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Sunday November 15, 2015

Important Lessons about what Matters in Higher Education

By Robin H. Carle

National Higher Education SummitI recently attended the National Higher Education Summit, sponsored by the National Urban League and USA Funds. Among the insightful presentations and discussions over the two-day Summit was the presentation by Brandon Busteed, Executive Director of Education for Gallup. Mr. Busteed discussed the Gallup-USA Funds Minority College Graduates Report, a study based on the findings of a larger survey, the Gallup-Purdue Index.

The Gallup-Purdue Index examined the elements that underpin higher education alumni responses to the question – Was your higher education “worth it”? Gallup measured “well-being” using five interrelated elements: purpose, social, financial, community and physical well-being in answering the question. Overall, only about half of all college graduates are “thriving” in all five categories.

The Minority College Graduates Report clearly identified a significant difference in responses when comparing black alumni of HBCUs vs. those who graduated from non-HBCUs institutions. According to the report, “black graduates of HBCUs are more than twice as likely as black graduates of non-HBCUs to recall experiencing all three support measures that Gallup tracks (having a professor who cared about them as a person, a professor who made them excited about learning and a mentor who encouraged them to pursue their goals and dreams). Black graduates of HBCUs are more likely to strongly agree that they had each of these experiences, and the gap between HBCU and non-HBCU black graduates is widest when recalling having professors who cared about them as people (58% vs. 25%, respectively).

A similar positive relationship exists within experiential learning opportunities, with black graduates of HBCUs recalling more involvement in applied internships, long-term projects and extracurricular activities.

Gallup has found that support and experiential learning opportunities are strongly related to graduates’ feelings of preparedness for life outside of college, workplace engagement and well-being….Black HBCU graduates are more likely to be thriving in purpose and financial well-being than black graduates who did not receive their degrees from HBCUs. This indicates a higher likelihood of HBCU graduates liking what they do each day, being motivated to achieve goals and effectively managing their economic life to reduce stress and increase security.”

“Black HBCU graduates are more likely than black non-HBCU graduates to strongly agree that their university prepared them well for life outside of college (55% vs. 29%) and to be engaged at work (39% vs. 33%).”

There are many reasons HBCUs have a “special recipe” for their graduates’ life successes. These are institutions with generations of responsibility to community and to educating and nurturing future leaders. But these are also institutions under enormous, continuing and growing financial pressures due often to a lack of strong endowments and infrastructure funding. Recent changes in federal loan programs have added to the pressure, dramatically impacting student enrollment, forcing many students to defer their college educations.

There are lessons to be learned by recognizing the elements that make an HBCU experience so strong for their students. Even with a lack of robustly financed infrastructures and many students at the edge of being able to afford their educations – the graduates of these institutions are leading, thriving members of their communities and within their chosen professions.

Today many of our nation’s colleges and universities are struggling to honestly and openly address the lack of equity in their admissions process, as well as in the educational and campus life experiences of their students. Historical institutional and individual biases (conscious and unconscious) can make change hard and emotional. Yet change, when there is true collaboration and a uniting purpose, can be exciting and invigorating. Students, faculty and administrators at academic institutions both large and small are increasingly committed to doing it better – to making their institutions and all their students thrive.

The secure and mentored “safe haven” of an HBCU education is to be lauded and when and where possible, emulated. The importance of this nation’s HBCUs cannot be overstated. These institutions served as beacons of education in previous generations and are still very relevant in today’s education landscape.

Odds of Being Engaged in Work
Source: Gallup

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Thursday October 15, 2015

USCAHDR at CARICOM: New insights for improving U.S., Caribbean & global health

By Louis W. Sullivan, MD

CaricomI recently attended the 28th Meeting of the Council for Human and Social Development - Health (CARICOM) with Dr. Nigel Harris and other members of theU.S.-Caribbean Alliance for Health Disparities Research (USCAHDR) team. It was an excellent meeting.Dr. Harris’ last public update on the project’s progress was Spring 2015. This meeting offered the opportunity to highlight the USCAHDR team’s continued progress. I was pleased to see that CARICOM attendees (including leadership from PAHO and ministers of Health and other senior government officials from many Caribbean countries, and senior leaders from the National Institute for Minority Health and Health Disparities and the National Heart, Lung and Blood Institute of the NIH) found our research findings, comparing Caribbean and U.S. life expectancies most interesting.

The USCAHDR consortium’s current work won’t be completed until May 2016, but we’ve already identified a number of striking findings, especially from our novel analyses of mortality datasets reaching back to 1965 and including current (2013/14) data. Most significantly, the project has found that*:

  • While life expectancy has improved in all regions studied (North America, South and Central America and the Caribbean), Anglo-Caribbean gains were less than in other region. This finding is striking when you consider that in 1965, mortality and life expectancy for Anglo-Caribbean populations exceeded that of African-Americans and other Caribbean and Latin American countries’ populations.
  • In 1965, the life expectancy of the Anglo-Caribbean population exceeded that of African Americans by 1.5 years. Comparative results in 2009 were “inverted”, with life expectancy of African Americans exceeding that of Anglo-Caribbean populations by 0.6 years.
  • There are large differences in life expectancy among Anglo-Caribbean populations from nation to nation. For example, Trinidad & Tobago and Jamaica, showed little improvement in life-expectancy over the past 20 to 40 years, while Antigua and Barbados have done much better.
  • Beginning in 2000, marked differences were found in mortality trends between countries within the Caribbean with some showing substantial reductions in mortality while others showed little change – or even increases. Interestingly, the islands of Martinique and Guadeloupe (both French Caribbean nations) have low mortality, out-performing even the United States.
  • Non-communicable diseases (NCDs), particularly cardiovascular disease and diabetes, appear to responsible for a large percentage of these differences between Caribbean countries.

