Culture of Health News and views from the Robert Wood Johnson Foundation Tue, 2 Sep 2014 10:59:00 -0400 en-us Copyright 2000- 2014 RWJF (RWJF) <![CDATA[Living Out Their Salad Days: Shaping Healthier Environments for Kids in the Nation’s Schools]]>

A school lunchroom full of hundreds of young children, happily slurping up ... salad.

If you’re someone who’s ever struggled to get kids to eat their vegetables, it sounds like an impossible dream.

But this is reality at Anne Frank Elementary School, the largest in Philadelphia, with 1,200 students from kindergarten through fifth grade. Serving salads was the brainchild of Anne Frank principal Mickey Komins, who had the salads brought in from a local high school cafeteria.

Along with the after-school Zumba and kickboxing classes that the school now sponsors for kids, parents, and staff, healthier food offerings are among the innovations that earned Anne Frank an award from the Alliance for a Healthier Generation. The Alliance, a Robert Wood Johnson Foundation grantee, is a nonprofit founded by the American Heart Association and the Clinton Foundation to help stem the tide of childhood obesity. It’s at the vanguard of a growing national movement to turn schools into healthier environments, and offer kids fundamental lifelong lessons about maintaining their health.

The Alliance first sought to enlist Anne Frank Elementary four years ago in its Healthy Schools Program to support healthful eating and physical activity. With nearly 1 in 3 U.S. children overweight or obese—and since many children consume at least a third to one-half of their daily calories at school—it didn’t take much to persuade Komins, a former physical education teacher turned administrator, that combating child obesity would require such “revolutionary” measures as serving more green vegetables to kids.

Following the Alliance’s framework, Komins and his team first sent out a survey to the rest of the staff, soliciting their ideas for building a healthier school. Next came a survey of kids and parents to determine their interests and obtain buy-in for any changes.

 “We started out very small because we didn’t want to overwhelm people,” Komins says. “If you start small, you get small successes and find things you can build on.”

The initial building blocks included two councils created to advise the school on changes: one representing adults and another, students. Besides salad, fruits were added to the school menu. The school sent a letter home to parents asking them not to send in sweets for birthdays, and suggesting an alternate list of food and non-food items, such as stickers. One student arrived at school subsequently with 30 Greek yogurts for his classmates as a birthday treat.

On the activity front, teachers began scheduling a “JAMmin’Minute” in classes to get kids up and moving. A once-a-week exercise class for teachers after school eventually led to multiple classes for kids, teachers, and parents. And an annual 5K “color” run was scheduled to provide a fun-filled event in which the participants—students, parents and school staff—were blasted with colored powder as they passed various stations along the way.

The results are in: Average body mass index scores for Anne Frank’s students have decreased by three points—from 25 to 22—since the changes were initiated, according to an analysis conducted by the school’s nurse. (To put that in perspective, the Centers for Disease Control and Prevention considers a 10-year-old boy with a BMI of 21 overweight; with a BMI of 23, obese.) Komins is now a Healthy School Ambassador for the alliance—one of a group of 30 innovators who’ve adopted program and policy changes to support healthful eating and physical activity in schools.

These voluntary efforts have gained reinforcements at the federal level. Revised federal nutrition standards governing school meals are being phased in from 2012 to 2022, and new standards governing snack foods and beverages sold in schools take effect this school year. Still other public-private partnerships, like First Lady Michelle Obama’s Let’s Move! initiative, have sparked the Salad Bars to Schools program to raise private donations to install such facilities in schools.

Best of all, there’s growing evidence that such measures work. Although a Government Accountability Office study earlier this year reported a 3.7 percent decline in the number of students participating in the National School Lunch Program, a separate study, sponsored by the RWJF Bridging the Gap research program, shows that 7 in 10 U.S. public school administrators surveyed say the majority of students like the meals produced under the new federal standards. Still other RWJF-funded research shows a link between strong school meal standards and lower rates of child obesity.

The bottom line: At Anne Frank Elementary and elsewhere, millions of kids nationwide are returning to healthier schools this fall. That means that they’ll be able to look back on their school days as genuine salad days for many more years to come.

Join us for a live Google+ First Friday Hangout on September 5 at 12 noon ET to hear from schools and other organizations leading innovative ways to address childhood obesity through healthier nutritional options and more activity.

RSVP for the live event

Tue, 2 Sep 2014 10:59:00 -0400 Susan Dentzer School foods Childhood obesity School snacks Children (6-10 years) Urban Pennsylvania (PA) MA <![CDATA[Healthy Communities: The Building Blocks of a Culture of Health]]> Baldwin Park California

What do Corvallis, Ore.; Baldwin Park, Calif.; and Buffalo, N.Y. have in common? It certainly isn’t their weather.

Hint—the commonality is something much more relevant to RWJF’s newly refined mission. These three cities are building a Culture of Health for all their citizens. They are tapping into the skills and resources of a diverse group of partners to ensure everyone has access to healthy choices. It’s their collective efforts, along with dozens of other communities supported by the Foundation’s Healthy Kids, Healthy Communities (HKHC) program, that make me so optimistic about our organizational goal.

My strong belief that environments—physical, social and educational—play a prominent role in our individual health and well-being is what initially drew me to RWJF. So, in 2008, I excitedly embraced the opportunity to be the national program officer for HKHC, which addressed the root causes of childhood obesity by transforming the physical activity and food environments in which children and their families live, learn and play.

Without us necessarily realizing it at the time, HKHC started “planting the seeds of a Culture of Health” and served as an early model for our current work. Its approach to the childhood obesity epidemic is what the movement is all about—addressing health in a way that is more than just the treatment of a disease.

As our HKHC investment wraps up, it’s a perfect time to celebrate those communities that have supported and nurtured healthy places, kids and families.

HKHC’s umbrella organization, Active Living By Design, developed three substantive reports and resources from the program that comprise lessons learned and provide compelling community examples. While the reports contain many great nuggets of information, I want to highlight one of my favorite themes from Growing a Movement: Healthy Kids, Healthy Communities Final Report.

Giving locals a real role and voice are key ingredients in establishing a Culture of Health. Here’s how HKHC made it happen:

  • HKHC worked with local governments to make community engagement more of a priority. In many instances, elected leaders and/or departmental officials developed new procedures to accommodate, and even require, greater participation from local residents. This is one place where Corvallis, Ore., excelled. HKHC helped “Creciendo en Salud,” the local partnership, focus on building the capacity of youth and low-income residents to advocate for health opportunities in their neighborhoods. For the first time, in many cases, Latino and low-income residents testified at city council meetings, city advisory groups and school board meetings.
  • HKHC-supported communities also made sure to prepare their residents, so they could engage in civic-planning processes and improvement projects in a meaningful way. Preparation took a variety of forms, ranging from periodic educational sessions addressing healthy eating and active living issues to a year-long curriculum for equipping residents with the skills they needed to participate in city council meetings and, in some cases, even serve on boards. Locals also learned about a range of topics including government services, political processes, land use planning, utilities and economic development. For example, the HKHC project in Baldwin Park, Calif., worked with local partners to launch an initiative solely focused on strengthening resident leadership. It produced results. Resident advocates, armed with cameras and assessment tools, led a grassroots campaign for healthier corner stores and prompted the development of a nationally recognized Complete Streets policy.
  • The best part of HKHC’s work with local residents is that they collaborated with both adult and youth leaders. Kids and teens were able to have a seat at the table and share input that really shaped the changes made in their communities. In Buffalo, N.Y., HKHC helped facilitate the creation of a youth advisory committee that led to youth seats on three different city-wide councils. The youth committee members also participated in the city’s zoning and land use change process, and they hosted a youth training session to educate high school students about land use planning and effective participation in public meetings. Another successful effort resulted in a policy change that will remove the old, unhealthy vending machines throughout the school district.

I am certain that the HKHC local partnerships, especially resident supporters, will continue to serve as leaders and resources to the Culture of Health movement that is occurring in communities across the country. The childhood obesity epidemic didn’t happen overnight, and we’re not going to reverse it overnight. Similarly, realizing our Culture of Health vision is going to take time. It’s also going to take partnerships like the ones HKHC developed. This is an opportune time to leverage the investment we made over a decade ago to reverse the childhood obesity epidemic and to create a Culture of Health everywhere. Corvallis, Baldwin Park and Buffalo are just the tip of the iceberg. How can we replicate their achievements, and the achievements of the 46 other HKHC communities, in cities and towns around the country?

Mon, 25 Aug 2014 09:15:00 -0400 Jamie Bussel Childhood obesity Healthy communities Built environment RWJF Staff Views <![CDATA[Are E-Cigs a Gateway to Smoking for Teens?]]> Vaping Electronic Cigarette

As you step through the door of Beyond Vape, you are enveloped in the warm scent of vanilla, tinged with butterscotch. The sleek glass counters and display cases are reminiscent of a high-end cigar shop, but there are no tobacco leaves on hand here. This popular, high-end “vaping” parlor, on one of Williamsburg Brooklyn’s more popular streets, is one of seven the company owns on the East and West Coasts.

Vaping—or inhaling richly flavored, heated vapor through a slender, battery-powered tube—is the latest trend in “smoking,” without actually lighting a traditional cigarette. Cindy Hsu, the store’s manager, explains that some of her customers “vape" without even adding liquid nicotine to the tube’s cylinder. “They prefer to just enjoy the extensive menu of flavors such as mocha mint, kiwi strawberry and pineapple.”

Tasty flavors are one thing, but there’s another popular incentive to vape: the claim that vaping can help you stop smoking. Another neighborhood shop, Brooklyn Vaper, advertises its wares with a video explaining that vaping is a “greener, cheaper alternative to help you quit smoking effortlessly... while vaping in 40 flavors.”

Is that true? Can vaping or pre-packaged e-cigarettes help smokers quit?

It depends on which research you're reading. One recently published survey of almost 6,000 adult smokers in Britain found that those who used e-cigarettes were 60 percent more likely to quit than those who tried nicotine replacement therapy or willpower alone.

However, many other researchers have come to very different conclusions. For example, an analysis published in the May 2014 JAMA Internal Medicine found no evidence to support the contention that e-cigarettes help conventional smokers quit, and the Center for Tobacco Control, Research & Education at the University of California, San Francisco, has called upon the Food and Drug Administration to "prohibit e-cigarette marketing that promotes false health claims."

And that's not even taking account the potential health risks associated with e-cigarette vapors, which are regarded as toxic.

That's the debate swirling around adult e-cigarette smoking and vaping, but there is an even more worrisome issue: What do we know about the effect of e-cigarettes on adolescent smoking behavior?

The Impact on Teens

Sociologist and demographer Adam Lippert, PhD, a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2013-2015), is one of many researchers asking the same question.

“My research was motivated by 2011-2012 data showing that the rate of adolescent e-cigarette use had doubled (from 5 percent to 10 percent) in a single year,” he says. The rate is increasing even though many states, including New York, ban the sale of e-cigarettes to people under 21. (Editor's note: Newly published research by the Centers for Disease Control and Prevention shows a threefold increase in the number of young people who had tried an e-cigarette in 2013, from roughly 79,000 in 2011 to more than 263,000 in 2013.)

Understanding why adolescents begin smoking is critical because almost nine out of 10 smokers pick up the habit by age 18, and 99 percent start before 26, according to the Centers for Disease Control and Prevention (CDC).

“I wanted to know whether adolescents were also using e-cigarettes to quit conventional cigarettes, like adults, or if e-cigarettes were used along with conventional tobacco,” Lippert explains.

His research found that teen smokers in general were most likely to be white and male, and that this group was also most likely to use e-cigarettes. The bad news: Those teen smokers tended to use conventional cigarettes and e-cigarettes together. Lippert reported that for teens, “e-cigarette use does not appear to be part of a [smoking] cessation regimen among conventional cigarette smokers wishing to quit.”

He makes his argument in the article “Do Adolescent Smokers Use E-Cigarettes to Help Them Quit? The Sociodemographic Correlates and Cessation Motivations of U.S. Adolescent E-Cigarette Use,” published online in the American Journal of Health Promotion in June.

Protecting Kids

Not only does Lippert express concern about the possible unknown health effects of e-cigarettes, he also suggests that for some young people, e-cigarettes might serve as an easy introduction to smoking. (A March study published in the journal JAMA Pediatrics makes just that assertion. The CDC research cited above paints an even more distressing picture. It shows that young people who had tried e-cigarettes were about twice as likely to intend to smoke tobacco cigarettes.)

“Other research has shown us that for adolescents, peers are the greatest influence on substance use,” Lippert says. And as every parent knows, even with legal restrictions in place, hot social trends, like vaping and e-cigarette products, transcend legal barriers and easily end up in the hands of teens.

“When smoking is portrayed as a social norm among others who are seen as cool, sophisticated, rebellious, or fun-loving, teens often respond by copying the behavior and trying cigarettes themselves,” according to the CDC report Preventing Tobacco Use Among Youth and Young Adults.

For parents and policy-makers, Lippert advises:

The danger, he adds, is slipping backward in time when it comes to adolescent tobacco use. “Teen smoking is at a historic low now, so we have something to protect. If we do nothing, we risk losing that. We do not want to go back to the days of Joe Camel.”

Learn more about the RWJF Health & Society Scholars

For an overview of RWJF scholar and fellow opportunities, visit

Thu, 21 Aug 2014 15:44:00 -0400 Sheree Crute Tobacco cessation Tobacco control Tobacco <![CDATA[Straight Talk: Black Women, Hair and Exercise]]>

When you're starting to exercise, you look for reasons not to, and sometimes the hair is one of those reasons.—U.S. Surgeon General Regina Benjamin, August 2011

I once wrote about how black women can care for their hair when physically active. It featured the perspectives of women ages 21 to 65 on how we protect our weaved, straightened, and natural styles while exercising. After reading the post, a well-respected public health leader admitted, “I did not know that hair care was an issue that kept black women from exercising.”

