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Churches – still a beacon of hope as communities undergo changes both good and bad.

This post is written by CHMP Senior Fellow, Charmaine Ruddock. Ms. Ruddock joined the Institute for Family Health formerly known as The Institute for Urban Family Health in 2000 to direct Bronx Health REACH, a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities.

Bronx Health REACH

In an open letter from President Obama addressed to African American families in the November 2012 issue of Ebony magazine, the President begins thus, “ As a young man , I got my first start working with a group of churches on the South Side of Chicago, helping families who had no place to turn when the local steel plants shut down. I worked with local leaders to rebuild neighborhoods, improve schools and, most of all, to broaden opportunities for people who felt like it was slipping away.” In reading this I was reminded of the fact that time and time again it is the churches in so many hard hit communities that are the mainstay of those communities. They stock and staff the food pantries that feed the hungry. They educate the children of the poor or at least supplement the diabolically inferior education provided by many of the local public schools (read any of Jonathan Kozol’s seminal works such as Savage Inequalities to get a first-hand description). They rehabilitate neighborhoods that more look like the bombed out neighborhoods of Beirut than cities which are part of the greatest city in the world – New York. It is ironic that it was the churches in New York through such efforts as the Nehemiah low cost housing program that kept many of those neighborhoods now being transformed by gentrification sufficiently intact to be now so desirable that they are the site of a feeding frenzy by vulture real estate developers. Many of these same vulture developers had bought buildings and boarded them up for decades, not caring how much it decimated the lives and real estate value of those who couldn’t flee and who clung to their American dream of home ownership. And, it was churches that operated the front lines in the battles against the scourge of crack/cocaine in those neighborhoods.

The church as an engine of change or, at least, a bulwark against the bleak social and economic forces that attempt to disembowel many of our neighborhoods is one we know well in Bronx Health REACH. Within our community coalition we have a group of 47 churches of different denominations and sizes. It is these churches that have been the mainstay of our efforts as we grapple with 18% of south Bronx residents diagnosed with diabetes. Many more are at risk for diabetes with the obesity prevalence rate at 31%. Bronx Health REACH is founded on the partnerships that its parent organization, the Institute for Family Health, built with churches (as well as other community based organizations) to establish health centers in the south Bronx at a time when Medicaid Mills were the main access to health care ( I use ‘healthcare’ very, very loosely here).

Over the last decade, church leaders working with Bronx Health REACH have sought to embed health ministries in their churches. They have either incorporated these ministries into such existing ministries as their men’s ministry, women’s ministry, youth ministry, nurses’ ministry, or have created new ministries with a singular focus on health. A few weeks ago in San Francisco at the annual American Public Health Association (APHA) conference we presented on some of our faith based initiatives that have had demonstrable impact on some of the bleak statistics I cited earlier.

During the past year we have had visitors from the University of New Mexico, the UK and even from the Netherlands who wanted to come hear and see for themselves the work that the churches are doing in community health development. They have explicitly remarked on the leadership role of the churches not only in the work they are doing in their respective congregations but in strongly advocating for systemic changes, most notably in ending segregated care based on health insurance status in academic medical institutions.

When the day arrives that the Bronx Health REACH slogan, “Making Health Equality a Reality’ is a fact of life it will in no small part be because of the movement that the churches in the Bronx led, and because they taught and fought to hold on to the promise of possibilities even when everything seems to point to away from that. Their faith will have made us whole.

Charmaine Ruddock

November 27, 2012

author: Editorial Staff

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This post is written by CHMP Senior

Health, HealthCetera, Policy

Opioids and the Public's Health

Source: Top Secret Writers

When I was the editor-in-chief of the American Journal of Nursing, we had a column on pain management that was coordinated by Chris Pasero, RN, MSN, FAAN, a passionate expert on the topic. Pasero and her mentor, Margo McCaffery, PhD, RN, FAAN, had taken it upon themselves to be leaders in educating nurses on how to better evaluate and manage the pain of patients with acute and chronic health problems. They knew of the research showing that too many patients were needlessly suffering with moderate to severe pain because physicians underprescribed pain medication and nurses too often delivered these medications in dosages and with a frequency less than prescribed. In response to this research, leaders in pain management advocated for pain to become the “fifth vital sign” —something that clinicians were to assess regularly (along with the other vital signs of temperature, pulse, respirations, and blood pressure), usually with a 10-point scale on which the patient rated their pain from none to extreme. “Believe the patient’s report” became the mantra for improving pain management.

On several occasions, the editorial staff had conversations with Pasero about the need to address opioid addiction. She would not do so because she feared that nurses would again withhold pain medication from patients out of oftentimes unfounded fears of addiction. It was an understandable argument in an earlier time.

But a recent commentary in JAMA (Journal of the American Medical Association) points out that we must pay attention to the potential for opioid addiction and abuse. Noting that deaths from drug overdoses now surpass those from motor vehicle accidents, Alexander, Kruszewski and Webster challenge us to recognize that opioid abuse is a major public health problem. They point out that the pharmaceutical company may be a co-conspirator in the development of campaigns to eliminate or reduce pain at all costs, since it has resulted in skyrocketing sales and profits for them.

The authors discuss the problem of opioid diversion that occurs all along the pathway from production to dispensing and ingesting of opioids. Most opioid abusers report that they got their drugs through the legitimate prescriptions of family members and friends. I was surprised by the authors’ claim that there is relatively little research that compares the efficacy of various opioids with their adverse effects and abuse.

A few years after my last conversation with Chris Pasero, I interviewed another nurse who works with a peer support system for nurses who have surrendered their licenses while in treatment for licit and illicit drug problems. She argued that we are now too quick to eliminate all pain, all of the time. She asserted that no patient gets addicted to opioids if they are not exposed to it and pushed for scaling back the agressiveness of our pain management approaches. She wasn’t advocating that patients suffer with severe pain or that pain management not be a priority for those who are terminally illl and seek to die comfortably. Rather, she argued for a reasoned, balanced approach to pain management that considers the potential for addiction. So do Alexander and his colleagues.

If I’m in severe pain, I want to be able to request that the pain be relieved and to have clinicians who are sensitive and responsive to this request. If I’m terminally ill, I want to die comfortably and don’t want any clinicians withholding opioids because they fear I’ll become addicted. But what about the potential diversion of these medications by others? That’s a more difficult problem to tackle, but I would argue that a public education campaign may be in order, as well as a national database on opioid prescribing that clinicians can access anytime to determine whether a patient has been over-prescribed these medications.

I was once hit by a car while walking and ended up in Bellevue Hospital’s emergency room. I was in severe pain. I had never had morphine before and, when the nurse gave it to me intravenously, I thought, “Ahh. So that’s what it’s all about.” I then vomited, which I hate to do, and decided that the trip was not worth the side effect. But I understood the attraction of these drugs–their power and their danger. I wonder if Rush Limbaugh understood these things. Does he now? Do others who think they’ll try the opioid high?

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

November 26, 2012

author: Diana J. Mason

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[caption id="attachment_5320" align="aligncenter" width="300"] Source: Top Secret