In addition, our researchers, comparing data (2000 forward) of White Americans with that of African-Americans, found:

  • The mortality and life expectancy differences between the two populations are shrinking, due in most part to reduction in African-American mortality figures
  • The gains in life expectancy made by African-Americans are largely attributable to gains made by African-American males.
  • When U.S. data are examined by state, regional differences in mortality figures for African-Americans and white Americans are found. For example, 2009 data shows African Americans in Massachusetts with better life expectancies than that of White Americans living in many Southern states at that time. These findings contrast with earlier findings from 2000 when African-Americans in nearly every U.S. state had higher mortality and shorter life expectancies than Whites Americans, regardless of state or region.
  • Reductions in mortality from cardiovascular disease and diabetes among African-Americans appear to contribute substantially to the reduced disparities in mortality between African-Americans and White Americans.

Life expectancy among Afro-Caribbean and US populations

Life expectancy (LE) among Afro-Caribbean and US populations showing
(a) LE at birth for women, (b) LE at birth for men, (c) the LE gap relative to African Americans: 1990–2009.
Source: American Journal of Public Health.
Note. The 6 Caribbean indicator countries were Antigua, Bahamas, Barbados, Grenada, St. Lucia, and St. Vincent and the Grenadines.

We are continuing to analyse the relative contribution of different causes of death to the trends outlined above. We were pleased to share these latest findings with CARICOM meeting attendees. Here are links to the five papers we have published to date:

Our goal for the USCAHDR consortium has been to identify and review chronic disease data and related health disparities between and within populations in the Caribbean and United States with the intention of informing the development of future interventions to improve health and reduce these health inequities. As I listened to the team’s CARICOM presentation and discussions, it was clear that our research and review has brought nuanced focus to certain underlying causes of health disparities across the region.

In some cases, our work has yielded more questions than answers. For example, why has there been life expectancy gains made by African-Americans in the last ten years (particularly males)? Why has there been remarkable improvement in life expectancy in French-speaking Caribbean countries – but less consistent progress in the Anglo-Caribbean? Why does the most recent data show such different trends in mortality between Caribbean countries? And if, as our work and that of others suggests, non-communicable diseases (NCDs), such as coronary artery disease and diabetes, are responsible for much of these differences, what are the next steps to improve health outcomes and life expectancy within Caribbean and U.S populations?

Our findings coincide with an evaluation of the impact of the CARICOM 2007 Port of Spain Declaration on NCDs, and they show which countries are doing well, and which are doing less well in reducing mortality from NCDs. USCAHDR findings can be used to help assess both the impact of policy measures taken in response to the Port of Spain Declaration and the challenges that different countries face in meeting the 2025 targets on NCDs (as part of the WHO Global Action Plan). Our USCAHDR findings, focused on chronic disease states, will help to highlight interventions needed in the poorly performing Caribbean nations and help to reduce health disparities within the region. We are eager to find appropriate avenues to apply the USCAHDR findings to efforts that will help to improve health outcomes not only in the Caribbean, but also in the United States.

Reducing health disparities, improving life expectancy, better understanding of population differences as they relate to chronic disease and health outcomes…. Our research, supported by NIMHD, is an important element of the global effort to improve the lives, the health and the productivity of our world. Stay tuned.

*Thank you to Dr. T. Alafia Samuels at the UWI for summarizing the USCAHDR consortium’s research findings.

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Tuesday September 15, 2015

A tribute to our friend, the Honorable Louis Stokes

Congressman Louis StokesThe Sullivan Alliance’s esteemed board member, former Congressman Louis Stokes, lost his battle with cancer last month. It is difficult for all of us to lose such a great friend, mentor and colleague. Mr. Stokes had such a remarkable and productive life so we dedicate this blog to him. Congressman Stokes played an active role in The Sullivan Alliance and shared his guidance and wisdom generously in support of our efforts to increase racial and ethnic diversity among the nation’s health professions.

Dr. Sullivan and a few of our board members have shared their thoughts about his life and legacy. We thank our board for being part of this tribute to our great friend. He will be long remembered and honored and most of all, missed.

We will share this tribute with Mr. Stokes’ family and we hope it will bring additional pride and comfort to them.

Dr. Louis W. Sullivan and Former Congressman Louis Stokes
Dr. Louis W. Sullivan and Honorable Louis Stokes

“With the passing of the Honorable Louis Stokes, The Sullivan Alliance lost one of its most revered members…. We will miss Lou Stokes’ sense of optimism, his collegiality, his great sense of humor and his strong commitment to public service. Lou Stokes has given us a strong legacy of public service, particularly for those who are disadvantaged socioeconomically…We extend our heartfelt condolences to his wife, Jay, to his children and other members of the Louis Stokes family.” [Read complete message]

Louis W. Sullivan, M.D.

“The nation has lost a hero in the truest sense of the word. Congressman Stokes was a role model, advocate and champion for education, diversity and health care funding not only in Northeast Ohio but across the country. Congressman Stokes was an outstanding individual with the highest of morals, who displayed integrity and commitment to those in need. Through his work and persuasion, he was responsible for much of the legislation that increased scholarship support for health professionals including those in underserved communities and minorities…” [Read complete message]

Dr. Jay Gershen, D.D.S, Ph.D.