I wasn’t surprised that a middle-aged, middle class, white male had missed this not-too-insignificant tidbit. But I was saddened that someone with a prominent role in prevention wasn’t aware of an important factor behind the obesity crisis among black women.

There are many reasons why four out of every five black women in the U.S. are overweight or obese: We live in neighborhoods that make eating cheap, high-calorie foods and beverages very easy, but physical activity very hard. Some wonder if our genes predispose us to excess weight; others say that we are beyond motivation, given data suggesting that too many of us suffer untreated depression.

But hair, for black women, adds a whole other level of complexity, as we struggle with how we can maintain our hairstyles while being physically active. Hair is no small matter for us—it is intimately connected with our life experiences, from whether we get married, to how much money we make, to who we socialize with. Ultimately hair is a powerful mediator for how African-American women feel about themselves.

Many of us struggle with shame around our body image. This includes how we present and care for our hair. In work settings, we feel pressured to have "professional" hair that doesn’t bring too much attention to ourselves. Socially, the rules wax and wane, but overall it is important to be not too far beyond the mean with your tresses. Most black women spend a great deal of time and money finding the right fit. Physical activity, with its attendant sweat and dishevelment, adds another layer of concern.

So what are we, as public health stewards, to do if we are serious about getting more black women active? Any public health initiative targeting physical activity for black women must be culturally responsive, and that means taking hair care into consideration. Rutgers University’s H. Shellae Versey has closely studied how hair influences physical activity among black women, and recommends that public health efforts include strong social networking, social media, and responsiveness to cultural norms and preferences.

I agree. Within the last five years, there has been an upsurge of groups that are promoting physical activity in the black community. In Birmingham, Alabama, where I live, nearly 6,000 black women are moving with GirlTrek and Black Girls RUN! (BGR!). We log thousands of miles monthly even when the temperature is 30 degrees, in the pouring rain, or when the humidity is over 90 percent. You'd best believe that this causes hair stress for black women.

Birmingham trekker, Rukiya, does not let what’s on her head get in the way of what is in her heart. She is resolute about keeping her hair straightened and reaching her health goals. For Rukiya, being physically active means fewer curly styles as well as taking extra time to use protective grooming techniques. She has found the right balance that permits her to walk five miles, three days per week. She also does strength training three times per week and has begun to add interval runs to her routine. Rukiya spreads the word about walking to family members, sorority sisters, and friends in BGR! and GirlTrek.

Her diligence is paying off. Her loved ones have begun to take note of a more toned and active Rukiya. She has dropped two dress sizes over the past three months and continues to explore new ways to be active. After a recent GirlTrek skate party, I asked Rukiya what keeps her moving and committed. She quickly replied “I see what you all are doing or have done, and it's encouraging. The support is amazing. In some things, I'm a loner. But my fitness journey, I believe, is not something I'm meant to do alone. I tried it that way and failed. Thank you all for being such shining stars!”

Rukiya’s story should set a trend for how we tailor physical activity programming in public health—it should be inspirational, culturally responsive, and build community. We have to set the stage for more shining stars to emerge from communities of color and in low-income communities. We must ponder the types of policies and practices that can promote a culture of health and bolster health equity. Ask yourself: “What if more public health programming was framed to be culturally and circumstantially responsive? What policies and funding decisions can build upon the strategies of BGR! and GirlTrek? What role can I play in ushering in this type of change?”

Hair will remain an issue, but the allure of powerful social networks and positive imagery has shifted the dialog for black women’s wellness. Many have transitioned from asking ”can I be active” to “how can I try on more and new activities” in the comfort of a community of other black women.

Our fitness community also includes our daughters. It is not unusual to see Rukiya with her 9-year niece, Garnier, along the walking trail. She is the spitting image of her aunt, and she too wears her hair straightened. Garnier has a powerful role model that lets her know that she can be active and have any hair style she chooses. We need to spread that message to all girls and women of color—they can have great hair and great health as well as public health systems that make it possible.

About the author

Keecha Harris, DrPH, RD is a walking enthusiast who has trekked every day since October 2012.  Her consulting company has provided support to the Robert Wood Johnson Foundation Childhood Obesity Team and the Research, Evaluation and Learning unit.  

Thu, 21 Aug 2014 09:00:00 -0400 Keecha Harris Physical activity Behavior change Cultural competence <![CDATA[Building the Information-Rich Culture of Health]]> Reform by the Numbers Visual

What if your mother wanted to take some ibuprofen for her arthritis, but didn’t know if it would interact adversely with her other medications?

No problem, right?

She could whip out her smartphone and launch an app that connected to her local health information exchange. Within fractions of a second, the exchange would verify her identity, locate the computer storing her electronic health record (EHR), and shoot an answer back to her.

This scenario is just one example of the many ways that having timely access to health information could contribute to health. It could, that is, if the nation had an agreed-upon way to organize data about health and health care in ways that made it easily accessible and usable while still secure and protected.

But for now, we don’t.

There are many more ways in which we could all benefit if things were different. What if a community’s planning department wanted to know where building a new bike path would provide the most benefit and could call up on an app the most common cycling routes that citizens already use? Or a public health department could immediately tap into data about who was showing up in clinics with flu-like symptoms as it sought to pinpoint a local disease outbreak?

You get the picture. Health information—our ability to organize it, access it, and actually use it, is a critical part of building a Culture of Health.

The nation is on its way to building systems that could make all these data uses possible, but it isn’t as far along as it needs to be. Rather than having the data structures in place that would allow the agile uses these examples suggest, it’s as if, at least for the type of clinical data collected on EHRs, the nation had installed a bunch of freestanding fax machines that could somehow send faxes, but never receive them.

That was the conclusion of a Robert Wood Johnson Foundation forum on the nation’s health information infrastructure held in Washington, D.C., on August 7. (See the videos: Part 1 and Part 2.)

On the one hand, the United States has made enormous progress in health information technology (HIT) adoption since enactment of a 2009 federal law aimed at spurring HIT adoption.

The latest RWJF annual HIT adoption report—“Health Information Technology in the United States: Progress and Challenges Ahead, 2014” shows that almost 3 in 5 U.S. hospitals had at least a basic EHR in 2013. In 2012, about 2 in 3 eligible hospitals were receiving incentive payments from the government for meeting initial “meaningful use” criteria of the technology, up from fewer than 1 in 2 hospitals in 2011.

What’s more, nearly half of U.S. physician practices had adopted at least a basic EHR, double the number that had one in 2009. No other large nation has made so much progress in HIT adoption so quickly, one of the authors of the report, Harvard’s Ashish Jha told the forum.

But looked at from another perspective—just how much are health care professionals really exchanging health care information—the accomplishments to date have fallen short. Only one in 10 hospitals are providing patients with access to their health information, for example. Only about half of hospitals use EHRs to identify gaps in care. Important parts of the nation’s health care continuum—particularly small physician practices and medical specialists—are far less likely than hospitals and other providers to have adopted EHRs. And when it comes to exchanging health information among providers—for example, sending lab results from one hospital or health system to another when a patient is transferred—only about 1 in 3 hospitals are actually doing it.

Organizing health and health care information so that those who need it can access and use it, quickly and easily, while still protecting patients’ privacy, is critical. That’s why, in 2013 RWJF collaborated with the Agency for Healthcare Research and Quality and the Office of the National Coordinator for Health Information Technology (ONC), and asked a prestigious group of the nation’s scientists and academicians to tackle the issue. The group, known as the JASONs has been advising governmental agencies, such as DARPA, on science and technology matters for more than 50 years. The report it produced, “A Robust Health Data Infrastructure,” represents one of the first times—if not the first time—that federal agencies have asked the JASONs for assistance with a health-focused question.

The report recommends that ONC prompt the development of an overall software architecture that could make robust health data exchange possible nationwide. The architecture would be based on “open” standards for collecting data. Developers of EHRs would have to publish so-called application program interfaces—the directions for how various software components can connect with each other. Such a system would be similar to the arrangement that allows millions of developers to create apps that connect to proprietary smartphone software developed by an Apple or Samsung.

The JASON vision frames the big technical data infrastructure challenges, but emphasizes that those are surmountable. It does not, however, deal specifically with many of the other barriers to such an effort—including legal, economic, societal and even cultural ones. Those other challenges are likely the most difficult to overcome.

Speaking at the RWJF forum, National Coordinator for Health Information Technology Karen DeSalvo called the JASON report “a gift to the nation” for proposing a pathway to a health information architecture. Arguably, if we cannot find ways to harness the tremendous power of the health and health care data that we are collecting, we will not be able to attain that vision. Now, the nation needs focused, intense work to promote and tend the development of system that can deliver on the promise of an information-rich Culture of Health.

Wed, 20 Aug 2014 10:36:00 -0400 Mike Painter Information technology Data RWJF Staff Views <![CDATA[A Survivor’s Take on Depression: We are the Sad Ones. Try to Understand Us]]> Depression Painting to go with blog post Painted in the hospital after suicide attempt

(This post was written by a member of the RWJF family who has asked to remain anonymous.)

Every day I worry that I will be caught. It could happen any time, any place, and by any one person that looks past my smile and into my eyes and knows immediately that I am not like him nor her. He or she will not see the color of my eyes, but rather that I am hiding something.

I have been in and out of therapy since the age of 9, and on and off antidepressants of every color and brand for more than 20 years. Yet I stand here today with the same diagnosis that I had when I was a child, despite the “help” and the “work” that I have devoted to my illness ever since I can remember. I have clinical depression.

I will never be “okay” by conventional standards without medication. I have finally come to realize that this is not my fault, but rather a product of my DNA. Nonetheless, I hide in shame. No one knows of my diagnosis, or the medicines that I take to help control it, or the acting that I perform daily to hide it.

I could be your sister, your friend, your neighbor, your co-worker, your daughter, and you would never know it unless I told you.

The recent passing of beloved actor and cultural icon Robin Williams has spurred an online conversation around depression, shining a light on the disease’s severity, and the millions who suffer from its affliction. The confusion that surrounds his death prompted me to write my story.

So many people have wondered why he didn’t seek help. We (the sad people) know there is help. We just don’t want it. A 1-800 number will not help those who have reached the end, the point of no turning back. When we are sad, the last thing we want is “help.” But what may work is compassion and empathy for our suffering, and a communal acceptance that we are not crazy.

My mother would always ask “what’s wrong with you, you have everything, you have amazing talent and you are so smart, why can’t you snap out of it?” My response was always a calm, steady three words: “I don’t know.”

As a sufferer of mental illness, I cannot control it. It is as scary to me as it is to you. If I could change, I would.

I will forever hold on to the memory of attempting suicide and being held in a mental facility afterwards. My freedom and dignity stripped from me because I had a “bad night” and cut my wrists. Instead of compassion and empathy for my suffering, I was stripped of my clothes, locked in a dirty room with nothing but a stained cot and intense fluorescent lighting that prevented me from resting. I was questioned by very young psychology students who asked me remedial questions that were meant to judge my mental state, but all I could focus on was the thought of losing my entire life (job, children, family, etc.), and being locked away in a mental hospital against my will. I still recall the cries of the patients in holding cells next to mine.

I gathered my strength, stood in a poorly laminated floor hallway, and spoke to the loved ones of those in the adjacent holding cells. Everyone but me was a minor who had attempted to take his or her own life. I tried to sneak a peek at the boy across the hall; his dad just shook his head and said; “the system is broken and it really fails to protect the young. My son is being shipped over 90 miles away because all of the local juvenile mental facilities are full.”

Our society needs to take mental health care seriously, and make sure it is accessible to everyone. Simply asking the mentally ill to reach out for help, reminding us that “suicide is not the answer,” will not save us. Providing us with resources and support systems might. Make sure that health insurance covers the mental health needs of people like me, and that there are community-based mental health resources, so that all who need help can afford it, and find it. So don’t call us crazy, don’t feel sorry for us. Most of all, be patient with us. We did not ask for this affliction and we do not want to be sad. We just are.

Read Brent Thompson's post on bipolar disorder, and the death of a friend

Read Jane Lowe's post on an intervention program to prevent development of severe mental health problems in young people

Fri, 15 Aug 2014 11:22:00 -0400 Culture of Health Behavioral/mental health Chronic illness <![CDATA[Preventing Suicide: If You See Something, Say Something]]> Dave and Brent Dave and Brent

The second week of August is one of the worst weeks of the year for me. At least it has been since 2008.

Six years ago this week, my friend Dave decided he had enough of the daily struggles of this world and took his own life on a trailhead in the desert near Tucson, Ariz.

He was 31 years old and left behind a fiancé, family, and scores of friends who loved him deeply.

Dave was one of the most incredible people I’ve ever known: a generous soul, full of humor, creativity, compassion, and love. He had more friends than anyone I know. Dave elevated everyone who knew him, inspiring them to find joy, open their minds, chase dreams, and see beauty in the world. It is impossible to count the lives Dave changed for the better, including my own.

But, like so many other people, Dave battled mental illness. He wasn’t afraid to talk about his bipolar disorder or his depression. He didn’t care who knew about it. He felt absolutely no social stigma about his conditions. He wasn’t afraid to discuss his challenges, and in fact, often joked playfully about the flawed brain chemistry with which he was born.

Those of us who were close to Dave were lulled into complacency, because even though he had mental illnesses, he understood them and had the appropriate support systems in place to manage them.

Until he didn’t.

Unfortunately, Dave got seriously injured at his job, preventing him from working. His small employer did not support him once he couldn’t physically perform his duties. He lost his health insurance. He lost his prescription coverage, and he went off his medications.

