Prescription for a healthier America

by Marilyn Gaston, MD '64, U.S. health care advocate

Learn what you need to do to stay well, and motivate yourself to do it. I know that lifestyle changes are not easy, but we have much more control over our health than most people believe. Genetics is only 20 percent, the environment is another 20 percent and quality of care is 15 percent of what makes us healthy or sick. The rest -- 45 percent -- is lifestyle.

Promote "well care" in addition to sick care. Prevention gets less than 1 percent of the $1.3 trillion spent yearly on health care in the U.S., even though it could potentially lower costs, improve quality of care and enhance outcomes. The American health-care community certainly has the capacity to take care of sick people, but we need to work on keeping people well.

Encourage a more holistic approach. We know that the integration of emotional, physical and spiritual approaches to health care leads to better outcomes. We don't understand how it works, but we can document that it does.

Make pharmaceuticals affordable for all Americans. People have to be able to get their medicines. Without them we will not be able to decrease the complications of hypertension -- renal disease, heart disease, stroke -- that lead to bad outcomes.

Offer more accessible health care. Millions of Americans are uninsured, and millions of those with insurance can't get care because of system barriers: language, distance from providers or limited hours. If their only choice is a hospital emergency room, that drives up health costs.

Expect better health outcomes. America is 18th in the world in life expectancy for women, 24th for men and 26th in infant mortality. The Institute of Medicine says 98,000 people die each year in our hospitals, due to errors. There is a lot of waste in our system, a lot of duplication of effort and useless paperwork. How we run the systems, and their quality and safety, is very important to the health of this nation.

Dr. Marilyn Gaston, a former U.S. assistant surgeon general, recently retired from federal service as director of the Bureau of Primary Health Care, Department of Health and Human Services. Co-author of "Prime Time: The Complete Guide to Health and Wellness for the Midlife African American Woman" (Ballantine, 2001), the UC alumna is currently working on a second book and fulfilling speaking engagements.

Link:

Biography of Gaston

How to bring art to the inner city

by Rosalind Manifold, MA (DAAP) '95, arts educator and good neighbor

Have a vision. I had always wanted to teach art in the inner city. My thesis was the very germ of the City Art Education Center. I envisioned a studio space with storefront windows so that people walking by could watch at the sidewalk level. And that's exactly what we found. The space had been boarded up since 1978, when it was the Big Six Pool Hall. It took us about 10 months to renovate. We have two floors. It's small, but it's nice.

Learn to write grants. I had never written a grant in my life, so at first I wrote a lot of grants that got rejected. Our first funder was the Greater Cincinnati Foundation, which granted us $15,000 in two parts. The first was to get us going, and the second was a matching grant so we could challenge other foundations to help generate more funding.

Be a good neighbor. It has to be a give-and-take relationship when you try to implement something new in a neighborhood that is kind of set in its ways. At the very beginning, we used to prop the front door open and anybody could come in and see what we were doing. A lot of neighbors were relieved because we weren't another deli or pool hall. And we have a sliding scale for kids from the neighborhood; a lot of them take classes for free.

Teach the basics. We offer a discipline-based arts education: visual art classes and professional art experiences such as exhibits and opening receptions. Each month tends to be a unit where the kids explore a new medium. It may have painting, sculpture, and printmaking in it, but drawing is pretty much the foundation of everything. So they draw every day, at least for a little bit.

Stay committed. With any nonprofit arts organization, funding is a challenge. Still, we're not going anywhere. We're coming up with new marketing plans. But the greatest reward is working with the kids. If it weren't for that part I wouldn't have anything to do with it. It's incredible the amount of talent and energy in this area.

Roz Manifold received a BFA in painting and sculpture from the Art Academy of Cincinnati. She is director of the City Art Education Center, which she founded in downtown Cincinnati in 1996. The nonprofit has survived dwindling funding, riots and urban flight, while providing access to art for anyone regardless of income. The center also displays regional artists, and a percentage of its income is based on commissions from sales.

