads, a group that recruits student volunteers to support doctors prescribing food, heat and other basics to low-income patients.

In Brazil, they deal with this problem through a program that routinely sends low-income children home after hospitalizations with resources to make sure they have access to nutrition, sanitation and psychological support, the paper notes.

But in the U.S., the current system provides few incentives to connect patients with basic needs. For example, the authors write that Medicaid reimbursements are specifically forbidden when it comes to getting patients plugged in to social services, or helping them obtain food stamps or energy assistance.

Health Workers In The Community

Paul Farmer is an authority on radically rethinking where care is provided. In Haiti’s Central Plateau, with just one doctor for every 50,000 people, Farmer helped pioneer the concept of paying community health workers, or accompagnateurs, to visit the homes of patients to make sure they take their medicines, but also attend to other critical needs, like transportation, shoddy housing and emotional support. Based on this model, the PACT program was launched in Boston to serve the sickest and most vulnerable HIV-positive and chronically ill patients in the city. That model, in turn, has expanded to help other poor, chronically sick patients who live in “the shadow of Harvard’s finest hospitals.”

Beyond The M.D.

By expanding the ranks of community health workers, the authors note, doctors, nurses, social workers and other professionals can “practice to the top of their license” and spend more time doing what they’re trained to do. This “task-shifting” also saves money and reduces inefficiencies.

The paper concludes:

It is by no means a new discovery that poverty and poor health are linked or that health resources are more likely to be used if they are offered conveniently to the recipient, or that a goal as complex and ambitious as “health” can be effectively pursued only with a multidisciplinary team of workers.

…

But what’s new is this: The U.S. health care system has reached a tipping point. Reform is in the air with primary care especially positioned for transformation.

…

“Health” is a bold, expansive aspiration. Let’s make sure what we call “health care” is broad enough to get the job done.

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.

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.

These are just some of the immediate health consequences that have been documented. Bangladesh has a high rate of tuberculosis, which requires daily treatment for six months to cure. Evictions and displacement can interrupt treatment, creating risks for drug resistance. BRAC’s programs depend largely on the activities of community health workers, who live in these communities and are equally vulnerable to these events.

In just a week, Korail’s slum dwellers demonstrate astonishing resilience; the rubble is quickly giving way to rebuilding structures, new water piping, and families resettling. Within a few weeks, most signs of last week’s violence will be invisible to most of us. Not all slums will recover so easily. Even this community remains in danger; obviously living with the constant threat of eviction takes a toll — economically, socially, and psychically.

“We have created a structure where there is no place but slums for low-income people to live. They are the engine of the informal economy and yet the State likes to pretend that they don’t exist and this is the result of that indifference,” said Asif Saleh, Director of Communication, BRAC.

Dhaka is home to over three million slum dwellers, all of whom reside in what are considered illegal structures. According to a research done by the Department for International Development (DFID), at least 60,000 people were displaced due to the evictions from 27 slums in Dhaka between 2006 and 2008. Bangladesh’s success in reducing poverty is threatened by forceful evictions that disrupt communities, destroy livelihoods, and uproot families.

The urban poor deserve better policies, but without assistance, are rarely heard. On April 8, BRAC and several other organizations have submitted a demand of justice notice, to ensure that the government is in compliance with the High Court’s requirements of providing adequate notice, compensation, resettlement and rehabilitation to affected households.

“However technically legal the form of the eviction may have been, nothing can justify the fact that the manner and spirit in which it was carried out was fully devoid of humanity,” said Faustina Pereira, Human Rights Activist and Director of BRAC’s Human Rights and Legal Services Programme. “No adequate advance notice was given, no compensation mentioned – and rehabilitation is so distant and unreal a dream that no one even utters it. What a mockery of constitutional safeguards of life, livelihood and shelter.”

This is a legal issue, but also one that concerns those interested in health and development; having secure housing is a necessary foundation for well being. Bangladesh’s urban poor deserve a place not only in the growing economy, but also space to live.

There was peaceful demonstration on the day following the evictions. “Without relocation, slum will not disappear,” the signs said, “Don’t destroy schools, mosques, and madrassas.”

For more information, read this personal reflection from a BRAC staffer; and this op-ed on the eviction in a local paper and see more pictures here

The Boston nonprofit Health Leads, whose successful programs have doctors “prescribing” basic resources like food, transportation, housing and heating assistance to low-income patients to boost their overall health, announced it’s been awarded $4.5 million from the Robert Wood Johnson Foundation to expand their programs and “to demonstrate the economic value of our model.”

Here’s the news release:

“We are pleased to provide this renewed funding for Health Leads, whose innovative model helps to eliminate the social barriers that stand in the way of people improving their health,” says Wendy Yallowitz, program officer for the Robert Wood Johnson Foundation’s Vulnerable Populations portfolio.  “We look forward to working with Health Leads as it continues to build the infrastructure needed to scale its model and help change the way health care is delivered so that patients’ unmet resource needs are addressed as a standard part of medical care.”

The largest grant in our 16-year history, the funds will support the growth and evaluation of our program to build a case that compels the US health care system to invest financially in connecting patients with the basic resources they need to be healthy.  This grant also allows Health Leads to make the key capacity investments in technology and talent necessary to support this work.

“Health Leads envisions a health care system that connects low-income patients to resources such as food and utilities as routinely as it makes any other subspecialty referral,” says CEO and Co-Founder Rebecca Onie.  “Health Leads is uniquely positioned through our partnership with the Robert Wood Johnson Foundation to quantify the impact of a model that systematically addresses the intersection of poverty and health by making these connections.”

The Health Leads model enables physicians to write “prescriptions” for basic resources just as they do medication, mobilizing college students to “fill” them by connecting patients to community services such as the nearest food pantry or exercise program.  In 2009, Health Leads received a two-year $2.1M grant from the Robert Wood Johnson Foundation to support program-model improvements.

Currently operating in 21 clinics in six cities, Health Leads expects to recruit nearly 1,000 college volunteers to assist over 9,500 low-income patients this year.  With the support of our many funders including the Robert Wood Johnson Foundation, we anticipate a significant increase in the successful resource connections we facilitate for patients annually.

For more on Health Leads and its CEO Rebecca Onie, read earlier CommonHealth coverage here and here.