When further financial strain hit, Dave became overwhelmed. He couldn’t see a path out of the problems he faced. Unfortunately, because Dave was such a positive outward presence, it was hard for anyone close to him to understand how much pain he was in, and how much he was suffering inside. He was just too damned joyful, at least to the outside world.

Every year at this time, I feel the deep loss. I think about his pain, what he was going through, and the methodical, deliberate way he ended his life. I usually try to reach out to his mom, to let her know that I haven’t forgotten her wonderful son.

But this year, it feels like sharing Dave’s story might help others who have a heightened awareness of suicide because of the tragic, high-profile death of Robin Williams.

So many things said in the hours following Williams’ death stuck an eerily familiar chord, making me think about Dave and about suicide in a new light.

A quick scan of just my own Twitter feed produces sentiments that are almost exactly the same as things said about Dave when he died. Some excerpts:

"He brought so much joy...” - ‪@ddiamond

"Robin Williams taught us that pain could be subdued with humor. It is only now, in his death, that I realize he couldn't do that for himself”‪@mckinneykelsey

"Robin Williams made everybody around him laugh. But maybe he couldn't hear it.”@CitizenCohn

Those are precisely the sentiments expressed about Dave when he died in 2008. And they still burn my insides today.

"Think tonight about those nearest you. Who is hurting? Reach them.” -@jmsiniff

Every time I think about Dave, I question myself. Why didn’t I pick up on the severity of the trouble he was in? If I had called him that day, could we have talked it out? While Dave was never ashamed of his illness, I believe he felt shame about his situation. Could I have done something to help him find his way through it? Those thoughts haunt me, and I know they haunt others who have lived through the suicide of a loved one.

If someone you care about is struggling, try to help, even if they put up a convincing front. Find a way to connect on a human level, in whatever way is appropriate for them. Don’t be disarmed by their fun-loving personality or their steely defense mechanisms.

Make sure you are within reach when they stumble.

And know that there is always help, even for those who don’t have friends or family they can talk to.

"Important: do not ever feel ashamed of depression. Please, if you ever feel helpless, call the national suicide hotline: 1-800-273-8255.” - @HeyThereJac

Read a first-person post about depression and the best way to support those who are suffering with it

Read a post by Jane Lowe on an intervention program to prevent development of serious mental illness in young adults

Wed, 13 Aug 2014 09:16:00 -0400 Brent Thompson Behavioral/mental health Prevention RWJF Staff Views <![CDATA[To Build a Culture of Health, There Is No Place Like Home]]> Child First

A century ago, it was normal for a doctor to make a house call to tend to a patient in need. By the time I was a child growing up in New Jersey in the 1970s and 80s, the practice had become virtually obsolete.

The case for bringing health care back into the home is becoming more compelling every day. One place where we see the potential to make a big impact is with new parents and newborns.

Last month, JAMA Pediatrics published new research from on the effects of nurse-home visits on maternal and child health. The randomized, clinical trial followed a group of low-income, primarily African American mothers and children living in disadvantaged, urban neighborhoods of Memphis over a 19-year period. Specifically, they wanted to see whether home visits conducted by the Nurse-Family Partnership before and after a birth influenced whether the mothers and children died prematurely.

The research revealed that “mothers who did not receive nurse-home visits were nearly three times more likely to die from all causes of death than nurse-visited mothers.” It also found that “there were lower rates of preventable child mortality from birth until age 20.” The new findings come on top of other research showing that the same nurse-home visiting model leads to better prenatal health and behavior, reduces risks for child abuse, reduces chances that children would be hospitalized before the age of 2, and improves the mental health and behavior of children at home and in school.

As a mother of two young kids, I know that what happens at home is as important to the health of my family—if not more important—than what happens in the doctor’s office. The interactions my husband and I have with each other and with our children, how we cope with stress, whether we can meet the basic needs of our children for things like food, clothing, or a safe place to live—all of these things matter. In fact, what our children experience in the home in their first years actually affects how their bodies and brains develop. It has a lasting impact on their health over their entire lives. Recent RWJF-supported research bolsters that point of view.

As a society, we ought to be doing much more to help families with young children establish a solid foundation for health from day one. And the best way to strengthen families is to meet them where they are, and help provide them with the tools they need to make healthy choices where they live: at home.

To be clear, the best interventions are ones that empower families to make healthy choices. They don’t preach to parents or do the work for them. They give parents tools and information to help them become the parents they want to be. The nature of the relationship with parents is informal but caring because that’s what it takes to be able to hear what parents need and to offer advice in a way that is heard in return.

Home health professionals also help caregivers overcome the obstacles that make it hard for them to support their children’s well-being and development. That obstacle can be something internal, like depression, or external, like access to healthy food or a safe and stable place to live.

Not all interventions designed to help new parents at home are equal. Research suggests that trained specialists—like nurses, midwives, and mental health professionals—are much more effective at preventing or treating conditions like postpartum depression than models that depend on lay- or peer-based support. Even with the higher bar, there’s no reason why we, as a society, shouldn’t do more to make home health visits a standard practice for all new families and all new babies. It ought to be part of how we build a culture of health for families with young children.

If it sounds far-fetched, consider the fact that every family in the UK gets a visit from a nurse or midwife after the birth of a child. They start with a home visit within two weeks of the birth. After that, they maintain a relationship that combines in-home and in-clinic visits until the child is 5. They monitor and support both the physical and emotional development of children, and help to address the financial or emotional sources of stress that may affect a family’s health. They also have the ability to provide greater support to families who are especially vulnerable or face higher risks. Because home health visits are universal, they can track what is and is not effective and make improvements that can lift the health of entire populations.

For a stateside example, head down to Durham County, North Carolina. A local program, known as Durham Connects “provides in-home nurse visits free of charge to all parents of newborns in Durham County. “Nurses check the baby’s weigh and overall health. They make sure the mother is recovering well after giving birth. If necessary, they assist with breastfeeding and parenting classes. They are trained to spot and address postpartum depression. They help families find options for child care and connect them to financial resources. Research shows that families served by Durham Connects require fewer hospitalizations and emergency medical services, exhibit more positive parenting, and have a safer and healthier home environment.

Even with everything we know, there is still a lot to learn about how to get the most out of home health visits for families with newborns and, especially how to do that at a large scale. We shouldn’t be afraid to do that learning, and to learn by doing. Because home health visits have so much potential to be a home run.

Mon, 11 Aug 2014 15:36:00 -0400 Kristin Schubert Families Home visiting Children (0-5 years) RWJF Staff Views <![CDATA[In a Culture of Health, People Get the Sleep They Need]]> sleep

How can we help people get more sleep?

I asked that question in a blog post back in February. Since then, I’ve been actively exploring the area of sleep health. I’ve talked with researchers, behavioral economists, physicians and mindfulness experts. I’ve talked with people who think they get enough sleep, and people who think they don’t. I’ve talked with anyone I can to discover what we need to know and do in order to help Americans sleep.

Sleep has tremendous ripple effects on our overall health and well-being. Lack of sleep affects your brain. There’s evidence that it affects your working memory. And as any new parent will confirm, we don’t need research to tell us that those who are sleep deprived are less able to control their tempers.

Sleep is important. Research shows that you think better, make better decisions, and recover from colds more quickly. The Centers for Disease Control and Prevention goes so far as to call insufficient sleep a public health epidemic.

And yet, for all the research that exists about the effects of insufficient sleep on health, and all the statistics indicating Americans aren’t getting enough sleep, I’ve discovered that there’s very little research into why. Why can’t more of us get the sleep we need?

Of course, theories about the causes of sleep deprivation abound: We’re stressed out, we’re glued to our devices until the wee hours, or we drank too much (or too little) red wine before bed. Organizations such as the National Sleep Foundation offer tips to fall asleep and stay asleep. But as far as I can tell, there’s no definitive understanding of why many Americans consistently get less than seven hours of sleep.

So I’d like to ask a new question: “Why aren’t Americans getting enough sleep in the first place?”

Are we choosing less sleep? (The coffee shop in the town near my office sells “sleep is for the weak” t-shirts.) Is our physical environment working at cross purposes to a good night’s sleep? Is our sleep health being sabotaged by choices and behaviors in ways we don’t fully understand—or even notice? (For insight into New Yorkers’ sleep habits, check out the very interesting Clock Your Sleep citizen science project from WNYC). Do Americans not know—or not believe—or not care—that good sleep is essential to good health?

We need to understand the full spectrum of reasons for Americans’ sleep deprivation if we are going to imagine and design truly innovative, effective interventions to support better sleep.

Those interventions may be high-tech, such as f.lux, a program that prompts your computer screen to get dimmer as night falls—the idea being that exposure to light sources might overstimulate us and keep us awake past the point of fatigue; or they may be as simple as writing down what’s bothering you on a piece of paper as a way of releasing the anxiety of the day.

For many people, the necessary interventions will almost certainly require resetting cultural norms around work/life balance—when office workers brag about how well rested they are instead of how effectively they can run on fumes, we’ll know we’re making progress.

But I’m getting ahead of myself.  Before we can effectively solve the problem, we need to understand it better.

Here’s where you come in. If you’re a researcher working on this issue, or know of someone with whom I should connect, I’d love to hear from you. If you have a theory or story about why people get or don’t get enough sleep, share that, too.

And if you are a champion sleeper, what are the secrets of your success? We need to understand how good sleep health works, too!

Email me at

You can also follow me on Twitter at @lorimelichar, where I’d love to exchange the latest news and ideas about sleep health.

RWJF’s vision to build a Culture of Health in this country that makes it easy for Americans to be healthy wherever we live, work, learn and play can’t be achieved if we’re bleary-eyed and running on empty. In a Culture of Health, people get the sleep they need.

I look forward to hearing from you.

Listen now: In the latest episode of RWJF’s Pioneering Ideas podcast I talk with Harvard economist Sendhil Mullainathan, author of Scarcity: Why Having Too Little Means So Much, about the ripple effect of sleep on our mental and physical wellbeing—and why this serious health issue doesn’t get more attention.

Mon, 11 Aug 2014 09:52:00 -0400 Lori Melichar Health promotion and disease prevention Behavior change Self-care RWJF Staff Views <![CDATA[An Ounce of Prevention, Even for Serious Mental Illness ]]> CAP_84483_8

As we work to build a Culture of Health for all Americans, it is time to end the stigmatizing distinctions between mental and physical health. After all, the brain and the body are in constant contact, and affect the well-being of each other in too many ways to count. A true Culture of Health recognizes the interdependence of mental and physical health, and places a premium on prevention and early detection of illness, regardless of type.

We commonly provide preemptive treatment or suggest early lifestyle changes for people at risk for diabetes before the condition evolves into full-blown disease. Yet, we typically don’t approach care for serious mental illness in the same way. It’s time for that to change.

The results from a recently released national study of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), a project RWJF funded between 2006 and 2013, demonstrate that early intervention to prevent the onset or progression of psychosis in teenagers and young adults improves health and well-being. By helping family members, pediatricians, teachers, young people, and other community members identify young people experiencing early symptoms of serious mental health problems, EDIPPP was able to engage and treat these young people early. That early intervention in turn helped them stay in school, remain employed, and maintain vital connections to family and friends. These benefits mitigated the effects of mental illness, and allowed these teens and young adults to lead healthier and more productive lives.

This study should shift our thinking about how we best treat young people at high risk of serious mental illness. It should also remind us to look at good health and good health practices through a much broader lens, because building a Culture of Health means finding and sharing solutions, and celebrating signs of progress.

Read a Washington Post article on the program

Read a first-person post about depression and the best way to support those who are suffering with it

Read a post by Brent Thompson on bipolar disorder and the death of a friend

Thu, 7 Aug 2014 01:30:00 -0400 Jane Isaacs Lowe Behavioral/mental health Preventive care Early intervention RWJF Staff Views <![CDATA[Exactly How Much DOES That Appendectomy Cost?]]> L1031049

Want to know one of health care’s dirty little secrets? While we know how much the country spends on care each year, we have little understanding of what it actually costs to provide care.

Think, for example, about an appendectomy. What does it really “cost” the health care system to perform that procedure? The answer is complex, and of course it includes everyone’s time—from the surgeon to housekeeping staff—and it also includes the drugs, equipment, space, and overhead associated with your stay.

The cost of your visit will also depend on who is delivering your care. A consult with a registered nurse (RN) is less costly to the hospital than one with a physician.

Then, consider insurance. If the price your carrier pays for that RN consult is $85, but the price another carrier pays is only $65, what does it actually cost the hospital—and how do those variances affect what you pay both out-of-pocket and for insurance premiums? Moreover, health care providers are currently not trained to think about the costs of the care they provide—and often have no incentive or means to even consider those costs.

These complexities have made it difficult to reform the way we purchase and pay for health care.

Vivian S. Lee M.D Vivian Lee, MD, PhD, MBA

We spoke with the University of Utah’s Vivian Lee, MD, PhD, MBA, senior vice president for health sciences, dean of the School of Medicine and CEO of University of Utah Health Care, about an impressive effort their health system undertook to develop a comprehensive costing tool they call “Value-Driven Outcomes.”

What’s unique about the tool is not only the detailed level at which the health system is able to understand its costs, but also that the tool was rolled out with substantial physician support and engagement—rather than being perceived as a tool that was intended to punish high-cost performance.

Q: Why did University of Utah create the Value-Driven Outcomes tool?

All of us recognize that in our health care systems, we are being held accountable for providing value, and one of the greatest challenges to this is measurement. We haven’t been able to measure value, much less put that metric in our providers’ hands to inform their delivery. I, for one, am constantly amazed at our lack of knowledge about costs in our health care systems.