Honorable Louis Stokes, Jay A. Gershen, Dr. Louis Sullivan
L-R: Dr. Edgar B. Jackson Jr. (Community Advisory Board Co-chair),
Honorable Louis Stokes (Community Advisory Board Co-chair),
CSU President Ronald M. Berkman, NEOMED President Jay A. Gershen,
Dr. Louis Sullivan, chairman and CEO, the Sullivan Alliance to Transform the Health Professions,
Daisy L. Alford-Smith (NEOMED Board of Trustees member), Cleveland Mayor Frank Jackson

Ronny Lancaster, Mr. Stokes, Dr. Sullivan
Ronny Lancaster, Honorable Louis Stokes,
Dr. Louis W. Sullivan

“I have many fond memories of Congressman Lou Stokes. For the past two decades, I was fortunate to know this political and social policy legend. I, like many…will miss the way he made things happen; his dependability, which he carried with such ease; his steady hand and easy smile; a friend who always had a listening ear; his joyful and easy laugh; a Washington colleague who never forgot why he came to this city – to help Clevelanders, all Americans, and the world. A man who successfully and effectively cut across party, racial, and geographic lines. I will miss the trailblazer, the leader, the giant. The gentleman.” [Read complete message]

Mr. Ronald Lancaster

“Dental education has lost a valiant champion and warrior for health, research and health careers that will be missed in the Nation’s leadership for health promotion and disease prevention…. I recently served with Congressman Stokes on The Sullivan Commission and The Sullivan Alliance. Conversations with him were always bidirectional, insightful and visionary….I will miss him as a great human being, a champion of justice, and my friend. The dental profession will continue to benefit from his many accomplishments now and in the future.” [Read complete message]

Jeanne Sinkford, D.D.S., Ph.D.

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Saturday August 15, 2015

Inspiring Florida’s next generation of health diversity researchers

Q&A with Cynthia M. Harris, Ph.D., DABT, Director and Professor, Florida A&M University, Institute of Public Health and Chair, Florida Alliance for Health Professions Diversity.

On July 22, 2015, the Florida Alliance for Health Professions Diversity held its annual Florida Alliance Scholars Culminating Event at the Hilton University of Florida Conference Center-Gainesville. The Sullivan Alliance spoke with Dr. Cynthia Harris about the Florida Alliance’s eighth cohort of scholars and highlights of this year’s event.

2015 FAHPD ScholarsYou recruited Cohort VIII of your Florida Alliance Scholars this summer. How many scholars did you select and which Florida schools did they represent?

We selected 19 scholars this year. They are a mix of high school, undergrad and graduate students who represent many Florida schools including Florida State University – College of Medicine, University of Florida – Student Science Training Program, Florida A&M University, University of South Florida, Edward Waters College, Morsani College of Medicine – Moffitt Cancer Center, Florida State University – Center on Better Health and Life, and the University of Florida – Department of Animal Sciences. We are pleased that eight of our scholars are high-school students from the Student Science Training Program.

How do you find your Scholar applicants? Are the mentors already linked to the FL Alliance?

We have an established network of schools – FAMU, Edward Waters, USF, UF, FSU, UCF – as well as the connections we have through the Health Equity Research Institute that we established thanks to funding from the state legislature. Funding from HERI and the Aetna Foundation enabled us to select and support our largest cohort so far. The students identify their mentors – many of whom are familiar with our work – and we guide the mentors as they help scholars with their projects. We provide modest stipends to scholars and their mentors after they attend the event.

Brandon Guillory presentsHow did the 2015 Cohort differentiate themselves from previous years?

This year, we were especially impressed with the increased rigor of the scholars’ projects. More scholars also chose to research genetics, molecular biology and chemistry. Biomedical sciences was highlighted in the Sullivan Commission report as having too few minorities so we are very pleased to be addressing that issue.

Were there poster presentations that were particularly interesting to you?

There were many great project presentations on various health disparities topics. For example, one discussed how the essential nutrient zinc might help in the treatment of depression. Others tackled novel approaches to researching everything from breast and prostate cancer, to Alzheimer’s and HIV in minority populations. It is gratifying to see our students really looking at and gaining an appreciation of health disparities research.

Which part of the event did the scholars most enjoy? Or find most compelling?

The students really enjoyed listening to each other and presenting to each other. The tour is always popular too. This year, we visited the UF Emergency Medicine Facility and saw the trauma area and even went up to the helicopter platform. Many scholars were fascinated to be in a clinical setting and see how an ER works. It was a very interesting and well-designed tour.

I see that the scholars created a group mission statement at the event. Could you share it?

After lunch, we had a debrief session where scholars came up with what they pledged to do in the coming years to remain focused on health disparities. Here’s the mission that our 2015 scholars created together:

We adopt the mission of collective collaboration through service, education, and research in order to raise awareness while creating innovative ways to address the barriers of health disparities. To fulfill this mission we will implement and disseminate knowledge to our community to promote science interest to our posterity. Within the next year, we will strive to put ourselves in a position to fulfill our mission and extend our knowledge and experiences to future generations. Within the next five years, we will emulate and advance the goals of the Florida Alliance Scholars Program.View the Mission Statement

FAHPD Scholars Panel DiscussionHow do you engage with scholars after the Culminating Event? Do you have an alumni network? Or do scholars remain in contact with each other?

In the early years, we could keep track of our Florida Alliance Scholars on an ad hoc basis but now the group is bigger, we are creating a more formal tracking system to see where they go and what they study. Last year’s scholars came to the HERI Summit this past January so we continue to engage with them – and we are working on ways to continue engaging our newest scholars throughout the year. Scholars’ parents have thanked us for including their children in such an inspiring event, and we hope to continue to inspire them.

How do the mentors participate in the Florida Alliance Scholars program and event?

Mentors help students with their 8-week projects and a large percent of mentors attend the Culminating Event to support their scholars. Our mentors are pleased to be giving students exposure to science research at such an early age. Frankly, lack of exposure has been a critical factor so it gives us great pleasure to share our passion for health science and give them the early exposure they need.

Is there anything else you’d like us to know?

Rep. A. Williams, Parents, Executive Committee and StaffI’d like to knowledge Dr. Penny Ralston, former Program Chair of The Florida Alliance for Health Professions Diversity and one of the architects of the program. I’d also like to acknowledge Executive Board members, Dr. Alma Littles (FSU) and Dr. Lisa Barkley (UCF).

