As the nation’s largest philanthropy dedicated to improving the public’s health, the Robert Wood Johnson Foundation recognizes that “health is influenced greatly by education, housing, income and numerous other factors outside of the health care we receive.”
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At the local level, this means livable communities and healthy communities are inextricably linked. On a national level, it means changing the way we think in order to build a Culture of Health in which everyone in the United States can lead healthy lives today and for generations to come.
Since 2003, the Robert Wood Johnson Foundation has been led by Dr. Risa Lavizzo-Mourey, a Harvard Medical School graduate who went on to specialize in and teach geriatric medicine at the University of Pennsylvania, where she also earned an MBA from the Wharton School. Lavizzo-Mourey’s other credentials include working as the deputy administrator of what is now the Agency for Healthcare Research and Quality and serving on numerous federal advisory committees and White House task forces, including the President's Council for Fitness, Sports and Nutrition. In addition to being the president and CEO of the Princeton, N.J.-based foundation, Lavizzo-Mourey serves on the Smithsonian Board of Regents, the governing body of the Smithsonian.
1. Please explain the connection between a Culture of Health and the communities where people live and work.
At the Robert Wood Johnson Foundation we want to help Americans build a comprehensive Culture of Health for our nation. What does that mean? It means working together to build an understanding that health means so much more than not being sick. Health is a vital aspect of every part of our lives. How and where we live. How we raise our children. The choices we make for ourselves and our loved ones.
Imagine living in a community making sure the health of all of our children is a matter of fact and not a matter of chance. Imagine knowing that all of our employers, our mayors, our educators and our faith leaders were working together to give everyone the tools and the opportunities they need to make responsible choices. A Culture of Health means living in a society that not only believes but also insists that every person has the chance to be as healthy as they can be.
The thing is, if we are going to get there, we have to get there together. We have to recognize that health includes creating safe places for kids to play. It includes improving access to high-quality health care. It reaches into our workplaces, our schools and every one of our neighborhoods. Every community is going to build the Culture of Health that serves it best, and that’s the way it should be. The change has to come from the ground up. It has to be driven by ordinary citizens with the help of business, community organizations and government. We all have to forge partnerships in our communities, and then we have to make the commitment to stick to our goals for health until we see success.
2. What efforts does the Robert Wood Johnson Foundation support to create healthy communities across the United States? How might these efforts impact people age 50 and older?
The Robert Wood Johnson Foundation supports programs all across the country that help create healthy communities, a major component of a Culture of Health. And these programs may not all fit into the traditional idea of “health.”
The County Health Rankings & Roadmaps program measures vital health factors in nearly every county in America, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, air and water quality, income and teen births. This information provides a revealing snapshot of how health is influenced by where we live, learn, work and play. The foundation’s Culture of Health Prize honors communities that place a high priority on health and bring partners together to drive local change.
On a very different note, look at the Green House Project, a skilled-nursing care model that returns control, dignity and a sense of well-being to elders, their families and direct care staff. In the Green House model, residents receive care in small, self-contained homes organized to deliver individualized care, meaningful relationships and better jobs through a self-managed team working in cross-trained roles.
Programs like this and numerous others that help create healthier communities also help to build a Culture of Health in America, where all people, regardless of their age, geographic location, race, ethnicity or socioeconomic status, live longer, healthier and even more fulfilling lives. We invest in promoting health and a sense of community rather than just treating illness. And when we do this, older adults can get to know their grandkids better, play with them more, maybe continue to work if they need to or find it enjoyable. Or volunteer or travel or take care of their grandkids while the parents work. The possibilities are endless.
3. How can individuals, businesses, government and organizations work together to foster a Culture of Health in communities?
At the Robert Wood Johnson Foundation we believe that collaborations are essential to building a Culture of Health. When businesses, nonprofits, public officials, educators and families work together to create and put in place solutions that are tailored to their communities, then the changes are most likely to be both real and lasting.
Spokane, Wash., one of our six 2014 Culture of Health Prize winners, illustrates the strength of collaboration. The prize recognizes communities that place a priority on developing innovative strategies to improve the health of their residents.