Beyond tackling the costs of care, we also recognized we had little data to share with providers about their outcomes or the quality of care they were providing. A wide range of quality metrics are beginning to impact our reimbursement and our rankings, and yet providers’ ability to track their own metrics has fallen short.

Of course, the key is putting those two together—outcome and costs. In most industries, a key measure of performance is the value provided by the business. In health care, that means looking at quality (which includes outcomes and satisfaction) measured against the costs of care. Our goal was to put these measures into our providers’ hands, so they could begin to manage themselves, and we as health system leaders could roll up the data to manage the entire system.

Q: How were you able to develop the tool?

About two years ago, we launched a new project, which we called Value-Driven Outcomes (VDO). We started with our version of a “sequestration.” We put a group of our top performers and senior leaders from finance, decision support, quality improvement, biomedical informatics, and IT (among others) into a building in our University’s Research Park. We pulled them out of their daily roles three days a week for six months and gave them a challenge: Come up with a tool that would enable us to visualize our value—that is, ideally, to be able to plot our outcomes against our costs—and to do this for every patient, every provider, and every diagnosis in our system.

Critical to our success was our strong enterprise data warehouse. With a whole series of intelligent business tools, our teams extracted vital data and developed web-based user interfaces that were simple and intuitive enough for our providers to use.

This was no modest undertaking. The initial beta version of the VDO involved more than 150 million lines of code.

Q: Can you share an example of the types of costs your tool is able to capture?

The short answer: just about everything. The Value-Driven Outcomes tool starts by organizing cost type grouping, which includes laboratory, supply, pharmacy, diagnostic imaging, operating room time, hospital facility charges and others. These groupings are aggregated by diagnosis and provider groups. From there, we can drill down into each category to view costs by professional and facility direct costs. If we need to, we can dig down even further to look at each and every supply, imaging service or lab test a particular provider uses in a specific episode of care. We can even get down to individual patients. We can now see our system’s costs from 30,000 feet to below sea-level—and just about everywhere in between.

Q: What’s your sense of how common the ability to understand costs at this level is among other health care providers?

We are starting to see other systems get a better picture of their actual costs, but our sense is that such granular views are relatively new to the industry. Only a few years ago, Michael Porter, PhD, and Robert Kaplan, PhD, thrust this decades-overdue costing conversation into the spotlight with a game-changing paper, “The Big Idea: How to Solve the Cost Crisis in Health Care.” Published in Harvard Business Review, the paper zeroed in on providers’ “complete lack of understanding” about health care delivery costs. This costing void, they explained, made it nearly impossible to improve processes, eliminate unnecessary procedures, and deliver better outcomes. According to the Harvard business professors, figuring out the costs would be the “single most important lever to transform the value of health care.”

We could not agree more.

Q: One of the most interesting things about your tool was the way in which it was developed and rolled out. You speak a lot about the importance of understanding what physicians want and need when it comes to practicing care. How did you work with your providers so that everyone felt like Value-Driven Outcomes was something they owned, and a useful tool for their work? And what are some examples of how that’s playing out?

By the time we had developed a functioning VDO tool, our system already had two things going for it: engagement and process improvement training. My predecessor, Lorris Betz, MD, PhD, championed our Exceptional Patient Experience initiative, designed to engage providers in a culture shift toward more patient-centric care. In 2012, University of Utah Health Sciences became the first academic medical center in the nation to publish our patient satisfaction scores online, with complete transparency and ultimately, full engagement of our providers. The impact? Nearly half of our providers are now in the top 10th percentile and one-quarter (25%) are in the top 1st percentile in patient satisfaction compared to national benchmarks.

At the same time we launched the VDO project, we also began a systemwide roll-out of LEAN training in partnership with the University Of Utah Eccles School Of Business. LEAN is a production practice, mostly developed by Toyota, that we and others have adapted for our health care systems. Essentially it is a process of producing something with the most efficiency (fewer resources) and the most effectiveness (creating a better value), all the while focused on the highest level of quality. The responsibility for ensuring the best outcomes is held by the people on the front lines—in our case, all the people engaged with the patient in the practice of health care. This efficiency training and engagement has helped providers who participated in our earliest pilot projects embrace the VDO tool and enabled them to use the data, working closely with our value engineers, to drive process improvement.

We also discovered some things that we didn’t completely expect. First, we came to realize that by putting the VDO tool in providers’ hands, we tapped into a profound desire on the part of many to help be a part of the solution. Most of us entered health care to do good. Our providers now have the tools and capability to impact not only their patients, but also the ways in which we, as a system, deliver health care. We also found with our patient satisfaction initiative and with VDO, our providers’ competitive natures can be useful drivers of change. Our providers want to be the best, whether it’s in patient satisfaction or in quality and value. By making the data accessible and easy to understand, we’ve managed to engage our physicians and have real improvement to show for it.

Q: What are some of the changes and improvements you’ve seen since implementing the tool?

This process improvement has been limited to some pilot studies, and even there, it has translated already into more than $2.5 million in savings for our system and helped us pave the way to accepting more risky payment models. For example, our hospitalists have harnessed VDO to gain a view of how many tests they are ordering. This view has empowered them to change their rounding structures, create attending-approved checklists and save more than $550,000 so far this fiscal year in unnecessary tests, without diminishing patient outcomes. VDO helped one University of Utah physician group realize that a commonly prescribed bronchodilator that costs $200 delivered the same outcomes for most patients as a similar $15 drug. By switching to the less expensive bronchodilator, the group was able to save more than $200,000 a year.

All these process and care improvements stem from our new ability to quantify and continually improve the value we deliver. Specifically, VDO gives us the ability to question whether the quality and outcomes of the care we deliver to patients is worth what we, and ultimately they, pay for it.

Q: How has getting a solid handle on costs positioned University of Utah to move into a national environment that’s focused on changing the way providers are paid?

Having a solid handle on costs is the necessary first step for any health care system to be willing to become more financially responsible for our patients’ outcomes. Take Medicaid in Utah, as an example. In the past, we could care for Medicaid patients and then send a bill to the Medicaid office and expect to be paid for our services. In the past year and a half, our health plan has received a fixed amount of revenue from the state of Utah to cover all the care we deliver to Medicaid patients. This means that whether cardiac Medicaid patients, for example, receive bypass surgery or just need a coach to help them improve their diet and exercise, we are paid the same amount for their care. To be successful with these patients, we must know how effective the cost of the care we provide is for their condition.

Another model of payment we can begin to feel more able to manage is bundled payments, where insurers and employers who contract for direct payment have already started to say, “We will pay you $X, for this diagnosis.” We can engage in those new ways of thinking about medical payments if we have the right tools, and this could be a real win for businesses and employers who want to get on top of health care costs.

As a result of these payment models, health care systems will ultimately begin to share the risk for those patients’ care. This doesn’t mean we will do the least amount for them to get them home again. This means we have to be able to care for them with the greatest efficiency and effectiveness to restore their health and give them the ability to return home safely for as long as possible. In fact, if we don’t do enough, they’ll be back at our hospitals, which isn’t good for anyone.

Q: Are you seeing other examples of health systems and providers embarking on similar efforts?

We’ve heard about launches of similar initiatives from University HealthSystem Consortium, Kaiser, University of Pittsburg Medical Center and others. Harvard Business School has a tool they’ve been using with a few health care systems (MD Anderson, Mayo Clinic, Cleveland Clinic) called Time-Driven Activity Based Costing (TD-ABC), as a result of Professor Robert Kaplan’s efforts. In fact, we recently completed a University of Utah/Harvard Business School partnership project that focused on using VDO and TD-ABC data to improve processes around 4 different episodes of care and in our billing procedures.

Generally speaking though, there continues to be a lack of data about the costs of care to any level beyond the general ledger. We hope that we can share some of the lessons we’ve learned to enable others to develop tools like Value Driven Outcomes.

Q: What advice would you give to health systems and provider groups that are interested in developing something similar to Value-Driven Outcomes?

Bite the bullet and do it. And we here at the University of Utah are here to help in any way we can. This is a nationwide problem that demands a nationwide solution and we all need to work together to succeed. Understanding your costs is fundamental to business management.

Yes, the health care system is broken. Yes, each of our systems and populations is different. Yet we have to remember that our ultimate purpose is to offer value to society. To be able to deliver that value, we have to start by measuring it. It’s so basic and so clear. Don’t give up. As Colin Powell once said, “Perpetual optimism is a force multiplier.”

While the University of Utah example is compelling, we know other efforts are under way across the country aimed at helping providers prepare for a new financial environment. But those examples aren’t easy to spot, so we’re looking to you for help.

Here’s how:

  • Learn more about Value-Driven Outcomes by viewing a recording of Lee’s webinar. If you’re interested in learning more from Lee and her team, let us know that in the comments below, as well.
  • Share in the comments below what you or your organizations developed to help understand the cost of delivering care. How are you sharing what you’re learning?
Fri, 1 Aug 2014 16:29:00 -0400 Andrea Ducas Cost of care Payment reform Data Health IT <![CDATA[If It’s Broken, They Fix It]]>  A nurse fills a syringe, while another nurse watches

By “broken,” we mean medical equipment or processes that could use a little improvement—and sometimes a lot of improvement. And by “they,” we mean nurses who harness the power of their own creativity, often using whatever material they have on hand—and sometimes taking inventiveness to a whole new level.

They call them MakerNurses, eager participants in the emerging “maker” movement. One MakerNurse, Roxana Reyna, RN, of Corpus Christi, was honored at the recent White House Maker Faire for her innovative wound-care techniques in caring for infants born with their organs outside of their bellies, sparing them immediate surgery.

RWJF supports such nurse-inventors through the Little Devices @ MIT initiative’s MakerNurse program, because they hold the potential to make health care more effective and affordable.

It’s a sound investment with even larger possibilities, said RWJF President and CEO Risa Lavizzo-Mourey, MD, writing in the professional social networking site LinkedIn.

“The “maker” movement has the potential to empower all kinds of people to devise the solutions that make possible a Culture of Health—not just nurses, but caregivers, patients, and family members, all creating and sharing devices and ideas that improve health.”

Read Lavizzo-Mourey’s blog post on LinkedIn

Wed, 30 Jul 2014 15:25:00 -0400 Risa Lavizzo-Mourey Disruptive innovations Nurses From the President <![CDATA[Advanced Practice Nursing: Providing Care and Promoting Health]]>
Check out an August 1 Google+ Hangout with the Campaign for Action and RWJF.

The U.S. population is growing, getting older and suffering from more chronic disease. Thanks to the Affordable Care Act (ACA), more people are gaining health coverage and the means to obtain care. And there’s a widespread view that the country faces a drastic shortage of doctors—and primary care providers in particular.

So why are so many states seemingly determined not to let advanced practice registered nurses deliver the primary care they specifically trained to provide—and help millions of patients in the process?

Across the country, 31 states impose varying limits on the ability of nurse practitioners (one of the four types of advanced practice registered nurses) to evaluate patients; diagnose, order and interpret diagnostic tests; and to initiate and manage many treatments, including prescribing medications.

Although these limits are often staunchly defended by medical societies and other physician groups, that posture seems hard to defend. After all, federal workforce projections show that the primary care shortage would significantly decrease by 2020 if growing populations of advanced practice nurses and physicians’ assistants were allowed to practice at a level commensurate with their education and training.

Making the argument that states should drop their limits and allow advanced practice nurses to practice in line with their education and training is a key focus of the Future of Nursing: Campaign for Action, an initiative of AARP and the Robert Wood Johnson Foundation (RWJF). (Read more about it.) The Campaign, now in its fourth year, grew out of an RWJF-funded Institute of Medicine (IOM) report in 2010 that recommended raising the level of nursing education and training and making better use of nurses in redesigning and delivering U.S. health care.

All 50 states and the District of Columbia have Action Coalitions organized around the Campaign’s goals, notes Campaign Director Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing. And although there is considerable distance left to travel, there has been progress, as follows:

Building the business case

To recruit more allies, the Campaign for Action has sought to educate corporate leaders, health system executives, and insurers, on the value that advanced practice nursing can bring to their bottom line. Broad and convenient access to primary care is essential to health—and if “employers’ workforces are healthy, they are much more likely to show up at work, and if [employees’]  family members are healthy, it means less stress for them,” says Winifred V. Quinn, PhD, director of Advocacy and Consumer Affairs, Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF.

The center has organized a coalition of companies advocating that states modernize their scope of practice policies; it includes corporations such as Target, whose network of in-store clinics relies largely on advanced practice nurses to deliver care. Quinn says the effort is paying off, as more lawmakers in states like California move to adopt model legislation allowing advanced practice nurses to practice a level of care commensurate with their education and training. In the meantime, a white paper by the Bay Area [California] Economic Institute calculates that enacting such reforms would lead to an increase in the number of nurse practitioners in practice; more primary care visits; and, because of increased visits,  lower per-visit costs.

Getting to “80 by ‘20”

A key IOM recommendation is to raise the overall level of nursing education, with a particular goal of 80 percent of the nation’s nurses having bachelor’s degrees—or even higher ones, such as master’s or doctorates—by 2020. According to the Campaign for Action’s “dashboard” indicators, in 2010, 49 percent of the nation’s nurses held bachelor’s degrees in the science of nursing (BSNs); in 2013, 51 percent did—a 2 percent increase. The rise represents about 30,000 more nurses with bachelor’s degrees—and Hassmiller says that the numbers will rise further as more nurses with associates’ degrees from community colleges enroll in programs to complete their bachelor’s. Since the release of the IOM study, the American Association of Colleges of Nursing reports a 53 percent increase in enrollment among registered nurses advancing to bachelor’s  degrees.

