Envisioning a Healthy America

A message from Risa Lavizzo-Mourey, President and CEO

A message from Risa Lavizzo-Mourey, President and CEO


This is my 10th annual report on the state of the Robert Wood Johnson Foundation’s (RWJF) mission to improve the health of the American people.For the past decade, I’ve used these messages to think out loud about the state of health and health care in America, the Foundation’s achievements and its ongoing challenges. Recently, I took the time to re-read those reports and I am proud of the role RWJF has played in addressing the major health and health care issues of our time, including:

  • The quality, value, and safety of care.
  • The vast variations and inequalities in patient care and outcomes.
  • Health insurance coverage.
  • The social and environmental obstacles to good health.
  • The long-running debate over the policies, priorities and cost of health care.
  • Childhood obesity.

But the world is changing more quickly than it ever has before, and the time has come to set new horizons. We began to think deeply about this at the Connections Conference marking the Foundation’s 40th anniversary last fall, where we considered RWJF’s role as a change agent in the past, present, and future. I asked my colleagues, “If we begin today, can we reach far enough into the future to make an even bigger difference for the generations yet to come?” Their answer was, “Can we start now?”

As a result, we are undertaking one of the most comprehensive reviews of the Foundation’s work since our founder and namesake charged us with improving the health and health care of all Americans. To make it really interesting we are beginning, not in the present, but in the future; not with a dream, but with a new vision for RWJF and the nation. 

We envision a future in which we, as a nation, will strive together to create a culture of health enabling all in our diverse society to lead healthy lives, now and for generations to come. An America where good health is a fundamental and guiding social value that helps define American culture.

"We, as a nation, will strive together to create a culture of health enabling all in our diverse society to lead healthy lives, now and for generations to come."

—The Trustees and staff of the Robert Wood Johnson Foundation

What we foresee, accordingly, is a vibrant, all-inclusive American culture of health in which...

  • Good health flourishes across geographic, demographic and social sectors.
  • Being healthy and staying healthy is valued by our entire society.
  • Individuals and families have the means and the opportunity to make choices that lead to healthy lifestyles.
  • Business, government, individuals, and organizations work together to foster healthy communities and lifestyles.

In this new culture of health...

  • Everyone has access to affordable, quality health care.
  • No one is excluded.
  • Health care is efficient and equitable.
  • The economy is less burdened by excessive and unwarranted health care spending.

It will be a given that...

  • The health of the population guides public and private decision-making.
  • Americans understand that we are all in this together.

A Renewed Vision

In this video you will hear how we are strategically thinking about how the world is changing, how those changes will impact health and health care in the future, and what RWJF must do to meet its mission in the years to come.

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Join us as we share our new vision for @RWJF and the nation #cultureofhealth







Today, most people consider good health and healthy living as activities that are consciously chosen, or something that only those who are already fit can fully achieve. Our intent is to empower everyone living in this country to make healthy living part of their life every day, even if they are dealing with illness or physical limitations. Our vision is that our society will make the healthy choices the easy choices for every family, school, neighborhood, and community.

Yes, our vision is audacious. It may take 20, 30, even 40 years to accomplish. But we are convinced it is possible. And we pledge to see it through. Right now, at our Princeton campus we are realigning our strategies, structures, and resources to catalyze this national movement. We don’t expect the transformation to be easy. But when it’s done the grand prize will be that everyone in America will have the means and the opportunity to live healthier and more fulfilling lives. It will require collaboration, courage, conviction, knowledge and staying power. To tell the truth—we can hardly wait!

Since its founding, our nation has been viewed as a society rich with the opportunity to pursue happiness. Being healthy widens that opportunity. Just ask Rajiv Narayan, a young man I met a few months ago at the Partnership for a Healthier America summit in Washington, D.C.

Rajiv is a recent college graduate from California who was significantly overweight as a teenager. When he got to college, he discovered that his new surroundings encouraged a healthier lifestyle and he embraced the change. He walked and rode his bike to class and began visiting the gym, even studying while exercising. He educated himself about food and nutrition, and he discovered that as he grew healthier he felt better, not just about his body but also about his future and fulfilling his potential. Today, Rajiv is 100 pounds thinner and he just completed his first marathon. Even more important, he has decided to devote his life to public policy focused on making communities more healthy. 

“Everything you do for your health is connected to everything else,” Rajiv says. “I’ve learned that through personal experience. I am living a more engaged life, and that is a happy side-effect of making healthy choices.”

Health may not always guarantee engagement and happiness. But being healthy certainly enhances the probability of achieving lofty aspirations like fulfillment, and it’s hard to think of a more persuasive reason to choose a healthy path.



Every expedition has an embarking point. Ours began with in-depth discussions of some of the powerful forces that are influencing the rapidly changing landscape of health and health care in America:

Health care spending: America spends twice as much per person on health care than anyone else on Earth. But we rank far behind other major nations in access to care, quality, fairness, efficiency, longevity, infant mortality, and patient outcomes. Paradoxically, high-cost acute care routinely trumps lower-cost preventive care in the struggle for federal and local resources.

