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As the costs of American health care continue to climb, so does the cry for innovative cost effective solutions. The business of American health care has paved the road to wellness with a monopoly game board of medical offices, hospitals, acute care facilities, and pharmacies.

A combination of medical missions to the Dominican Republic and an admiration for the amazing Lillian Wald and the Henry Street Settlement introduced me to the amazing world of home health visitation. Home visitation may hold great opportunities to decrease health costs, improve health outcomes, and help bring health home to many Americans.

The city of El Cercado is nested along the Haitian border in the mountains of the Dominican Republic. There is one hospital that serves the entire community, no rapid emergency medical response system in place, no pediatric trained specialists, and local physicians are sparsely distributed. Due to these challenges, much of health care in El Cercado happens in the community and home settings. I was graced with the opportunity to help care for the children and pregnant women of this amazing city- and will be forever grateful for the introduction into the benefits home visitation.

Home visitation is a home-based service that combats social determinants of health by providing support, information, and health assistance to those in need. Prior to the Patient Protection and Affordable Care Act (ACA), home visitation programs lacked federal support and functioned via fragmented funding sources. Evidence supports that home visitation to high-risk mothers and their young children correlates with increased maternal employment, better prenatal health, decreased incidence of childhood injuries, and enhanced school readiness.

With interventions aimed to assist impoverished families, pregnant women, and young children; the federally funded Maternal, Infant, and Early Childhood Home Visitation (MIECHV) Program reached 145,000 families in 2015. Financial support from the ACA helped to set a strong foundation for home visitation programs.

Further innovation and expansion of home visitation programs to reach a more diverse network of families could help improve health outcomes, decrease health care costs, and de-institutionalize health care. Additionally, both palliative and hospice care represent alternative forms of home visitation that allow health care to happen at home. Under the new administration and Congress, there is a strong possibility for changes in funding priorities which are likely to alter resources for many social service initiatives. While home visitation programs represent tremendous transformative capacity, they are not sustainable without solid federal financial commitment.

As the costs of American health care

Source: http://www.pri.org/stories/2016-07-31/one-japan-s-most-popular-mascots-egg-crippling-depression

Lots of people are saying they’re depressed over the outcome of the 2016 elections. A low level anxiety about the future and feelings of deep concern over our country’s support for a new president who has expressed bigotry and misogyny has led to some people saying, “I’m so depressed.” But for those who have experienced severe clinical depression, every moment of life can be painful and it’s not caused by elections.

Indeed, some people have a genetic tendency for severe depression. But we cannot discount the impact of the externals environment on our state of emotions. How do people who are trying to exist in war-torn countries not feel depressed? And when daily stressors mount for the single mother who is trying to raise a family while living in poverty, is depression an avoidable state?

On January 12, 2017, at 1:00, HealthCetera producer Diana Mason, PhD, RN, talks with Dr. Edilma Yearwood, PhD, RN, a pscyhiatric-mental health nurse and Associate Professor in the Georgetown University School of Nursing and Health Studies, about depression and the factors that contribute to it. Dr. Yearwood notes that the World Health Organization has projected that depression will be the leading health problem worldwide by 2020, possibly as a result of greater awareness and diagnosis of the condition, but also because of deteriorating conditions in so many countries, such as Syria, Sudan, Nigeria, and others. Certainly, in the United States, persistent poverty and the anxiety that people are feeling about what is in store for our nation and its relationships with other nations, can lead to depression if people don’t pay attention to it and take actions to feel more in control of their lives. Such actions may include proactively developing social support systems that can provide venues for sharing how you feel, taking actions such as demonstrations around issues of concern, exercising, taking a news holiday and deliberating seeking out things that bring you joy. For people who are immobilized by their depression, Dr. Yearwood recommends talking with a health care provider, whether a social workers, primary care practitioner, or other individual to determine whether additional help is needed.

You can listen to the interview on WBAId, 99.5 FM in New York City and streaming at www.wbai.org. Or you can listen anytime by clicking here:

 

HealthCetera is sponsored by the Center for Health, Media & Policy.

 

 

[caption id="attachment_12011" align="aligncenter" width="937"] Source: http://www.pri.org/stories/2016-07-31/one-japan-s-most-popular-mascots-egg-crippling-depression[/caption] Lots of

Yesterday, our president-elect met with a noted vaccine skeptic. Trump and his team have been mulling the privatization of the Veterans Health Administration. Republican congress members are eagerly anticipating their repeal of the Affordable Care Act, even though most Americans say they don’t support a repeal without a replacement.

 

“We can’t sleepwalk through this one, Darlings.”

 

That’s Joanna Macy, longtime peace and environmental activist, scholar of Buddhism and systems theory, and translator of the poet Rilke whose work, since November 9, has been my light and my salvation. Macy made that remark in an inspiring 20-minute talk she gave at the Bioneers conference in 2014. She shows in this speech how Rilke’s words are inextricable from her philosophy:

I am so grateful to be alive now. For life to continue, that means . . . we have to make a giant step in our consciousness. We have to make real what we dream and know and intuit. That we are one-planet people and we can only be one-planet people if we honor all our differences. . . . Rilke said:

Quiet friend who has come so far,
feel how your breathing makes more space around you.
Let this darkness be a bell tower
and you the bell. As you ring,

what batters you becomes your strength.

I’ve written at this blog, over the past several years, on the power of poetry to inform health care practice and policy. But we are entering a new political era, one that may force a further dissolving of many rigid old divisions—the arts from science, environmental activism from health care advocacy, research from clinical practice.

 

For this, we need poetry. Why? Because we have to make a giant step in our consciousness. Because we have to make real what we dream. Because we can’t sleepwalk through this one, Darlings.

 

Last November MacArthur fellow Claudia Rankine published a poem she had written a year before the passage of the ACA, called The Health of Us. The poem creates community from its first word, “We.” Rankine’s incantatory rhythm reminds us of the hope inspired by the mere thought of health care for all:

                                                         we understood
the impossibility of real equality but this single shift
toward a national community we thought
despite being founded on genocide and sustained by slavery
in God’s country we thought we were ready
to see sanity inside the humanity

Of the many challenges ahead, perhaps our greatest will be preserving that sight. How will we maintain our ability to see, and help one another to see, what Rankine so brilliantly calls “sanity inside the humanity”?

 

I wrote in 2015 that what poetry has to offer health care and health policy is its “reporting on the human beings at the heart of a vast and sometimes spiritless industry.”

 

But Rilke says it better. His sonnet, which Macy quotes from in her speech, continues:

Move back and forth into the change.
What is it like, such intensity of pain?
If the drink is bitter, turn yourself to wine.

Yesterday, our president-elect met with a noted