More nurses on boards

The IOM report recommended that more nurses be placed in leadership positions to influence the transformation of health care. In Texas, the local Campaign for Action Coalition has partnered with the Texas Health Care Trustees foundation to train 400 nurses for board service.  “We’re very fortunate that Texas is leading the way on this,” says Alexia Green, professor and dean emerita at Texas Tech University’s School of Nursing, who helped to found and formerly co-led the Texas campaign.

“By virtue of its numbers and adaptive capacity, the nursing profession has the potential to effect wide-ranging changes in the health care system,” the IOM report said. Thanks to the Campaign for Action, that potential is several steps closer to becoming reality.

Tue, 29 Jul 2014 10:50:00 -0400 Susan Dentzer Advanced practice nurses Primary care Susan Dentzer: Toward a Healthy America <![CDATA[Putting a Female Face on the Need for a Culture of Health]]>
A doctor examines a patient.  An image appears on a computer monitor.

Statistics are “human beings with the tears washed away,” an old saying goes. Sadly, the tears behind one set of statistics, showing that women’s life expectancy has been falling in just under half of U.S. counties, have rarely garnered much notice.

How to put a face on this story, to help mobilize corrective action?

Progress toward that end was made last week, when the Robert Wood Johnson Foundation teamed up with Women’s Policy, Inc, a nonprofit, nonpartisan organization that seeks to inform policy-making on women’s issues, to sponsor a briefing on that subject on Capitol Hill. About 75 people, including several female members of Congress, gathered in the Rayburn House Office Building to learn what is driving the widespread trend of poorer female health. (Watch the webcast by clicking here).

They also learned the names of some of those seemingly faceless human beings behind the statistics—names like Melissa, Mary and Maria.

Those were pseudonyms (out of respect for privacy) for real patients encountered by Debbie Chatman Bryant, a 2012 recipient of RWJF’s Community Health Leaders Award and a current RWJF Executive Nurse Fellow.  Bryant, a doctor of nursing practice at the Medical University of South Carolina, directs a program that sends a mobile van into racially diverse and medically underserved communities to conduct mammography and other cancer screening.

  • Melissa, a 35-year-old African American woman expecting her fifth child, was screened through Bryant’s program and diagnosed with advanced breast cancer. Despite treatment, she died not long after giving birth.
  • Mary, 51, is homeless, has a history of mental illness, and still cares for her adult son, who suffers from bipolar disorder. Her breast cancer was discovered and treated successfully, and she continues in recovery.
  • Maria, 46, works as a machine operator, doesn’t have health insurance and, as Bryant said, “let too many years slip by between mammograms.” When her breast cancer showed up on a scan, she was treated, and later relapsed. A so-called navigator on Bryant’s team has helped guide Maria into a clinical trial.

Such faces “represent an inescapable public health crisis of our time,” Bryant told those at the briefing. “We live in a world troubled with health challenges complicated by the stress of social pressures, poverty, fear, and a complex health environment.” The toll is high: Relative to women in other high-income countries, US women lose about twice as much life before age 50 from a host of conditions. These range from troubled pregnancies  to falls, traffic accidents and other unintentional injuries, to diseases linked to obesity, hypertension, and smoking.

Sometimes, part of that toxic stew harming women can be drug and alcohol abuse, according to Nora Volkow, director of the National Institute of Drug Abuse, another lead speaker at the briefing. Fluctuating hormone levels influence women’s responses to these substances and make them prone to abuse and addiction over the course of their lifetimes.

And with women more likely than men to report suffering from chronic pain, Volkow painted a troubling picture of high rates of prescriptions for opioids and other pain-relieving drugs. The surge has led to a sharp increase in deaths from opioid overdoses, which as of 2008 exceeded deaths from heroin and cocaine use combined.

Both Bryant and Volkow lamented the fact that evidence-based interventions and policy responses that could address these problems either go unused or aren’t adopted. Bryant pointed to the fact that her state, South Carolina, has so far declined to expand Medicaid eligibility under the Affordable Care Act. Yet a recently released report from the President’s Council of Economic Advisers estimated that if the state expanded Medicaid, 8,000 more women would receive mammograms and 12,000 more would get pap smears to rule out cervical cancer.

Similarly, Volkow noted, depression often goes hand in hand with chronic pain and is a risk factor for drug use and abuse. But millions of Americans have unmet mental health needs, with about half of them citing unaffordability of care as the key reason.

Clearly, throughout the country, many faces of desperation are female. That’s all the more reason to insure that efforts to build a Culture of Health in America have a distinctly feminine cast.

Fri, 25 Jul 2014 11:29:00 -0400 Susan Dentzer Barriers to care: cultural, gender and racial Community outreach Susan Dentzer: Toward a Healthy America <![CDATA[Doing More Means Doing Less: Young Innovators Lead the Charge]]> CAP_84483_10

Here at the Robert Wood Johnson Foundation, we often talk about the idea of making the healthy choice the easy choice. To many of us, that means putting the cookies in a high cabinet, and putting the fruit on the counter. But when I think about building a Culture of Health in America, and especially within our health care system, making the healthy choice the easy choice means so much more.

In health care, often the healthy choice actually means doing less—fewer invasive tests and less dependence on medication—and instead watchfully waiting or making healthy lifestyle changes. But it’s not always easy to show a patient that you care when you only have a few minutes to spend together, and ordering a test or prescribing a medication is a simple way to show “I’m doing something to help you.” The trouble is, those tests, procedures and treatments often don't help, and sometimes they can hurt.

Too many people receive unnecessary tests and treatments that don’t help them, and can potentially be harmful to them. Recently, we learned that, every year, about 25 percent of Medicare beneficiaries receive services they don’t need. That means they—and American taxpayers—are paying a lot of money for treatment that provides no benefit. At the same time, there are still far too many people who can’t get the health care they need.

Physicians and researchers tell us that a big part of the overuse problem comes from a “more is better” approach in medicine, and that this approach is conveyed to new doctors as they learn to practice medicine in medical school, and when they start their residencies. In health care, it is easy to err on the side of prescribing a drug or a test or performing a procedure, while the potential harms can be harder to spot.

We believe that clinicians are ready to embrace a new kind of medical culture, one that emphasizes that, often, “less is more.” In addition to other efforts to reduce overuse we have been working with the RightCare Alliance, a project of the Lown Institute, founded by Bernard Lown, MD. Lown encouraged his students to do more for the patient, while doing less to the patient. The RightCare Alliance is working to increase clinician awareness of the causes and consequences of overuse, and to create tools to foster change in the way care is delivered. The project is hosting action-oriented local and national gatherings that focus on reducing overtreatment, fielding a national physician survey to explore underlying drivers of overuse, and developing a toolkit of resources to counter overuse in health care.

Since the “more is better” approach starts in medical training, young innovators in the health professions are just the people to take action to change medicine’s “more is better” philosophy. With support from the Robert Wood Johnson Foundation, the RightCare Alliance has just released a call for proposals for their Young Innovators Grants, which offer funding for students in the health professions, residents, and junior faculty to pilot programs that teach clinicians to recognize and avoid overuse, provide compassionate care, and build more meaningful relationships with patients. Grant award recipients can receive up to $7,000 to cover project expenses, conference travel, and participation in national Right Care Alliance leadership training. We encourage you to check out the call for proposals, and to share it with young innovators in your network!

Those who are just starting out in their health care careers have an important role to play in shaping a Culture of Health, and in making the healthy choice the easy choice in health care. Young innovators are well-positioned to reshape the environments in which they are working, and encourage a culture in which the idea of “more is better” refers to caring and commitment, not to unneeded tests and procedures.

Wed, 23 Jul 2014 13:28:00 -0400 Emmy Ganos Disruptive innovations Health care delivery system RWJF Staff Views <![CDATA[Help or Hype: The True Costs of Robotic Surgery]]> Robotic Surgery

Joe Meyer is the model of a well-educated, engaged patient. A self-described “typical Midwestern guy” who settled in Chapel Hill, N.C., to raise a family and build a career, Meyer did everything in his power to make the best decisions when his 2013 physical produced unexpected and frightening results.

“I live a pretty healthy lifestyle. I exercise. I eat well,” says the 62-year-old chief operating officer of a large manufacturing company. “I was very surprised when my PSA test came back at 5.1 [3 to 4 is normal]. Further testing showed that I had prostate cancer.”

One of more than 200,000 men who are diagnosed each year, Meyer put his faith in his physician and the health care system when gathering information about treatment.

“After the biopsy, they told me my Gleason score was 7. [The higher the score on a scale of 1 to 10, the more likely a cancer will spread.] I realized I was high risk, so I started reading as much as I could about the choices I was offered—hormone therapy, radiation, or prostate removal.” He chose robotic prostatectomy over open or laparoscopic prostatectomy. Surgery, as opposed to hormone therapy or radiation, was widely considered a good decision for someone with Meyer’s prognosis.

Not the type of guy to watch and wait, Meyer says, “I’ve been in management a lot of years. I’ve learned, if you got a problem, you address it right away. He adds that he “would have been happy to choose the non-robotic prostate surgery,” if it had been what was available in his area.

Making sure that our system of medical innovation is working well enough to give men like Meyer a full range of treatment options, no matter where they live, and the information needed to make a well-informed, cost-effective choices is the primary goal of Charles D. Scales Jr., MD, and Jonathan Bergman, MD, both urologists and Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars (2011-2013).

In their case study “Robotic Surgery,” they contend that the rapid uptake and aggressive marketing of robotic prostate surgery is an example of a “‘medical arms race’ between competing hospitals that is driving up health care costs ... while there is scant evidence of improved surgical outcomes and even some evidence that robotic surgery may create problems.” Their work is part of the RAND report Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.

Hidden Risks for Patients

By many measures, robotic surgery appears to be a successful new technology. Bergman offers the option in his practice at the David Geffen School of Medicine at UCLA, and he explains that many patients do have “shorter post-surgical hospital stays.” Meyer, for example, went home from the hospital the day after surgery.

Health care systems have also been purchasing robotic equipment at a furious rate.

“In 10 years, we went from open prostate surgery to robotic surgery being used for 80 percent of cases,” Scales says. “This is dramatic—it’s one of the biggest changes in modern medical practice. It’s also being driven by patient demand. After 2005, hospitals without a robot—primarily the da Vinci®Surgical System—saw an estimated 41.2 percent decrease in cases.”

But Scales and Bergman question whether patients armed with promotional materials, rather than research, are getting the information they need to make the best decisions.

Advertising campaigns touting robotic prostatectomy as the “gold standard” (according to Duke Medicine, where Meyer was treated and Scales is a professor of surgery) and offering reduced hospital stays are common. The Cleveland Clinic promises the procedure allows for “more precision, offering patients improved outcomes.” Columbia University Medical Center contends that patients will experience improved urinary continence and sexual function after surgery.

Information offered online also focuses primarily on robotic procedures. A small study of Internet search results conducted at MD Anderson Cancer Center in Houston, Texas, showed that Internet information on prostate surgery is biased toward robotic prostatectomy.

Scales is not surprised that this type of advertising persuades patients to choose robotic procedures. “Men are justifiably concerned about the effects of any treatment for prostate cancer because it’s linked to their quality of life. Anything that promises to protect that would understandably draw their attention.”

 At least one of those claims holds up. But on others, the benefits are less conclusive. “The robotic procedure does offer faster recovery times [it’s less invasive and there is less bleeding]. But, there’s no data proving improved urinary continence or sexual function. There is also no evidence of better, post-surgery cancer control,” Scales says.  

“The major potential harm is that you do prostate surgery on someone when it is not necessary,” says Bergman. They report that, since 2005, the number of prostatectomies among American men has increased 60 percent.

“I do what the patient asks,” says Bergman, “but we just don’t have the data.” A small number of observational trials are the basis for most assertions that robotic prostatectomy is superior.

“It is misleading to tell prostate cancer patients that robotic surgery will lead to improved outcomes, beyond less bleeding and a shorter hospital stay,” Bergman says. There is also concern that robot-related complications are not shared with patients.

All surgical procedures have a learning curve, Scales and Bergman agree, but a spate of recent lawsuits from injured patients, robotic surgical instrument recalls, and several reports about a da Vinci robot surgical tool burning patients, suggest that more research is needed.

There also may be more to the story. A 2013 study conducted at Johns Hopkins University found that adverse events related to robotic procedures “were underreported to the Food and Drug Administration.”

Rising Hospital Costs

Beyond their concern for patients, Bergman and Scales explain that, while hospitals and physicians earn no more for robotic procedures than open surgical procedures, other hospital fees may be raised to compensate for robot-related costs.

“The savings from shorter hospital stays are erased by the much higher costs of acquiring the robot and replacing the expensive, disposable instruments needed for robotic procedures,” Bergman says. “They can also charge more for services associated with the robot.”

“We are not against new medical technology; we want to see innovative procedures adopted based on research that shows we are doing our best for patients,” Scales adds. They suggest that “moving away from a fee-for-service payment system that rewards hospitals and physicians for procedures to reimbursement based on quality and patient outcomes” would spur patient-centered, cost-effective medical innovation.  

Mon, 14 Jul 2014 10:29:00 -0400 Sheree Crute Medical technology Evidence-based <![CDATA[Let’s Help Each Other Cope With Stress]]> L9992063_RET

Just about everybody experiences stress, to a greater or lesser degree. The bad news: Too many of us fall into the "greater" category.

All of that stress has consequences not just for our mental health, but for our overall wellbeing, says Risa Lavizzo-Mourey, MD, Writing in the professional social networking site LinkedIn.

