Culture of Health News and views from the Robert Wood Johnson Foundation Mon, 22 Dec 2014 17:08:00 -0500 en-us Copyright 2000- 2014 RWJF (RWJF) <![CDATA[The Best Defense is a Strong Offense: Strengthening Our Nation’s Outbreak Preparedness]]> Outbreaks 2014

In the shadow of this year’s Ebola outbreak, the Trust for America’s Health and the Robert Wood Johnson Foundation released a new report, Outbreaks: Protecting Americans from Infectious Diseases.

The report finds that while significant advances have been made in preparing for, responding to, and recovering from emergencies, gaps in preparedness remain and have been exacerbated as resources have been cut over time.

On the eve of the report’s release, I spoke with Jeffrey Levi, PhD, executive director of the Trust for America’s Health to get his thoughts on today’s preparedness landscape—think, Ebola—what to do about shrinking budgets and growing infectious disease threats, and where to go from here.

As this year’s Ebola outbreak made clear, our public health system needs to be modernized to match rapidly evolving global disease threats. Every state should be able to provide a baseline of public health preparedness—and the sustained funding to support this is simply not there. We also need to work better together across the health care system, hospitals and public health agencies the common goals of protecting patients, health care workers and the public.

Paul Kuehnert: Ebola is, of course, getting significant attention this year. How does this draw attention to preparedness needs? Has it caused us to overlook other important threats?

Jeffrey Levi: The Ebola outbreak has obviously been a major wake-up call to the United States—highlighting both the strengths of, and some serious gaps in, the country’s ability to manage severe disease outbreaks and contain their spread. But, our hope in writing this report is to remind Americans that as frightening as Ebola seemed, there are routine infectious diseases that pose a greater and daily threat to Americans as well as many other emerging threats that health officials are monitoring.

Antibiotic-resistant Superbugs, health care-associated infections, foodborne illnesses, HIV/AIDS, the seasonal flu, mosquito-borne diseases (Chikungunya, West Nile, Malaria, etc.) Hepatitis B and C, and TB all deserve attention. Beyond Ebola, there are many other emerging diseases of concern that health officials are monitoring—MERS-CoV, pandemic flu, Marburg, dengue fever and Enterovirus D68—all of which illustrate that infectious disease threats can arise without notice.

Infectious diseases are not just a threat to health; they have an impact on how Americans live their daily lives and—depending on the severity and scope of a threat—can influence decisions about sending children to schools, limiting travel, restricting public events and even quarantine activities.

Paul: We all know budgets are tighter every year. How should our nation prioritize spending to prevent and treat infectious disease?

Jeffrey: The best offense to fighting infectious diseases is a strong and steady defense. The post-2001 investments in public health preparedness have led to significant progress in many areas of health emergency preparedness, but they did not lead to a serious modernization of the nation’s approach to infectious disease control. 

The current system must be brought up to date to better match modern global disease threats, technological advances and a clear, consistent set of baseline capabilities. These capabilities should include: investigative capabilities; containment strategies, including vaccines and medicines; continued training and testing for hospitals and health departments for infection control and emergency preparedness; strong surveillance to identify and track threats and communicate across the health care system; and maintaining a strong research capacity to develop new vaccines and medical treatments.

Paul: What other agencies or organizations can help prevent and treat outbreaks?

Jeffrey: Government is only one part in the fight to prevent and control infectious diseases. To take a 24/7 approach, government must work with the health care sector; pharmaceutical, medical supply and technology companies; community groups, schools and employers; and families and individuals. While governments at all levels have the ability to set policies and establish practices based on the best science available to better protect Americans from infectious disease threats, government needs help in creating new vaccines and antivirals, in tracing contacts who may have been exposed to a disease, in communicating risk to Americans that is based on sound science, and any number of other endeavors that keep people safe.


Interested in learning more about our nation's outbreaks prepareness? Download the full report here

Mon, 22 Dec 2014 17:08:00 -0500 Paul Kuehnert Emergency Preparedness and Response Disease Prevention and Health Promotion <![CDATA[Violence and the Media in 2014: Q&A with Lori Dorfman]]> Cease Fire A Chicago bumper sticker.

A culture of violence is the antithesis to a Culture of Health. As Risa Lavizzo-Mourey recently said in a speech to the American Public Health Association, “We will never be a healthy nation, if we continue to be a violent one.”

Violence is always in the news. But 2014 saw several high profile stories about violence dominating news cycles, including major stories about child abuse (Adrian Peterson), intimate partner violence (Ray Rice), sexual assault on college campus, and, of course, the deaths of Michael Brown and Eric Garner.

Because media coverage influences the social and political response to violence in America, I wanted to hear from Lori Dorfman, who directs the Berkeley Media Studies Group. She has spent decades monitoring how the media cover violence and other public health issues, helping public health advocates work with journalists, and helping journalists improve their coverage. The following is an excerpt of my interview with her.

How would you rate media coverage of violence over the last few months?

What we’ve seen is typical coverage. Despite some horrifying events—the decision not to indict St. Louis police officer Darren Wilson who shot Michael Brown, the strangulation of Eric Garner, assault by NFL players, and rape on college campuses—we’ve seen front page coverage of how the protests about those events have “turned violent” with fewer investigations of what brought us to the point of protest in the first place. We can point to some excellent stories, of course, but overall, the coverage doesn’t go far enough.


The problem is, in the aggregate, news coverage of crime and violence presents distorted patterns tied to race, age, and frequency that don’t accurately portray “the big picture.” The consistent depiction of crime or criminal justice as a series of isolated events unrelated to any broader context reinforces the idea that violence is random and inevitable. Instead, research shows us violence is both predictable and preventable.

Crime reporting tends to focus on the “next” or “biggest” breaking story. Therein lies the rub: the unusual can seem normal the more it gets repeated. Whether national or local news reporting, we want reporters to follow the full context and consequences of a story, not parachute from one instance to the next.

Additionally, crime reporting tends to be primarily episodic, with very little coverage of solutions or prevention efforts that help stop violence before it starts. If journalists brought these efforts to light, then questions about how our systems and institutions respond to violence would make more sense.

Have you seen any particularly good examples of violence coverage in the media?

Yes. In early 2014, in response to pressure from advocates, the White House established a task force specifically focused on addressing the issue of sexual assault on college campuses and released its first report titled Not Alone.  As a result, news media throughout the country turned their spotlights on colleges and held them there. We saw a number comprehensive stories emerge, including a front page piece by The New York Times in July, which investigated a sexual assault at Hobart and William Smith Colleges in central New York. What struck me about this piece, and much of the new coverage about sexual assault at colleges, is the inclusion of institutional actors and broader discussion of the alleged perpetrators. The story was a high-quality, in-depth report into an institution’s systematic failure to protect its students.

The recent controversy over a similar story by Rolling Stone at the University of Virginia shouldn’t distract reporters from the need to continue to report on sexual assault or on college campuses need to act on it.

How has social media changed the way we cover, interpret or react to violence?

Despite the intoxicating reach of social media, by and large it’s still news coverage that sets the agenda for policymakers. While there’s no doubt that social media ups the ante when it comes to public expression, the reason social media could explode is because of news coverage. We are having a national conversation about violence and the NFL because there was a video recorder in an Atlantic City elevator and a news outlet that broadcasted the story first.

That said, social media is becoming a stronger influence on news choices and frames. Twitter is now a common way to reach out to reporters, while #BlackLivesMatter, #ICantBreathe, #WhyIStayed, #WhyILeft and other hashtags are becoming news stories themselves as people organize around ideas they don’t see enough of in news coverage.

We know from our own research that acts of violence are usually part of an intergenerational cycle of trauma. How can we help the media broaden the lens?

In the newsroom, journalists can start by asking better questions, look for patterns, and make stronger links between past and present. Along with asking “who, what, when, and where,” they can spend more time investigating “why” by bringing public health data to bear and asking about risk factors. Take the Adverse Childhood Experiences (ACEs) Study, as an example. We know the data are clear: the higher people’s ACEs scores are, the more likely they will suffer from chronic disease and mental illness, or be victims of violence. This data are making it easier to understand an expanded definition of violence that includes childhood adversity in all its forms. If all beat reporters knew about ACEs research and the science that informs it they could tell very powerful stories that link systems and structures to health. Reporters could investigate the places that have implemented that understanding about ACEs and ask, “Could that happen in our town”?

But journalists are only half of the equation. Their sources are the other half. If we’re going to have more complete and accurate news about violence then public health and violence prevention advocates must become better sources. To do that, we have to provide solid data and concise answers, and help create news about intervention and prevention apart from specific incidents of violence.

“How important is race as a factor in the way violence is covered in America?”

It’s so important, Eric, that it could have been your first question. The evidence on this is overwhelming. In anticipation of the news from Ferguson, I looked again at Erna Smith’s analysis of news coverage after the Rodney King verdict. Her report prompted me to look at the Kerner Commission report and its assessment of news coverage after the civil disorders across the country in 1967. The fact is we have a longstanding problem we can’t turn away from. I’m willing to bet that by just saying “youth violence” I would conjure a picture of a young man of color in most Americans’ minds. Conflating youth, race and crime is hard to undo. As with violence news generally, the repetition in news coverage makes it seem normal when, in fact, most young people, most people of color, and most young people of color are not violent. The problems with reporting on violence we’ve discussed are a big part of the problem.

But the other part of the problem is that we have too few stories that illuminate the rest of the picture: what people are doing together to create communities that foster health and dismantle structural racism. A harder story to tell, perhaps, but essential if we are to create a Culture of Health.

Thu, 18 Dec 2014 17:59:00 -0500 Eric Antebi Violence and Trauma Guest Posts <![CDATA[Top 10 Signs We are Building a Culture of Health]]> Buncombe Children Playing

Last January the Robert Wood Johnson Foundation alerted the world to its new strategy: To build a Culture of Health for all, one that would allow every one of us to make healthy choices wherever we live, work, and play. A big reach, we know, but we are nothing if not optimistic. So, 12 months on, we asked ourselves—How’re we doing? Pretty good, as it turns out. Here are the top 10 signs that America is moving towards a Culture of Health (in no particular order).

10. The evidence is in—kids are beginning to slim down.

Research published in February shows continued signs of progress toward reversing the childhood obesity epidemic: Obesity prevalence among 2 to 5 year olds dropped by approximately 40 percent in eight years, a remarkable turnaround. There is still much work to do in this area, but at least our youngest kids can look forward to a healthier future.

9. Kids are also eating healthier lunches—and liking them.

In July a study funded by RWJF revealed that 70 percent of elementary school leaders nationwide said their students generally like the healthier school lunches that rolled out in fall 2012; 70 percent of middle school students and 63 percent of high school students also like the meals.

8. mHealth has arrived! Silicon Valley is putting its innovators to work developing mobile apps that will help us get healthier.

When Apple introduced its latest iPhone in June, much of the hullabaloo was around Healthkit, a new mobile app that will help consumers track their health. Google, Samsung, and Microsoft also rolled out health tracking devices and/or platforms this year, developments sure to appeal to millennials.

Walking Meeting

7. The new trend in offices—sitting is bad, walking is good.

A Washington Post illustration showing the dangers to our health of sitting all day became wildly popular this year, and more people started taking their meetings on foot—at RWJF, we love our walking meetings.

6. Cycling takes off.

2014 could be called the year of the bicycle. At least 36 urban areas now have bike sharing programs, up from just six four years ago. Even small cities and towns are embracing pedal power—just look at Cyclobia in Brownsville, Texas, one of six communities to win an RWJF Culture of Health Prize this year.

5. Workplace wellness programs are spreading—even cigarette makers are getting with the program.

Over the next three to five years, 48 percent of employers intend to put in place workplace wellness programs that improve productivity and reduce absences.  Among the more surprising ones—in October, Reynolds American, the second-largest U.S. cigarette company, announced that smoking is banned inside its facilities. “We believe this is the right thing to do and the right time to do it,” a Reynolds American spokesman told U.S. News & World Report. We agree.

CVS In Store Tobacco Quit Sign

4. CVS Health kicks the habit as well, and demonstrates that good health is also good business.

In September CVS stopped selling all tobacco products in its 7,700 stores nationwide, forgoing $2 billion in annual sales. It is the only national drugstore chain so far to take this important step. “Tobacco just doesn’t fit in,”  said CVS’s chief medical officer. CVS’s stock price rose on the news.

3. Voters pass the nation’s first city tax on soda.

In November voters in Berkeley, Calif., passed the nation’s very first tax on sugary beverages, including soda—a major contributor to the obesity epidemic. I know what you’re thinking—Berkeley. But consider all the trends that started in California!

2. College campuses are becoming hotbeds of health.

There are now 1,477 tobacco-free college campuses, up from 446 just four years ago, and the infamous Freshman 15 has shrunk to a Freshman 3 to 6 at many campuses. The Princeton Review even rates college health facilities. A sign perhaps, that the 20-something generation will create their own Culture of Health?

And finally, the Number One sign that we are making progress:

Talk Health Insurance to Me English_Spanish combo ad

1. Thanks to the Affordable Care Act, some 13 million formerly uninsured people are now covered by health insurance.

The rate of uninsured people in the U.S. dropped by more than 30 percent from September 2013 to September 2014. With the next open enrollment period ongoing, the numbers should continue to improve.

So that’s our list, but it’s far from definitive. What do you think we left out? Please share your sign that a Culture of Health is building, in the comments area below. Be great to see a top 20, or 50!

And while you’re at it, any thoughts on what to shoot for in 2015?

Wed, 17 Dec 2014 19:18:00 -0500 Catherine Arnst <![CDATA[Home is My Facebook Page: mHealth’s Potential to Help the Vulnerable]]> La Clinica del Pueblo LaClinica del Pueblo, a federally qualified health center in Washington, DC, serves many Latino patients — and relies increasingly on social media to communicate with vulnerable patients about sensitive topics, such as using condoms to help prevent HIV and sexually transmitted diseases.

Say the words “smartphone user” and “app,” and what comes most readily to mind is probably some hipster pulling out his iPhone to book a ride from Uber. But at last week’s mHealth Summit in Washington, D.C., those words were also linked to far different images—of highly vulnerable people seeking and obtaining health care.


  • At La Clinica del Pueblo, a federally qualified health center (and previous RWJF grantee) based in Washington, D.C., smartphones and Facebook are key communications channels for reaching hundreds of young gay Latino men and transgender women at risk for HIV. The clinic’s executive director, Alicia Wilson, said on one panel at the mHealth conference that La Clinica’s Facebook page now has about 1,000 followers. “It allows us to spread prevention messages and bring people into care who have been marginalized,” alerting them to free counseling, testing and referral services available through the clinic, Wilson said.
  • A company called Healthvana has a Yelp-like feature that allows people to search for places to get tested for HIV or sexually transmitted diseases. They can also register and set up secure accounts to receive the results from partner testing centers quickly and discretely, along with advice about “actionable next steps” to take should the tests be positive, says CEO and founder Ramin Bastana.
  • Based in Britain, but with a growing presence in the United States, a website and social network called Big White Wall offers a “professionally curated community” for people with psychological issues or mental illness—a virtual space where they can stay anonymous and confide in others; take courses on managing depression and other illnesses; and even have secure consultations with therapists via Skype. Endorsed by England’s National Health Service, and now offered in a “soft launch” phase to enrollees of Kaiser Permanente Northwest, the site demonstrates that “the depth of the need for alternative person-centered health care across the globe is really profound,” says founder Jen Hyatt.

