Joining Forces to Build Momentum
2016 Annual Message
Near the front door of the Robert Wood Johnson Foundation hangs a quilt that tells the stories of several lives—stories of love, spirit, and joy—tragically cut short because of HIV/AIDS.
Near the front door of the Robert Wood Johnson Foundation hangs a quilt that tells the stories of several lives—stories of love, spirit, and joy—tragically cut short because of HIV/AIDS.
Every six months for the past 14 years, we have had the privilege of displaying a different section of the AIDS Memorial Quilt at our headquarters, and the profound honor of getting to know these individuals through the moving patchworks created by their loved ones.
Every time a new section arrives, I stop and take it in. I think about the kaleidoscope of people who came together to create the commemoration. And the meaningful mosaic of fabric—a pair of favorite blue jeans, a military uniform, a choir robe, a fluffy childhood blanket—they selected in tribute. Pieced together—ultimately covering the entire National Mall in Washington—the Quilt is a testament to the power of joining forces.
Building a Culture of Health in America, I’ve realized, is much like assembling a quilt. It requires many hands working together. And often, the most unlikely pairings create the most evocative designs.
The Foundation never intended to build the movement toward a Culture of Health alone. And, in the two years since we first shared the vision, it has become increasingly clear how critical it is that we join hands with others in this effort. In fact, it’s imperative.
Why? Because no individual, organization or sector can alter the course of America’s health single-handedly. In January, at the World Economic Forum in Davos, Switzerland, National Institutes of Health Director Dr. Francis Collins noted that just 20 percent of health outcomes depend on the health care sector. Health is inextricably tied to where we live, learn, work and play. It is shaped by the stability and safety of our housing, the quality of our schools, and the availability of clean, safe, open spaces in our communities.
That is why, now, more than ever, we at RWJF are convinced this movement must be championed not solely by those in the health sector, but also by those who have not historically seen themselves as part of the health arena—sectors such as criminal justice, real estate development, finance and technology; as well as organizations focused on civic engagement, equity and economic prosperity.
RWJF Culture of Health Prize
With that in mind, as part of this Annual Message we are issuing a challenge to individuals and organizations across America to forge new and unconventional partnerships with the goal of building a Culture of Health that benefits all.
At RWJF we have been striving to walk the talk. Over the past year, my colleagues and I have traveled many miles expanding our existing partnerships and establishing relationships with new allies. Some may be surprised to learn that we—the nation’s largest philanthropy dedicated solely to health—have been actively co-creating strategies with organizations such as the Federal Reserve Bank of San Francisco, AARP and the Urban Land Institute.
Now, I’ll admit, it’s not always easy to build alliances with unexpected partners. You have to step outside of your comfort zone, and sometimes learn a new way of thinking and communicating (I can attest to this first-hand as a physician who recently addressed a room full of bankers). But we are committed to doing this more intently in the days and years to come. And we will be asking our grantees to do the same.
Additionally, last fall we introduced an Action Framework that illustrates how we intend to work alongside others in the national effort to build a Culture of Health, and how different sectors can mobilize and measure progress. Rigorously developed with insight from more than 1,000 stakeholders, this Action Framework has been embraced by organizations and communities nationwide.
It has been inspiring to see how others are using—or, as Alonzo Plough (our Vice President for Research-Evaluation-Learning and Chief Science Officer) likes to say, “riffing on”—the Action Framework to achieve their own visions of a Culture of Health. I’ve shared some examples below, and I encourage you to visit www.CultureofHealth.org for more stories from the field.
Equity is Essential
Our country cannot build a comprehensive Culture of Health as long as many continue to face steep and stubborn barriers to well-being.
That is why the Foundation has identified achieving health equity as a critical component of everything we do.
As we move forward, RWJF will continue to concentrate on engaging with partners and researchers who consider equity fundamental to health; experts like Raj Chetty, professor of economics at Stanford University and a MacArthur “genius” Fellow, whose Equality of Opportunity Project focuses on how we can give children from disadvantaged backgrounds a better chance of upward mobility and success.
Additionally, through our three new research programs, we hope to bring new and necessary findings to light in order to more clearly identify and address the root causes of health inequity.