I’d like to acknowledge our “Dynamic Duo” – Mrs. Marchelle Dunston Lawrence and Dr. Iris Young-Clark – who were responsible for the day-to-day running of the Florida Alliance Scholars program. These are the individuals who are the first point-of-contact for our scholars and mentors, and handle every question that comes in. Mrs. Dunston Lawrence manages everything from the application guidelines, application submissions and processing, to working with mentors during the 8-week project. Dr. Young-Clark plans the event and manages event logistics. The dedication and competence of this duo cannot be underestimated. Thank you, Marchelle and Iris, for all of your hard work!


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Wednesday July 15, 2015

On the Frontlines of a Broken Dental System

By Mary Williard, DDS

Mary Williard, DDSThe Sullivan Alliance team have known our guest blogger Dr. Mary Williard since we began our work with the W. K. Kellogg Foundation in 2011. She and the Alaska Native Tribal Health Consortium hosted Dr. Sullivan in Alaska at the 10th anniversary Dental Health Aide Therapist graduation ceremony last June. She also presented at our oral health conference in July 2012.

In this blog, Dr. Williard, a mother and a dentist working in Alaska Native communities, describes how our broken dental care system brought her adopted daughter into her life for the first time. And, how an innovation she has made her life’s work could change the way we provide dental care to the millions in the United States, like her daughter, who have suffered without it. The original post can be found at Moms Rising’s Blog.

I met my future daughter in Operatory #10 at the Yukon-Kuskokwim Health Corporation clinic in Bethel, Alaska 16 years ago. She was 3-years-old, in foster care, and lying there in terrible pain. Her face was swollen from an abscessed tooth, her temperature was 104 degrees.

My heart went out to her. As a staff dentist at the clinic, I see many people in pain. My heart goes out to all of them, but I struggle the most when I see young children suffer and face serious health consequences from conditions that could have been prevented.

She had an infected tooth and could have died. And, she suffered horribly. Why? Because she couldn’t get dental care where she lived. Because of a dental care system that makes it almost impossible for some people to get care when they need it, in their own communities.

It is because of children like my daughter that I am on the front lines of trying to change how we provide dental care in this country.

One of the things I am most proud of is that I have helped establish dental therapists here in Alaska. In just 10 years, dental therapists have been able to expand dental care to 40,000 people here who couldn’t get that care before. They are so effective because they work with dentists as part of a team to bring dental care to communities that dentists can’t get to very often. They allow the dental team to treat more patients—in much the same way that nurse practitioners and physician assistants allow the medical care team to do the same.

I believe dental therapy can improve access to dental care across the United States. Unfortunately, my daughter’s story isn’t unique. I hear similar stories from people in every community I visit as I travel the country. While we all want our children to be healthy, millions of children and families across the United States struggle to get the dental care they need.

It is a serious crisis.

As a dentist, I have seen firsthand the devastation lack of access to care can result in. When people cannot get dental care, they suffer, miss work and school, and, like my daughter, are at risk for serious, sometimes life-threatening infections.

There are many reasons why people have difficulty getting dental care: they live in a rural area or Tribal community where dentists don’t practice; they have hourly wage jobs they can’t afford to leave to get care during office hours; they live in a city flush with dentists but none who will accept their Medicaid insurance; or the cost of care is simply more than they can afford.

Dental therapy is an innovation that could be widely adopted throughout the United States. Minnesota and Maine already allow dental therapists to practice, and many other states and Tribes are pushing for dental therapists in their communities. Efforts are underway in Kansas, Ohio, New Mexico, North Dakota, Oregon, Vermont and Washington.

Unfortunately, this common-sense, proven way of getting dental care to those who need it most faces an uphill battle because the American Dental Association (ADA) has fought against dental therapists every step of the way — even suing the bright young people we initially trained as dental therapists in Alaska. It’s a typical story of an entrenched, privileged interest group fighting against change, perhaps fighting to protect its turf, in the same way that doctors once opposed nurse practitioners, even though they couldn’t imagine functioning without them now.

As a dentist, I find the ADA’s opposition disappointing and shortsighted. The concerns raised by the ADA have no basis in fact. The evidence is clear, dental therapy is a safe, effective and appropriate way to address dental access issues.

As the mother of a child who suffered so horribly from lack of access to dental care, I find the ADA’s opposition reprehensible and borderline immoral.

As fate would have it, I was able to adopt my daughter 4 years after we met and now she is a healthy young woman who looks forward to visiting her dental therapist! As a mother, it is so clear to me that we all have the same goals and want the same things—healthy thriving children, families and communities.

Dental therapists have worked to help us achieve that in my community and they can work in yours.

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Monday June 15, 2015

The National Pharmacist Workforce Surveys – A brief look inside a growing, diverse profession

By Lynette R. Bradley-Baker, R.Ph., PhD.
AACP Vice President of Public Affairs and Engagement
Vice President of the Pharmacy Workforce Center (PWC)

Lynette R. Bradley-BakerOur guest blogger Dr. Lynette Bradley-Baker is the vice president of public affairs and engagement overseeing a variety of elements for AACP including advocacy, professional affairs, communications, information technology and membership. She has been at the AACP since 2010. She graduated from the University of Maryland School of Pharmacy with a Bachelor of Science in pharmacy and from the University of Maryland, Baltimore Graduate School with a Doctor of Philosophy, with an emphasis on patient education/information services.

I appreciate the opportunity to share information regarding the pharmacy profession and some of its evolving areas of diversity. As a licensed pharmacist for more than 20 years, I have witnessed the continued progress of pharmacy practice; indeed, since joining the American Association of Colleges of Pharmacy (AACP) nearly five years ago, I continue to be amazed at the rapid growth of pharmacy practice as our healthcare models continue to change.