In the meantime, U.S. health spending is on track to devour 20 percent (fully one-fifth) of GDP—something no society can sustain without succumbing to the harsh tyranny of zero-sum choices. Just imagine having to choose between quality health care and other important needs, such as housing, child care, college, and retirement. Far too often, the high cost of health care is leaving Americans in financial distress.

Big Data: The 21st century opened the door to a new frontier known as Big Data. The sheer volume and velocity of information at our fingertips today is unprecedented. When Neil Armstrong went to the moon, the computer on board Apollo 11 held four kilobytes of storage. Today an average smartphone holds about 16 million kilobytes of storage. Because of Big Data, much of what once was hidden about health and health care is now providing us with valuable insight into genomics, clinical data, and evidence-based analysis on a scale never before encountered. At RWJF, we elected to use data sets to create the County Health Rankings, assessing and comparing the social determinants of health of every county in America. The rankings make it possible for communities to see the specific health issues facing their residents, and tailor their own responses to hometown problems.

Technology: Potent new interactive tools for information analysis are deepening our understanding about health and health care. We are learning how to individualize care in a way that has never before been possible. Using digital technologies as common as smartphones, physicians can now harness a wealth of biological and physiological data from individuals. This new knowledge is leading to radically new applications, such as crowd-sourced diagnostics and social media-supported self-care.

Changing parameters of influence: With the rapid rise of the Internet, mobile devices and social media, the power of influence once reserved for a small group of elite leaders has become more democratic. Popular sentiments, social movements, even political revolutions have been sparked by grassroots movements based on social networking. This broad-based shift in the realm of persuasion gives us a glimpse into the way communication, advocacy, and leadership will change in the future.

We also examined a few core assumptions about the future of health and health care in America that we believe must frame how the Foundation moves forward:

  • Our population is aging and increasing in ethnic and racial diversity, with the highest concentration of this diversity among the youngest. This suggests that improving lifelong wellness nationally will provide the highest return on investment for the young. 
  • Education and income disparities are widening and non-medical determinants of health such as income, education, employment, safety, and other environmental factors will continue to be closely tied to health.
  • Spending on health care will continue to pose a challenge to individuals and our society. And the locus of care will increasingly shift from the doctor’s office to the community.

Using these societal forces and core assumptions as our starting blocks, we carefully constructed our vision of an American culture of health. 







The sheer volume and velocity of information at our fingertips today is unprecedented.











Better Education = Healtheir Lives

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What is a culture of health?  To us, it means individuals, neighborhoods, communities, businesses, organizations, and decision-makers embracing health as an esteemed American value and expecting it to be a routine part of life.

What does it look like? It’s an America in which all the people—whatever their demographic, ethnic, geographic, racial, or socioeconomic circumstance happens to be—live longer, healthier lives.

It’s an America that provides access to health care that is high-quality, high-value, and affordable to all. It is a nation in which everyone has the information and the means to make choices that promote healthy lifestyles and behaviors.

In a flourishing culture of health, private and public leaders will keep the health of the entire population foremost in their minds when making decisions. And business, government, schools, individuals, and organizations will work together to build and bridge good health care with communities that promote healthy lifestyles.

RWJF is committed to this vision of a healthy America, and to catalyzing the transformation of our entire society into one that venerates the pursuit and preservation of wellness.

I believe the idea of a culture of health has the potential to reach what author Malcolm Gladwell would call a “tipping point,” which he describes as a societal change that begins to spread on its own volition. With our collective effort, the tipping point could happen soon.  Already we have begun to see some individuals, communities, businesses, media, and other sectors independently embrace the notion.

Creating a Culture of Health

Every community needs the building blocks to give everyone the chance to make healthy choices, so we can all share in a culture of health. Together we can give all Americans the chance to lead healthy lives.

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Stable Jobs = Healthier Lives

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  • IBM’s global “culture of health” fosters healthy living as a company norm and promotes prevention, healthy lifestyle choices, comprehensive primary care, and informed decision-making at every level.
  • Johnson & Johnson’s long-running wellness program not only paved the road for others to follow, but also has saved $250 million in health care costs over 10 years.
  • Spelman College recently decided to redirect its athletic funds from sports teams to create what President Beverly Daniel Tatum calls a campus-wide “culture of movement,” offering all students classes in yoga, swimming, tennis, Pilates, and other activities they are more likely to continue after college.
  • Pinterest’s “Infuse a culture of health” online pinboard showcases eye-catching infographics, articles, and reports posted by the general public, showing how businesses, organizations, and individuals can collaborate to blend wellness programs into daily living at home, at work, and at school.


