Population Health Blog

Population Health Blog

Why It Matters

Guided Storytelling in Late Life: The Road to Positive Aging

By Sarah Charbonneau

There used to be a common belief that people who reminisce are living in the past. Over the past several decades, this notion has shifted as the literature surrounding life review and reminiscence has expanded. Dr. Robert Butler, a physician, gerontologist, psychiatrist, and the first director of the National Institute on Aging coined the term “life review” and believed that it did not make people senile but instead was a way to benefit older adults as they coped with end-of-life issues.

Why does it matter?
Reviewing, reminiscing, and telling stories about the past in late life can act to empower older adults to gain a sense of hope, meaning, and value in their lives. Capturing and understanding how past experiences have influenced the path of one’s life can assist with understanding how an individual has become the person they are and where to go in the future. Family members might also find that the process of life review and storytelling can capture the history of the family to pass down from generation to generation. For example, there might be a philosophy that a family has held on to when it comes to certain values and beliefs. Making sense of these passed down philosophies, values, and beliefs can come from listening and documenting our familial elder’s oral histories.

What are the possible benefits?
There have been several documented benefits to an elder reviewing one’s life. Some are a decrease in depression and anxiety and an increase in life satisfaction. Completing life review, story-telling, and reminiscence in a group setting can also be a way to increase social networks and decrease social isolation. As groups of older adults review their lives together, they can make sense of how their experiences have been very similar or different from one another. This understanding can bring one to see that they are not alone in what they have gone through or to see how and why others have the ideas, values, and beliefs that they bring to the table.

How this is currently being done?
Life review, reminiscence, and story-telling can be conducted in several different ways. It can be done one-on-one or in groups. It can also be very structured or flexible as thoughts flow through one’s mind. As a Schweitzer fellow, I am conducting the life review process in groups to understand the most feasible way to capture the benefits of the process. I am doing this in a more structured way, distinguishing different themes and using several questions to guide these themes. So far, groups have expressed their notion of feeling more connected and closer, creating a sense of community. I have observed that several older adults participating in the life review process have visited memories that they have not thought about in a very long time. Some of these memories have seemed to help the older adults come to accept their past and notice how their past is important in shaping the person they have become today.

Sarah Charbonneau is a master’s student in the Wayne State University School of Social Work and 2018-19 Albert Schweitzer Fellow.

Rx for Racial Healing

By Dr. Gail Christopher

I define Rx Racial Healing as the individual, collective and societal process of replacing the now consciously and unconsciously embedded belief in a false taxonomy and hierarchy of human value with a heartfelt awareness, appreciation, and belief in the sacred interconnectedness of humanity. It is the process of learning that we are one expansive human family. This is a journey from factionalization to wholeness; from division and separateness to unity.

The idea of healing racism is not new. It emerged in the 20th Century. There are now centers and Institutes for the healing of racism in many states and cities across America. What distinguishes Rx Racial Healing from the various approaches to the healing of racism is the focus; the subject matter. In Rx Racial Healing our subject is healing. The modifier is racism. Healing means to make free from injury, fear and disease; to make sound or whole. My emphasis on healing reflects my understanding that our capacity to heal and to be whole as individuals and collectively as a society has been and continues to be hampered, indeed thwarted, by racism. We should never underestimate the power of human beliefs. The belief in a hierarchy of human value is as core to America as is our asserted belief in democracy. Changing, eradicating this belief is our work in the 21st Century. Neither the Civil War, nor the Civil Rights movement addressed this fundamental driving belief system. Both attempted to address the consequences of the belief – enslavement and the discriminatory polices and systems that were created. However, America has yet to eradicate the belief itself; the fallacy and absurd idea that human variation in superficial physical characteristics is a basis for assigning personhood and value, as well as freedom, citizenship, and access to opportunity.  Our failure to create this vital consciousness change makes us vulnerable as individuals and as a society. Our enemies exploit that national vulnerability. Our bodies are weakened by the exposure to the stress that is created by the belief and its consequences.

The pathways through which the resulting stress can interfere with our healing and wholeness are beginning to be understood and elucidated within health, genomic, biological,  psychological, social and political science. In my forthcoming book, Rx Racial Healing: A Handbook: Answers to Your Questions, I explore some of this science and offer guidance in the practice of racial healing.

 

This blog was originally published in the fall 2018 newsletter of the National Collaborative for Health Equity. Dr. Christopher, formerly vice president of the W.K. Kellogg Foundation, is the founder of the Ntianu Center for Healing and Nature.

The dog bite epidemic: a public health crisis

By Kathy Beard

The economic resurgence in Detroit has lead to many improvements in the Midtown and Downtown areas, as well as some neighborhoods. The Detroit Parks and Recreation Department is reactivating many community parks.Walking and biking paths are being built and bikes are now available to rent. Still, some residents are reluctant to use them due to the fear of roaming dogs. Their fears are not unwarranted.

Although estimates of stray and feral dogs were once as high as 50,000, newer estimates put it at one stray/feral dog for every 14 residents: still too high. In a city where residents struggle with poverty, diabetes, heart disease and obesity, access to inexpensive exercise, such as biking and walking, could significantly improve residents’ health. So, how is the city responding to this? And how can the MOTION Coalition Support these initiatives?