Pharmacy is the third largest health profession in the U.S., behind medicine and nursing, with approximately 303,500 licensed pharmacists. Pharmacists are educated and trained to provide healthcare services including medication therapy management, medication counseling, wellness and preventative care services such as immunization services and management to ensure safe and accurate medication distribution.

consultation with a pharmacistThe Pharmacy Workforce Center (PWC), formerly known as the Pharmacy Manpower Project, is a nonprofit organization comprised of 11 national pharmacy professional and trade organizations; its mission is to serve the public and the pharmacy profession by developing data regarding the size and demography of the pharmacy workforce and conducting and supported research in related areas. The National Pharmacist Workforce Survey (NPWS) was commissioned by the PWC in 2000 with the Midwest Pharmacy Workforce Research Consortium. Since that initial survey, there have been additional surveys in 2004, 2009 and 2014.

The most recent survey demonstrates that the pharmacy profession is continuing to evolve, particularly in three areas of diversity: gender, practice setting and pharmacists’ services.

Pharmacy is emerging as an excellent profession for women. The 2014 NPWS reports that more women are serving as actively practicing pharmacists; they now represent 53% of licensed pharmacists, versus 43% in 2000. In addition, women are rising within the profession; they make up 55% of managers, a striking increase from 37% in 2000.

Women are also taking advantage of career opportunities outside of retail, supermarket and hospital pharmacy. Indeed, women had the highest representation in industry and other non-patient care settings, at 66% and 61%, respectively. And the gap between men and women in terms of hours worked continues to narrow; in 2014 males contributed to 0.95 FTE (full-time equivalent) and females contributed 0.93 FTE.

PharmacistPharmacists are now providing more patient care services in more settings with greater patient access than in the past. These settings include independent, chain, mass merchandiser, supermarket and hospital practice as well as HMO-operated pharmacies, clinic pharmacies, mail service, nuclear, nursing home/long term care and home health. In 2014, 48% of chain pharmacists and 57% of supermarket pharmacists offered health screenings (compared with 7% and 27%, respectively in 2004). In 2014, more than 25% of hospitals and other patient care settings had collaborative practice agreements in place, allowing pharmacists to expand their role as an integral member of the patient’s healthcare team.

Over the past decade there has been a dramatic increase in the percentage of pharmacists who are performing healthcare related services, as well as a decrease in dispensing services. In 2014, 60% of pharmacists provided medication therapy management (compared with 13% in 2004), and 53% performed immunizations in (compared to 15% in 2004). Over the past five years, the percentage of time that full-time pharmacists spent on services associated with medication dispensing decreased from 55% in 2009 to 49% in 2014.

This is truly an exciting time for the profession of pharmacy, as well as for patients’ access to healthcare and wellness services. Pharmacists will continue to help people live healthier, better lives.

The executive summary and full report of the 2014 NPWS (as well as previous surveys) are available on the PWC website. Feel free to contact me any questions regarding the PWC or the NPWS.

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Friday May 15, 2015

The Heckler Report: Reflecting on its beginnings and 30 years of progress

By Louis W. Sullivan, MD

I recently had the opportunity to participate in DHHS’ celebration recognizing the 30th anniversary of the release of what’s now referred to as “The Heckler Report.” The report was developed thanks to Secretary Margaret Heckler who recognized the “sad and significant fact… [that] there was a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation’s population as a whole.” Secretary Heckler created the national platform that made the issue of minority health disparities a national issue – but I’d like to share a little of the history that led her to create the “Heckler Report” which has shaped minority health policy for the last 30 years.

Health Equity Summit on Capitol Hill, April 27, 2015Health Equity Summit(left to right): Dr. Satcher, Dr. Sullivan, Dr. Gracia, Dr. Pinn, Mr. Stokes

Walter Bowie (Dean, Tuskegee), Ralph Cazort, MD (Dean, Meharry Medical School), Anthony Rachal (Vice President, Xavier University) and I (Morehouse School of Medicine) founded the Association of Minority Health Professions Schools (AMHPS) in 1977. These four individuals came together with the purpose of working together to develop and promote programs that were (and remain) important to improving minority health status.

We were soon joined by the other health professions schools from the HBCUs (Drew, Florida A&M, Hampton, Howard, and Texas Southern). AMHPS now included colleges of medicine, dentistry, pharmacy and veterinary medicine. The common thread that bound us was our interest in creating more African-American health professionals in these fields. We soon added Latino, Hispanic American and Native American programs to our priorities.

“there was a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation’s population as a whole.”

Secretary Margaret Heckler

In the early 1980s, we commissioned a study that was led by Dr. Ruth Hanft. The study entitled “Blacks and the Health Professions in the 1980s: A National Crisis and A Time for Action” was a concise report that clearly showed the shortage of minorities in the key medical professions. The health status of Blacks was worse than Whites and we needed greater support in order for that to change. We wanted to make this issue a national priority.

In March 1983, Al Haynes (Charles Drew), David Satcher (Meharry), Walter Bowie (Tuskegee) and I met with Secretary Heckler to inform her about the AMHPS study’s key findings. She was very positive and agreed to review the study closely and get back to us soon. As we left the meeting, we had mixed feelings because although we were well received, we weren’t sure if she really meant it.

But a month later, she let us know that she was setting up a Secretarial Taskforce lead by Dr. Thomas Malone, Deputy Director of the National Institutes of Health, and Dr. Katrina Johnson. Dr. Robert Graham (first administrator of HRSA) was a prominent member of the Taskforce. We were heartened by this development. And two years later in August 1985, Secretary Heckler released the “Report of the Secretary’s Taskforce on Black & Minority Health” that both affirmed our report and extended far beyond it.

Based on the report’s recommendations, DHHS’ Office of Minority Health was created by Secretary Heckler within a year and Dr. Herbert W. Nickens was appointed as the office’s first director. Creating OMH got a lot of attention and helped to set the tone. It began a cascade of Federal-level activities that focused the nation on minority health.

The Heckler ReportIn 1990, during my tenure as U.S. Secretary of Health and Human Services, I created the Office of Minority Health at NIH which first evolved into the Center for Minority Health and Health Disparities, then in 2010 with Congressional legislation, became the National Institute on Minority Health and Health Disparities (NIMHD).