These sites and services demonstrate the growing reach into health and health care of mhealth, e-health, and digital and social media. Long-established health care providers such as the Mayo Clinic have embraced the technologies, as have multiple new entrants into the field. A study by Startup Health, an organization that invests in digital health companies and serves as a network for digital health entrepreneurs, forecasts that by the end of 2014, digital health companies will have raised about double the $2.8 billion in funding raised in 2013—and that the growth in this sector shows no sign of abating.

The shift toward mHealth could be fueled further as health care transitions away from fee-for-service payments based on volumes of doctor “visits,” and more toward capitation and other payment models that incentivize provision of care in novel and more efficient ways. And with nearly six in 10 adult Americans owning a smartphone—and three out of four adults who access the internet using a social networking site such as Facebook—there’s more opportunity than ever to employ these technologies to narrow health disparities, and better address the needs of those living on society’s margins.

Noting that blacks, Hispanics and Latinos are disproportionately affected by HIV in the U.S.—and may also have smartphones—Healthvarna’s Bastana believes that “we can dramatically reduce HIV and STDs through our radically different approach utilizing technology in a smarter way.” Meanwhile, La Clinica’s executive director Wilson says some of the Latino immigrants that her clinic serves live a “nomadic” existence, often traveling back and forth between their home countries and the United States, or changing residences frequently once here. As a result, “their Facebook profile is their ‘home’,” she said, making the social network the only practical way to reach them.

“In a social network, our lives are witnessed, [and] we grow and we change with others,” Jen Hyatt said in a TEDMED talk earlier this year. Now the opportunity to employ mHealth in growing the Culture of Health is at hand.

Tue, 16 Dec 2014 12:09:00 -0500 Susan Dentzer Health Data and IT <![CDATA[How Cataract Surgery Helped Me See the Future of Health Transparency]]> Robotic Surgery

More and more health care costs are shifted to consumers. So why, asks RWJF President and CEO Risa Lavizzo-Mourey, can’t we easily discover and compare health care costs and quality?

Here’s how the subject came up. Recently, Lavizzo-Mourey underwent cataract surgery at an outpatient center in Philadelphia. No matter whom she talked to—and she was shunted from one person to the next—she could not learn the all-in cost of the procedure.

Lavizzo-Mourey finally did manage to find out the cost of her surgery: $2,000, including co-pays and deductible. But the whole episode, she says, is illustrative of a larger problem.

Writing in a recent blog post on the professional social networking site LinkedIn, Lavizzo-Mourey asks: “Could there be a clearer example of the lack of transparency in the U.S. health care system?”

To get the information we need, the Robert Wood Johnson Foundation is funding a set of studies to help us better understand how greater price transparency influences consumer and provider decisions. “And in March,” Lavizzo-Mourey adds, “we will host a summit on transparency that will attempt to come up with more answers."

Along those lines, RWJF last year issued a challenge to developers to devise consumer-friendly tools to parse the abundant hospital price data released by Medicare. The winner? Consumer Reports, for the Consumer Reports Hospital Adviser: Hip & Knee, a personalized app for health care consumers seeking the best hospital for hip or knee replacement surgery.

You can help us move the cost and quality needle forward. Do you know of any other price/quality apps or tools? Let us know.

Fri, 12 Dec 2014 13:34:00 -0500 Risa Lavizzo-Mourey Health Care Costs Health Care Quality From the President <![CDATA[ How to Build a Healthier Millennial]]> Game of Life Photo: Will Folsom


Millennials get a lot of attention as today’s trendsetters. What are they buying? What social media are they using? How are they voting?  But there is an equally important question that is rarely raised: How healthy are 20-somethings? A new report explores that last question, and the answers are not good. An even better question might be: What’s standing in the way of healthier, more productive lives for millennials?

Adults between the ages of 18 and 26 are "surprisingly unhealthy," according to the report from the Institute of Medicine (IOM) and the National Research Council (NRC). One out of every four young adults is obese, and those numbers are rising. One in 10 has suffered from untreated mental illnesses within the past year. What lies behind these disturbing trends might be a much bigger issue than what young people choose to eat or how they handle stress. The report points to big-picture causes—broken pathways from quality education to solid jobs, and widening disparities that make it harder for marginalized young adults to succeed.

The report explains that millennials need more education than past generations to stay competitive in today’s job market, but the percentage of young adults in the United States either not in school or working is greater today than it was 25 years ago. Because a person’s health is tightly linked to their level of education and economic stability, these social challenges make this population more vulnerable than ever before. For young adults aging out of the foster care system or those with history in the juvenile justice system, there is an even greater risk of poor health.

We want to reverse these trends. Though it reports some grim statistics, the IOM report also highlights ways we can work together with young adults to build communities where they—and the families they will raise—can succeed.  

For starters, the report calls for state governments and other partners to experiment with new ways to boost high school graduation rates and better prepare students for colleges and careers. While that may sound daunting, there’s a reason for hope: Two decades ago, a wave of  "zero tolerance" policies for student misbehavior led to an epidemic of suspensions and expulsions that disproportionately targeted minority students. This harsh and unfair approach to discipline was linked to higher rates of student absences, disengagement, and school dropouts. Today, these policies are being replaced with common sense alternatives that consider the legacy of trauma that many kids experience that often contribute to misbehavior.  Where those changes are happening, more kids are staying in school and graduation rates are going up

Millennial parents are a particularly critical group, and a larger one than many might suspect—44 percent of U.S. women still have a child before age 25. Without adequate professional skills and income to support a family, the resulting stress can not only limit this generation’s chances for success but also that of their children. The report emphasizes the need for interventions and preventive services that address the needs of young adult parents and their children at the same time. Programs like Nurse Family Partnership (a nursing home-visit program for low-income moms) and Child First (a program to connect young families to community and mental health support) show that with the right supports, parents can gain greater stability in their lives by securing jobs, higher quality housing, and more education, while their young children get off to a healthier start. One trial found that moms in the Nurse Family Partnership program were twice as likely to be employed by the time their child was two years old when compared to a control group not in the program. Right now, these programs are the exception to the rule. They ought to be the norm.

On the health care side, we need better screening and other clinical prevention services for young adults that address health problems before they become significant. The good news is our nation is in a much better position to improve the health of young adults—and close the gap on untreated illness—due to the Affordable Care Act (ACA). According to the Dept. of Health and Human Services, as of 2012 there were three million young adults newly insured under the ACA, and that number has surely risen since.

Young adults represent so much of the creative energy and potential of our nation, and yet they have been stuck in our collective blind spot. They are our future, and as parents, they will profoundly influence the health of generations to come. The IOM report helps to make visible the barriers and challenges young adults face, while providing realistic solutions. Now it is up to us to work together with young people to create a healthier future for generations to come.

Are you aware of efforts that are having success improving the health and well-being of young adults? Let us know.

Thu, 11 Dec 2014 16:50:00 -0500 Kristin Schubert Social Determinants of Health Health Disparities RWJF Staff Views <![CDATA[Data for Health: Live from Charleston]]>

The Robert Wood Johnson Foundation had been running a five-city listening tour to learn how to better use Data for Health; the final stop was Charleston, SC, on December 11.  

While the cities we have visited have all been very different the first U.S. capital of Philadelphia to Des Moines, the corn capital; from the desert city of Phoenix to San Francisco, city by the bay—all are committed to using data and information to help improve the health of their communities.

One of the things I keep hearing is that health data needs to be communicated in a way that’s easy for a patient to interpret. I sure can relate to that! I can remember being in the hospital, on full bed rest for a week before I had my twins. And although I generally had confidence in my doctors, it was a little scary to not totally understanding why they decided to schedule my C-section early. They talked about the chances of this and the chances of that, but it was not clear to me what they were really saying, and quite frankly, in such a stressful situation, I wasn’t thinking very clearly. 

Renee Woodside with twins Renee Woodside with her twins Maggie and Zachary

So as a patient, I’m excited to see this all unfolding. I hope that in some small way (or maybe even in a big way), it will kick-start a process to making health information, just that. Informative.

The information from the five “Learning What Works” events will inform a report that will be released in early 2015. Learn more about Data for Health and join the conversation on Twitter and Facebook using the hashtag #Data4Health.

Data for Health: Learning What Works for Charleston details:

DATE: Thursday, December 11

TIME: 9:00 a.m. — 10:30 a.m. ET


  • David Blumenthal, MD, president, The Commonwealth Fund
  • Karen DeSalvo, acting assistant secretary for health, US Department of Health and Human Services
  • Bernie Mazyck, president and chief executive officer, South Carolina Association for Community Economic Development
  • Ida Sim, MD, PhD, professor of medicine, University of California, and co-founder, Open mHealth
  • Lisa Wear-Ellington, chief executive officer, South Carolina Business Coalition on Health



Tue, 2 Dec 2014 18:21:00 -0500 Renee Woodside Health Data and IT <![CDATA[Seizing Opportunities to Reinvent Public Health]]> A doctor talks in a friendly manner to a disabled patient sitting in a wheelchair

“The only thing we know about the future is that it will be different,” wrote the late management guru Peter Drucker.  To the list of society’s sectors that are struggling with that conclusion, add government-funded public health.

State and local health departments face growing challenges, including infectious disease threats such as Ebola and chikungunya; a rising burden of chronic illness; an increasingly diverse population; even the health impact of global warming. At the same time, fiscal constraints accompanying the 2007–2008 recession and its aftermath hammered local, state, and territorial health agencies, which lost nearly 30,000 jobs—6 percent to 12 percent of their total workforces—from 2008 to 2013.

With fewer hands—and heads—to carry out the critical and evolving work of public health, agencies have little choice but to adapt, says a recently published report funded by the Robert Wood Johnson Foundation and produced by the nonprofit organization RESOLVE. “We have to rethink and reimagine what governmental public health does, and how we do it,” says Paul Kuehnert, who directs the foundation’s work on bridging health and health care and formerly served as the county health officer and executive director for health in Kane County, Ill.

As the RESOLVE report outlines, a traditional role of public health agencies as direct service providers—for example, offering immunizations; family planning; and preventive screenings, especially to low-income populations—is likely to fade, as many of these services are now covered in health insurance policies under the Affordable Care Act. The trend is likely to open up opportunities for health departments to move into new roles as “chief health strategists” for a community or region, and to convene others to shape and carry out broad plans for improving population health.

Around the country, a number of public health agencies and departments are already assuming this role, and adopting key practices enumerated in RESOLVE’s report. Consider two examples, one local, one state, of health departments that are leading the way:

The Public Health department of Seattle and King County, Wash., is employing several key practices identified in the RESOLVE report: Identifying leading causes of illness, injury and premature death; collaborating with a broad array of allies; building bridges to the health care system; and developing strategies tailored to today’s communities.  A case in point is the Global to Local Initiative, which focuses on the cities of SeaTac, near the Seattle airport, and Tukwila—two immigrant-rich areas where more than 80 languages are spoken, and the overall health status is on a par with some communities in sub-Saharan Africa.

Under the initiative, the health department partnered with a premier local hospital and health system, Swedish Health Services; HealthPoint, a local nonprofit network of medical, dental, and school-based health centers; Washington State University; and the Washington Global Health Alliance (which represents the state's largest global health research and delivery organizations, as well as global health nonprofits such as the Bill & Melinda Gates Foundation). The partnership’s focus is “a simple one, which is, let’s take what works in other places and apply them here,” county health officer David Fleming explains in a video. As a result, the partnership is now adapting approaches used in resource-poor settings abroad to improve health locally. These include training and developing a cadre of community health promoters to work with the local population—including many African immigrants—and developing a community initiative to spark entrepreneurship in food-related businesses aimed at promoting healthy eating.

Maryland’s State Department of Health and Mental Hygiene, meanwhile, is also engaged in initiatives employing principles from the RESOLVE report. One is drawing on real-time data and channeling it to communities to help them improve health.

Under an arrangement struck with the federal government and private insurers, Maryland’s hospitals now effectively operate under global budgets—a reality that gives them new incentives to curb costs by keeping people healthy and out of the hospital. Thanks to the state’s health information exchange, data on the top five causes of hospital admissions and readmissions can readily be compiled and given to communities so they can address the underlying health issues.

Laura Herrera Scott, Maryland’s deputy secretary of Health and Mental Hygiene, points to a collaboration now occurring on Maryland’s largely rural Eastern Shore. There, a 62-bed hospital, —is drawing on the state-compiled hospital data to identify people with conditions such as congestive heart failure and diabetes who are frequent hospital users. Through a partnership with the Worcester County health department, and with the aid of a federal grant, the hospital has instituted a patient-centered medical home approach in its seven primary care practices that is working to keep more of these patients healthy and at home.

“Destiny is no matter of chance. It is a matter of choice,” said the famed American orator and politicians, William Jennings Bryan. Public health departments now have the chance to forge new roles for themselves, and improve the health of millions of Americans as well.

Join a Robert Wood Johnson Foundation “First Friday” Google+Hangout to discuss New Strategies in Public Health, featuring Paul Kuehnert, David Fleming, Laura Herrera Scott and Barbara Ferrer (the Chief Strategy Officer, W.K. Kellogg Foundation and former executive director of the Boston Public Health Commission). To participate, sign up at

Tue, 2 Dec 2014 10:57:00 -0500 Susan Dentzer Public and Community Health National Washington (WA) P Maryland (MD) SA Susan Dentzer: Toward a Healthy America <![CDATA[Health Data Outside the Doctor’s Office]]> A man rides a bike, with a child on a bike kid trailer behind him. "... if a city wants to plan bike infrastructure, they could invest millions in conducting studies into where bike lanes should go, or they instead could quickly access information generated by bikers, such as Map My Ride or Strava, to see where people are actually riding."

Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive. If we’re to have an accurate picture of health, we need more than what is currently captured in the electronic health record.

That’s why the U.S. Department of Health and Human Services (HHS) asked the distinguished JASON group to bring its considerable analytical power to bear on this problem: how to create a health information system that focuses on the health of individuals, not just the care they receive. JASON is an independent group of scientists and academics that has been advising the Federal government on matters of science and technology for over 50 years.

Why is it important to pursue this ambitious goal? There has been an explosion of data that could help with all kinds of decisions about health. Right now, though, we do not have the capability to capture and share that data with those who make decisions that impact health—including individuals, health care providers and communities.

