Health Grants

The health program has had three long-term goals: to make health and a sense of well-being accessible to everyone; to enable individuals to become full participants in both public and private health-related decisions, and to shift the nation's concept of health care from one that is focused almost exclusively on treating disease to one that is equally focused on prevention. For the last four years, we have pursued these goals by awarding grants to improve the health of low-income families with children, and by awarding grants to develop and advocate for health care which takes into account the needs of the whole person, including the link between emotional states and physical health. Since 1992, we have supported patient-centered cancer prevention and treatment.

PATIENT-CENTERED CARE/THE MIND-BODY CONNECTION

In an article in The New York Times (11/26/91), Daniel Goleman reported that, prior to the discovery of antibiotics, physicians saw their role as "comfort always, cure rarely." Antibiotics and the technological and scientific advances which dominate and direct medicine and the delivery of health care appears to have changed that. Impressive strides have been made in curing disease, but comfort has all but been forgotten as an objective. It is time to bring it back.

A growing body of scientific evidence supports the view that an expanded notion of health and health care delivery is needed for the twenty-first century. Research suggests that mental and emotional states affect physical health, and that effective psychological interventions can have a positive impact on health and health outcomes. Yet, research in this area is woefully underfunded. In addition, anecdotal evidence suggests that most physicians do not know how to interact with patients in ways which maintain hope and overcome demoralization when cure is not a possibility.

For the last four years, the Nathan Cummings Foundation health program has supported projects which test whether low-cost psycho-social interventions will have a positive impact on health outcomes; advocate for proven psycho-social int erventions to be included as a complement to more orthodox medical treatments; and educate the public about mind/body techniques which can improve the quality of life and extend the lives of those with a chronic or life-threatening disease

For example, between 5 and 10% of pregnant women develop pregnancy-induced high blood pressure-a condition which can result in the death of both mother and child. Because medication is usually contraindicated in pregnancy, treatment involves bed rest and, sometimes, mild sedatives. Rarely do low-income women comply. The nature of their lives is such that bed rest is often not possible. As a result, these women wind up in the hospital with their lives and that of their unborn children at risk. This year, we awarded a grant to North Charles Mental Health Research and Training Foundation in Cambridge, Massachusetts to support a study on the efficacy of a home kit which teaches pregnant women to use biofeedback and relaxation to lower their blood pressure. Past studies have shown that this approach works for white, middle class pregnant women. This study will determine whether, and under what circumstances, it will work for low-income pregnant women, including women of color and women who speak a language other than English.

Emotional state may be as critical to the prevention of disease as it is to successful treatment. Research suggests that a sense of control over one's life, a sense of optimism, and social support are critical to health and well-being. For example, studies have suggested that workers whose jobs place high demands on them but offer little task control (e.g., assembly line workers) are at high risk of cardiovascular disease. While the ultimate solution for this problem may be redesigning jobs so that workers have greater task control, stress reduction techniques may ameliorate the problem and retard or prevent the development of cardiovascular disease. To this end, the Foundation supported a study by the Stanford Center for Research in Disease Prevention to develop and determine the health outcomes and cost effectiveness of a stress reduction technique that can be practiced by a worker at his/her work station. If effective, Blue Shield of California will consider the technique for reimbursement. This could lead to coverage of stress reduction techniques by health insurers nationwide.

CANCER

Three out of four families in the United States are touched by cancer. Yet the medical community does not operate, in the main, as if it understands and appreciates the human experience of cancer and other life-threatening diseases. As a consequence, it often fails to provide cancer patients and their families with the information they need and want. We decided that we could make a contribution to the field by supporting innovative, patient-centered approaches to cancer prevention and treatment.

In 1993 we awarded a multi-year grant to the Policy Resource Center/Center for the Advancement of Health (CAM) for a cancer initiative. Despite a growing interest among cancer patients in psychological support services which will improve the quality of their lives and increase their chances for survival, those services are not readily available. CAH will identify the essential elements of a comprehensive cancer support program and advocate the inclusion of these elements in treatment programs.

In addition, we awarded a multi-year grant to Commonweal for its Institute for the Study of Health and Illness. The Institute is a professional development program for physicians and other licensed health professionals working with patients with cancer. The Ins titute's curriculum was developed with the input of over 600 people with cancer who have attended the Commonweal Cancer Help Program-a program which better enables cancer patients to cope with the disease and which was featured in the widely acclaimed PBS series, Bill Moyers' Healing and the Mind. The outcome of the Institute's work will be programs around the country modeled after the Cancer Help Program, as well as doctors, nurses, and other health professionals who are better able to provide services to cancer patients in a manner which engenders hope, rather than despair.

THE UNDERSERVED

The largest percentage of health program funds are expended on projects addressing the special, health-related needs of the underserved, especially low-income families with children. Our primary goal has been to increase the access of low-income families to the services they need so that their children are born healthy and remain healthy through their adolescence. We define health broadly. As a result, we are as concerned about the nutrition of pregnant women and infants as we are about access to health care. We consider access to family planning and abortion services critical to the long-term health of families.

In 1993, we made grants to groups providing consumers with a full and fair exposition of the health care reform proposals under public debate. It seems likely that some form of national health care reform will be enacted in the near future. The greatest impact of reform, if realized, will be felt by low to moderate income families with children who are disproportionately represented among the uninsured and underinsured. Most people did not understand the issues under discussion and had no idea what impact the various health care reform proposals would have on their families and communities. Because we believe in the importance of citizen participation in public policy deliberation, we contributed to the efforts of public interest organizations committed to presenting bias-free, state-specific information about the ways in which various health care reform proposals would affect their constituencies.

For example, we supported the work of the Families USA Foundation and the National Consumers Foundation. Families USA Foundation mounted a public education campaign in 10 Southern states which encouraged hundreds to become directly involved in the national health care reform debate by holding meetings in their homes to discuss health care reform with their friends, neighbors, and co-workers. It provided information to radio, television, and print journalists which enabled local media outlets to transmit health care reform information which addressed the impact of reform on families with different demographic profiles. In Illinois, thirty news stories a month on how health care reform would affect state residents appeared as a result of the work of the National Consumers Foundation. The organization also held on-going briefings for the leaders of 250 organizations across the state so that those organizations could inform their constituencies about how the state and national health care reform debates related to their day-to-day lives.

We believe the current health care reform debate does not go far enough. It has focused on who will be covered by insurance and how that coverage will be financed. We hope that part two of the health care debate is engaged in the not too distant future. That discussion should focus on the benefits package, specifically services which help us prevent disease and improve our ability to function when prevention has not worked and cure is not possible. We must begin to consider the patient, or consumer of care, as a partner in the health care enterprise and offer consumers and health care professionals the information and support they need to interact effectively. gram-a program which better enables cancer patients to cope with the disease and which was featured in the widely acclaimed PBS series, Bill Moyers' Healing and the Mind. The outcome of the Institute's work will be programs around the country modeled after the Cancer Help Program, as well as doctors, nurses, and other health professionals who are better able to provide services to cancer patients in a manner which engenders hope, rather than despair.