RWJF Award for Health Equity
Our Four Themes
In line with our new approach, we have categorized our funding and programming into themes that reflect our determination to move beyond place-based problem-solving and aim, instead, to change the interconnected systems that influence health. The themes are:
- Healthy Children, Healthy Weight
- Healthy Communities
- Transforming Health and Health Care Systems
- Leadership for Better Health
How will our new themes affect funding? We anticipate our overall funding to remain the same—$400 to $450 million—for the next 12 to 18 months. But in order to stay nimble and respond to changing needs, we will review our strategies regularly and, if needed, adjust our levels of support.
Our Focus Areas
Healthy Children and Families
Every child in America should have the opportunity to develop socially, emotionally, physically and cognitively to the best of his or her ability. That includes growing up at a healthy weight.
For more than a decade, RWJF has been deeply committed to reversing the childhood obesity epidemic in America. We have partnered with schools, policymakers and the food industry to help kids eat healthier and participate in more physical activity, and we are beginning to see signs of positive change. Across the nation, obesity rates are down five percentage points among our youngest children. But the progress is fragile and uneven. African-American and Latino children are still faring worse than their white counterparts and, overall, one of every three kids remains overweight. So we have to keep at it. That is why last year the Foundation committed another $500 million over a decade to continue the effort. This new round of funding will support family, school and community initiatives to eliminate obesity disparities, and to ensure that every child starts kindergarten at a healthy weight.
We also will continue to support cross-cutting work by organizations like the Partnership for a Healthier America and the Alliance for a Healthier Generation that have garnered voluntary agreements to create healthier environments for kids. The American Beverage Association, for example, recently met its agreement to remove full-calorie sodas from schools and reduce the number of total beverage calories shipped to schools by 90 percent. And McDonald’s is moving forward on its commitment to transform Happy Meals® to include healthier options, offer more fruit and salad and remove soda from menu boards that target kids.
To flourish, children must receive good nutrition and they must also experience healthy cognitive and emotional development—particularly in their earliest years.
RWJF supports work that provides families—and the neighbors, educators, health care practitioners and others in their lives—with the tools they need to help kids thrive right from the start. Our priorities include raising awareness of prenatal care, addressing adverse childhood experiences and eliminating barriers to health care and coverage for families.
This comprehensive approach is reflected in a 10-year initiative we have launched with our longtime allies at the YMCA of the USA. With our support, the Y is exploring new ways to meet the specific needs of individual communities by providing clinic-to-community health services and by strengthening the quality of early learning programs for all children.
We also are funding research to determine what types of home visiting programs can help families the most. And we are working alongside Sesame Workshop® and other organizations to promote social and emotional development of families and young children using new technology and other creative approaches.
The Foundation is working to help all communities be as healthy as possible by creating strong collaborations among the many different sectors that influence health.
In Philadelphia, for instance, positive change is building upon itself. For almost a decade, the city’s school district has worked with advocates and the health department to push forward a comprehensive nutrition policy for children, removing sugary beverages from schools and deep fryers from school kitchens. In 2007, the city passed a worker protection indoor smoking ban. And the following year, it enacted the nation’s most comprehensive nutrition-labeling law for chain restaurants. In 2010, parks and recreation centers went smoke-free, and the police worked with the streets department to add many more bike lanes. Prisons, homeless centers and group homes adopted healthier food service standards, and media campaigns led to a sharp drop in the consumption of sugary beverages by kids. The efforts have worked to lower childhood obesity, particularly among minority youngsters.
Our annual Culture of Health Prize honors communities that are pursuing better health locally by creating new and powerful partnerships. Twenty diverse communities have won the Prize since 2013—from the Bronx in New York City, to Williamson, W.Va., in Appalachian coal country, to the Taos Pueblo tribe in New Mexico. These communities are building momentum by sharing their experiences with others. And it’s these connections that are starting to build a Culture of Health from coast to coast.
Children With Strong Social Skills More Likely to Thrive as Adults
Transforming Health and Health Care Systems
RWJF remains deeply committed to improving America’s health care system, and increasing the coordination between care, cost, prevention and decision-making.
The programs we fund aim to cultivate effective partnerships between hospitals and communities; examine how the delivery of care can be improved to meet the needs of local residents; and provide greater access to health care and coverage for everyone.
This area of our work also underscores our continued support of the expansion of Medicaid at the state level, as well as programs that help everyone in America obtain health insurance.