The new report, called Data for Individual Health, builds upon the 2013 JASON report, A Robust Health Data Infrastructure. It lays out recommendations for an infrastructure that could not only achieve interoperability among electronic health records (EHRs), but could also integrate data from all walks of life—including data from personal health devices, patient collaborative networks, social media, environmental and demographic data and genomic and other “omics” data.

This report, done in partnership with the Agency for Healthcare Research and Quality (AHRQ) and the Office of the National Coordinator for Health Information Technology (ONC) with support from the Robert Wood Johnson Foundation, comes at a pivotal time: ONC is in the process of developing a federal health IT strategic plan and a shared, nationwide interoperability roadmap, which will ensure that information can be securely shared across an emerging health IT infrastructure.

Data sharing is a critical piece of this equation. While we need infrastructure to capture and organize this data, we also need to ensure that individuals, health care professionals and community leaders can access and exchange this data, and use it to make decisions that improve health.

Initiatives like Blue Button and OpenNotes are already empowering patients and allowing them to take a more active role in their care. But giving individuals access to integrated streams of data from inside and outside the doctor’s office can increase the ways in which people engage directly in their own health and wellness.

Broadening data beyond the four walls of the doctors’ office will give health care professionals a more holistic view of their patient’s health. Sharing that data among members of the health care team will also lead to greater care coordination. Ensuring this data is used in meaningful ways will of course require training our health care workforce to a higher level of quantitative literacy.

Efforts now under way like County Health Rankings guide community leaders in setting priorities for improving health. With access to more data, communities can make faster, smarter decisions that support health—creating healthier homes, schools, workplaces and neighborhoods. For example, if a city wants to plan bike infrastructure, they could invest millions in conducting studies into where bike lanes should go, or they instead could quickly access information generated by bikers, such as Map My Ride or Strava, to see where people are actually riding.

While there are an enormous number of uses for the data that we can imagine and many more we cannot yet anticipate, it will be vitally important that we all make every effort to protect the privacy and security of these data. The report highlights numerous ways to protect the data in ways that benefit health and wellness, while also prompting accelerated innovation.

We’re excited by the potential to take this emerging data and turn it into useable information to build a Culture of Health—a nation where everyone has the opportunity to live longer, healthier lives.

We encourage everyone—consumers, providers, employers, purchasers, health IT developers and others—to take a look at the report and share your comments below. We look forward to hearing from you.

Tue, 2 Dec 2014 09:46:00 -0500 Karen DeSalvo, HHS/ONC Health Data and IT Patient-Centered Care <![CDATA[Improving Health through Collaboration: The BUILD Health Challenge]]> Brownsville Farmers’ Market Enhancing community health: Customers buy produce at the Brownsville Farmers' Market in the Culture of Health Prize-winning city of Brownsville, Texas

Here at the Robert Wood Johnson Foundation, the name of the game is collaboration. Our goal—to build a Culture of Health in which getting and staying healthy is a fundamental societal priority—is an ambitious one, requiring coordinated efforts among everyone in a community, from local businesses to schools to hospitals and government. It also calls for those of us at the Foundation to collaborate with other like-minded groups to address the complex challenges that stand in the way of better health.

That is why we are so pleased to be a partner in the BUILD Health Challenge, a $7.5 million program designed to increase the number and effectiveness of community collaborations to improve health.

Established along with our partners at The Advisory Board Company, the de Beaumont Foundation, and the Kresge Foundation, the BUILD Health Challenge will make two kinds of awards, for planning and for implementation. The awards are aimed at strengthening community partnerships in order to improve the health of low-income neighborhoods in cities with populations greater than 150,000. We are especially interested in seeing collaborative efforts that leverage leadership from public health departments, hospitals and health systems, and community organizations.

There are many other partners that will need to be engaged; who and how will vary depending on each community and their goals. And while the BUILD Health Challenge will focus on urban neighborhoods, we know that this type of collaborative work is happening in communities of all sizes across the nation.

The emphasis on fostering collaborative relationships in communities mirrors the focus of our annual Culture of Health Prize. Last June, we announced the six winners for 2014, all communities that place a high priority on developing innovative partnerships for improving the health of their residents. The prize winners recognize that a host of factors, such as education and job training opportunities, play a part in boosting health outcomes.

Consider prize winner Spokane County, Wash. In 2009, Priority Spokane, a non-profit with members from local businesses, government, community organizations, health care providers, public health leaders, and schools, polled residents about the community’s pressing issues. The most urgent need it uncovered was education. What’s more, a local health department report linked lack of access to quality education to poor health and lower incomes. Improving educational opportunities and raising high school graduation rates could improve overall health, they determined.

To that end, the group spearheaded multiple innovations, from creating a new high school with backing from a local business—with a curriculum related to current and future workforce needs in the region—to a web-based interactive system that enables teachers to monitor attendance and grades, so they can step in before excessive absences get out of hand. The result: Spokane’s high school graduation rate rose to about 80 percent last year compared to less than 60 percent in 2006.

Another winner, Brownsville, Texas, is one of the poorest metro areas in the country, with high levels of diabetes and obesity, even among higher-income residents. In 2001, after researchers from the University of Texas School of Public Health presented alarming health data to local residents, the Community Advisory Board was formed with community, business, health care, and education leaders coming together to address these health issues.

Around the same time, city officials and large employers in the area formed a long-range plan called Imagine Brownsville. Working with the Community Advisory Board, they developed an ambitious strategy for health-promoting initiatives, such as traffic-free Sundays that allow thousands of residents to walk, run, cycle, and enjoy outdoor activities; new bike trails, sidewalks and a complete streets policy that allow residents to be active and safe all week long; supporting “promotoras”—health workers who engage and educate people who otherwise wouldn’t have access to health care; and cultivating community gardens in economically depressed, food-insecure neighborhoods.

Like the Culture of Health Prize, the BUILD Health Challenge is all about encouraging collaboration. It is structured to identify the most promising partnership models, provide resources to accelerate their work, connect them with other innovators, and disseminate best practices.  Planning Awards will offer up to $75,000 to awardees for one year, with the potential for an additional year of funding. Implementation Awards will be up to $250,000, with a two-year duration. Communities can also apply for low-interest loans to support complementary community revitalization efforts.

BUILD, by the way, is an acronym for the core principles of the Challenge:

  • Bold: Novel partnerships that tackle community health challenges in innovative ways.
  • Upstream: Addressing community factors, from affordable housing to access to healthy food, that shape health before any clinical intervention is necessary.
  • Integrated: Collaborative strategies that integrate the capacities and competencies of each partner.
  • Local: A focus on the neighborhoods, census tracts, or zip codes that are experiencing significant obstacles to health.
  • Data-Driven: A commitment to share and use data to define problems, target interventions and provide opportunities for continuous learning and improvement. 

Applications are due by 5 p.m. ET, January 16, 2015. You can join us December 2 at 2 p.m. ET or December 4 at 1 p.m. ET for a conversation about the program and application process.  I look forward to seeing the innovative proposals you submit.                    

You can find out more about the Challenge at

Wed, 26 Nov 2014 08:59:00 -0500 Abbey Cofsky Public and Community Health Disease Prevention and Health Promotion <![CDATA[If You’re Not at the Table, You’re on the Menu]]> IMG_3113

I hear the phrase in the title used a lot when people talk about the important role advocacy plays in health policy-making, and it’s very appropriate. But there is one voice often missing in the conversation about how to fix the way we deliver, pay for, and think about health care: Consumers, the very people the system is designed to help. We must make sure that the people at the center of the health care system have a say in how it changes.

Like many of you, I read a lot about what’s broken. Prices are too high, costs aren’t clear, and a lot of procedures may not help patients. Sometimes they even hurt. Furthermore, a lot of what determines our health happens outside of the hospital and doctor’s office. But how can we—patients, doctors, nurses, employers, foundation, nonprofits, and others—connect those factors to health care? At the Robert Wood Johnson Foundation (RWJF), we know that in order to build a Culture of Health, we must rid our health care system of wasteful spending and ensure that everyone has access to quality, affordable health care.

In New Orleans last year, consumer advocates met and discussed the challenges of—and opportunities for—finding systematic ways of ensuring that consumers' concerns are reflected in health policy conversations. Providers, insurers, and employers are all looking at how to deliver better care and pay for care differently, but organizations that represent consumers also need to be at the table, in an organized and sustained way. That table might be a policy-making table, such as a state health department, or it might be the table at a board room in a hospital system.

To help meet this need, RWJF recently awarded a grant to Consumers Union to create an information hub for consumer advocates who are addressing health care value issues. The hub’s purpose is to support and connect consumer advocates across the U.S., arm them with comprehensive fact-based information, and help them advocate for change. Beginning in March 2014, the hub will include a website that houses material that advocates need when entering into health policy conversations, such as short issue briefs that help put emerging research into context, and relevant material from other sources, consolidated in one place.

Just as important—what happens offline. The hub will connect advocates to one another, as well as to subject matter experts, to make sure they take advantage of what others are learning.

In order to support health care value advocates at the state or local level, the Foundation will issue a request for proposals (RFP) to fund a limited number of advocacy coalitions that will pursue policies and systems changes that increase value. These efforts could include a range of agendas, such as payment reform, or linking population health with the health care system. We will work with Community Catalyst, a leader in supporting state and local consumer health advocacy work, to manage this grant-making effort and provide technical assistance across a range of advocacy capacities. Community Catalyst has worked for years with RWJF and other foundations to guide large-scale advocacy efforts; their deep bench of experts will be a great asset as we support consumer advocates. Organizations will receive an invitation to submit a letter of intent (LOI) to apply for funding in December 2014. Based on the LOIs, selected organizations will be invited to submit full proposals.

We also expect that the resource hub and grant-making effort will share information and resources, enhancing one another’s efforts. These two organizations, Consumers Union and Community Catalyst, have strong track records in this field, and we are proud to work with them. Over the course of these projects, we hope to see consumer advocates become even more involved in issues of payment and delivery system reform. Our hope is for these issues to continue to become a focus for consumer organizations, and for consumers to have a stronger and more developed voice as more states and region consider how to get better value from our health care dollars.

If you’re a consumer advocate, you don’t need to wait to get involved. Feel free to seek help from Consumers Union in advance of the website launch; advocates can contact Lynn Quincy AT If you would like to ensure that your organization receives an invitation to submit an LOI from Community Catalyst, please register here.

Let us know what you think about our plans by leaving a comment below. What else we should consider? What other approaches we should be pursuing?

Tue, 25 Nov 2014 11:03:00 -0500 David Adler RWJF Staff Views <![CDATA[The “Resilience Dividend” and the Culture of Health]]> Red Hook Ikea The Red Hook IKEA after Superstorm Sandy. Credit: Flickr user Ham Hock

Red Hook, Brooklyn, is named for its original red clay soil, and the “hook” of land that juts out into Upper New York Bay. Two stores located close to the water there fared very differently during Superstorm Sandy, which ravaged parts of New York and New Jersey in October 2012.

Judith Rodin, president and CEO of the Rockefeller Foundation, recounts the saga in her new book, The Resilience Dividend: Being Strong in a World Where Things Go Wrong.

Ikea, the Swedish household goods chain opened its Red Hook store in 2008, built on pilings with a ground floor garage, an emergency generator, and show rooms and inventory well above ground level. Although its parking lot flooded during the storm, the inventory was untouched, and the store recovered quickly. It functioned as a local office for representatives from the Federal Emergency Management Agency and served as “a neighborhood hub for the distribution of food, clothing, and other supplies,” Rodin writes. The store also “strengthened its neighborhood connections by taking on a new and important role.” 

By contrast, Fairway, a local supermarket chain, was housed nearby in a 19th century warehouse building that was flooded so badly it had to be gutted, renovated and entirely restocked with inventory. The store, the only large supermarket in the area, didn’t reopen until four months after the storm hit. Rodin’s verdict: “It lost business and lost its connection with the neighborhood during a critical time.”

Rodin isn’t trying to apply Aesop’s fable about the ant and the grasshopper to modern-day retailing; she’s underscoring how forward-thinking communities can take stock of likely dangers, prepare for the worst, and reap a “dividend” later. Taking her theme further, communities — or even countries — that are struggling with health issues could also take proactive steps, and achieve a “resilience dividend,” too.

Consider three pressing health challenges: Obesity, infectious disease epidemics, and climate change.

Obesity: A new McKinsey report says that nearly 30 percent of the world’s population is now overweight or obese, and obesity causes about 5 percent of deaths worldwide. Any community or country seeking to reap a “resilience dividend” from obesity would attack the many probable causes, from shaping a healthier food supply to boosting levels of activity through new parks.

The U.S. already abounds with examples where communities have responded and dividends have been earned. Take the movement to create new parkland out of abandoned railways, such as New York City’s Highline, a 1.5 mile-long “linear” park and walking trail built from an unused elevated freight rail line. City officials estimate that the park will generate $4 billion in private investment and $900 million in additional tax revenues over the next 30 years, part from the real estate boomlet in the surrounding neighborhoods. Atlanta officials are hoping for a similar effect from the Beltline, a network of public parks and trails now being developed along 22 miles of unused railroads.

Infectious disease epidemics: As Rodin notes, disruptions can become disasters “when leadership fails or other human-related factors exacerbate the problem.” In retrospect, it’s clear that this phenomenon contributed to the rapid spread of Ebola in West Africa. But the initial response in the US was also flawed; witness the differing policies that the US military, the Centers for Disease Control and Prevention, and various state governments adopted toward quarantining US health-care workers once they returned from Africa.

University of Michigan medical school professor Howard Markel points to such longstanding problems as “hazy lines of authority and fierce internecine battles among local, state, and federal health agencies as well as individual hospitals and healthcare systems” (How the Ebola Quarantine Became a States’ Rights Issue). A more coordinated set of responses would surely reap a resilience dividend, which could include greater public confidence in epidemic-control measures, and greater willingness of U.S. health care workers to help out overseas.

Climate change:  This phenomenon has emerged as “an undeniable contributor to the severity and extent of [global] disruptions,” Rodin writes. Extreme weather is a factor in the instability seen in Africa, Asia, and the Middle East. The Natural Resources Defense Council predicts that excessive heat caused by climate change could kill more than 150,000 Americans by the end of the century in the nation’s 40 largest cities.  

Although prospects for achieving a new global climate change agreement appear uncertain, efforts to mitigate the damage are gaining steam. Rodin cites Via Verde, a housing development in New York’s South Bronx, where gardens not only boast healthy fruits and vegetables for harvesting by residents, but “provide a soft solution to climate change mitigation by dissipating heat and absorbing water runoff.”

