Gail Williams was 15 when her mother died of a heart attack. “The world seemed like it got dimmer, a shade darker than it was,” said Williams, now 60, of New Haven. The death of Shirley Mae Burgess, Williams’ mother, at age 41 was a shock and a tragedy for her family. But it also is a story of how economic and social determinants of health shape lives. Even though deaths from heart disease have been falling, it is still the No. 1 killer for both men and women, reports the Centers for Disease Control and Prevention (CDC).
HUSKY members in a person-centered medical home (PCMH) practice are more likely to get recommended preventative health services and less likely to visit the emergency room, according to Department of Social Services (DSS) data. A PCMH is a medical practice that provides comprehensive and coordinated care. That can mean helping a child get an appointment with a behavioral health clinician; making sure a patient’s apartment is free of asthma triggers; and many other services hard to get in time-crunched primary care offices. Medical homes must also provide a high level of accessibility through measures like extended hours, electronic or telephone access or rapid appointment scheduling. The state instituted HUSKY PCMHs in 2012 with an eye toward improving care for patients with chronic conditions, according to Kate McEvoy, director of the Division of Health Services at DSS.
Wanda Perez considers the price and nutritional value of everything she puts in her shopping cart, as the New Haven woman relies on the Supplemental Nutrition Assistance Program (SNAP) to buy groceries and is trying to eat healthy to manage multiple chronic illnesses. Just over 364,000 people receive SNAP benefits in the state, a number that has decreased about 4.7% in the past year. “I try to stay on top of everything that’s going on,” said Perez, a member of Witness To Hunger, which organizes SNAP users to speak about food policy and poverty. Perez lives on just over $700 in disability assistance a month, plus $192 in SNAP. Though her SNAP benefits are safe for now, proposed federal rule changes could push other Connecticut users off SNAP.
Betty Williams says giving up crack cocaine was easier than her ongoing struggle to quit cigarettes. “A cigarette is a friend,” said Williams, who lives with schizophrenia and chronic obstructive pulmonary disease. People with mental illness account for 44% of the cigarette purchases in the United States, and they are less likely to quit than other smokers. High smoking rates among people with mental illness contribute to poorer physical health and shorter lifespans, generally 13 to 30 years shorter than the population as a whole. About 37% of men and 30% of women with mental illness smoke.
When immigrant families bring their children to the Yale Children’s Hispanic Clinic, it’s just not about check-ups and vaccinations. Clinicians help them deal with everything from teething to nutrition to finding a place to live. But these days when front-line clinicians encourage families to use the many services offered through federal public programs, parents have questions—and misgivings. “They are hesitant because they are afraid,” said Patricia Nogelo, a clinical social worker at the Yale Children’s Hispanic Clinic. A proposed change in immigration law is making immigrants in Connecticut and nationally wary of utilizing federal programs that cover health, food and housing assistance.
Among women, those who are low-income or minority are less likely to get treatment for depression, according to multiple studies. A report by the Connecticut Behavioral Health Partnership found that women were underrepresented in Medicaid-funded behavioral health services in the state even though research shows that women suffer from the most commonly diagnosed mental health disorders more frequently than men. Racial and ethnic disparities, while still considerable, are decreasing in some physical illnesses. “But in mental health care, in the last 10 years, we see those disparities widening,” said Megan Smith, associate professor in the Departments of Psychiatry and in the Child Study Center in the Yale School of Medicine, who runs the Mental health Outreach for MotherS (MOMS) Partnership®, a program that offers mental health services to “overburdened and under-resourced mothers.”
In this podcast, sponsored by ConnectiCare, Colleen Shaddox discusses the hurdles to mental health care and the programs breaking barriers to care with Yale’s Megan Smith and UConn Health’s Dr. Sarah Nguyen. Lack of insurance coverage, the cost of treatment, a shortage of qualified clinicians, stigma and even fear of losing custody of their children can keep women from seeking help, Smith said.
Depression is the leading cause of disability worldwide, according to the World Health Organization, and affects women at about twice the rate that it does men. In Connecticut, 21.4 percent of women report experiencing depression, compared with 13.4 percent of men, according to 2015 Department of Public Health data. Millennial women in the state experience depression four more days in an average month than their male counterparts, the Status of Women data project reported this year. Women are more likely to use mental health services than men, but studies consistently show that the majority of Americans with depression go untreated. In this podcast, sponsored by ConnectiCare, Colleen Shaddox discusses depression and pathways to better mental health with Yale’s Carolyn Mazure, and NYTimes best-selling author Luanne Rice.
Iasiah Brown, 25, of New Haven, said he does not see a need for a primary care doctor for himself and his daughter, opting to visit clinics in the area instead of waiting up to two weeks for an appointment at a doctor’s office. Brown is among the 83 people who said they didn’t have a primary care doctor in response to a health-care usage survey by the Conn. Health I-Team and Southern Connecticut State University. The team surveyed 500 people and interviewed dozens statewide between January and March. About 83 percent of respondents said they had a primary care doctor, but the rate was lower for African American (78 percent) and Hispanic respondents (75 percent).
Joanne Goldblum of New Haven is on a mission to get health care clinicians to recognize that poverty may be the underlying cause of their patients’ illnesses and that the best treatment might be as simple as a brown bag of food or a tube of toothpaste. Goldblum is CEO of the New Haven-based National Diaper Bank Network (NDBN), an organization dedicated to getting basic needs to people. She co-authored the Basic Needs-Informed Care Curriculum—with support from Yale School of Medicine faculty—designed to help clinicians, social workers and educators recognize the myriad ways a lack of resources can present itself. For example, a baby comes to a well child visit in dirty clothes. Clinicians might typically ask: Is the mother too depressed to care for the infant?
When doctors and patients communicate well, research shows that patients are more likely to follow treatments, recover more quickly and are less likely to be the victims of medical errors. But with an average office visit of just 18 minutes and an increasingly complex variety of diagnostic and therapeutic options, good communication may be modern medicine’s final frontier. In this podcast, sponsored by ConnectiCare, Dr. Juan Estrada, medical director of Sanitas Medical Centers and Lisa Freeman, director of the Conn. Center for Patient Safety, provide tips on how to communicate with your doctor. A recent patient survey by ConnectiCare found that patients generally rated communication with their doctors highly, but there were concerning gaps.