Program Areas: Specifics

1. Obesity

The Issues  
A 2005 report in the New England Journal of Medicine startled the nation with its prediction that the current generation of children will be the first in America to have a shorter lifespan than their parents’ generation – due largely to obesity-related disease.

This dire prediction was supported by a recent report by the Centers for Disease Control and Prevention (CDC) that found that approximately two-thirds of U.S. adults and one-fifth of U.S. children are obese or overweight. According to the CDC, during 1980 to 2004, obesity prevalence among U.S. adults doubled, and it increased substantially among children. In addition, African Americans have a 51% higher prevalence of obesity, and Hispanics have 21% higher obesity prevalence compared with whites.

Obesity is a significant driver of increased medical costs, and undermines people’s health as well as their financial wellbeing. Being either obese or overweight increases the risk for many chronic diseases, including high blood pressure, heart disease, type 2 diabetes, certain cancers and stroke.

A 2009 study by the CDC, with RTI International (a nonprofit research group), found that the direct and indirect costs of obesity in the U.S. are as high as $147 billion annually, or 9.1% of medical spending. The study was based on figures collected in 2006.
       
Our Approach
Learning more about the underlying causes of obesity can inform and shape effective population-based health and wellness programs. The Aetna Foundation wants to understand the contributors to obesity, particularly among minority populations, and what supports and sustains better choices that can stave off overeating and reduce inactivity.   

Grant-making in this area focuses on initiatives that create a better understanding of the root causes of the obesity epidemic.

Examples of grants we would support include projects and/or studies that identify causes of obesity and potential best practices for addressing obesity, such as:

• Domestic food policies and their impact on individual food choices
• The impact of our neighborhoods and the “built environment” on promoting population health and  weight loss
• Assessments of why communities with high rates of food insecurity also are more likely to experience high rates of obesity
• How children use recreation time
• How school lunch and food policies impact our children
  

2. Racial and Ethnic Health Care Equity
 
The Issues 
Inequities persist in the health and health care of various racial and ethnic minorities in America. This is demonstrated by the following data from the Center for Disease Control and Prevention’s (CDC) Office of Minority Health:

• While the nation’s infant mortality rate has declined in the past few decades, African American infants are still 2.4 times more likely to die in their first year of life than are white infants.
• Heart disease death rates are more than 40% higher for African Americans than for whites.
• Among people younger than 20, American Indians aged 10-19 have the highest prevalence of type 2 diabetes.
• Vietnamese American women have a higher cervical cancer incidence rate than any ethnic group in the United States -- five times that of non-Hispanic white women.
• African American women have higher death rates from breast cancer, despite having a mammography screening rate that is nearly the same as that for white women.
• Compared with non-Hispanic whites, Hispanics living in the United States are almost twice as likely to die from diabetes.  They also have higher rates of high blood pressure and obesity than non-Hispanic whites. 

Additionally, according to the Institute of Medicine's report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, African Americans and Hispanics tend to receive lower quality of health care across a range of disease areas (cancer, cardiovascular disease, HIV/AIDS, diabetes, mental health, and other chronic and infectious diseases) and clinical services.  For example, African Americans with heart disease are less likely to receive angioplasty or bypass surgery as cited by the AHRQ.

Our Approach
We focus our philanthropic giving on understanding connections between where people live and receive health care, and the quality and equity of the care they receive.  We know these issues are important, but we want to understand why and how to effect change.

The Aetna Foundation also is interested in how to improve health and health care among the nation’s Medicaid population, particularly in settings with large numbers of minority patients. We also want to drive improvement in one of the longest-standing disparities in health care -- infant mortality.

Examples of grants we would support include projects and/or studies to: 

• Explore how a stronger primary care model and relationships with providers could benefit minority populations and close the persistent health care gap 
• Help providers who treat large minority populations become leaders in delivering high-quality care
• Determine what can be done to reduce the numbers of low-birth weight babies born to mothers at risk
• Examine, through observational studies, the correlation between a mother’s health, stress level, and social supports; and the likelihood of having a healthy baby who lives through its first year of life
• Determine, through interventional studies, whether stress-reduction programs (including yoga and meditation) can improve health outcomes for minority patients with chronic conditions, as well as postnatal outcomes for mothers and pregnant women
  

3. Integrated Health Care
 
The Issues 
Integrated care seeks to repair a fractured health care system and eliminate gaps in shared information and communication that detract dramatically from patient safety and quality in health care. 

Integrated health care starts with good primary care and refers to the delivery of comprehensive health care services that are well coordinated with good communication among providers; includes informed and involved patients; and leads to high-quality, cost-effective care. At the center of integrated health care delivery is a high-performing primary care provider who can serve as a medical home for patients.

A February 2010 article in the Journal of the American Medical Association explores and more deeply defines integrated care, and notes that fully integrated health care systems have proven to be some of the highest-performing health care providers in America. How can we achieve integrated health care in the absence of an integrated health care system?

Our Approach
A newer focus of the Aetna Foundation is advancing an integrated health care agenda that builds on a foundation of strong primary care.  We believe the primary care provider is the key to integration, but more study is needed regarding the barriers toward achieving integrated care. And more critical than ever is the need to achieve greater value in health care. Highly coordinated, high-quality health care can be cost-effective, but the links between these factors and the best way to establish and maintain them need greater study and exploration – work the Aetna Foundation plans to support. 

The Aetna Foundation seeks to support projects that demonstrate the key components, best practices and benefits of integrated health care delivery that center on strong primary care.

Examples of grants we would support include projects and/or studies that: 

• Explore the relationship between patient engagement and integrated care
• Enhance communication between patients and care providers, as well as among care providers themselves
• Investigate the impact of poor coordination on patient safety, quality and costs
• Identify best methods for engaging patients as partners in their care, particularly for managing chronic conditions
• Identify best practices to align incentives for achieving well-coordinated care