Winston Churchill may have admonished, “Never let a good crisis go to waste,” but “people do ‘waste’ a crisis, by which I mean they do not take the opportunity to address their vulnerabilities nor do they take action to make positive change and improvement,” Rodin writes. Given the clear U.S. health crisis, it’s time to seek an even greater resilience dividend from building a Culture of Health. 

Tue, 25 Nov 2014 08:23:00 -0500 Susan Dentzer Emergency Preparedness and Response <![CDATA[Data4Health: Live from San Francisco]]>

Leading national experts discussed using data to build a Culture of Health.

DATE: Thursday, December 4
TIME: 12 p.m.—1:30 p.m. ET/9 a.m.–10:30 a.m. PT


  • Karen DeSalvo, acting assistant secretary for health, US Department of Health and Human Services
  • Andrew Rosenthal, group manager for platform + wellness, Jawbone
  • Gary Wolf, co-founder, Quantified Self Movement
  • Roni Zeiger, CEO, Smart Patients

Blog post by Ivor Horn, MD, Advisory Committee Co-Chair and San Francisco MC

It has truly been a fun experience working with the team at RWJF on the Data for Health Initiative. Since we embarked on this journey at the end of October we have been moving at break neck speed to learn how people throughout the country want to use data to build a Culture of Health. As co-chair of this initiative with Dave Ross, director of the Public Health Informatics Institute, I have had the honor of being a “fly on the wall” during discussions in three amazing cities (Philadelphia, Phoenix, and Des Moines). Each session started with insights from local leaders actively engaged in using data to better understand the communities and populations that they serve. But the power of the meetings has really been the content of the Q&A sessions after the talks. This is when people in the room–the folks with “boots on the ground”–give their input.  


Ivor Horn, Seattle Children's Hospital

In addition to interacting with brilliant, passionate advocates for health, I have usually walked away from each meeting with as least one key lesson, and I take that lesson to the next meeting. In Philadelphia, one of the participants made a statement that captured the true essence of why we are doing this–she said we need to move from using data to ask “What’s the matter?”  to instead ask “What matters to you?”

In Phoenix, one of our participant experts reminded us that we don’t just need “big data” we need “long data” as well. We need to understand how things are changing over time in order to understand the interventions that make a difference in people’s lives.

Our most recent visit, to Des Moines, just blew me away. The richness of the conversations made me want to stay for another day (and the weather almost did). Someone brought up the importance of the “usability” of big data.  We need to collect it, share it, and use it. 

WOW! Just WOW!

To get an even better flavor of the dialogue so far, check out Storify summaries from Philadelphia, Phoenix, and Des Moines, and previous blog posts by Mike Painter, Susannah Fox, and Matthew Trujillo.

We are compiling all the information from the discussions; after the meetings, we will develop a report in collaboration with our expert committee, to be released by RWJF in Washington, D.C., in the spring of 2015. It is our hope that this report will lend voice to those who weren’t in attendance but have a lot to contribute, AND those who are in D.C. all the time. 

So I ask you, “What should using data to build a Culture of Health look like in the future? And how do we get there?”

The next step is yours.


Thu, 20 Nov 2014 15:47:00 -0500 Culture of Health Blog Team Health Data and IT <![CDATA[Our Focus Might Change, but We’re Still Guided by Our Research]]> slide_girl

There is change afoot at the Robert Wood Johnson Foundation as our entire organization reorients its focus to implementing our Culture of Health strategy. At the heart of this new approach is the belief that everyone—regardless of their ethnic, racial, geographic or socioeconomic circumstances—should have the means and the opportunity to lead the healthiest lives they can. Achieving a Culture of Health requires us to broaden the understanding that good health is far more than the absence of illness; where we work, where we live, what we eat, and where our children play and go to school fundamentally affect our ability to lead healthy lives.

Looking ahead, we see this new focus on building a Culture of Health as catalyzing a larger national movement toward real societal transformation—a chance to eliminate health disparities caused by social, environmental, and economic factors, and a powerful way to improve and advance public health. This is a big challenge for all of us, but there are significant pockets of progress around the country where a diverse range of activities is already driving such transformation.

Alonzo Plough Headshot Alonzo L. Plough VP, Research-Evaluation-Learning and Chief Science Officer

How do we plan on realizing these ambitious goals? It really comes down to continuing what RWJF has always done best: identify and support research that promotes progress in improving the health and well-being of our diverse populations. The Foundation has funded such research for more than 40 years, greatly contributing to a common understanding of the major health and health care issues of our time. That’s a legacy we’ll continue even as our research efforts focus more intently on understanding and realizing our vision, and finding the most effective ways to measure our progress. Our grant-making will always be grounded in sound research, good data, and strong evidence that informs the discussion and leads to a healthier nation.

As the vice president for Research and Evaluation and chief science officer, this heightened focus on research is especially gratifying to me. Although I am relatively new to the Foundation—I joined in January 2014—my staff and I have been fully engaging people both within and outside of our organization, in helping us shape the vision for RWJF’s extensive research and evaluation efforts across all areas of study.

As we continue to make these connections and work in tandem to achieve our strategic goals, I am excited to announce that significant funding will be available next year to pursue new research directions that can help us build and strengthen the evidence base. Specific research strategies will include exploring the most promising trans-disciplinary  approaches for advancing our strategy: identifying action–oriented research that can create real cultural change through engagement with key populations and sectors; and expanding and deepening our relationships with emerging research fields and experts not usually associated with health and health care. We will continue supporting ongoing RWJF work on issues that support our strategy.

Over the next few months, with your help, we will translate our strategic framework into a set of tangible measurements that resonate at all levels—from health professionals to community members to policymakers. To better prioritize our research we have identified four interrelated “Areas of Action” that will inform all future work at RWJF. If we can make strong progress in all of these domains, we believe we can move the needle further.

Areas of Action:

1) Building a Shared Value of Health

This Area of Action focuses on engaging communities, providers, and advocates in understanding social and economic determinants of health. When people join forces and place a high value on health they are more likely to demand health-affirming policies and practices. Many of our current partners and grantees are likely to find their work falls within this Area of Action, including Healthy Communities, providers, and organizations who are trying to reduce chronic illness in underserved communities, and advocates for local policy and environmental changes to prevent childhood obesity.

2) Fostering Collaboration to Improve Well-Being

Let’s face it, the U.S. has some serious health issues, and we can’t rely on any one sector to solve them alone. Leaders across sectors, including health professions, academia, business, and government, must bring their skills to the table and work together to improve health in communities and across the nation.  In this Action Area, an activity might bring policymakers, school health officials, local businesses and parents together to achieve healthy weight for children. In others, employers and health insurers might team with community partners on wellness programs to improve both worker and broader community health.

3) Increasing Equity in Healthy Community Environments

Your ZIP code should not negatively determine your health status—nor should your race, income, or level of education. All residents deserve to live in neighborhoods that are safe and free from environmental threats. They should have access to nutritious and affordable food, recreational facilities, healthy school environments, and access to bike trails and sidewalks. This Area of Action focuses on interventions that promote health through equal access in all communities to activities and conditions that promote wellbeing where we live, work and play.

4) Re-Envisioning Health and Health Care

The current health care system remains too fragmented, too costly and too out of reach for too many people. This Action Area focuses on improving access to high-quality, effective, prevention-focused and affordable health care, for everyone around the country. Specific activities will include reducing overuse or misuse of services, increasing cost transparency, and improving care coordination and prevention strategies. Collaboration will be a key focus. For example, when providers are linked with community partners they can better address the complex health and socioeconomic factors affecting many lower-income people with chronic disease.

It's a lot to take in, but we'll continue to break it down for you with stories of progress, sharing evidence from innovative projects and research directions, new research funding opportunities, and robust measurement tools to track our national progress in building a Culture of Health.

There's a quick and easy way to keep informed of our work and progress. Sign up for our weekly e-newsletter, Advances.

Wed, 19 Nov 2014 13:47:00 -0500 Alonzo L. Plough RWJF Staff Views <![CDATA[What We Learned from the First Open Enrollment Period, and What to Expect from the Second]]>
A man fills out an insurance application

It seems like just yesterday we were celebrating the victories from the first open enrollment period under the Affordable Care Act. More than 8 million consumers signed up for coverage through state and federal marketplaces, and millions more enrolled in Medicaid.

As the spring of success gave way to the summer of planning, we are once again in the autumn of enrollment. As work gets rolling for the second open enrollment period, it is an opportune time to reflect on lessons learned from the first open enrollment period, especially since the second one is shorter and there are fewer navigator resources available from the federal government.

It Is Not Just One (Touch) and Done

We learned that many consumers needed multiple contacts and in-person help to get through the enrollment process. According to Enroll America’s State of Enrollment report, “With each contact from an Enroll America volunteer or staffer, consumers became more likely to successfully enroll.” They found this effect was particularly strong among African-American and Latino consumers.

Results from a survey conducted by PerryUndem found that while 52 percent of consumers enrolled online on their own, 20 percent got help on the phone and 18 percent got help in person. It is also important to note that Latinos were much more likely to rely on in-person help. Among Latinos who enrolled, 34 percent got in-person help. Every foundation will approach this work differently, but given the importance of multiple contacts with consumers, foundations may want to think about how to incorporate information about enrollment into multiple areas of work, so that they are consistently reinforcing the message.

"Never Put Off Until What May Be Done Day After Tomorrow Just As Well.”
 —Mark Twain

All of us procrastinate. It is a natural tendency. Last year, we saw huge upticks in enrollment numbers during the final few weeks of enrollment. While this is not shocking, it did take many groups in the field by surprise. Going forward, it is imperative that assisters and navigator organizations anticipate and prepare for a surge in demand around the end of the open enrollment period. Groups should also do what they can to head off or minimize procrastination. For example, they might get the word out to the eligible but unenrolled that if they wait too long, they might face longer wait times.

It Is the Messenger as Much as the Message

One of our key assumptions in making grants to support outreach, enrollment, and consumer assistance was that the best way to reach people is to partner with groups that are trusted and credible sources of information within their communities and that develop tailored, relevant, and engaging messages, materials, and approaches for the groups they are serving. Ensuring that consumers are hearing from trusted messengers means working together.

Across the country, we saw how successful enrollment efforts focused on collaboration among navigators; assister organizations; local grassroots organizations; and national groups like Enroll America, Community Catalyst, National Association for the Advancement of Colored People, National Council of La Raza, Families USA, the Asian Pacific Islander American Health Forum, and Young Invincibles, to name just a few. Furthermore, faith-based organizations, libraries, community colleges, sports teams, and retail stores were key partners. In New Jersey, the New Jersey Health Initiatives program of the Robert Wood Johnson Foundation supported veterans who were trained as assisters.

We can go on in listing myriad types of groups, both expected and unexpected, that had a hand in contributing to the great success of the first open enrollment period; ultimately, the lesson is to have a diverse set of groups on board so that consumers can hear from trusted messengers.

Coordinate, Do Not Dublicate

Another important lesson is the critical role of a statewide coalition where enrollment activities are coordinated within the state, as well as with national groups. Through our Consumer Voices for Coverage initiative, the Robert Wood Johnson Foundation was able to support these coalitions in a dozen states, and many other funders also contributed to these statewide coordination efforts in these and other states.

Having this coordination function in place ensured that enrollment materials, best practices, and data were being shared, and also worked to make sure that gaps were filled. It also provided an important feedback loop between on-the-ground groups and policymakers. Coordinating bodies were able to collect information on how enrollment was going in their respective states and detect patterns of problems and then provide this information to policy-makers to help resolve issues that were identified. They were also in a position to see where things seemed to be going smoothly and share that information. Finally, they were able to play the connector role with national enrollment efforts, such as Enroll America. Community Catalyst’s report Connecting Consumers to Coverage: Mobilizing for Enrollment (2014) provides examples of how these coordinating tables operated in various states. States need to figure out what model will work best for them, but the key is to have a coordinating table.

"What Gets Measured Gets Managed.”
 —Peter Drucker

An important element of success was using data to target enrollment efforts and track results. In this case, many groups found that the most effective messages focused on individual financial concerns.

For example, Enroll America found that consumers were more likely to click on when they were presented digital tools like calculators that helped them get individualized information about coverage versus personal stories, and they found consumers who used these tools were more likely to be motivated to enroll than consumers who saw other messages. This was important information for tailoring their work and helped them devote resources to the most effective tools and messages.

Similarly, early research that PerryUndem conducted for the Robert Wood Johnson Foundation showed that the most effective message was that financial help was available—a message that became very important for groups working on enrollment. The availability of financial help was the central theme of the Robert Wood Johnson Foundation’s digital advertising, which steered targeted consumers to their marketplaces at an unusually high rate for a digital campaign. Without the research and monitoring to find this out, many groups may have wasted time and energy on messages and materials that were not very effective.

Expect Tough Customers in 2015

As this next open enrollment period begins, conventional wisdom is that 2015 may be more challenging than 2014 in some key ways. Those who were highly motivated to get health insurance (i.e., the low-hanging fruit) probably got it out of the gate in the first open enrollment period. Further, assisters this year will need to have an eye on enrollment, as well as on re-enrollment. New research from PerryUndem shows that many of the remaining uninsured may have looked for insurance during the last open enrollment period but found it was unaffordable. Convincing the remaining uninsured of the benefits of insurance compared to the penalty and risk of being uninsured may prove difficult.

Final Thought

The Affordable Care Act presents a tremendous opportunity for the nation to move toward a society where everyone has access to affordable, stable insurance. At the Robert Wood Johnson Foundation, this is a longstanding goal and a key feature of what it means to build a Culture of Health in the United States. Last year we saw tremendous success in increasing the number of people in this country with health care coverage.

Armed with the lessons from last year, we know that the broad enrollment community, including grantmakers, is up for what may be a challenging second enrollment period. We look forward to continuing to share lessons and information as we go through this next period of work.

David Adler and Lori Grubstein are RWJF program officers. This post was originally published in Grantmakers in Health Views from the Field.

Tue, 18 Nov 2014 10:32:00 -0500 David Adler Health Insurance Exchanges Uninsured Individuals Medicaid and CHIP RWJF Staff Views <![CDATA[Putting the People in Data]]>
Data for Health Phoenix Photo

I recently had the privilege of attending the Data for Health listening sessions in Phoenix and Des Moines, initiatives that explore how data and information can be used to improve people’s heath. The key lesson I took away: We cannot forget about the human element when we think about health data and technology.

I have to be honest and admit that I attended these sessions with some admittedly naïve expectations. I half expected that the Des Moines airport would be in the middle of a corn field and that the conversation in the two sessions would focus on the technical side of health data – with people using terms like interoperability and de-identification. But I quickly learned that Des Moines is a flourishing city full of great running paths and people who are passionate about health data. The conversations in both cities actually focused not on the technical side of health data but rather on the human side.