And there are many other examples of the growing prominence of minority health, including the two seminal reports published by the Sullivan Commission and the Institute of Medicine (IOM) in 2004. We can’t ignore the disparities that still exist – such as the low percent of African American scientists who have received NIH research grants – but much has improved.

The Heckler Report was a significant historic touch point for the nation. That’s why it’s so appropriate that DHHS is celebrating its 30th anniversary. Whenever I see Margaret, she always reminds me that the AMHPS report and our meeting focused her on the issue of health equity. It’s good to be a part of the history that made this issue a national priority. With today’s U.S. demographics, these long-standing and recalcitrant disparities have become everyone’s issue, and not just a minority issue.

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Wednesday April 15, 2015

North Carolina Expands Commitment to Diversity in Healthcare

By Dr. Peggy Valentine, Dean, School of Health Services, Winston-Salem State University
and Jacqueline R. Wynn, MPH, Associate Director, NC AHEC Program, President Elect, National AHEC Organization

Spring offers us an opportunity for new beginnings and in North Carolina, we’re excited to be renewing our efforts to transform the health professions and reduce health disparities. In late March, we proudly brought together twenty-two leaders from twenty higher education institutions, state and local governments, to commit to the North Carolina Alliance for Health Professions Diversity (The North Carolina Alliance) at a MOU signing ceremony at Winston-Salem State University (WSSU). Many of us have worked together since 2008 but now, we are formally standing together to reduce disparities in health status and healthcare by creating a diverse healthcare workforce that’s proficient in cross-racial and cross-cultural interactions.

NC Alliance MOU signing

Serendipitous Beginnings

The North Carolina Alliance is unique in many ways and it started with our serendipitous beginning! In 2008, the NC AHEC and WSSU were working on two separate diversity health events and when we learned of each other’s events, we knew we needed to merge them. Around the same time, Dr. Peggy Valentine noticed the work of the Florida Alliance for Health Professions and had a staffer attend one of their meetings to learn and bring their best practices to North Carolina. We held the first North Carolina Health Professions Diversity Conference on March 31-April 1, 2008 in Greensboro, North Carolina where over 150 health professionals, educators, policy makers and legislators attended.

Due to the conference’s success, we were eager to form a steering committee with representatives from various health professions schools, the community college system and local health organizations. At that time, there were a number of disparate organizations focused on diversity workforce issues but no state-wide programs tackling the issue. But thanks to Tom Bacon (NC AHEC), Jacqueline Wynn (NC AHEC) and Dr. Valentine (WSSU), the foundation of the NC Alliance was set. Who knew that seven years later, we’d be working together to make our alliance stronger than ever!

What is at Stake in North Carolina

North Carolina is among the most diverse states in the nation when it comes to race and ethnicity, but minorities only make up a small percentage of North Carolinians employed in the state’s healthcare careers. In a recent NPR interview, Dr. Valentine pointed out that minority representation is 10 percent or less when it comes to those employed as pharmacists and dentists -- so without a concerted effort, North Carolina’s healthcare workforce will not get even close to reflecting the demographics of its population.

North Carolina’s Diversity & Healthcare Statistics: At a Glance

  • North Carolina ranks ninth in respect to percent of African-Americans at 22 percent, Hispanics at 8.9 percent and American Indian/Alaska Natives at 1.6 percent.
  • But in North Carolina, minorities number only one of six health professionals.
  • Licensed practice nurses (LPNs) and primary care providers are the two professions with diversity comparable to the statewide population (around 30 percent are non-white).
  • Nearly four out of five minority health care providers are located in metropolitan counties, thus emphasizing the need to bolster rural health care access.
  • The Health Resource and Services Administration has designated 134 primary care health professional shortage areas (HPSAs) statewide, which encompass a population of over 1.2 million residents.
  • Projections anticipate the need for 184 additional primary care providers to be added to the state’s workforce in order to address the shortage designation.

NC AllianceIn North Carolina, we are very lucky to have one of the nation’s workforce analysis centers – the Cecil G. Sheps Center for Health Services Research (Sheps Center) at the University of North Carolina at Chapel Hill – to rely on for the latest workforce data. This research informs our members on the current status of North Carolina’s healthcare workforce and will allow us to create more data-driven outcomes.

We want our North Carolina Alliance activities to encompass everything from pipeline programs for middle and high school students, to college and graduate school preparation, to practice and retention strategies for practicing health professionals. This comprehensive approach will foster an interest in the health professions and retention of the practitioners through mentorship once they have entered the workforce.

Some of our institution and individual members focus their work deep in the education pipeline because many young students (and their parents) do not know that the health professions require a strong background in science and mathematics – and they are unaware of the variety of healthcare fields. Sometimes young students become aware of the health careers because of a family member’s illness or an accident but otherwise, how can a young person learn about – and choose to be – a health professional? How do they learn what it takes to become a physical therapist, pharmacist, nurse, doctor, or dentist? How would they know that doing well in math and science in middle school will establish good habits and knowledge that will give them options in the future?

For all of these reasons, members of the North Carolina Alliance are already reaching out to middle and high-school students and guidance counselors to provide advice and develop plans for their careers. We also have to a number of initiatives including summer enrichment programs for students and faculty, and mentors for aspiring healthcare professionals and those working on research projects and funding initiatives. And of course, supporting practitioners once they are in the field is just as important as training them. There are too many instances where people don’t stay in the healthcare field due to lack on financial and community support.

NC Alliance founders with Dr. Louis SullivanAnother unique feature of The North Carolina Alliance is our monthly in-person meetings. Twenty or more of us meet monthly. Each meeting is hosted on one of partner’s campuses. Early on, we realized that we really liked working together and learning about each other’s programs first-hand. Our face-to-face meetings create the energy and synergy we need to support our work. We believe in consensus-driven action. Everyone is heard, everyone is equal.