Lavizzo-Mourey cites the results of a recent NPR/RWJF/Harvard School of Public Health poll, which shows:

  • One in four said they experienced a great deal of stress in the previous month.
  • Almost half reported a major stressful event or experience within the past year.
  • Seventy-four percent said stress affected their health.
  • Forty-three percent said that a health concern is a leading cause of their stress.
  • Eighty percent of people in poor health reported that their health problems raised their level of stress.

If we are to make progress in building a Culture of Health, we need to acknowledge the deleterious role of stress in Americans' lives and health—and everybody needs to be at the table.

"This is clearly an area where health care providers, communities, and employers can help," Lavizzo-Mourey writes.

Read Lavizzo-Mourey's blog post on LinkedIn

Fri, 11 Jul 2014 12:04:00 -0400 Risa Lavizzo-Mourey Behavioral/mental health Health promotion and disease prevention Behavior change From the President <![CDATA[Carrying the Burden of Stress]]>
Forum at Harvard School of Public Health: The Health Burden of Stress, and What We Can Do About It. Presented in collaboration with the Robert Wood Johnson Foundation and NPR. (July 9, 2014)

Nearly half of us suffer through one major stressful event every year, and the weight of that stress can be heavy indeed. Take, for example, trouble at work, problems in a personal relationship, or the death of someone close to you.

At the top of the list: health issues—either yours, or those of a loved one. In fact, a health concern is the leading cause of stress for 43 percent of us. And all of that emotional turmoil can have a ripple effect, extending out into the realm of our overall well-being.

An NPR/Robert Wood Johnson Foundation/Harvard School of Public Health poll analyzes the role of stress in our daily lives, its impact on our health, and how we deal with it. In connection with the poll, we convened a webcast with experts to talk about stress and health and good ways to manage stress in different settings.

Moderated by Joe Neel, Deputy Senior Supervising Editor of NPR, the event featured:

  • Kristin Schubert, director, Robert Wood Johnson Foundation
  • Robert Blendon, professor of health policy and political analysis, Harvard School of Public Health and Harvard Kennedy School
  • Joshua Riff, medical director and director of health and well-being, Target Corporation
  • Gregory Fricchione, director of the Division of Psychiatry and Medicine and the Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital

As Schubert noted, if we are going to build a Culture of Health in America, "it is critical that we begin to recognize the role that stress plays in our own lives as well as those around us, because we know that too much stress can really impact a person's ability to make healthy choices for themselves and their families."

We think this conversation is a good start. We’ve also put together a list of resources to help you deal with the issues that cause stress in your life. We hope you find them helpful.

Help for Caregivers

Mon, 7 Jul 2014 11:36:00 -0400 Jeff Meade Behavioral/mental health Health promotion and disease prevention Consumer engagement RWJF Staff Views <![CDATA[How Do We Empower Communities to Get Healthy? ]]> Shoppers at an outside food market in Philadelphia

I’ve been privileged to live in many communities across the nation—16, to be exact. My wife Lisa and I recently moved from Iowa City, a "college town" of 80,000 people, to New York City, a bustling urban region of 23 million. Life from city to city and region to region is different in some ways, yet concerns related to community wellness remain the same.

On any given Saturday throughout the year, one can find dozens of farmers markets in New York City with fresh local produce and other offerings that encourage healthful choices. This is something we expected while living in Iowa, but were pleased to also find in the city. However, despite the fact that both communities benefit from farmers markets, health awareness campaigns and arguably the finest health care providers, both also struggle with obesity and chronic illness. Even within cities well equipped to promote health and provide care, certain individuals and neighborhoods thrive, while others struggle; is this merely a reflection of wealth disparity, or could it have to do with something more?

When health outcomes are related more to one’s ZIP code than genetic code, as James S. Marks, MD, MPH, senior vice president at the Robert Wood Johnson Foundation, stated, it is clear that we need to look beyond basic ideas about health being a personal responsibility. We need to identify best practices within communities that empower their residents to pursue healthy lifestyles.

What factors lead to a successful Culture of Health in certain communities? What barriers do we need to remove to encourage even greater adoption of healthful living in others? How can we as a country understand that the context of health is an all-encompassing one that should inform every aspect of our lives? And with this, what stakeholders are willing to commit to making this "Culture of Health" a reality for all Americans?

To answer this question, Hope Street Group convened more 55 stakeholders, ranging from employers, government and faith institutions to hospitals, universities, nonprofits and the media, to determine how best to encourage collaboration among them. We sought to define the roles each of these stakeholders could play in building a Culture of Health, as well as motivations and limitations to participation. This has culminated with the publication of Tipping the Scales: Engaging Community Stakeholders to Build a Culture of Health.

Our findings were encouraging. Several communities are already on the right path. However, our research also shows that community stakeholders need to unite to identify solutions for scaled impact and opportunity. There must be opportunities for stakeholder and community engagement; without initial community buy-in and an effective feedback loop to share best practices, successful programs cannot be created and brought to scale. We must unlock currently untapped resources to fund these initiatives, as opportunities exist on the local and regional level that, once packaged correctly, will become accessible to more communities.

The farmers markets I spoke of earlier are a great example of what this kind of collaboration can achieve. Not long ago, many of these areas that feature an abundance of fresh, local, organic produce and good cheer were blight-ridden. Thanks to local collaboratives formed by city health, education, civic and business leaders, communities of well-being are thriving.

Building a Culture of Health is something that cannot be done alone. Our current health crisis affects all Americans, and we must work together to solve it. Health is not only an individual concern, but a community one, and it imperative that we enhance these models to drive a more productive and healthy workforce. This shift, along with the creation of a marketplace that values prevention, health and outcome-based evidence, and the integration of family and community into wellness, must occur if we want healthy and meaningful lives to be determined by more than a five-digit number.

Martin Scaglione is president and CEO of Hope Street Group, a national nonpartisan, nonprofit organization dedicated to expanding economic opportunity and prosperity for all Americans. Hope Street Group's health program focuses on upstream issues that could significantly enhance our workforce and economy.

Hope Street Group (@HopeStreetGroup) invites you to lend your voice to the conversation around building healthier communities by joining a Twitter Chat on Tuesday, July 8, from 2-3:30pm Eastern Time using the hashtag #healthycommunities.

Sun, 6 Jul 2014 21:03:00 -0400 Martin Scaglione Health promotion and disease prevention Social determinants of health <![CDATA[GirlTrek: Black Women Walking for Body, Mind and Soul ]]>
Keecha Harris GirlTrek

I first met my friend Leah in September 2013, when she started walking with GirlTrek in Birmingham, Ala. GirlTrek is a movement of thousands of Black women across the country mobilized in response to the problem of staggering rates of obesity and its co-morbidities. Leah read a local NPR article about Black women walking for wellness under the banner of GirlTrek, and she decided to check it out.

As a GirlTrek volunteer, it is always a pleasure to connect with women new to our local organizing efforts. Leah joined us on a Full Moon Trek. Under celestial brilliance, Leah and I walked into the woods of the Hillsboro Trail as strangers. By the end of the trek, I had a new and humorous sister who fearlessly faced the possibility of running into snakes and other wildlife.

And when there is the promise of a storm, if you want change in your life, walk into it.
If you get on the other side, you will be different.
And if you want change in your life and you’re avoiding the trouble, you can forget it.
—Bernice Johnson Reagon

Friends were exactly what Leah needed. She and her husband had moved to Birmingham in 2007 to escape Michigan winters, and to establish a vibrant community of people with common interests. The winters are warmer here, true—but friends aren’t always easy to come by when you’re a stranger in a new city.

And that was the beginning of Leah’s relationship with a warm, welcoming organization of women passionate about improving their health—and fostering change. In short: she found the new friends she had been seeking. But these friendships gave her much more than she anticipated. Her doctor had delivered the grim news the month before that she was pre-diabetic. So walking with others was very timely.

Leah found herself in good company. GirlTrek has a goal of engaging 1 million Black women and girls in its walking-related programming by 2015. The program is sparking a health revolution, and it does so by building upon the rich cultural legacy and assets of the African American community.

Take, for example, Harriet Tubman. She’s a patron saint to GirlTrek supporters. Tubman was known to walk as many as 15 miles per day in uncut forests, through mossy swamps and across the Appalachian Ridge. Within the course of a decade, Tubman walked north toward freedom with hundreds escaping slavery. If Harriet Tubman could walk her way into new realities, the thinking goes, then so can we.

Leah was intrigued by the Full Moon Trek—and why would she not want to be part of a group of Black women who trekked to the light of the moon?  We connected through Facebook, excited to learn more about each other during a night walk in nature.

Walking to bring about change was a familiar theme for Leah. In fact, she was born to trek.

“Thinking back, walking has always held importance in my life—even before I took my first steps or took my first breath of air. My mother was weeks past her due date. Upon her third trip to the hospital, she was put in a hospital gown and instructed to walk up and down the halls.”

Thereafter, Leah and her mother racked up quite a few miles on foot. On weekends and evenings, her mom walked to relish joy or to ease pains, with little Leah in tow: “She’d walk, and walk, and walk, and walk. My little legs would go as fast as they could to keep up. When we returned home, I’d nearly collapse. But of course the next time she put on her shoes, I’d be ready to go again!“

That began to change in October. Leah has stepped up to lead other walkers to wellness. For the past eight months, she has led daily treks at the University of Alabama at Birmingham. These “smokeless breaks” are about 30 minutes each, with two to six women walking together.  Sometimes they walk to Railroad Park. During inclement weather, they trek inside along the long corridors connecting area hospitals.  

All of that walking has paid off for Leah—in a way that the everyone should applaud her for. In 2003, Leah did her first half-marathon. Over the last eight months, she has lost 30 pounds ... and shaved 17 minutes off her half-marathon time. She is no longer taking Metformin to treat her pre-diabetes. She feels more confident and peaceful. Moreover, Leah has found the warm, vibrant community of friends that she desired when she moved here.

For Leah, there is now no challenge too great. In May, Leah and other GirlTrekkers committed to walk at least 52.4 miles to honor their mothers. She walked at work and on weekends with her 5-year-old daughter, Neah Imani, in tow. Neah’s name means "moving faith."

Movement has been transformational for these three generations of trekkers. Leah’s mom continues to inspire her walking journey. In fact, Leah’s mom lost over 40 pounds in 2013, by walking the hallways at the University during her breaks.  

These days, though, mom can’t keep up with Leah any longer. She says Leah walks too fast. But even though they can’t walk together, they’re still walking in common cause: to heal their bodies, soothe their souls and form community with other black women.

About the Author
Keecha Harris, DrPH, RD is a walking enthusiast who has trekked every day since October 2012.  Her consulting company has provided support to the Robert Wood Johnson Foundation Childhood Obesity Team and the Research, Evaluation and Learning unit.   

Thu, 3 Jul 2014 10:21:00 -0400 Keecha Harris Healthy communities Physical activity Women and girls Black (incl. African American) <![CDATA[What’s Keeping the Cardiac Polypill off the Market?]]>
Lisa Ranson Lisa Ranson

No matter how busy Lisa Ranson’s morning gets, somewhere between preparing breakfast and suiting up for work or play, she takes the first cluster of eight pills that protect her from a family legacy of heart disease so powerful she had bypass surgery at 34.

Even at that young age, she was no stranger to daily prescription regimens. Growing up, she watched her dad struggle. These days they compare notes. “He’s survived two heart attacks, had bypass surgery, and he has a pacemaker,” Ranson says.

An avid walker who treks three and a half miles most days near her home in the small town of Dunbar, W.Va., Ranson is now 51 and in great shape. But her healthy lifestyle is no match for her genetic inheritance—she is one of 34 million people living with hypercholesterolemia.

“My cholesterol was 350 in my 20s,” Ranson recalls. “By the time I was 34, I had a 99 percent blockage in two arteries.”

A compeer coordinator for people with behavioral health problems at KISRA, a West Virginia nonprofit, Ranson says she’s grateful for the $246-a-month (with health insurance) prescription ritual that cuts her heart attack risk, but she adds: “I take a handful of pills in the morning and a handful at night, that’s the only way I can keep up with them. Bless people who don’t have health insurance. I don’t know how they would do this.”

Saving Lives, Saving Millions

The estimated cost of cardiovascular disease (CVD) in the United States in 2010 was $443 billion. CVD is responsible for one in four deaths each year and it affects more than 83 million Americans, according to the American Heart Association.

Surely, if there were a treatment that might prevent CVD, keep people healthy longer, and lower costs, it would be swiftly brought to market. But it’s not that simple, argue the authors of a new RAND report, Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value, co-authored by Art Kellermann, a Robert Wood Johnson Foundation (RWJF) Health Policy Fellow (2006-2007) and RWJF Clinical Scholar (1983-1985). (Read a Human Capital Blog post by Kellerman here.)  

The Power of a Single Pill

The “polypill” just might be that treatment. It is a combination of generic medications that have been proven to combat heart disease, hypertension and stroke that could replace one or more of the medications patients like Ranson take each day.

People with heart disease are so overwhelmed by complicated treatment regimens that only 50 percent take their prescribed daily medications. “No one is happy when I take out my prescription pad,” says Nihar Desai, MD, MPH, a cardiologist at Yale School of Medicine and author of the Rand report case study: A Cardiovascular Polypill. “Most patients that I see are taking more than five pills, and some take that many twice a day.”

Working with his mentor, Harlan Krumholz, MD, director of the RWJF Clinical Scholars program at Yale University, Desai decided to investigate why the polypill has not made it to market after 11 years of trials.

Several studies, including “the Indian Polycap Study and the UMPIRE trial, have shown that some formulation of a generic polypill—a blood pressure medication, beta blockers, and a statin, possibly combined with aspirin—is safe, effective and increases patient adherence with few side effects,” Desai explains.  “The UMPIRE trial showed 86 percent adherence to a prescription regimen in the polypill group versus 65 percent in the multiple pill group.”