While health data and technology are complex, the complexity of the the individuals and communities who generate and use them are far greater. At first glance, this human complexity may seem like the source of many health data problems but, as pointed out by the session attendees, it is actually the source of many health data solutions:


In a conversation in the Des Moines session about how to create incentives for individuals to provide health data, attendees stressed that one of the strongest leverages is the social incentive. Individuals will happily share data, they said, if we can get them to feel that the act of sharing their data brings them closer to others making them  part of a data-sharing community that includes their friends or family.

In Phoenix, attendees said that data is often not enough to lead to action. Most often, individuals have access to data but are at a loss as to what action to take or, even if they know the right action, lack sufficient motivation. One potential solution offered was to appeal to the human interest through narratives—using data to tell stories that both inform and motivate individuals to take action.

The listening sessions in Phoenix and Des Moines gave me a chance to leave my comfort zone and challenge my assumptions–both about health data and Iowa. I walk away from these sessions with a greater appreciation of the fact that health data does not exist in a social vacuum, and that behind each data point is a person.

Catch the live-stream on December 4th of our San Francisco event. Register here.  

Also, check out the Storify's we put together for both Phoenix and Des Moines where we’ve captured some of the conversations that took place online. 

Tue, 18 Nov 2014 08:00:00 -0500 Matthew Trujillo Health Data and IT Public and Community Health <![CDATA[Healthy Community Planning Means Healthier Neighbors]]> 5716 Wellness is housed in a historic Albert Kahn-designed cigar factory. 5716 Wellness is housed in a historic Albert Kahn-designed cigar factory.

Too often, U.S. public health policy focuses on treating illnesses after they are diagnosed, instead of encouraging healthy lifestyles to prevent illness in the first place. But architects—my profession—are engaged in a wholesale effort to reverse this focus. Throughout the U.S., right in the buildings where we live and work, architects are incorporating design techniques that can help prevent illness and benefit the local communities that live with their designs.

One of the best examples of this effort—even amidst bankruptcy and a historic unraveling of a once-dominant American city—is the Detroit Collaborative Design Center (DCDC), a nonprofit architecture and urban design firm that offers proof that neighborhoods that facilitate holistic wellness and preventative care are as valuable as doctors who make house calls.

Helene Combs Dreiling Helene Combs Dreiling, FAIA

What began as an effort to encourage healthy living surrounding a new health care center morphed into a 40- to 50-year plan for an entire neighborhood in southwest Detroit built around the idea of wellness. The center, 5716 Wellness, is housed in a historic Albert Kahn–designed cigar factory, and was redeveloped and designed by local nonprofit Southwest Solutions in partnership with Covenant Community Care.

The new center embodies health and wellness in its most direct form, providing medical, pediatric, obstetric, dental, psychiatric, pharmacy, and behavioral counseling services to primarily low-income clients, who often lack insurance. While it serves the medical needs of 8,000 to 10,000 patients each year, little was being done at first outside the facility to encourage a healthy lifestyle before or after treatment. Though architecture can inspire healthy choices within its walls, the two organizations soon realized that to truly foster better health, a wellness initiative would have to take shape on an urban planning scale.

They reached out to the DCDC design firm, affiliated with the University Of Detroit Mercy School Of Architecture. Their Wellness Center Campus Strategy would begin transforming southwest Detroit into a picture of better health—but first they had to determine what that picture would look like.

By talking to residents, business owners, and community organizations, DCDC discovered that a lack of access to healthy food options was a great barrier to wellness. In the city, increased urban agriculture was making local produce more available, but connecting local growers with communities that needed the food most remained difficult. To help bridge this divide, the center is taking advantage of almost 1,000 urban farms in Detroit, creating satellite branches of well-known markets and integrating walking paths and bike lanes throughout southwest Detroit for greater city access. These small but significant design changes are making physical activity easier and healthy lifestyles more accessible on a daily basis to residents.

Urban neighborhood wellness may sound complex, but intentional design choices to promote the ongoing wellness of a community before they have to come into a health clinic is crucial to rethinking preventive health. Working with architects who are able to integrate design thinking into community planning turns small choices into long-lasting health outcomes.

Helene Combs Dreiling, FAIA, is president of the American Institute of Architects.


The American Public Health Association annual meeting, taking place this week in New Orleans, has as its theme “Healthography: How Where You Live Affects Your Health and Well-Being.” Follow our live coverage of APHA on our Twitter feed @RWJF_Live, join in the conversation using the hashtags #APHA14 and #CultureofHealth, and read a blog post by our own Linda Wright Moore. We will share original reporting of conference sessions, exclusive interviews with speakers and attendees, and up-to-the-minute information from New Orleans on Twitter.

Mon, 17 Nov 2014 15:44:00 -0500 Helene Combs Dreiling Built Environment and Health Disease Prevention and Health Promotion Public and Community Health Urban Michigan (MI) ENC Guest Posts <![CDATA[American Public Health Association Meeting: All About Where You Live]]> Commission NOLA built environement 4

The Robert Wood Johnson Foundation (RWJF) has long embraced the idea that advancing America’s health is a community affair. Much of our work—and our current vision for building a Culture of Health—is grounded on the basic premise that where we live, work, learn, and play is inextricably connected to our health and well-being.

Consider that life expectancy can differ by 25 years in neighborhoods just a few miles apart; that a ZIP code can determine rates of preventable disease, violence, and access to healthy food. With this in mind, RWJF supports a wide range of programs designed to foster healthy communities—including efforts to prevent obesity and chronic disease, reduce disparities in health and access to care, and improve early childhood development.

We recognize that the best strategies are driven by local data and address the unique challenges and characteristics of individual communities. We know that what works for Camden, N.J., might not fly in Minneapolis or Baltimore.

That’s why we are so thrilled that the American Public Health Association has chosen “Healthography: How Where You Live Affects Your Health and Well-Being” as the focus of its annual meeting. This mega-event—some 12,000 people attending nearly 1,000 sessions—takes place November 15-19 and offers researchers, clinicians, and anyone else with an interest in public health a complete immersion in the field.

For us at RWJF, having the APHA conference in New Orleans is especially gratifying. Last year RWJF chose the Big Easy as one of the winners of its inaugural Culture of Health Prize—recognition of the city’s innovative public health efforts.

I got to know New Orleans well during many visits while my daughter was an undergraduate at Tulane University’s school of public health. Over four years starting in 2009, we witnessed the city’s slow but steady recovery from Hurricane Katrina.

Before the storm devastated the city in 2005, New Orleans’ approach to health was similar to many places across the country—focused more on clinical care than prevention and public health. Rebuilding the city gave leaders a chance to address long-standing public health problems such as obesity, chronic disease, violence, and the paucity of healthy food options.

The change is palpable. A community partnership joining the city’s health department, schools, businesses, and non-profit organizations has led to a revitalized East New Orleans—complete with a full-service hospital, 24-hour urgent care clinic, new athletic fields and a pool. Schools were reopened with a new focus on academic excellence along with better support for children’s health and wellness. Roads washed away by Katrina now boast bike lanes; miles of walking paths crisscross the city; and grocery stores stocked with fresh produce have sprung up in neighborhoods that were formerly food deserts. With these changes, and continuing efforts, New Orleans just might meet its goal of being one of America’s healthiest cities by 2018. The city certainly has the heart and resilience to get there.

The APHA’s “Healthography” theme underlies many other RWJF initiatives, particularly the work of the Commission to Build a Healthier America, a national, nonpartisan group of leaders convened from both the public and private sectors that generates and supports research focused on building healthier communities. Earlier this year the Commission made three recommendations for spending priorities and major new initiatives to improve the health of all Americans:

  • Increase access to early childhood development programs
  • Revitalize low-income neighborhoods
  • Broaden the mission of health care providers beyond medical treatment.

Working toward these ambitious goals will require a commitment to research, collaboration and bold new strategies for building healthier communities.

That’s where you come in. If you will be in New Orleans, stop by our booths—1236, 1238 and 1242—at the APHA conference. Don’t miss our "Briefings at the Booth" series, featuring mini-presentations and discussions by RWJF scholars and alumni. And check out our live coverage of APHA on our Twitter feed @RWJF_Live and join in the conversation using the hashtags #APHA14 and #CultureofHealth. We will share original reporting of conference sessions, exclusive interviews with speakers and attendees, and up-to-the-minute information from New Orleans on Twitter.

With your help, we can strive to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come.

Fri, 14 Nov 2014 09:55:00 -0500 Linda Wright Moore Social Determinants of Health Health Disparities Public and Community Health RWJF Staff Views <![CDATA[Every Child Counts: Stopping Infant Loss]]> mother with son on her lap

“Matthew was born big and healthy, just under eight pounds,” Carol Jordan says.

That’s why it was such a shock to her to lose him on an otherwise average Sunday afternoon.

“We had just gotten home from church. My daughter Taylor and my other son Jacob settled in with their video games,” Carol recalls. “I breastfed Matthew and lay him down on his back in his bassinet. He was 3 and ½ months old. About 30 minutes later, I went to check on him. He was on his stomach and he was not breathing.”

Despite being overwhelmed by grief, Carol remembers, “I had two kids to take care of and that got me out of bed each day.” Matthew was a victim of Sudden Infant Death Syndrome (SIDS), a leading and little understood cause of infant mortality. With the love and support of family, friends, and First Candle, one of the largest SIDS support organizations in the country, the family slowly recovered.

A year after Matthew’s death, Carol gave birth to a daughter, Rachel, in 2002, whom she calls “my little gift,” but she continues to give back. In addition to holding an annual Matthew Jordan Golf Tournament near her Decatur, Ga., home, to benefit the CJ Foundation for SIDS, she is working to open a camp for children who have lost a sibling to SIDS.

Carol is one of the many African American women who disproportionately experience infant mortality—the loss of a child in the first year of life. When it comes to life-threatening pregnancy complications, infant mortality is one of three issues—including fetal mortality and low birth weight (LBW)—that are more likely to threaten the lives of African American, Hispanic, and Native American children than white babies.

A Quiet Crisis–Uncounted Losses

America's infant mortality rate is in fact high for all women; the US ranks 56th in the world, and the lowest of any wealthy nations. The rate among white women is 5.33 per 1,000 births. For African Americans, the rate is more than double that number at 12.40 per 1,000 births. Among Hispanics and Native Americans it is. 8.41 and 7.18 per 1,000, respectively.

Yet these statistics tell only part of the story. The rates for fetal mortality (the loss of a child after 20 weeks of pregnancy) are nearly as high for children from these communities of color, with 23 percent of the babies lost after the seventh month. Again, the rate among African American women is more than double that of white women; likewise, the rates are disproportionately high among Hispanic and Native American women.

Low birth weight (under 5.5 pounds) and very-low birth weight (under 3.4 pounds) is also disproportionately high among African American infants (13.4 percent and 2.9 percent) compared with 7.2 percent and 1.2 percent for white women.

If a child does survive being born underweight, he or she may face a lifetime of heightened health risks—including increased odds of respiratory, cardiac, and developmental problems in childhood, and possibly higher rates of hypertension, diabetes, heart disease, and joint disease in the knees and hips in adulthood.

My Baby Matters

As part of a national movement to find solutions for this persistent crisis in infant health, the documentary Surviving One Year focuses on the epicenter of America’s infant mortality crisis—Rochester, N.Y., the fifth poorest city in the country. In this community, children of color are three times more likely to die than white infants. The film, which will air on PBS, is part of the series America by the Numbers (check your local listings or the PBS website for broadcast times).

Poverty is at the root of the problem in Rochester, but when it comes to pregnancy complications in Black women, other issues are in play. College-educated African American women still have higher rates of preterm birth and LBW, for example.

Another important contributor to the infant mortality puzzle, says Joanne Cacciatore, PhD, and founder of the MISS Foundation, is the confusion surrounding fetal mortality.

“Fetal mortality is still a great mystery. We don’t exactly know the statistics because each state defines it differently,” she says.

Cacciatore and her colleagues explored issues such as the lack of attention to fetal mortality prevention in the Lancet series “Stillbirths: Why They Matter.” In some instances, she notes, “uninsured women, or women with poor coverage, for example, are allowed to go post-term because of the cost of caesarean delivery, but every day a woman carries past 41 weeks increases her chance of a stillbirth. There is also a tremendous lack of support for mothers who experience fetal loss at any point in a pregnancy.”

Myra Gomez knows the issue well. “One of my twins, Angela, passed away at 23 weeks. In order to protect Alessandra, her sister, I carried them both for 34 weeks. I delivered my sleeping baby and my survivor.”

Yet, says Gomez, who is Mexican and lives in Dallas, “we have a tradition, novenario, you mourn the dead for nine days, but for my baby, the period of mourning was only one day. People kept saying, ‘At least you had one twin,’” Gomez recalls. “But I am always going to be the mother of twin girls.” She was finally able to heal with support from MEND (Mommies Enduring Neonatal Death).

Tia Jenkins was astonished by the reactions she encountered when she lost her first child after a full-term (38 week) pregnancy. “People around me kept saying `God does not make mistakes,’” Jenkins says, the anger still fresh in her voice after six years. “Tell me that when you have to buy a coffin the size of an ice cooler and put in the toys you bought for your newborn.”

Jenkins was also furious about the care she received. An African American woman who was 28 at the time, she was still at risk for preeclampsia. Yet when she started bleeding during her pregnancy and bloating from excessive fluid, her doctor said nothing was wrong. In fact, she gained only 11 pounds during her pregnancy and her son Adan was only four pounds at full-term delivery. She was determined not to try again.

“Instead, I got pregnant four months later, but this time I secured an appointment with a highly recommended African American woman obstetrician near my Atlanta home. It was a completely different experience.”

When Jenkins began experiencing complications during her second pregnancy, she was monitored bi-weekly instead of monthly, she received nutrition counseling, and was tested and found to have preeclampsia. She spent the last month of her pregnancy in the hospital. Her son Joshua was born healthy at full term, but also at a low birth weight—4.4 pounds.

“He spent 10 days in the neonatal intensive care unit, but today he’s a healthy 6-year-old.” Jenkins says, “I am grateful. I believe the second doctor’s care decisions saved my baby’s life.”

Working Toward Solutions

Improving quality of care may be one answer to helping at-risk infants, according to new research by Eileen Lake, PhD, RN, a professor of nursing at the University of Pennsylvania School of Nursing. Her work, supported by RWJF’s Interdisciplinary Nursing Research Initiative, revealed that the health of seven out of 10 very-low birth weight African American babies could be improved through nursing care.

Lake’s study adds to the growing knowledge that complex factors, including racism, stress, and inadequate social support, may contribute to the persistently high rates of infant mortality, LBW, and fetal mortality among African American, Hispanic and Native American children.

Sadly, there will always be a need for the work of such advocates as Jordan and organizations such as First Candle and MEND, but there is hope that through increased awareness and improved research, they will have far less work to do.