One initiative that reflects the transformation we seek is the BUILD Health Challenge. It is a national award program supporting “bold, upstream, integrated, local, and data-driven” (BUILD) community health interventions in low-income, urban neighborhoods. The Challenge aims to strengthen partnerships among local nonprofit organizations, hospitals and health systems, and local health departments to improve the health and well-being of communities. It is funded by RWJF, the Colorado Health Foundation, The Kresge Foundation, the de Beaumont Foundation and the for-profit Advisory Board Company.
RWJF Research Programs
Leadership for Better Health
Albert Einstein is often quoted as saying, "We cannot solve our problems with the same thinking we used when we created them." To build a Culture of Health, our nation needs diverse leaders who are eager to drive change by accepting risk, working across disciplines and drawing inspiration through collaboration.
We are initiating four new leadership programs to develop, train, and network these new agents of change. A select group of organizations are working with us to co-develop the programs, which will launch later this year. The programs and organizations are:
- Health Policy Research Scholars (led by Johns Hopkins University): Providing doctoral students from underrepresented and/or disadvantaged populations training in health policy, health equity and population health, with the goal of implementing change in communities across the nation and influencing the broader conversation about health.
- Interdisciplinary Research Leaders (led by University of Minnesota): Connecting researchers and community members through networked teams to spur on-the-ground change that puts evidence-based research into action.
- Culture of Health Leaders (led by the National Collaborative for Health Equity, a project of the New Venture Fund, and CommonHealth ACTION): Developing a diverse group of leaders representing key sectors influencing health—such as education, transportation, public health, public policy, business, health care, community development and urban planning—with the goal of achieving health equity through collaborative and cross-disciplinary solutions.
- Clinical Scholars (led by University of North Carolina at Chapel Hill): Establishing highly networked groups of seasoned, professional clinicians—physicians, nurses, pharmacists and others—and providing them with the coaching and collaboration they need to drive transformative change in communities across the country.
As part of our focus on cross-sector leadership, the Foundation will also work alongside business and industry to encourage the development of healthier workplaces, goods and services that encourage health, and stronger ties between companies and the communities they serve.
Leadership for Better Health
The Action Framework
If the themes represent what the Foundation does, the Action Framework outlines how we and our partners are doing it: Inviting people across the nation to join forces, across sectors, to put the Culture of Health vision into action.
Drawn from thorough research, analysis, and iteration, the Action Framework was developed by RWJF in collaboration with the RAND Corporation, and with input from more than 1,000 experts, partners, focus group participants, and global leaders over an 18-month period.
Everyone who worked on this project was driven by one question: “What is holding our nation back from the health to which we aspire?”
What we discovered is that our nation is not addressing the interdependence of the many social, economic, physical, and environmental factors of health and well-being. Therefore, the Framework is grounded in four interconnected Action Areas that demonstrate how health and well-being is the sum of many parts:
- Making Health a Shared Value
- Fostering Cross-Sector Collaboration to Improve Well-Being
- Creating Healthier, More Equitable Communities
- Strengthening Integration of Health Services and Systems
Culture of Health
Together, these Action Areas are intended to achieve an outcome of improved population health, well-being, and equity.
Each Action Area includes a set of corresponding Drivers—long-term priorities that we hope individuals and organizations across sectors will focus on to accelerate change, both nationally and at the community level. Together, the Action Areas and the Drivers create the key building blocks of the Action Framework that will remain constant over time.
In addition, the Framework includes 41 national, evidence-based Measures, selected as points of assessment and engagement. The Measures are not limited to traditional health indicators; instead, they encourage us to think of health in broader ways, incorporating all aspects of well-being.
The Action Framework will guide RWJF’s investments over the next 20 years. And while we plan to fund work in all four of the Action Areas, we will not focus on every aspect of the four. We recognize that we are just one of many organizations working toward the common cause of improving health in America. And we hope the Action Framework will shine a light on the transformative roles everyone can play in this national effort.
The following examples highlight how organizations across America are connecting with the Action Framework and inspiring creative partnerships.
This Action Area encourages placing our nation’s health goals front and center; increasing the demand for healthy places and practices; and promoting social connections that foster a sense of security, belonging and trust in our communities. Measures such as volunteer engagement, sense of community and the number of tweets about wellness (relative to illness and acute care) can help us gauge how we’re doing as a nation in this Area.
Dr. Georges C. Benjamin, executive director of the American Public Health Association (APHA), is spearheading this sort of action through APHA’s Generation Public Health. It is a national movement of people, communities and organizations working together to create the healthiest nation in one generation.