Desai adds: “Most experts believe that a multidrug combination pill that simplifies care delivery, reduces costs, and improves adherence would have far-reaching implications for reducing the global burden of CVD. Estimates suggest it could reduce the burden by more than half. We are sure it could save hundreds of millions of dollars.”

Used as primary prevention in countries where people have poor access to care, a polypill could dramatically lower rates of heart disease. In the United States, polypill use for the primary prevention of heart disease is analogous to the current use of statins. But, Desai adds: “In the U.S. people are reluctant to take medication unless they are sure they need the treatment.”

The more important role for a polypill here would be treating people who already have heart disease, like Ransom and her dad.

Yet, at a time when the nation is fighting to cut health costs, the polypill’s ability to do exactly that is one of the major factors keeping it out of the hands of consumers.

Blocking Progress

“The current economics of drug development reward the creation of patentable products that can command high prices,” Desai says. 

The polypill has been proven safe in phase 2 trials. The components of the pill are taken in individual doses by millions of people each day, though there are some pharmacologic concerns about developing a multi-component pill. But a costly phase 3 trial is needed before a polypill can make it to market. Because it would be a generic drug, pharmaceutical companies are reluctant to invest in such expensive research.

Desai points out: “This case illustrates one of the limitations of our medical innovation system. It is not optimized to ensure development of inexpensive, but highly effective therapies. The interests are not necessarily aligned with the interests of the patients.”

Investing in Public-Centered Innovation

“To be fair, pharmaceutical companies have finite resources,” Desai adds. “Perhaps this is a perfect time for the creation of a government-academic-generic drug manufacturer innovation partnership. The government can look at vaccines as a model because the polypill has a similar ability to produce significant public health benefits.”

Ultimately, Desai says, it comes back to the patients. “Millions of people are in an ongoing battle with heart disease. In the end, this is about helping them live healthy and productive lives, and enabling them to do the things they really want to do.”

Thu, 3 Jul 2014 10:05:00 -0400 Sheree Crute Prescription drugs Cost of care <![CDATA[Bedtime Story]]>
Sarah Meade Reading Pic Sarah, having a read at Granny's house

The globby tears, the quavering voice, the pudgy outstretched hands, the plaintive word “please.” They all come to mind as vividly as if it were yesterday.

Our daughter Sarah was (and still is, at 27) a good soul, but like every small child, she had her moments. And when those “moments” more or less coincided with bedtime, the worst punishment we could mete out was to refuse to read her bedtime stories—or “sturries,” as she called them. We would kiss her good night, and adjourn to the living room, there to sit and look at each other guiltily as our little girl suffered the tortures of the damned.

We listened to that heartbreaking little plea, “But I HAVE to have sturries!” echoing down the hall, and our hearts would break, too. We felt like the worst parents ever

Our heads told us that discipline needed to be consistent. But in the end, our hearts always gave in. And so we would return to our comfy bedtime routine, which, I confess, we treasured as much as Sarah did. One of us would snuggle up next to Sarah’s warm, jammy-clad body, and read through her favorites: “Make Way for Ducklings.” “Harold and the Purple Crayon.” “Corduroy.” Of course, the timeless “Goodnight Moon.” And so many more.

We came to feel that we were on a first-name basis with Margaret Wise Brown, Robert McCloskey, Dr. Suess, Maurice Sendak, and all of the authors of all of the kid lit classics that lined Sarah’s book case.

We read to Sarah not because we were trying to home-grow a genius. On some level, yes, we knew that early literacy might give Sarah an intellectual leg up, but that was never the point. Reading is what we did because we were readers ourselves. Reading gave us great joy, still does, and that’s the gift we wanted to give our daughter.

And so, when Sarah began to read at age 3, we weren’t surprised. We were glad. We still remember our daughter sitting on what we called “Sarah’s Reading Rock” at day care, a book perched atop her knees, her face intent. That’s all we had ever wanted to do: raise a child who loved to read.

I thought about Sarah on her reading rock recently while perusing a story in The New York Times. The story described a new policy announced by the American Academy of Pediatrics that strongly recommends that primary care pediatricians urge parents to read aloud to their infants, toddlers and young children. (Literacy Promotion: An Essential Component of Primary Care Pediatric Practice)

What could reading to kids possibly have to do with child health? Well, read, if you will, the first sentence of the policy statement:

Reading regularly with young children stimulates optimal patterns of brain development and strengthens parent-child relationships at a critical time in child development, which, in turn, builds language, literacy, and social-emotional skills that last a lifetime.

I’ll confess, the science supporting the value of reading to small children never occurred to Diane or me as we enthusiastically acted out all the parts of Janet and Alan Ahlberg’s drolly clever “The Jolly Postman.” But of course, it makes intuitive sense, and there is no shortage of research to back up the AAP’s claims. The policy statement alone includes 48 citations.

When we at RWJF talk about building a Culture of Health, we often speak of the big things, like health care coverage, a healthy weight for all children, violence prevention, and equal opportunity. But we’re not forgetting the little things. We always frame the discussion within a much broader context—in short, building a Culture of Health everywhere each person lives, works, and plays.

So thank you, pediatricians for driving home the critical importance of reading to wee ones. That message hits me where I live.

And hold fast to your beliefs, pediatricians, when parents—particularly new parents—express doubt that reading to a child as young as an infant has any value. If they want to know where to start, my first answer would probably be any appropriately aged kid’s book. Ask your local librarian for recommendations. But insist: Just read to your kids. Repeat daily, or even more often.

My second answer, drawn from the warm, loving, revelatory memories of my own early parenthood, might be more specific. I would start with Robert Louis Stevenson’s gently lulling poem, “The Moon.” It was one of Sarah’s first “sturries,” and one of my favorite “sturries,” too.

The moon has a face like the clock in the hall;
She shines on thieves on the garden wall,
On streets and fields and harbour quays,
And birdies asleep in the forks of the trees.

The squalling cat and the squeaking mouse,
The howling dog by the door of the house,
The bat that lies in bed at noon,
All love to be out by the light of the moon.

But all of the things that belong to the day
Cuddle to sleep to be out of her way;
And flowers and children close their eyes
Till up in the morning the sun shall arise.

Editor’s note: What was your little one’s favorite story? What was your favorite story? Share your thoughts in comments, below.

Tue, 1 Jul 2014 10:33:00 -0400 Jeff Meade Barriers to care: language and literacy Pediatric care Early childhood Children (0-5 years) Children (6-10 years) RWJF Staff Views <![CDATA[Supporting Families to Succeed ]]> ACEs Billboard Version 2 Mobile

It has been more than 15 years since the Centers for Disease Control published the Adverse Childhood Experiences (ACES) study. What we learned from that study, and then subsequent research, is that sustained exposure to toxic stress and adverse childhood experiences—including abuse, neglect, neighborhood violence and chronic poverty—without the support of an engaged supportive parent or adult caretaker, can have serious extended effects on children’s subsequent development and success in life. This stress, without intervention, can lead to a lifetime of poorer health, including chronic diseases in adulthood, such as heart disease and diabetes.

In 2012, the American Academy of Pediatrics published a policy statement calling on pediatricians to become leaders in an effort to decrease children’s exposure to toxic stress and to mitigate its negative effects. They acknowledged how much science had taught us about how our environment affects our “learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity.” The statement was a significant shift in the conversation. It provided a biological framework and imperative for why we must do something about adverse childhood experiences now.

The Robert Wood Johnson Foundation is actively working with our partners to build a Culture of Health, a culture where being healthy and staying healthy has social value, and where the healthy choice is the easy choice. But clearly—with all that we now know about early exposure to adversity—this will not happen if, as a country, we continue to allow a culture of violence—in all its forms—to persist. Every family should have the opportunity to raise their children in a nurturing environment that allows them to thrive. In too many communities and too many families, exposure to violence and trauma undermines this goal.

So, the two of us—as well as our colleagues—are currently spending our time educating ourselves to determine precisely what the Robert Wood Johnson Foundation can do to prevent exposure to violence in early childhood and promote resiliency. How can we help strengthen families and their communities? The good news—and there is good news—is that while exposure to trauma in childhood can last a lifetime, it does not need to. Well-conceived interventions can promote individual and community resilience and healing. We’re poring through research, identifying what is still not known, determining the role policy will play, and talking to thought leaders, organizations, government agencies, schools and health care providers who are doing remarkable work.

We’ve said it before; we think we're in the midst of a major paradigm shift. Dr. Sandy Bloom has likened it to the understanding of germ theory. It’s a knowledge and science shift that changes everything and has the potential to save lives. Many communities across the U.S. are using this science and knowledge to bring together multiple partners—schools, health care, law enforcement, early childcare, community agencies—to address violence and trauma and promote health and wellbeing. Within this growing movement, there are bright spots: communities that have established partnerships to create training, action and advocacy to change outcomes and trajectories for children and families dealing with violence and trauma. We are learning from these communities and are eager to share their stories, and connect with one another to increase the momentum for action.

At the end of last year, a small group of researchers, policy leaders and practitioners working to address adverse childhood experiences joined us for two days at the Robert Wood Johnson Foundation for the National Collaborative on Adversity and Resiliency. We talked, inspired each other, occasionally disagreed and, most importantly, developed a plan to compel others to join us in an effort to expand the reach and impact of this growing social movement.

Today, with our support, the Health Federation of Philadelphia is releasing a report that reflects the outcomes of that gathering. It outlines the strategic goals we defined and the action steps we need to take. Yes, it’s a report, but we don’t want you JUST to read it. We want you to recognize it as a call to action to researchers, policy makers, business leaders, health care providers, communities, schools, parents, communicators, funders and YOU.

What can you do? Read the report from the National Collaborative on Adversity and Resiliency. Join the discussion about the report over at ACES Connection. (And join that online community if you have not already done so!) But, also, talk to us. Use the comment space to tell us about the people and organizations with which you think our colleagues and we should speak as we develop our plans. Be a part of this powerful effort to support children, parents and families to succeed.

Mon, 30 Jun 2014 09:31:00 -0400 Jane Isaacs Lowe Child abuse and neglect Families RWJF Staff Views <![CDATA[I'm Happy I Dropped my iPhone in the Pool ...]]> Bye Bye, iPhone

But I wasn't happy at first. While on vacation, I was mortified when I saw “him” lying at the bottom of the pool. “He” was my constant companion through boredom-and caffeine-fueled late-night working sessions.

Snap back to reality. Moments later my other companion—my husband—frantically rescued my iPhone from the depths of crystal clear waters. First aid involved promptly powering off the phone and depositing “him” into a bag of rice where “he” would remain for a week (or two!), drying out

The remainder of vacation seemed bleak as I anticipated hours of boredom and feeling disconnected from the world. But my experience proved otherwise. Here’s what happened:

I engaged in more physical activity. I could no longer lounge by the side of the pool dipping my feet in the water while surfing celebrity gossip sites in eager anticipation of discovering what triggered the Jay Z vs. Solange duel. So I actually got into the pool and swam. The next morning, instead of prolonging breakfast by checking email and fretting over meetings I missed, I went outside and took a walk with my family, soaking in the sun, enjoying the vistas and marveling at the clear blue sky.

I spent more time meaningfully interacting with my family and others. Until this pool incident, my daughter was a constant critic of my need to stay connected ... and rightly so. A recent New York Times article notes that children can feel hurt by the lack of attention that results from chronically connected parents. Thanks to the pool incident, I was meaningfully engaging and playing with my kids without the distraction of an electronic device.

I slept better. Like many others, I’ve struggled with bouts of insomnia. However, once I lost access to my phone, my quality of sleep improved significantly. Apparently this wasn’t a coincidence. Researchers are finding that artificial blue light emitted from computer screens and other devices lower levels of the hormone melatonin which regulates our internal clocks and sleep cycles. This is problematic since adequate sleep is needed to relieve stress, reduce the risk of many chronic diseases, improve memory and regulate body weight.

My mood and mental outlook improved. I became more relaxed. My friends and family noticed it and openly commented. Freedom from constant interruptions and cognitive stimulation—positive or negative—that came from being chronically connected left me feeling more relaxed. And many organizations are starting to recognize the mental health benefits (and subsequent benefits to productivity) associated with employees disconnecting from electronic devices. Hope Woodhead and I were discussing this very phenomenon when she shared a recent story highlighting email embargo policies being implemented at various organizations. A researcher interviewed for the piece noted: “If you stay on your email, you become transactional. You become reactive. You’re not inspirational”.

In this digital age, disconnecting is hard. In fact, it’s so hard that I couldn’t do it voluntarily and I even went through some early withdrawal! But once I was forced to do so, the cumulative benefits were undeniable. I became a healthier person both physically and mentally. And being healthier is making me a more conscious parent, an attentive partner and an inspired, productive worker.

So imagine how far we’d come toward building a culture of health in this nation if each of us re-evaluated our relationships with our electronic devices. Movements such as the National Day of Unplugging pose this very challenge, recognizing how hyper-connected our society has become.

There are undeniable benefits to having access to the sorts of devices our ancestors couldn’t even imagine. But I challenge you to spend a vacation, weekend, or at least a day with those you really love—and without your electronic companions. Pay attention to how that affects your mood and mental outlook. Striking a new balance might just help you get healthy and stay healthy.

Sun, 29 Jun 2014 11:23:00 -0400 Najaf Ahmad Information technology Behavior change <![CDATA[Promoting A “Green” Culture of Health: Instead of Wasting Food, Getting it to Those Who Need It]]> Mercer Street Friends Food Bank Warehouse Trenton

“A mind is a terrible thing to waste,” goes an old slogan of the United Negro College Fund. Another terrible thing to waste is healthy food.