Finally, our partnership is unique because our members are so diverse. During the official ceremony on March 27, senior representatives from 20 colleges, universities, state and local organizations and agencies, and The Sullivan Alliance signed the Memorandum of Understanding. We were thrilled that the North Carolina Office of Minority Health and Health Disparities became our most recent partner. Their involvement underscores the state government’s commitment to diversifying our health professions.

It will take all of us working together to reach the ideal of having our North Carolinian health workforce mirror our population. That’s why our next conference (co-hosted by North Carolina Alliance, NC AHEC, and WSSU) is entitled “Joining Forces to Diversify the Health Professions.” Come and join us on August 27 and 28, 2015 at the Grandover Hotel in Greensboro, North Carolina. Together, we can reduce disparities in health status and healthcare by creating a diverse healthcare workforce. The future looks bright!

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Sunday March 15, 2015

Progress on identifying health disparities in Caribbean and U.S. populations: A Q&A with E. Nigel Harris, MD, Vice Chancellor, UWI

Nigel HarrisIn February 2015, the steering committee for the U.S.-Caribbean Alliance for Health Disparities Research (USCAHDR) gathered in snowy Alexandria, Virginia to hold its annual meeting. The Sullivan Alliance’s Communications Director Samantha Edwards sat down with Dr. Nigel Harris, the Vice Chancellor of the University of the West Indies, to discuss the progress the partnership has made in its first four (of five) years. Dr. Harris has been the USCAHDR’s principal investigator since the inception of the project.

One of the main goals of the USCAHDR partnership is to lessen knowledge gaps in health disparities between English-speaking American and Caribbean populations of African descent. What have you learned over the last 4 years? Have you made any interesting findings?

Well, what excites me is that this is an area of research that’s not had much attention. Over the last four years, there’s much that we have learned – but we’ve also learned that there are more questions than answers. For instance, one of the more exciting pieces of research is that we’ve looked at mortality trends and found that Caribbean populations have fared less well than those of African descent in the United States. There are also huge differences depending on which Caribbean nation you look at. For instance, French-speaking nations are doing better than the English-speaking ones. There is not much research comparing one island to another – and even less comparing the Caribbean to the U.S., hence this work is path-breaking.

One area of research that has opened up is looking at how immigrants have fared in comparison to those populations left behind in the Caribbean. Some studies compare UK immigrants to the majority of the UK population. Few [studies] compare the population they’ve left back in the Caribbean. The same research needs to be done in the U.S. because there are much larger Caribbean populations in the U.S. and Canada.

How do you think this project has advanced the global health disparities agenda?

It’s given us a window into the existence of health disparities between American and Caribbean populations. We now have the evidence that these disparities exist. We know that within the Caribbean there are disparities, but we would not have guessed how large these might be until now.

How is the project advancing the professional development of U.S. and Caribbean researchers and scientists?

First of all, this project has provided new and exciting avenues of research that had not previously been explored comprehensively. And secondly, a number of junior investigators have been supported to do the sort of work that’s potentially ground-breaking – and can be the basis for their career development.

The project also provides a platform to expand collaboration between U.S. and Caribbean scientists.

I understand that The Sullivan Alliance made it possible for your Caribbean colleagues to access and analyze a lot of U.S. research data. What new data do you find most interesting?

I think we’ve been enabled access to a comprehensive array of publications. For example, for research related to diabetes and cardiovascular disease, we’ve been able to access many new journal papers that are not readily available in the Caribbean and select the best data.

How do you hope that this project will continue and expand this year?

There is a considerable amount of work that needs to be done based on what we’ve seen so far. We still need to complete reviews of some disorders, such as depression, stoke and cardiovascular disease. We have seen some exciting differences with respect to trends but we now need to drill down into the causes of those differences.

We also want to find fora in which we can present some of this data since some of our findings could have huge policy implications with respect to healthcare for communities in the Caribbean, as well as for providers and policy officials in the U.S. We need opportunities to tell our story to key players in these communities.

How do you think that future researchers will use this new data?

First of all, this study opens a multitude of new questions and avenues for research. It’s not simply differences between U.S. and Caribbean populations, but also looking at how immigrant populations fare…looking for factors for the differences that one sees – and interventions that might be embarked upon to reduce the disparities observed.

What challenges has the project had to overcome? How will those challenges influence future partnerships such as this?

One challenge was accessing data from the vantage point of the Caribbean, so having that access is a win. The other is finding sufficient numbers of partners in the U.S. – and that’s probably linked to funding. But with more funding, I think more partners will come on board. We are actively pursuing publication of our research and that should also attract more investigators. The first peer-reviewed publication is available online as Open Access.

What are your best memories of this project so far?

By far and away, it is the preliminary findings – some of which were unexpected. I believe that they will have huge implications to the directions in which health policy and healthcare will need to take in the short, medium and long-term future. This was not an exercise in gathering knowledge for knowledge’s sake, but one in which there’s likely to be many practical benefits.

Is there anything else you’d like to say about the USCAHDR partnership?

The Sullivan Alliance has enabled us to access resources and avenues of exploration that would not have been possible had this partnership not occurred. We are grateful for Dr. Sullivan’s influence in the health policy community in the U.S. – as well as his access to leaders in the funding community – that have provided us the wherewithal to support the work we have done – and offer the opportunity for additional studies to sustain this important effort.


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Sunday February 15, 2015

The State of Politics, Education, and Health Disparities in 2015

By Ronny B. Lancaster

President Obama delivered his sixth State of the Union address on January 20th and declared: “Our economy is growing and creating jobs at the fastest pace since 1999,…more of our kids are graduating than ever before, [and] more of our people are insured than ever before…. The shadow of crisis has past and the state of our union is strong.” As I listened to the speech, I wondered if the President would acknowledge our nation’s educational and health disparities – and suggest concrete ways to create equity for our low-income and minority communities.