This Action Area involves bringing actors to the table who have typically considered themselves outside the health care arena. Measures within this Area include the level of business support for workplace health, the percentage of full-time officers engaged in community policing and health policies that support working families.
For example, The Dow Chemical Company has taken a leadership role in the Michigan Health Improvement Alliance, a group of diverse stakeholders working to improve health in central Michigan, where Dow is headquartered. Not only does this initiative benefit the community as a whole, but it has been an important part of Dow’s overall health strategy contributing to their priorities of better health, better quality and better value. Dow’s health strategy has successfully driven a decrease in chronic disease among its employees. In fact, a recent study demonstrated that Dow spent 17 percent less than its peers on chronic health conditions.
In order to truly build a Culture of Health, we cannot leave anyone behind. Unfortunately, well-being in America can be unduly and unequally influenced by geographic, demographic and social factors.
The goal of this Action Area is to encourage communities to fulfill their greatest health potential by improving the environment in which residents live, learn, work and play. We will track progress through Measures such as access to healthy foods, the prevalence of Complete Streets policies, and the percentage of youth who feel safe walking to and from school.
For instance, in Ypsilanti, Mich., the Deborah Strong Housing complex is poised to be a game-changer. It’s the inaugural project of the Strong Families Fund, a new $70 million pay-for-performance financing initiative that pairs social services with quality, affordable housing for low-income families. Spearheaded by RWJF, the Kresge Foundation, KeyBank, and Goldman Sachs, the Strong Families Fund joins with local organizations to connect residents with a network of resources including job training, after-school programs, and health care services. The Fund is tracking the gains that stable housing and coordinated social services bring to residents’ lives, with a focus on health and wellness; work, income and assets; housing stability; youth and education; and community/neighborhood engagement.
This Action Area aims to better integrate medical treatment with public health and social services. It stresses improving the consumer experience and examining the role of health care as part of a larger network of partners. Measures within this Area include consumer experience across hospital, ambulatory, and home health settings, the prevalence of electronic medical record linkages and access to mental health services as well as treatment for substance dependence or abuse.
For example, Spartanburg Regional Healthcare System in South Carolina formed a partnership with 10 community organizations to create AccessHealth Spartanburg, designed to connect low-income, uninsured people to health care and address barriers to health services. By better coordinating primary care and focusing on the social issues that affect health—such as transportation, access to medications, housing and employment—the program reduced hospital costs for the targeted population by 42 percent and hospital admissions by 31 percent. This is one part of a community-wide health movement that earned Spartanburg County a 2015 Culture of Health Prize.
Building a Culture of Health requires a steadfast commitment to long-range goals that we can envision and achieve together.
The Action Framework is designed to give special attention to equity, creating conditions and opportunities that enable individuals to flourish physically, mentally and socially throughout their lifespan.
By joining forces within and across the four Action Areas, we can place well-being at the center of every aspect of American life.
Thinking Big, Acting Together
As we continue to concentrate on building a Culture of Health in America, an African proverb of which I’m fond comes to mind: “Walking alone leaves a narrow footprint.”
We are honored to be walking beside you on this journey, and we want to hear about your experiences and your challenges. We also hope that you will encourage others to join the movement.
Please invite your neighbors, your co-workers, your faith communities, and others to visit www.CultureofHealth.org, where they’ll find stories about the different ways people and communities are putting the Culture of Health vision into action:
Stories about communities like Bridgeport, Conn., where residents, policymakers and community organizations came together to turn an abandoned, unsafe and contaminated site into a thriving, two-acre urban farm where neighbors gather and school kids learn about nutrition and food production.
We want www.CultureofHealth.org to start new conversations about what is possible. We want it to be a place to share ideas, triumphs and struggles. And we want it to spark innovative and unconventional ways of thinking and working together to build a healthier future for all.
And so, we are using www.CultureofHealth.org to issue a challenge to you and all of our allies in this cause: To think bigger. To act more boldly. To join forces and build momentum with unlikely partners.
We are asking you to step out of your comfort zone, and team up with those who see health from a different perspective. Because that’s the only way we are going to spread the movement and create a greater sense of shared accountability. And it’s how, as a nation, we will build a Culture of Health that benefits everyone, now and for generations to come.
Risa Lavizzo-Mourey, MD, MBA
President and Chief Executive Officer