Thu, 13 Nov 2014 15:08:00 -0500 Sheree Crute Early Childhood Development Social Determinants of Health Family and Social Support Children (0-5 years) Black (incl. African American) Latino or Hispanic American Indian (incl. Alaska Native) Guest Posts <![CDATA[Transparency in Health Care? Sadly, That's Not How We Roll.]]>
Patrick Toussaint Andrea’s husband, Patrick Toussaint, using his super strength to tighten a lug nut.

What do changing a flat tire and scheduling a surgical procedure have in common? Nothing. And that’s the problem.

Last month, on our way home to New Jersey from Boston, my husband and I got a flat tire. And while this is a dreaded possibility on any road trip, it happened to us at 9 p.m. on a Sunday. No shops were open, and with an early morning flight just a few hours away we didn’t have time to wait for AAA.

At this point it’s important to emphasize that neither my husband nor I know a thing about cars. We didn’t even know we had a jack or spare in the trunk until we called my uncle, who teased us (“You have a new car! Everything you need is in the back!”) and gave us the pep talk we needed. So we pulled out our owner’s manual.

I’m not sure who that manual is written for, but it clearly isn’t for us. After five minutes of thinking I’d need to call the airline and book a later flight, I realized: There is a better way. I pulled out my iPhone, Googled “how to change a flat tire,” and called up a YouTube video and a step-by-step, picture-guided Wikihow article. Within 20 minutes, the tire was changed, our spare was filled with air to 60 psi, and we were on our way.

So what does any of this have to do with health care? Unfortunately, not very much.

Unlike the confusion most consumers face with when trying to find the right clinician, choose the right procedure, or figure out how much something is going to cost, I didn’t have to rely on the technical status quo. I didn’t have to depend on indecipherable instructions from my owner’s manual. There was accessible and immediately meaningful information out there, and I knew how to get it, right when I wanted it, in the format most actionable for me. And most important, I knew that I could trust the information.

I used this example in a keynote address I delivered on health care transparency at a Carolinas Society for Healthcare Strategy & Market Development conference last month, because it was such a powerful illustration of an alternative most people don’t have in health care. But that’s going to have to change. Increasing high out-of-pocket expenses for consumers (a third of all large employers are only going to offer high-deductible plans next year), shifting financial risks to providers, and narrow networks with limited provider choice, are all driving the need for greater information. Demographic changes are also shifting expectations. Can you imagine your 14-year-old niece being told she can’t make a doctor’s appointment on her iPhone, or find out how much something is going to cost her when she has to pay for it? Yeah. Neither can I. More and more, people are going to demand transparent and meaningful health care information that can help them make the best choices.

At the conference I discussed how health care transparency empowers not only consumers, but clinicians. They can use that knowledge to improve their performance, make better treatment and ordering decisions, and better referrals. The Robert Wood Johnson Foundation (RWJF) is currently funding a set of studies that will help us better understand how greater transparency in prices impacts different consumer and provider decisions. We’ll soon embark on identifying especially opportune “shoppable moments”—when people are most likely to seek out and use information to make health care decisions.

During my talk, I also focused on how transparency has the tremendous power to elevate an issue, much as the Dartmouth Atlas does with practice pattern variation, or County Health Rankings does with the factors that influence health within a community.

And finally, I talked about how empowering it is to have access to meaningful information. Let’s go back to my flat tire experience: My husband and I felt so good about what we accomplished in Connecticut that night that we posted about it on Facebook (the picture you see here is what we shared with our friends of family). Since then, we’ve felt indestructible when it comes to our car. We even changed our tail light bulb ourselves when it went out the next week—which might not sound like a lot, but it was a pretty big deal to us. And it was the direct result of our empowering experience with good and reliable information, and knowing we could successfully act on it.

In March, RWJF will host a summit on transparency that will explore many of these themes. At that summit, we’ll also discuss policy priorities and innovations in transparency.

Why are we supporting these efforts to make health care more transparent?

In addition to supporting information exchange for its own benefit, earlier this year we announced our new vision for a Culture of Health, which imagines a world in which everyone in this country has the opportunity to live the healthiest life they can. Resources, knowledge, and information are a big part of that opportunity. So is living in a world where health care prices and spending aren’t unjustly burdensome and where people are getting the care they need, both of which are served through more transparent systems.

We believe that in a Culture of Health, the healthiest choices should be the easiest choices. That means not only giving people the opportunity and the information they need to make the best decisions, but making sure that information is tailored, delivered at the right time, when people want it and are able to use it. That way, whether people are looking for routine health care, or are at their most vulnerable, they can take comfort in knowing they don’t have to rely on an indecipherable owner’s manual.

Fri, 7 Nov 2014 15:13:00 -0500 Andrea Ducas Health Care Costs Health Care Quality RWJF Staff Views <![CDATA[Babies are Dying in Rochester at Twice the National Average. Why?]]> America by the Numbers series on Infant Mortality Photo by: Paul de Lumen.

Rochester, N.Y., is the birthplace of Xerox, Bausch & Lomb, and Kodak, and home to two top-ranked research institutions, the University of Rochester and Rochester Institute of Technology. Nevertheless, babies die in this upstate New York city at a rate two times higher than the national average, and Rochester’s children of color are three times more likely than white infants to die before their first birthday. Why?

To come up with some answers, Futuro visited Rochester as part of its America by the Numbers series, made in partnership with Boston public TV station WGBH (check your local PBS and World Channel listings to see the series). We went knowing that the U.S. as a whole ranks 56th in the world for infant mortality, by far the lowest of any industrialized nation, despite the fact that we spend more on health care per capita than any other country, and the largest portion goes towards pregnancy and childbirth. This makes Rochester’s statistics even more tragic—an outlier in an outlier.

The overriding issue for the city’s dismal infant mortality rate is poverty. It is the fifth poorest city in the nation; 31.1 percent of Rochester’s residents live below the poverty level. The Latino and African-American populations that make up some 24 percent of the city’s population have it particularly hard, with 36 percent of African-Americans and 46 percent of Latino residents living in poverty. Poverty means chronic stress, poor nutrition and lack of access to good medical care—all high risk factors for infant mortality.

Yolanda Sayres, an outreach coordinator for the Perinatal Network of Monroe County, where Rochester is located, spends a lot of time in the city’s most underserved neighborhoods, and says at least half of the people she meets know someone who has lost a baby. Sasha Fontanez is just one of these too many tragic stories. She had her first child when she was 18, a healthy girl. But her second daughter, nicknamed Annie Bannie, died in her sleep less than four months after she was born.

Annie was one of 1,700 annual U.S. victims of Sudden Infant Death Syndrome, or SIDS—a catchall term for unexplained crib deaths of babies who are under 1 year of age. Still struggling to cope with this sudden and tragic loss, Sasha says she is constantly anxious about the health of her remaining family members. “I don’t sleep. I watch everybody in the house sleep, make sure everybody is breathing.”

The result of our investigation is the documentary “Surviving Year One.”  I will be hosting a screening of “Surviving Year One” in Rochester on November 13 at 6:30 p.m., followed by panel discussions with several of the people featured in the documentary, including Yolanda Sayres and Sasha Fontanez, and Jeff Kaczorowski, MD, founder of the Rochester-based non-profit The Children’s Agenda. We will discuss not just Rochester’s infant mortality problem, but some of the solutions being applied.

The screening is free and open to the public and is being presented in partnership with the Robert Wood Johnson Foundation and WXXI, Rochester’s public TV station. I hope the program leads to a nationwide dialogue that will lead to a change in this particular American number. To get the conversation started, please share your thoughts in the comments.

The Futuro Media Group is an independent nonprofit organization producing multimedia journalism that explores and gives a critical voice to the diversity of the American experience. Based in Harlem and founded in 2010 by award-winning journalist Maria Hinojosa, Futuro Media Group is committed to telling stories often overlooked by mainstream media.

Find more information at

Fri, 7 Nov 2014 11:13:00 -0500 Maria Hinojosa Early Childhood Development Family and Social Support Social Determinants of Health Children (0-5 years) Urban Black (incl. African American) Latino or Hispanic New York (NY) MA Guest Posts <![CDATA[Big (Box) Medicine?]]>
Lucy in the chocolate factory

Let’s see a show of hands. Who among us, doctor, nurse, patient, family member, wants to give or get health care inspired by a factory—Cheesecake or any other?


I didn’t think so.

True confession: I have never actually eaten at a Cheesecake Factory (hereinafter referred to as the Factory). My wife, Mary, and I did enter one once. We were returning from a summer driving vacation. Dinnertime arrived, and we found ourselves at a mall walking into a busy Factory.

It seemed popular. The wait was long—really long. We got our light-up-wait-for-your-table device. We perused the menu. There was a lot there. Portions seemed gigantic. We looked at each other and, almost without speaking, walked back to the hostess, returned our waiting device and left.

You got me—I cannot say 100 percent that I wouldn’t love Factory food. We were so close that one time!

A young woman in our small New Jersey town recently opened a new restaurant here. We tried it the other night. She and her business partner tended us and all the other patrons with such attention and care. We waited some, true, but she seated us near the bar while we waited and brought over pieces of cheese (no light-up device) for us to enjoy. The menu was ample and varied—not enormous. It’s also true that two items on the menu—including my first choice—were no longer available that evening. The chef, however, crafted the dishes that we did select with flare and pride. Dinner was a delicious, wonderful, relaxing experience, made better because of the human touch.

It’s probably not fair to contrast my one near-Factory dining experience with this other. Big chain restaurants have clearly figured out a way to provide a consistent meal for millions of satisfied customers. But the Factory way is not for everyone. People, I think, crave customized, attention-to-detail service experiences in their dining choices. And—I’ll go out on a limb—in their health care too.

Urban Institute fellow and renowned health care expert Robert Berenson MD recently interviewed Atul Gawande MD, The New Yorker writer, for an Urban Institute/RWJF brief, “Is Bigger Better? The Implications of Health Care Provider Consolidation.”Atul is an enthusiastic soothsayer for what he sees as the coming era of big medicine. In his popular New Yorker article published two years ago, “Big Med,” Atul cast his bright light on the virtues of the Factory as a model for health care. In this latest interview, Atul continues to carry the Factory flag. He observes that two years hence, we now have about 90 super-regional medical centers across the nation. These centers bristle, he says, with advantages like information systems and access to standardized measurement and improvement approaches—not bad things, of course. In the interview he also notes that “[w]e’re in the process of shifting from what I call ‘cowboys’ to ‘pit crews’ in medicine ...”

Hard to disagree that a shift to smart team-based care is a strong positive. The lone, isolated, unconnected physician working on his or her own providing care based on what he or she learned years prior, in school or in residency, is, thankfully, rapidly becoming a thing of the past.

Still, these are our choices? Lone, isolated, ill-informed cowboy-on-the-range care versus Factory care? I think there’s almost certainly another way.

I definitely get it. The Factory ideal is enticing. It’s a successful vision imported from the Industrial Age—i.e., the 20th century. But—brace yourselves—we are no longer in that century or age. We’re in a new one—a new machine age.

Think, for instance, about the waves disrupting or wiping away industries—cloud computing, disintermediation (e.g., video), unbundling of services (e.g., music, newspapers), the sharing economy (e.g., Uber, airbnb), new networking organizational approaches, democratization of knowledge (e.g., Khan Academy).

Consider the potential for customized care with predictive analytics, the range of new -omics data and the proliferation of health data from ever more sophisticated devices—not to mention the emerging power of DIY care from those same devices. Don’t forget the coming cognitive agents and artificial intelligence, robotics, and 3D printing. Incidentally, we’re just starting up the Moore’s Law-driven escalation.

The opportunities of our new age open novel ways, I believe, to improve care. We can create vibrant, joyful, human care relationships in small, intimate, connected settings, that also deliver informed, smart cutting-edge treatment when, where, and how people want it. One key aspect of our new age tools: They proliferate and get cheaper and better, year after year. That means that most of the exotic soon becomes commonplace. It may be ironic, but our new machine age is going to free us to reclaim our humanity. I fervently believe that.

At RWJF we are working on a range of projects exploring this sort of vision. Perhaps the most obvious is Flip the Clinic—essentially the anti-Factory. There, we’re inviting human beings to come together and explore what it might be like to co-create new caring relationships (not factories) fitting for the new age.

I understand. Many may find the Factory approach suitable, even desirable. That’s OK—the door for that is swinging wide open over there. If, however, you hunger for another way, you are not alone! Granted, the door this way is still a little hidden—you have to look for it a bit—but trust me, it’s there, and it’s big.

Thu, 6 Nov 2014 16:55:00 -0500 Michael Painter Health Care Quality Patient-Centered Care RWJF Staff Views <![CDATA[Five Takeaways from National Forum on Hospitals, Health Systems and Population Health]]>
Wake Forest Baptist Medical Center photo

The new faces of population health may be those of Annika Archie, Vernita Frasier, Pecola Blackburn, and Mary Dendy (shown in the photo on the right). They were once part of the cleaning crew at Wake Forest Baptist Medical Center in North Carolina, but their jobs were cut when the hospital outsourced those services to save money. But thanks to a creative initiative on the part of the hospital, they now they have new roles as “Supporters of Health,” serving the hospital’s uninsured, chronically ill patients in proactive ways.

Having come from similar circumstances as their patients, the four women help them cope with a range of needs–from understanding how to take their medications to getting assistance to pay their rent. In just a few months, the supporters helped cut hospital readmission rates for these patients to 2.5 percent, says Gary Gunderson, vice president of faith and health ministries at Wake Forest Baptist. “We gave them training as community health workers,” says Gunderson, “but it was sort of like just giving them a baseball hat”–a formality to acknowledge new roles that they had long played informally.

The story of the North Carolina health supporters was just one of many featured at the Robert Wood Johnson Foundation-sponsored National Forum on Hospitals, Health Systems and Population Health, held Oct. 22-24 in in Washington, D.C. They underscored how institutions across the country are adopting novel approaches to advance population health, and led to five key takeaways:

1) Many of the nation’s hospitals and health systems fully understand that the most important preconditions of health lie outside their walls. The “dominant story” in the US may be that health is created by the health care system, but dozens of institutions are now “rewriting the narrative,” said Jean Ayres, assistant commissioner of the Minnesota Department of Health. They are asking what they can do about the many factors outside the clinic that impact health–income, housing, education, community safety, and food security, among others, and they are embracing the World Health Organization definition of health–“the complete physical mental and social wellbeing and not merely the absence of disease and infirmity.”

A case in point: Promedica, a 13-hospital system in Ohio and Michigan, concluded that “if we couldn’t address social determinants in our communities, we were missing the ball with respect to our mission,” President and CEO Randy Oostra told the conference. Through community health needs assessments required by the Affordable Care Act, the system identified child obesity and food insecurity as issues affecting the regional population, and went to work tackling them. A partnership with a casino now delivers unused food to local food pantries, and Promedica doctors can write “prescriptions” for nutritious food, filled onsite in new “food pharmacies.”  “The pitch we made to our [hospital] board members was, ‘If not us, who is going to do it?’” Oostra said.