Notable trailblazers are setting the course for others to follow. On the far west side of Detroit, for example, the Joy-Southfield Community Development Corporation is using a combination of health classes, health clinic services, and collaborative partnerships with churches, schools, city organizations, and businesses to improve the lives of hundreds of residents in a struggling neighborhood where jobs are scarce, foreclosures are rampant, and more than 70 percent of residents are dealing with hypertension, diabetes, or other chronic illnesses.

Executive Director David Law says it was the RWJF County Health Rankings that sparked his organization’s drive toward better health for the entire community. “The data was stark. We were dead last,” he explains. “But it made us realize that by eliminating disparities we could improve our outcomes. Health is about safety, access to healthy food, access to information, jobs, help with housing, a lot of things we can do at the community level. If you want to build a healthy neighborhood, you have to start with healthy people.”

Over the past four years, in addition to providing residents with primary health care through its health clinic, the Joy-Southfield Health and Education Center also has started offering community-focused activities such as cooking classes, smoking cessation programs, a hypertension management program, and a diabetes support group. It has opened three community gardens in collaboration with local schools, and hosts a weekly farmers' market where kids can sell what they’ve grown. It provides tutoring for school children, helps adults with housing issues, and gives assistance in revitalization to local businesses. There are plans to build biking and hiking trails and to improve the facades of local retailers. “Five years from now,” says Law, “this neighborhood will be dramatically different.”

Law says he’s already seen a positive impact. In 2008, the health clinic introduced a computerized hypertension management program that, in just over one year, led to a 20 percent improvement in blood pressure control among African American women at the clinic, and a rise from 35 percent to 85 percent in participation in health education. Last year in a survey of 1,739 of the center’s 1,800 clients, residents wrote comments that underscored how much they value the center’s holistic approach to being healthy. “I love this clinic,” one patient wrote. “I was a walking time bomb (when I first came) and they worked on me and got me together (diabetes, high blood pressure). Everyone is so helpful and efficient.”  

The culture of health is also evolving in other “bright spot” communities:

  • New Orleans, La., one of RWJF’s Roadmaps to Health Prize winners, is turning its comeback from Hurricane Katrina into an opportunity to transform a city famous for overindulgence into a national model of community wellness. Today, as part of its ongoing recovery effort, NOLA is promoting a cross-sector public health partnership of schools, business, government, and nonprofits to recognize prevention and many other social determinants of health. Guiding their efforts are the standards set by the RWJF-funded Public Health Accreditation Board.

New Orleans Prize Video

New Orleans Transforms Community Health

New Orleans is one of six winners of the inaugural RWJF Roadmaps to Health Prize.

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  • York, Pa., is one of RWJF’s Aligning Forces for Quality (AF4Q) test markets. The AF4Q effort involves 37 million people in 16 communities across America, with the aim of informing and empowering those who give, get, and pay for care to improve health in their hometowns. York’s priority is to reduce disparities, turn conventional physician practices into patient-centered medical homes, and empower patients to manage their own health.
  • Santa Cruz County, Calif., another Roadmaps to Health Prize winner, is a prototype for local leaders collaborating on data-defined answers to community health problems. Using the annual community assessment data provided by RWJF’s County Health Rankings, partners in Santa Cruz are identifying causes and solutions to interrelated health issues like air quality, high school graduation, crime rates, and childhood obesity. A major Santa Cruz goal is for all children to have access to comprehensive health, dental, vision, and psychological care.  

Santa Cruz County Prize Video

Santa Cruz County Engages Youth

Santa Cruz is one of six winners of the inaugural RWJF Roadmaps to Health Prize.

Learn more

  • Hernando, Miss., is a city classified by RWJF’s County Health Rankings as part of the healthiest county in the nation’s unhealthiest state. A communitywide effort led by Mayor Chip Johnson has helped Hernando become home to the state’s largest farmers’ market, a new parks department, community gardens, and wider roads with bike lanes. Recently, Mayor Johnson told residents, “My job is to create an atmosphere and an opportunity for good health. If you want to take advantage of it, that’s great. If you want to stay home on your couch, go ahead.” Most are taking him up on the offer.

What do these places have in common? A strong sense of community. A firm commitment to collaboration. Evidence-based data used to measure improvements. The willingness to envision, and work for, a better future. At RWJF, we look forward to the day when the steps being taken in these communities are commonplace.

For the past 40 years, this Foundation has played a pivotal role in connecting innovative ideas with innovative people to improve our nation’s health. We promise to sustain our commitment to this vision until it is achieved. By working together to create a culture of health, Americans will keep our nation strong, our people productive, and our future promising.

At RWJF we are eager to get started, knowing that, as the African proverb, says:

Many little people in many small places undertaking many modest actions can transform the world.

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Can we reach far enough into the future to make an even bigger difference for generations yet to come?







Respectfully submitted,

Risa's signature, no background

Risa Lavizzo-Mourey, MD, MBA
President and Chief Executive Officer