Spokane was recognized for raising the county’s high school graduation from less than 60 percent in 2006 to over 80 percent today through the efforts of Priority Spokane, a nonprofit collaboration of leaders from local businesses, government, community organizations, health and education. Priority Spokane in turn is an affiliate of Greater Spokane Incorporated (GSI), the region's economic development council. These community leaders recognized that health outcomes can be directly linked to educational outcomes, and that they all had a stake in improving opportunities for health and wealth for every child, no matter where they live.
Priority Spokane started its mission by polling residents to find out what they considered the region’s most pressing issues (education was by far the number one concern) — setting the stage for community buy-in right from the start. It rigorously tracked and measured progress and regularly reported those results back to stakeholders, another important factor in its success. It brought in the juvenile justice courts to develop nonpunitive methods for dealing with truancy and local colleges to create a health professions campus. This is the essence of a successful collaboration — reaching out, finding common ground and issues, sharing information and ideas, and looking outward for fresh approaches from all stakeholders.
4. As you mentioned, earlier this year the Robert Wood Johnson Foundation named six communities, including Spokane, Wash., as “Culture of Health Prize Winners.” Tell us a bit about some of those other places to help us — and future applicants — understand what made these communities stand out as winners.
I’ve already talked about Spokane. The other five Culture of Health prize winners are Brownsville, Texas; Taos Pueblo, N.M.; Williamson, W.V.; Durham County, N.C. and Buncombe County, N.C. All are unique communities, but the one thing they all have in common is that they drove change by creating broad-based collaborations.
Brownsville, on the banks of the Rio Grande, is a member of the AARP Network of Age-Friendly Communities and is one of the poorest metro areas in the country. One-third of its residents live below the poverty level, one in three is diabetic, and 80 percent are obese or overweight. But over the past decade the people of Brownsville — from elected officials to community leaders to students — have come together in a shared mission to improve the health of everyone who calls it home.
The University of Texas School of Public Health, based in Brownsville, together with more than 200 organizations, residents and individuals from health care, education, business and community groups, formed the Community Advisory Board to find solutions to the area’s health challenges, while the city and other large employers in the area embarked on a long-range plan called Imagine Brownsville.
The two organizations developed a set of measurable goals in areas such as fostering active transportation and healthy eating, with a community champion for each. They worked together to pass an ordinance for new businesses to install sidewalks, initiated a successful bike-sharing program and created extensive bike trails. Brownsville also galvanized support for sweeping policies that were adopted by the city’s leadership to encourage walking, biking and other forms of exercise. The community is committed to ensuring that every Brownsville resident is within a half-mile radius of a bike trail, and on Sundays and Friday evenings the city shuts down traffic on some streets to stage CycloBia, where thousands of residents walk, run, cycle and enjoy outdoor activities.
We’re inspired by all of our prize winners for coming up with sustainable solutions for the health of their residents, often with limited resources, by working together to build a lasting Culture of Health.
5. Many communities are financially constrained. How can they find the support they need to improve their built environment and contribute to health improvements? Similarly, what resources does the Robert Wood Johnson Foundation have that can help mayors, council members and citizens move their community toward a Culture of Health?
There are numerous resources for communities looking to become healthier. The Affordable Care Act now requires nonprofit hospitals to provide care to the communities they serve in order to maintain a tax-exempt status, the National Association of Counties’ Healthy Counties Database also provides information on model policies, programs and initiatives that counties nationwide have enacted to support overall community health. And the National League of Cities is dedicated to helping city leaders build better communities.
The Robert Wood Johnson Foundation supports several programs that can help community leaders and members build a Culture of Health.
The County Health Rankings & Roadmaps program I mentioned earlier provides a great starting point for change in communities. Their website includes an Action Center that provides guidance and tools to understand the Rankings data and strategies that communities can use to move from education to action. Stories and examples of what other communities are doing to improve health are also available. The Roadmaps help communities bring people together from all walks of life to look at the many factors that influence health, focus on strategies that have been proven to work, learn from each other, and make changes that will have a lasting impact on health. In addition, the County Health Rankings & Roadmaps “What Works for Health” database is a great resource for policy- and decision-makers.
Interview published September 2014