2)  The pursuit of population health should begin with a health system’s own workforce. Since hospitals are often among the largest employers in any community, “an honest look” at their staff will raise obvious questions about whether conditions in the community are supporting health, said Raymond Baxter, Kaiser Permanente’s senior vice president for Community Benefit, Research and Health Policy. Hospital leaders must create “a culture of health within their walls before they expand outside their walls,” argued John Bluford, former President and CEO of Truman Medical Center in Kansas City, MO.

Bluford described Truman’s effort to address a key social determinant of health–education–by creating partnerships with local colleges and universities to offer onsite education and degree programs for hospital employees. One employee, a man in his 50s who had worked at the hospital for three decades, finally learned to read through one of the courses. “To see him get up in front of an audience of his peers and tell them, ‘Last week, I read a birthday card to my grandchild,’ was moving,” Bluford said.

3) To pursue population health outside their walls, hospitals and health systems need partners -– other local hospitals and health care providers, health plans, public health agencies, housing authorities, and community organizations. Hospitals in Santa Cruz County, California, for example, banded together to undertake joint assessments of local community health needs. Others have joined forces with public health agencies to carry out complementary assessments. The next step, said Kimberlydawn Wisdom, Senior Vice President of Community Health & Equity and Chief Wellness Officer at Henry Ford Health System in Michigan, should be that hospitals in a given area join forces to adopt and implement common community health improvement plans.

In the meantime, hospitals can learn from one another through collaboratives such as Stakeholder Health, a national group whose 90 members, including 52 hospitals and health systems, hold monthly webinars to share success stories and best practices.

4) New payment models to support population health approaches are evolving, “more rapidly than people realize,” said Patrick Conway, Chief Medical Officer of the Centers for Medicare and Medicaid Services. These new payment structures should eventually supplant the need for federal, state, and philanthropic grants used by many health systems now to pay for population health measures.  

Delaware-based Nemours Children’s Health System demonstrates the problem of relying on grants. The experience of Nemours demonstrates the need for a sustainable long-term payment model beyond time limited grants. The system's efforts to reduce avoidable hospital care for children with asthma, carried out under a federal grant, has led to reductions in revenue. “As a business executive, it puts me in a quandary,” said David Bailey, Nemours president and CEO. “I’m going to have to fill in the [lost revenue] from someplace. Do I take it from bone marrow transplants? Behavioral health? We’re going to have to work very hard to move reimbursement to allow for these new approaches, and still keep our doors open.”

The conference featured plenty of new approaches, however. Under a newly-revised federal Medicare waiver granted to Maryland–a pioneer in developing new payment models–the state’s hospitals largely operate under population-based payments, giving them incentives to keep people healthy and out of the hospital. New York has a new Medicaid waiver that encourages the formation of combined health care and social services organizations, such as hospitals and agencies providing supportive housing for people with mental illness. They “agree to take risk together, almost like an accountable care community,” said Mary Ann Christopher, President and CEO of the Visiting Nurse Service of New York.

The federal government will roll out new payment models and financial incentives for population health in the coming year, including a “next generation” accountable care organization model that would support creation of  “accountable health communities” not unlike what is under way in New York.

5) The need to embrace and spread population health is urgent. “The major natural resource of our nation is the health of its people,” acting Surgeon General Boris Lushniak told the conference–and by almost any measure, that resource is being depleted. But if the nation works diligently to improve the health of children, “within a generation you would begin to see health care costs become half of what they are now,” said Nemours’ Bailey.

“We are all mission-driven organizations,” Baxter of Kaiser Permanente said. “There is a powerful role now to work with other like minded organizations to move the field toward this change.”

To join in this conversation, watch the RWJF First Friday Google+ Hangout recapping highlights of the population health conference on Friday, November 7, from 12 pm to 1 pm EST. Sign up here

Wed, 5 Nov 2014 14:08:00 -0500 Susan Dentzer Public and Community Health Blog - Culture of Health <![CDATA[Data for Health: Learning What Works for Philadelphia]]> Philadelphia City Hall
Susannah Fox

The day was also captured in a Storify: #Data4Health: Learning What Works for Philadelphia

Once again I was struck by how wide open the definition of “data” can be. I shared the following data points, based on a Pew Research study I led:

  • 7 in 10 U.S. adults track a health indicator for themselves or someone else.
  • Half track regularly, half track when something comes up.
  • Technology plays a minor role — about 1 in 5 trackers use a medical device, an app, or any other digital tool.
  • 1 in 3 trackers uses paper and pencil to take notes.
  • Fully half of trackers say they do so in their heads (and that includes me).
  • 1 in 3 trackers share their data with family members or clinicians, but many do not. They are asking secret questions and we must not only respect that, but build it into our planning.
  • 45% of U.S. adults live with a chronic health condition; of those, 8 in 10 track some aspect of health.
  • Tracking data is not a hobby for this group, but rather a way to see themselves more clearly. This might be true of public health in general—data is a mirror we try to use to make good decisions, based on facts.

In a break-out session, people shared how they track their health:

  • A man who commutes by bike said he notices how he can take a certain hill so much faster at the end of the summer than in the spring, after a full season of training.
  • A woman tracks how many times per week she cooks at home vs. eating take-out or going to restaurants—a proxy for good nutrition without all the annoying calorie-counting or photo-taking.
  • A man tracks how many hours of sleep he gets per night.
  • A woman noted that tracking can have negative effects, such as weight obsession.
  • A man starts each day with a list of what he enjoys, sort of a spiritual check-in about being grateful. (I would have loved to hear more about this. I wonder if the list is longer on some days and if he tracks that or takes any action.)
  • A woman noted that caregivers often track more diligently for a loved one than for themselves. “Being aware, you help the other person.”
  • Someone responded with a comment: “Caregivers see the data disconnects that clinicians and public health workers cannot. How might we tap into that knowledge?”
  • A third person spoke up: “My mother carefully tracked my grandmother’s health and, when she died, my mom was left with notebooks of data—the narrative arc of her illness, which could inform other people’s health journeys. Mom was left wondering what to do and thought about volunteering at a local senior center, accompanying older people to their medical appointments since she had developed that unique skill set.”
  • A woman noted that trauma often triggers note-taking as a coping mechanism.
  • A man said that he wishes we could collect data about people we *don’t* see in clinic. Where else are they? How can we measure something that is not there? What proxy measures can we use?
  • A woman noted that mental health data is a challenge. What measures are useful?

My favorite insight of the day came from someone who, when discussing who should be part of the design process for health data systems, said that front desk workers are the ones who know the community best.

For example, if it is determined that a patient needs nutritional counseling (based on their data, let’s say), the front desk worker (not the MD or RN) will be able to say to that person: “To get to the nutrition counselor’s clinic, don’t take the 22, take the Broad Street line.” (Translation: they’ll know the city—particularly the public transportation options—better than the executives will. And that’s where the rubber hits the road, when the health data meets community data, such as traffic patterns and bus lines.)

If this quick summary intrigues you, stay tuned to the #data4health tweets and see if you can join an upcoming meeting in Phoenix, Arizona; Des Moines, Iowa; San Francisco; and Charleston, South Carolina.

Wed, 5 Nov 2014 12:37:00 -0500 Susannah Fox Health Data and IT Public and Community Health Blog - Culture of Health <![CDATA[Bringing Brain Science to the Front Lines of Care]]>

The brain is an exquisitely sensitive organ—so sensitive that, as recent advances in brain science show us, children who are exposed to violence, abuse, or extreme poverty can suffer the aftereffects well into adulthood. They are more likely to develop cancer or heart disease as they age, for example.

But how to translate these findings into practices and policies that can strengthen families and children? How do caregivers help traumatized children and their families cope with adversity? How can the science be applied to what teachers, doctors, social workers, and others on the front lines do every day? And how should the science affect whole systems, so that every person, at every level, can do their part to help children and families thrive?

To answer those questions, the Robert Wood Johnson Foundation has formed a new partnership with the Alliance for Strong Families and Communities and Canada’s Norlien Foundation. RWJF will invest $1.7 million to help 10 U.S. and five Canadian agencies use the science of trauma and resilience to transform the way they deliver services to families.

The partnership will look closely to see how transformation takes place across a single agency, from the CEO to the front desk employee, and we will document how these changes can affect a whole community—the practice, policy, regulatory and fiscal structures that need to change.  The grant will also enable the cohort of 15 agencies to learn from each other and share findings across the Alliance’s network—more than 400 nonprofits spanning 8,000 communities.

We hope to uncover any policies that serve as barriers to using brain science effectively on the front lines of care. For example, the science tells us that parent-child bonds are vital to building resiliency in young brains. It’s why so many of the most effective strategies treat parents and children together. Such strategies require time for communication and counseling, time that is often reimbursed poorly by insurance companies, if at all. This creates a huge financial disincentive, preventing doctors from taking the time needed to address such issues in depth during office visits. That’s a policy that needs fixing.

This project will help us locate existing policies that limit impact. It will guide where we focus our policy efforts moving forward. In fact, by having participants in Canada and the U.S., we will be able to see first-hand how different policy conditions affect this work.

How often have you heard, when someone wants to make a point that a particular topic or task is easy, say, “It’s not brain science.” In fact, if we are going to realize our full potential to save lives and strengthen families, we need to make brain science easy as well. We believe this partnership is a good start.

Tue, 4 Nov 2014 17:34:00 -0500 Martha Davis Violence and Trauma Early Childhood Development Children (0-5 years) RWJF Staff Views <![CDATA[What Baltimore Taught Us: On a Journey to Strengthen Families]]> young mother with her children

Recently a team from the Foundation went to Baltimore to talk to families and community leaders, gaining their insights into an essential question for us: What can the Foundation do to strengthen the systems—health care, education, community—to create a web of support for families, one in which those at greatest risk can’t easily fall through?

What follows are my colleagues’ reflections on our time in Baltimore.

Martha Davis: I spoke with a Violence Interruptor, a Safe Streets employee who works to stop street violence. He is a 37-year-old man who has spent nearly half his life in jail, and has been shot 14 times. When I asked him how it is that he got to where he is today, he told me he came to the streets to learn how to “be a man,” but the birth of his children inspired him to want to be on the “side of peace." His was a life of violence and suffering, deep poverty, and racism; now he makes people feel safe and hopeful. He and the other Violence Interruptors are living proof that change is possible.

Tara Oakman: We talk a lot about needing to meet people where they are. Realistically, that means meeting people where they live because the most vulnerable families aren’t necessarily coming into the health care space or schools or child care centers. Their lives are too overwhelming and stressful to reliably engage with these systems, even though they are there to help. The stories we heard and people we met will help us with “gut checks” as we work on future programming; we will return to the question, “how would this work for the people we met in Baltimore?”

Jennifer Ng’andu: Making sure our strategies are focused on people—not systems or issues—feels like the most important thing to keep in mind as we work towards strengthening families. We heard from several people that interpersonal relationships were the foundation of strong programs, but it was also clear how hard it is to find time to make those relationships happen. When asked what resources would help, most people said they needed time, not money—the time to be strategic, the time to collaborate, and the time to take care of issues in a comprehensive way. It made me think our work needs to help communities recognize their agency, foster coalition building, and allow folks to come together to strategize and aggregate their power.

Paul Cheh: One of the most striking takeaways for me was the issue around isolation. Many people felt an overwhelming sense of isolation not only within their community, but with the rest of society. But we saw wonderful programs that addressed this problem. It was inspiring to see the deep sense of brotherhood and sisterhood that some programs, like Elev8 and Safe Streets provided. I left thinking about how the Foundation could address isolation, whether through continued advocacy for vulnerable populations, through community outreach and capacity building, or through the design and support of safe spaces for communities to meet, discuss, and inspire change.

Sadia Kalam: From the Center for Dispute Resolution at the University of Maryland School of Law, I learned how both parents and children bring trauma into the school system. Many parents have negative associations with school themselves; and teachers and administrators can carry feelings of distrust for parents. Helping students, parents, and administrators learn to talk through conflict, build trusting relationships, improve communication—all are steps towards alleviating the multiple layers of trauma embedded within existing systems.

Here at RWJF we will continue to engage with communities throughout the United States and explore new possibilities to mitigate violence and its toxic effects. We plan to work with families most vulnerable to trauma, while advancing research-driven ideas so that all families can benefit and live healthy lives.

I hope you’ll join us on this journey. Together, we can build a Culture of Health for all.

Fri, 31 Oct 2014 13:12:00 -0400 Kristin Schubert Family and Social Support Urban Maryland (MD) SA Massachusetts (MA) NE RWJF Staff Views <![CDATA[Mental Health Challenges of Hurricane Sandy’s Aftermath]]> Hurricane Sandy - Shore Tour Driftwood Cabana Club, Sea Bright, N.J.

On her 90th birthday, instead of celebrating, Dottie (whose last name is withheld for privacy) lost her home in Superstorm Sandy. Two years later, she is still displaced, living in temporary rentals.

Dottie’s nephew is trying to change that. He’s been rebuilding Dottie's home. Like so many New Jersey residents, he says he’s going to keep at it until reconstruction is complete. Meanwhile, he’s getting some much needed support from groups like BrigStrong, the County Long Term Recovery Group, and the Mental Health Association in New Jersey (MHANJ).

It’s been two long years since Hurricane Sandy slammed into New Jersey on October 29, 2012. As a mental health worker, I still see the aftereffects firsthand.

For the past two years, the Mental Health Association in New Jersey (MHANJ), along with other local groups, has been on the front lines of the battle to maintain the mental health of Jersey Shore residents. Thanks to a major RWJF grant, MHANJ has been able to leave the county in a better position to deal with the next disaster:

  • We’ve given mental health first aid training to city employees who, in their daily work, encounter community members with mental health issues.
  • Through our Certified Recovery Support Practitioner program, we’ve improved our ability to reach out to the most vulnerable. Many community members certified through the program have faced mental health challenges themselves, which only increases their credibility.
  • We counseled populations with mental health issues on how to safely evacuate or shelter in place, thus ensuring that first responders will be safer in future emergencies.
Vicki Philips Vicky Phillips, executive director of the Mental Health Association in Atlantic County, N.J.

RWJF’s grant will continue to be crucial in carrying these initiatives forward. Even today, Atlantic County urgently needs our mental health services.

While acute conditions like Post Traumatic Stress Disorder have been the focus of much of the public conversation around Sandy and mental health, the aftermath also proved uniquely challenging for people who had difficulties before the storm. For many such people, Sandy raised the stakes by putting their basic physical safety at risk. For people whose mental health was otherwise sound before Sandy, the long wait for reliefncontinues to cause unbelievable frustration, anger, and anxiety.