A recent study by Laura Reese, professor of Urban and Regional Planning at Michigan State University showed that dog bites are more likely to occur in areas with vacant homes and commercial properties. Stray dogs tend to live in the buildings as a means of shelter and a source of food. So, boarding up or demolishing vacant buildings should help mitigate the problem. In the past year, the city launched an aggressive demolition and boarding up program. Since then, the Board Up Brigade has boarded over 10,000 homes. The demolition project has razed over 15,000 commercial and residential buildings.

The city has also improved Animal Control Services. They released the following statement about the situation:

Detroit Animal Care and Control (DACC) has increased its number of animal intakes by more than 850 in 2017, compared to [previous year], and the number of dog bites has decreased by 32.7 percent.

The safety of our residents is our primary concern and DACC is doing the following to reduce the number of stray dogs in the community: 

  • Canvassing neighborhoods throughout the city three nights a week.
  • Taking in stray dogs seven days a week.
  • Enforcing ordinances that require residents fix their fences where dogs are present.
  • Writing tickets to residents who do not comply with Detroit City Ordinance.
  • Partnering with non-profit agencies for free/low-cost spay and neuter services.
  • Hiring more employees to respond to calls.

All residents should call 911 if they feel there is an immediate threat to their safety.

Additional staff and vehicles along with a 7 day work week is currently in effect. This has resulted in a 106 percent increase in citations in the first half of 2018 and a decrease in the number of reported bites by 13 percent. Whether these measures have had an impact on the stray dog population remains to be seen. MOTION Coalition can be impactful by supporting the city in its on-going efforts to control blight and alleviate some barriers to outdoor activity.

Second, Dr. Reese’s study showed that not all areas of Detroit have the same issues. Some zip codes have a higher number of reported bites, particularly among young males. In these areas, violent crimes are also significantly higher than predicted. These factors may suggest a link between bites and dog fighting. Reporting these activities could help reduce the incidences; however,residents have legitimate concerns for their safety if it becomes known that they reported a crime. One solution is to use the city’s new interactive crime databank, Crime Viewer (http://detroitmi.gov/crime-viewer/index.html). It allows anyone to view crime statistics by crime, date, time and location. Missing from the crime list is animal cruelty. Adding this crime to the database would help develop neighborhood-specific policy efforts to addressthis crime without putting the safety of residents in jeopardy.

In order for Detroit to promote active living, it needs safe neighborhoods. Managing the wild dog population is one big way we can support this objective. MOTION Coalition can support these initiatives by voicing its support for these initiatives.

Further Reading:

Detroit’s Stray Dog Epidemic: 50,000 Or More Roam The City

The Dog Days of Detroit: Urban Stray and Feral Animals

Detroit’s Board-up Brigade marks 1 year changing lives, communities

Emergency Department Visits and Inpatient Stays Involving Dog Bites, 2008

Agency for Healthcare Research and Quality

Detroit Demolition Program

A Closer Look at Dogfighting

Detroit Crime Viewer

Kathy Beard is program manager for MOTION Coalition. The MOTION Coalition, an initiative of Authority Health, is a coalition of over 80 organizations in Southeast Michigan focused on obesity and wellness.

Sudden Infant Death Syndrome

By Lee Watson

October is Sudden Infant Death Syndrome Awareness month. The leading contributor to infant mortality is Sudden Infant Death Syndrome (SIDS). SIDS is the unexplained death of a seemingly healthy baby usually occurring during sleep among infants less than 1-year-old. As part of its Infant Mortality Reduction Plan, Michigan is promoting reducing sleep-related infant deaths and the expansion of home-visiting and other support programs to promote healthy women and children as two of its nine top priority goals.

Programs like the Detroit Nurse Family Partnership, administered through Authority Health promote prevention of SIDS through education and training in proper sleep positions for babies to reduce the possibility of SIDS in addition to their programs dedicated to the overall wellness of mother and child.

“Infant mortality is higher in Detroit that it is in some third world countries, but NFP is making a difference, one family at a time,” says Sharon Burnett, a registered nurse, and director of the Detroit NFP program. “Infant mortality and SIDS is real here in the city of Detroit.”

NFP is a national evidence-based home visitation model that pairs baccalaureate- prepared nurses with first-time mothers from the third trimester of pregnancy to 24 months after giving birth. Poor health outcomes for mothers and babies are frequently attributed to social barriers like racial inequity, poverty, stress, food insecurity, lack of education and resources, limited access to transportation or health care can contribute to poor health outcomes for mothers and babies. Addressing the psychosocial needs of first-time mothers result in healthier maternal outcomes, improved parenting, and promoting healthy family development. The goals of the Nurse Family Partnership program are to:

  • Improve pregnancy outcomes by helping women engage in good preventative health practices, including thorough prenatal care from their health care providers, improving diets, and reducing their use of cigarettes, alcohol, and illegal substances.
  • Improve child health by helping parents provide responsible and competent care.
  • Improve the economic self-sufficiency of the family by helping parents develop a vision of their own future, plan future pregnancies, continue their education and find work.

It’s clear that contextual factors that influence infant mortality differ between communities, and the NFP program is part of the solution for addressing health inequities. The nurses counsel the mothers and provide guidance for successful pregnancy and delivery and promote healthy habits for early childhood development. Their mission is to mobilize the community through education and support and a unified strategy to reduce infant deaths.

“NFP nurses and their clients build relationships over two and a half years and many of them are like family,” says Burnett.

September was Infant Mortality Awareness Month. It is important that the issues surrounding infant mortality and its contributing factors are not relegated to just one month of reflection but as an ongoing practice in solution. To find out more about the Detroit Nurse Family Partnership program and how you can support its mission, please click here or call 313.319.5717.