The President discussed the nation’s economy, environment, energy, defense, and foreign policy – but his boldest idea was to make two years of community college free for students with good grades. Clearly, making higher education more affordable will bring more minority and low-income students further through the education pipeline. And hopefully, with two additional years of education, they will strive towards higher-income careers. In fact, there are many accredited Associate’s degrees offered by community colleges that lead to well-paid jobs in the health professions.

On February 2nd, the President released his budget recommendations for fiscal year 2016. It is dramatically different from the first four years of his tenure. Gone is his cautious attitude towards funding the government. He seems to dismiss notions of continued austerity, citing the rebounding economy. Among the issues receiving more attention in this budget than in previous years are minority health and efforts to eliminate health disparities.

The President suggests that programs and agencies that prioritize strengthening both primary care and diversity among health providers are important investments. However, basically busting the budget caps, the new budget was met on Capitol Hill with extreme skepticism by the House of Representatives, which continues under Republican rule, and the Senate, which is under new Republican leadership. We will need to watch closely as Congress determines what its budget priorities will be.

In addition to the challenge of finding common ground with our Republican-led Congress, the President will need to tackle flux in his Administration since typically, the last two years of any President’s second term see turnover among top Administration officials.

For instance, it is not all surprising to see that Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS), is choosing to leave her position at the end of February. She completed a controversial, yet ultimately successful, enrollment period of the exchanges for the Affordable Care Act (ACA, or Obamacare) in March 2014, and she will complete the second enrollment phase today (February 15, 2015). It is noteworthy that she was able to roll out the exchanges, without material incident, while maintaining good working relationships with members of Congress, on both sides of the aisle. After she departs, it will be interesting to see if CMS/HHS leadership focus on bringing more of our minority populations – especially Latino and Hispanics who represent one-third of our uninsured – into the exchanges during the 2015/2016 enrollment period.

As we approach the last two years of the Obama Administration, it is unclear how much progress we will make in our collective efforts to address excess morbidity and premature mortality. The President will continue his fight to preserve signal accomplishments such as the ACA even as the Congress, with Republican majorities in the House and Senate work to develop an alternative health insurance plan. He must also aggressively propose new “practical, not partisan” programs that reduce America’s economic, educational and health disparities. Let us hope that one of the areas of common agreement is to preserve and strengthen programs and activities aimed at increasing equity for all Americans.

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Thursday January 15, 2015

Will dental therapists “change the world” (of U.S. dental care) in 2015?

By David Jordan, Project Director, Community Catalyst

David JordanChange is hard. Change takes time. Change is worth fighting for especially when it relates to improving access to oral health care. Faced with an oral health crisis, a decade ago the Alaska Native Tribal Health Consortium (ANTHC) turned to a nearly century-old dental provider model to provide care to their underserved residents. Yet, rather than being championed for employing an innovative and cost-effective approach to address their dental crises, the ANTHC was sued by the American Dental Association. The ANTHC prevailed and as a result, introduced a proven, culturally-competent and patient-centered approach to delivering dental care in the United States. Today, dental therapists are helping 40,000 previously unserved people get care where they live, when they need it.

The innovative approach adopted by ANTHC has become the most disruptive policy solution offered in oral health policy in a generation. As a result of Alaska’s example, Minnesota authorized dental therapists to provide routine and preventive care to the state’s underserved residents. Now, over a dozen states and tribal organizations are pursuing policy change to authorize dental therapists.

After nearly a decade in existence in the United States, the movement to establish the practice of dental therapy is gaining significant momentum despite the strong and well-financed opposition from the American Dental Association. In 2014, we saw great progress:

  • ANTHC celebrated 10 years of dental therapy and dental therapists increasing access to over 40,000 Alaska Natives
  • The Minnesota Department of Health issued a report highlighting that dental therapists that have practiced in Minnesota since 2011 and have expanded access to care, reduced wait times for rural patients, and can potentially reduce hospital ER visits for dental problems. They’ve also improved how dental teams function and as result are making care better for patients.
  • Maine passed legislation to establish the practice of dental therapists
  • The Washington Post editorialized in support of dental therapists
  • The New York Times featuring dental therapists in Social Fixes Column and then a month later noting that dental therapists are “changing the world.”
  • The Albuquerque Journal endorsed using dental therapists to address New Mexico’s unmet health needs.

As we start 2015, over half a dozen states are pursuing legislation to expand access to dental care by adding dental therapists to the dental team.

Building Momentum for Mid-Level Dental Providers

In New Mexico, which nearly established dental therapists last year, we’re seeing public health leadership such as Secretary of Health and Human Services Dr. Alfred Vigil highlighting the need for better care.

The reason there is so much momentum is the growing body of evidence highlighting the efficacy of the model in providing care to vulnerable populations and the significant unmet oral health needs in the nation, for example:

  • More than 181 million Americans go without regular dental visits
  • More than four out of ten children go without regular dental care
  • 51 percent of children on Medicaid did not receive any dental care in 2011, and
  • 45 million people live in areas where they can’t get dental care – and millions more can’t afford it

Now policymakers and the media are recognizing that dental therapists are part of the solution because the evidence that mid-level dental providers increase access to care and provide care at the same level of dentists is undisputed – with more than 1,100 articles showing that dental therapists increase access to quality, safe care.

Even the ADA’s own study found that “[a] variety of studies indicate that appropriately trained midlevel providers are capable of providing high quality services.” The same report noted that dental teams with mid-level providers were more successful at providing services to populations with untreated decay than dental teams with dentists alone.

Thankfully, state legislatures across the country are poised to make mid-level providers part of the solution to our lack of affordable dental care. We expect more to be launched this year. We also expect more states to authorize mid-level dental providers because, like Maine in 2014, policymakers will recognize how essential dental health is to maintaining overall health in their communities. Change is imminent.

Community CatalystCommunity Catalyst is a national, non-profit consumer advocacy organization founded in 1998 with the belief that affordable quality health care should be accessible to everyone. We work in partnership with national, state and local organizations, policymakers, and philanthropic foundations to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit

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