How to keep a broken marriage
from breaking the kids

by JoAnne Pedro-Carroll, Ed '73, Med '74, nationally renowned child psychologist

How children respond to separation and divorce depends upon how well parents negotiate the end of their relationship and create a solid foundation in the reorganized family. Here are some guidelines:

Contain conflicts. Ongoing conflict has a toxic effect on children. What children want most in the world is to have the two people they love get along. Even when parents don't stay together, children hope that the fighting will end.

Keep children out of the middle. Encourage children to have loving relationships with both parents. Don't let grown children look back one day and see that a dark cloud was always hanging over the big events of their lives because they couldn't invite both parents or they were afraid their parents would fight.

Maintain loving relationships with your children. Children need at least one person consistently available to them. All too often, parents who are unable to move on after a breakup find themselves so exhausted or preoccupied with conflict that they lack energy for their children. The good stuff goes away, like snuggling or reading together. Parents need to spend 15 to 20 minutes each day in a positive activity with their child.

Maintain your personal well-being. Since divorce is rated second to death in terms of stress, support is important. Reach out to friends, family, mental-health professionals, faith-based organizations and support groups. And avoid using alcohol, or any other substance, to reduce stress.

Structure a stable, dependable family life. Be authoritative. Monitor your children's whereabouts. Set consistent, reasonable ground rules, like earlier bedtimes and less television viewing. When parents feel guilty, they unwittingly cut their children some slack. But children really want some limits; it gives them a sense of security.

Strive for business-like co-parenting. Focus on the child's best interest. In our business lives, we've all had to work with someone we didn't like, but we had to figure out a way to work productively together. So we develop basic rules, such as being business-like, communicating in specifics and not leaving nasty messages on voice mail. The same model can be used effectively with co-parenting.

One word of caution: A cooperative model won't work if one parent is violent, abusive or really mentally unstable. Safety needs to be the first concern.

JoAnne Pedro-Carroll is associate professor of psychology and psychiatry, University of Rochester, N.Y.; director of programs, Families in Transition, the Children's Institute; recipient of the American Psychological Association's 2001 Award for Distinguished Contributions to Public Service; creator of a school-based intervention program used around the country; and an expert who has testified at congressional briefings and at the White House.

Link:

Dr. JoAnne Pedro-Carroll Web site

Steps to keeping kids off the wrong path

by Sister Mary Louis (Charlene) Russley, Ed '58, juvenile court public defender, Dominican nun

Provide supervision. Family, school and friends are important, especially when children are young. Guided supervision, however, is necessary to create structured study habits and play time. Kids have long lists of activities these days. While those can make them competitive and self-sufficient, they can also make them self-centered and self-indulgent unless they are guided and supervised.

Encourage them to reflect. Time for reflection -- discussion, prayer, whatever you want to call it -- with others is important. Kids need to spend time thinking about values. They need time to look internally to see how they're doing as they experience personal growth. Families, friends and schools can help with those values.

Promote discussion. The kids I work with have a hard time seeing anything as a moral issue. They have never seen the value in life. Life is so dispensable; it's just another thing that comes and goes. In a group, we can share our insecurities, our strengths, our weaknesses, our doubts, what we believe in. There's value in that.

Remember that kids can turn around. It's very rewarding when they do. If you just save a couple, that's a lot because they have impact on other kids. For example, I had a 14-year-old sentenced for murder, who had demonstrated model behavior in the juvenile facility. When he turned 17, I got him transferred to a rehabilitation center instead of the adult facility. There he attended high school, became one of the stars of their basketball team and graduated last summer. Now he's going to college in Florida and spending breaks talking to kids in a detention center.

Be realistic. Of course, there are no guarantees. I've known families who gave their kids all the right things, and the kids still took the wrong path. We don't know what happens. We just don't know the inner mystery of one's personhood. It's "there, but for the grace of God, go I." There are no simple answers.

An assistant public defender in Chicago's Cook County Juvenile Court, Sister Mary Louis Russley strives to get repeat offenders into rehabilitation. For 14 years, she has declined opportunities to move elsewhere because she feels her longitude offers children continuity. ("I try to keep up with them, in placement or incarceration, and write to at least one every day.") She previously taught at UC and the Dominican University, where she earned an MBA, followed by a JD from Loyola.

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