Another story that stands out for me involves two adult sisters who refused to leave a badly damaged home, even after their elderly parents moved out. The sisters had not left their home in 13 years. When my colleagues and I visited, the house was wet and moldy. The sofa sat soaking in the living room and pets were suffering from skin conditions attributed to bacteria. The sisters had gotten along relatively well before Sandy. After the storm, however, staying in the damaged house was downright dangerous. The home was cleaned early on, but the sisters are still waiting for funds to move forward with repairs. We are working closely with one of the sisters, who has a fear of leaving the house.

Nearby, Dottie’s nephew has made sure his aunt can still do one thing she loves: garden. The spring after Sandy he cleared a small plot in her storm-damaged yard. Last week she brought our staff a box of the season’s last tomatoes. Her nephew promises to have her back in her home by Christmas.

Even as we look forward to many more happy homecomings in Atlantic County, people are still struggling. To them we say:

  • Be patient with yourself and the emotional challenges you face
  • Talk with others about your experience
  • Seek support groups
  • Eat well, exercise, and beat stress with healthy behaviors
  • Find support in the community

The last tip is key. We’re all in this together, and finding strength in one another is something we can all do to speed physical and mental recovery.

Learn more about New Jersey Initiatives.

Wed, 29 Oct 2014 08:31:00 -0400 Vicki Philips Mental and Emotional Well-Being Emergency Preparedness and Response New Jersey (NJ) NJ National <![CDATA[“Tobacco Just Doesn’t Fit In:” CVS Exec Gives Story Behind the Story]]> CVS Employee Unpacking Shopping Basket Stop Tobacco Signs in Back

Along with the start of CVS Health, the sale of cigarettes and tobacco products at CVS/pharmacy ends today. By eliminating cigarettes and tobacco products from sale in our stores, we can make a difference in the health of all Americans.”—CVS Health CEO Larry Merlo

On October 20, The Campaign for Tobacco-Free Kids launched a national campaign calling on America’s retailers to stop selling tobacco products, and a new mobile-friendly website——that has an interactive map that allows consumers to search for the nearest tobacco-free retailers. The website currently features more than 20 retail chains with more than 13,000 separate store locations—chief among them CVS Health.

On September 3, CVS ended sales of tobacco products at all of its 7,700 stores, a month ahead of its previously targeted date of October 1. It is the first, and so far the only, national pharmacy chain to take this step. The company also changed its corporate name to CVS Health in order to reinforce its broader commitment to the health of its customers.

RWJF applauds CVS’s actions wholeheartedly—indeed, we collaborated with CVS on the initial announcement back in February that it would end the sale of tobacco products. So we asked CVS Health executive VP and chief medical officer Troy Brennan MD, to tell us the story behind the story. Just how do you get a publicly traded company to sacrifice some $2 billion in annual sales?

RWJF: What was the impetus for the decision to end the sale of tobacco products?

Troy Brennan: In many ways we are building a Culture of Health, just like you. Health is the most important thing in terms of what we do for our customers, who are often also our patients. We like to say that health is the prism through which we see all the work that we do—and tobacco just doesn’t fit in.

RWJF: When did CVS first start considering an end to tobacco sales?

TB: The appropriateness of selling cigarettes in pharmacies is not a new issue. The American Pharmacists Association has for years said that it was unethical to sell tobacco products in a pharmacy. I’ve been vocal about it and a number of people in the company, especially our CEO, agreed that as we started thinking of ourselves more and more as a health care company, we needed to end tobacco sales. In terms of the products we sold, tobacco was the number one threat to the health of consumers.

CVS Health executive VP and chief medical officer Troy Brennan MD Troy Brennan MD, CVS Health executive VP and chief medical officer

RWJF: Was there much pushback from within the organization?

TB: It was not an easy decision for anyone, based both on the revenue loss as well as the thinking that smokers would just buy their cigarettes elsewhere—which made us wonder whether our action would have an impact. We now have data that indicates that removing tobacco products from retailers with pharmacies will lead to substantially lower rates of smoking, with implications for reducing tobacco-related deaths. That’s been very gratifying to know that our decision can make a difference in people’s lives.

The response we received from our pharmacy benefits manager (PBM) clients was also gratifying. Our leadership got tremendous feedback, with clients saying that our decision to quit selling tobacco really does ‘tip the scales’ in their eyes in terms of what kind of company we are—a health care company.

It was also very gratifying to see how excited our colleagues were in the stores. It really had an important effect overall on company morale.

RWJF: Was it difficult to convince the board of directors and investors?

TB: Our Board of Directors was critical in making this decision and they were extremely involved and supportive. Everyone agreed that this was the right time for us to make this decision as a company—both strategically and financially. The analysts who follow us agreed and understood why we made this choice.

RWJF: How did you go about putting the plan into place?

TB: There was a whole logistical plan that went into operationalizing our exit from tobacco. We had to wind down inventory, starting with the February announcement and culminating Labor Day weekend. Lots of credit goes to our CEO Larry Merlo for his leadership as well as to Helena Foulkes, who is the president of CVS/pharmacy.

Helena was central to helping the organization understand the importance of making this decision as a health care company. She was also able to drive and inspire the front store team to get this job done quickly, and they did it in a seamless fashion.

RWJF: How were you able to beat your original timetable by a month?

TB: Once we decided to get it done, things moved very fast. Overall we felt like we could get it done sooner than October 1.

RWJF: How do you respond to criticism that the CVS stores continue to sell unhealthy snack foods and soda?

TB: None of those products have the same caliber of harm as tobacco. There is no such thing as "moderate use" of tobacco products.

RWJF: Why change your name to CVS Health?

TB: There has been tremendous positive feedback for the name change—nearly 100 percent. It’s helping to change our image to be both an innovative and caring company that is helping people on their path to better health. Our new name is a reminder of that.

RWJF: What changes do you see in the next few years for CVS Health?

TB: The pharmacy’s role is really changing. In the past, the major integrated academic medical centers had their own pharmacies. Now, we have affiliations with more than 40 major medical centers to work together as pharmacies and retail clinics play an expanded role as part of the health care team. We want to be active in the changing health care landscape and we’ve been developing comprehensive programs to do that.

Wed, 22 Oct 2014 16:01:00 -0400 Catherine Arnst Tobacco Control RWJF Staff Views <![CDATA[Global Health in a Time of Ebola]]> Nelson Mandela's cell on Robbens Island Nelson Mandela's cell on Robbens Island (photo by Paul Kuehnert)

I returned from Cape Town, South Africa a week ago and want to share some reflections on my trip and my participation in the Third Global Symposium on Health Systems Research, in Cape Town September 30-October 3, with the theme “Science & Practice of People-Centred Health Systems.”

In the opening session, Professor Thandika Mkandawire from the London School of Economics made two remarks that resonated with me, and that were referred to by other speakers throughout the conference. First, referencing Napoleon’s quote that “War is too important to leave to the generals,” Mkandawire said that “health is too important to leave to health specialists.”  Instead, there is a need for multiple disciplines and sectors to create health and devise health policy. He went on to address the policy issues related to the most vulnerable populations, saying that “policies targeting the poor are poor policies”, arguing for the importance of social solidarity, not charity.

The current Ebola epidemic highlights the gaps in public health in many nations, as well as the erosion of public health emergency preparedness and response at WHO and many other nations, including the US.. This is putting our health at risk from all kinds of infectious and emerging diseases (e.g., MERS, polio) and threatens progress in health in other areas.

As global citizens, we need to rethink and significantly enhance our ability to detect and respond quickly and adequately to population health threats—and foundations like ours have an important role to play in enhancing the "system" of preparedness and response. Convenings like this are also crucial for highlighting issues around public health around the globe, and sharing solutions.

Social solidarity—or, as RWJF puts it in our 2014 President's Message, “we’re all in this together”—was carried through as a key component of the idea of "people-centredness" in multiple discussions of access to care, quality of care, community mobilization, resilience, and innovations in care. Until this meeting, I was not aware of the large number of low- and moderate-income countries that are putting in place health insurance approaches to access rather than direct, government-funded and provided primary care services. There were multiple models, and debates about their merits, ranging from South Africa’s constitutional guarantee of a right to health and health care to Thailand and Rwanda’s much more gradualist and mixed market-based approaches.

A number of sessions focused on community mobilization strategies that addressed traditionally excluded and marginalized populations and specific patient populations, such as people living with HIV. I was struck by the way this strategy has had an impact on HIV prevention and care in South Africa: In the past 5 years, perinatal transmission has been almost eliminated (dropping from more than 66,000 cases to less than 2,000) and tens of thousands are now receiving anti-retroviral drug treatments, resulting in an addition of four years of life expectancy for the nation! All of this is due to a combination of grassroots organizing, consumer advocacy, anti-stigma and human rights advocacy, and supportive governmental health structure/resources.

Innovation, particularly in the use of mobile technology, was another theme of great interest to me. The World Health Organization’s (WHO) work in this area, coordinated by staff and faculty at the Johns Hopkins Bloomberg School of Public Health, was particularly impressive. They have developed a set of tools and approaches to scaling innovation that I think may be of great relevance and use to the Foundation.

There was also a fair amount of discussion of both individual and community resilience—economic shocks, poverty, violence, disaster. This seemed to me to be an area where the work RWJF and others in the U.S. are doing around Adverse Childhood Experiences and disaster preparedness and response, is not as well known in other countries. For example, I was surprised by the comments of leaders from Doctors Without Borders in one session who viewed the framework of resilience in disaster response suspiciously, speculating that it was a way to decrease disaster response resources from the international community.

Awareness of the unfolding Ebola disaster was ever-present at the meeting. A number of speakers referenced the moral and ethical questions raised by the slow pace of the global response to the outbreak and the tremendous impact in terms of human suffering and lives lost. Further, the fact that the three West African nations at the center of the current outbreak just recently came out of incredibly violent periods of internal conflict and had extremely fragile health systems raised questions about the responsibility of the global health and health care community to identify other countries at risk (e.g., Syria), and be more proactive. These discussions reminded me of the Foundation’s work around the core capabilities and services of public health—the ones that must be available everywhere for the health system to work anywhere.

Lastly, I would be remiss if I did not mention the experience of being in South Africa itself. It is a uniquely beautiful place. I enjoyed the rugged mountains, the amazing colors and power of the sea, the unique flowers, trees, and animals. But I was most impressed by the spirit of the people as they celebrate 20 years of post-apartheid freedom. This came through in a variety of ways, from the tour guide I met driving us around the Cape peninsula and working the history of apartheid and its impact on his family into his tour commentary, to the former political prisoner on Robbens Island who takes thousands of people like me through a place that confined him for five years but never broke his spirit and determination.

South Africa is a complex, multifaceted society that I experienced for only a brief time. But the spirit of very diverse people coming together and overcoming a powerful system that caused so much pain and suffering was such an inspiration and renewed my hope for humanity’s future!

I have a fair amount of additional information on the particular themes I reflect on here and would be happy to discuss in more depth with anyone who has an interest. Many presentations from the symposium and additional materials and resources can be found on the Health Systems Global website.

Let's hear your feedback.

Paul Kuehnert is a director leading the Foundation’s efforts to build connections between health, social sectors and health care to address the multiple factors that shape Americans' health.


Tue, 21 Oct 2014 14:44:00 -0400 Paul Kuehnert Emergency Preparedness and Response Public and Community Health RWJF Staff Views <![CDATA[Data for Health—Coming to a Town Near You]]>
Listen Image by Ky Olsen (CCBY)

We have some questions for you—questions, that is, about health information. What is it?  Can you get it when you need it? What if your community needed important information to make your town or city safe or keep it healthy? How about information about your health care? Can your doctors and nurses get health care information about you or your family members when they need it quickly?

I came across a recent Wall Street Journal article about a remarkable story of health, resilience and survival in the face of an unimaginable health crisis—a Liberian community facing the advancing Ebola infections in their country got health information and used it to protect themselves. When the community first learned of the rapidly advancing Ebola cases coming toward them, the leaders in that Firestone company town in Liberia jumped on the Internet and performed a Google search for “Ebola”. From that Internet search they learned how to protect themselves. Then those brave people acted on that new information—that new knowledge. They did a number of things like use the information to build quarantine and care facilities as well as map the advancing illness cases in their town—so they could be smart about identifying, quarantining and caring for those infected with the virus—and then stop it. Months later, this town is now essentially a lone bright spot of health in a country devastated by death and illness. Why?  Because the leaders of that town used technology to get the critical health information they needed, and then they used it to act.

Across the globe, in a far different place we find a prosperous, safe community in the United States. It’s a place fortunate to have vast resources and great wealth. It’s a place with beautiful health care facilities that have expensive, nearly brand new electronic health record systems with some of the world’s best trained health professionals. Almost everyone living in this community has a smartphone and nearly nonchalant, expected instantaneous access to detailed information about everything from traffic patterns and weather to the latest movies and best restaurants. This place faced its own Ebola crisis, and something different happened.

Sometimes data, in spite of all of the advantages, does not turn into useful information. We all know now about the health care system failure in Dallas that prompted the missed Ebola diagnosis there. The doctors and nurses in that Dallas hospital had  a brief opportunity to put key bits of information about the patient infected with Ebola together so they could make the right care decision —but they couldn’t quite do it. Instead they missed a chance to get a sick man the care he needed and at the same time triggered a community and national health crisis.

Miscommunication in health care is not unusual. That’s sadly not the headline for the Dallas Ebola story, and it’s not my main point here. It is, however, a striking example of the limits of our current health data system. We have potentially helpful health data all around us—but all too often when we need it to help us make smart health decisions for ourselves or our communities we can’t quite put it together.

What if, however, we developed the information capabilities that would help ensure that you, your community leaders, your physicians and nurses and other health professionals could easily, readily, rapidly and reliably get health information when they needed it in order to keep you safe and help you get and stay healthy? What would that system look like? What do you expect from such a heath information system? What worries you about data systems that provide important information about your health and the health of your community?

We at the Robert Wood Johnson Foundation want to know. We work with leaders like you across the country to help build a Culture of Health. None of us can build that health culture without a way to get and use the best health information possible, quickly and efficiently. So, we’re convening a series of meetings across the country in Philadelphia, Des Moines, Phoenix, San Francisco and Charleston this fall to ask you.

Specifically we’ll be inviting 100 community members from each of those places to tell us their hopes, aspirations, worries and fears about digital collection, access and use of data for health. National Coordinator, Karen DeSalvo is interested in these RWJF meetings as well. She will be at all five events listening in person.

Although creating a reliable data system is a tough technical problem—that’s not really the hard part. The really hard data system challenge will be deciding what we want as a country—what we expect—what worries us—and what we will ultimately demand.

As you can see, we have a lot of questions about health information. 

Mostly, though, we’ll be listening as hard as we can to you this fall for some answers.




Thu, 16 Oct 2014 06:00:00 -0400 Michael Painter Health Data and IT