That’s especially true in a nation where 1 in 7 U.S. households are “food insecure”—that is, they lack consistent, dependable access, typically for financial reasons, to “enough food for active, healthy living,” as a U.S. Department of Agriculture report puts it. About 1 in 10 U.S. households have food-insecure children—an equally appalling reality in a country that wastes an estimated 30 to 40 percent of its food supply, or a whopping 133 billion pounds of food in 2010 alone.

In California’s Orange County, however, a solution is at hand—and there’s no reason it couldn’t take hold and spread nationwide. Since 2012, the Waste Not Orange County Coalition, a public-private partnership, has worked to boost donations to local food pantries of surplus healthy food from local restaurants, grocery stores and other facilities. The organization was formed out of the realization that enough food was tossed out every day to feed the nearly 380,000 local residents—almost half of them children—who are deemed food insecure.

The brainchild of Orange County public health officer Eric Handler, MD, and county food pantry director Mark Lowry, the organization is now making a double-barreled effort to battle local food insecurity even further.

First, it is trying to alert community clinics, other health care providers, and social service agencies, to routinely ask patients or clients two questions designed to offer clues about food insecurity: Whether individuals or families have worried within the past year that their food “would run out before we got money to buy more,” and whether “the food we bought just didn’t last and we didn’t have the money to get more.”

If the answer to either or both questions is yes, individuals or families can be directed to a Google map that shows the location of all local food pantries. Clinics and other locations with the capacity to do so can also be encouraged to stock emergency supplies of nonperishable food, as at least two local clinics are now doing.

Second, to make sure that there’s ample stock at those food pantries, Waste Not Orange County has formed a new “food recovery task force” to boost food donations in two of the county’s largest cities, Anaheim and Orange. A prime objective is making it clear to 1,500 local restaurants and other food sources how easy it is to participate in the program.

For starters, federal law and some state laws and local ordinances provide liability protections for individuals or organizations that donate food to nonprofit organizations helping needy individuals. These protections mean that donors can’t be held liable in court for any reason—for example, if someone who ate donated food had a severe allergic reaction—unless the donor is guilty of gross negligence or intentional misconduct.

And more practically, food donors in Orange County don’t even have to deal with transporting donated food to pantries, as that job is handled by a separate nonprofit, Food Finders, that is affiliated with Waste Not Orange County.

Handler and his colleagues are now thinking beyond the county’s borders. They’ve held conversations with White House personnel about taking the same approach nationally to encouraging stepped-up food donations. They plan to create a “tool kit” to help organizations that want to donate food. They’re also contemplating creation of a smart phone app that would show the location for all food pantries nationally, and make it easier to direct those who self-identify as food insecure with the food sources they need.

Meanwhile, back in Orange County, “we have passed the tipping point” in terms of making local businesses aware of the opportunities to donate food, says public health officer Handler. A sign of the times: The local Theo Lacy county jail has even joined the effort, electing to go “green” and donate to food pantries the 2,000 pounds of uneaten food it was previously throwing out every day.

A terrible thing to waste, indeed. And how much better to get that food into the mouths and stomachs of those who need it.

Wed, 25 Jun 2014 15:54:00 -0400 Susan Dentzer Food access Nutrition <![CDATA[Special Olympics Holds Lessons, and Inspiration, for All of Us]]>

Special Memories

RWJF staff members spent several days at the Special Olympics games, at various venues, working at different events and in many different roles. Here are their memories in pictures.


Let me win, but if I cannot win, let me be brave in the attempt.”

—Special Olympics motto

The other day I cheered myself hoarse during a swim relay for a team from Maryland that put their all into the race. In fact, the whole viewing crowd cheered on this team. When they finished, the athletes were jubilant, hugging each other and their opponents, thrilled by their performance in this national event. It didn’t seem to bother them much that they finished last.

The 2014 USA Games for the Special Olympics, the world’s largest organization for people with intellectual disabilities, was held in New Jersey June 14-21. Some 3,500 children and adults from all 50 states competed in 16 different sports, and the vast majority took tremendous pleasure in the pure joy of athletics. Sure, plenty were fiercely competitive, but they were also happy and proud to have the opportunity to compete to the best of their ability.

That was pretty inspirational to the 110 staff members from the Robert Wood Johnson Foundation who volunteered at the Special Olympics.

The theme of this year’s event was “Inclusion,” a theme we also need to keep in mind as the Foundation works to build a Culture of Health for all Americans, no matter the obstacles they face. As RWJF Director Anne Weiss notes, “like all of us, the athletes were diverse individuals—some were outgoing and friendly, others were withdrawn. Some were physically vigorous and others were limited in their ability to walk, see, or speak. But this huge Special Olympics effort makes it possible for all of the athletes, their families, coaches, and volunteers not only to be physically active, but to make social connections, to learn new skills and resilience.  It was amazing!”

It was also a reminder that sport and physical fitness is something we can all pursue in some form, no matter how limited our abilities. That’s not the same message I get when I watch the traditional Summer and Winter Olympics from the comfort of my couch. I marvel at the physical perfection on display, but I never think that I too could be out there running or jumping or swimming. Ideally, however, sport should not be exclusionary, and the Special Olympics is prima facie evidence that it doesn’t have to be.

For example, the Special Olympics promotes “unified sports,” which bring together athletes of different abilities to play on the same team. RWJF VP for Communications Robin Hogen became an instant fan of the concept after watching a soccer game between the unified Pennsylvania and Wisconsin teams. “It is a wonderful way to teach the qualities of empathy, respect and awareness to able-bodied athletes who play on a par with physically challenged athletes,” says Robin. “They learn it is more important to play your best and lose than it is to care only about winning.”

The goalie on the Pennsylvania team, Dadly Thenor, moved from Haiti to Pennsylvania in 2006 and required numerous operations to correct a birth defect that left his legs deformed. He now walks independently with the aid of a walker, which Dadly puts aside when he tends goal. (Here's a news clip of Dadly on and off the field.) “Dadly is my new hero,” says Robin. “While his team lost to Wyoming 2-0, Dadly won the hearts of all who watched the game. There were no losers on that field of play.”

Every RWJF volunteer had similar reactions. CFO Peggi Einhorn was struck by the many shapes and sizes of the athletes, and how athletic ability was independent of physical handicaps. She recalled a swimmer with cerebral palsy—he could not use one arm, and one leg was turned inward.  “But he still swam fast and well and he did his flip turns with ease and grace, even if he twisted and pushed off the wall with just one leg,” says Peggi. “He clearly loved swimming, and participating.”

RWJF program financial analysts Sharleen Rajput and Jan Mihalow got to hear directly from the athletes as they worked the booth, selling shirts, hats and pins. Jan says that whenever she congratulated one of the contestants, they would proudly share their accomplishments:  “Hey, did you see me?  I did a really good job.  I hit a double today.”  Or “Hey, I was awesome. I got a hit and had a save.“ And then there was the thrill of victory. Senior Writer/Producer Jeff Meade recalls a 13-year-old swimmer named Sarah who won her meet, and reminded him about it several times. “It was all I could to keep her from running a victory lap,” says Jeff. “She was so thrilled, and pleased with herself.”

Some RWJF staffers had a very special connection to the event. Jes Carney, digital marketing and analytics director at the Foundation, has an older brother who is a Special Olympian. “The Special Olympics, without a doubt, helps people with intellectual disabilities thrive in ways that were not thought possible,” Jes says. She teaches painting to older adults with severe disabilities, and notes that any time these individuals are included in activities, be it sports, music, art, etc., they thrive.

The final word goes to Communications Associate Renee Woodside, who says the best part of her day of volunteering “was getting to see my husband’s cousin Henry swim.” He went home with three gold medals and a silver.

Tue, 24 Jun 2014 02:30:00 -0400 Catherine Arnst Competitions Philanthropy National RWJF Staff Views <![CDATA[Spotlight: Health Convenes in Aspen for the First Time]]>

For the past year, the Robert Wood Johnson Foundation has been thinking and talking about how to build a Culture of Health in America—a culture where health becomes a part of everything we do, and the healthy choice becomes the easy choice. This week we are ratcheting the dialogue up a notch at the first ever Spotlight: Health meeting, a 2-1/2 day expansion of the famed Aspen Ideas Festival, convened annually by the Aspen Institute in Colorado. 

Spotlight: Health will bring together world leaders, corporate executives, innovators, entrepreneurs, policy experts, influential media, philanthropists and thought leaders from a broad range of sectors to discuss the key issues of our time as they relate to medicine, population health, and the relationship between health and other disciplines. In keeping with the 2014 theme of the Aspen Ideas Festival, Imagining 2024, the Spotlight: Health meeting will focus on what the state of health might look like a decade from now. It will explore new frontiers in health, such as new advances in biomedical and environmental science, and the influence of related disciplines including the arts, community development and technology. 

RWJF CEO Risa Lavizzo-Mourey will lay out the challenges to be discussed at the meeting in her Wednesday keynote address, “We Will Have A Powerful Story to Tell: Building a Culture of Health in America,” which will be live-streamed at 10 a.m. (EDT). Other speakers and panelists will focus on four main themes: “Living Longer, Living Better;” “Health by Design;” “The Business of Health;” and “Innovations in Health.” The closing session will feature an interview with former Secretary of Health and Human Services Kathleen Sebelius by Aspen Institute President and CEO Walter Isaacson. 

Also on Wednesday, we will announce the six winners of the RWJF Culture of Health Prize, which honors communities working at the forefront of health improvement.  Members of the winning community organizations will be at the meeting as well, to share their strategies and learn new ones. 

We’re hoping all this talking, thinking, and sharing will lead to new ideas, new actions and new partnerships. For those that can’t attend, we hope you will follow the live stream and the Twitter hashtag #AspenIdeas. But most of all, I hope that Aspen will be just one piece of an ongoing dialogue that will spread across the U.S. over the next decade, as we all work to build a Culture of Health into the fabric of every community.

Robin Hogen is RWJF's vice president for Communications.

Mon, 23 Jun 2014 06:00:00 -0400 Robin Hogen Conferences Healthy communities <![CDATA[This Is Your Brain]]>

In 1990, RWJF refined its grantmaking goals to three strategies:

  • Assure that Americans of all ages have access to basic health care
  • Improve the way services are organized and provided to people with chronic health conditions, and
  • Promote health and prevent disease by reducing harm caused by substance abuse.

The Foundation had studied the issue of substance abuse for several years. In fact, RWJF’s first venture into this field was Fighting Back, a national program aimed at creating community-based solutions to reducing the use of illegal drugs.

RWJF Trustee James E. Burke played a vital role in helping to craft the Foundation’s grantmaking strategies to reduce substance abuse. In 1989, Burke became chairman of the Partnership for a Drug-Free America (PDFA). That same year, the Foundation issued its first grant to the PDFA, and this support continued through 2009. Today, PDFA operates as the Partnership at

During the two decades of RWJF funding, PDFA conducted national media campaigns to educate the public about the dangers of substance abuse. Public Service Announcements (PSA) served as one of its primary methods to curb drug use.

Arguably, PDFA’s most effective and memorable PSA was its 1987 ad called “Frying Pan.” The PSA shows an actor named John Roselius holding an egg in his sparsely furnished apartment. He announces that the egg represents a persons’ brain. He picks up a frying pan, and adds: “This is drugs.” He cracks the egg into the pan. Its contents quickly fry. He then delivers the powerful punch line: “This is your brain on drugs.” The ad concludes with the famous tagline: “Any questions?”

This Is Your Brain on Heroin

RWJF did not provide funding for the “Frying Pan” PSA, but Foundation funds did help produce its memorable 1997 sequel. In this version, actress Rachael Leigh Cook also holds an egg in her hand, once again symbolizing a human brain. The frying pan represents heroin. Cook places the egg on a kitchen counter. And then she declares: “This is what happens to your brain after snorting heroin.” The actress violently smashes the egg, wielding the pan like a cast iron cudgel. As she lifts the pan, the egg drips down over her hand and the pan.

It’s not over yet, as Cook makes all too clear. What follows is harrowing, a long string of violent declarations as she smashes everything in the kitchen—wine glasses, the ceiling lamp, the wall clock ... everything.

“This is what your body goes through! And this is what your family goes through! And your friends! And your money! And your job! And your self-respect! And your future!”

“And,” she adds, “your life.”

And once again, at the end, the chilling and memorable catchphrase: “Any questions?”

To this day, we possess an unusual but much appreciated token of appreciation for our two decades of funding for the PDFA. It’s a replica of the frying pan used in the Partnership’s ads. It’s even framed.

It’s hard to imagine a national Culture of Health that does not take into account the toll that drugs take on Americans every day. And not just the lives of vulnerable people dragged down by drug abuse, but the culture of crime and violence that can also short-circuit the lives and futures of so many young people involved in the sale of drugs. And that’s not to mention the deleterious impact on the health of the surrounding community.

And so that frying pan serves as a constant reminder that the work to improve the lives of so many vulnerable people and to improve and enhance the health of whole neighborhoods is still far from over.

Any questions?

Andrew R. Harrison is the Foundation's historian.

Fri, 20 Jun 2014 00:30:00 -0400 Andrew Harrison Addiction and substance abuse Health promotion and disease prevention RWJF Staff Views <![CDATA[A Community Fights for Light Rail, and its Health]]>

After 15 years of hard work and tireless commitment on the part of so many people—elected officials, engineers, urban planners, community leaders―the Green Line light rail line connecting downtown Minneapolis to downtown St. Paul is open for riders. The light rail runs through the very heart of the Twin Cities region and touches people in every walk of life—with the potential to transform economic opportunity, equity, and health.

It is our hope that once residents begin to use the line, they will find it easier to get to places where they can buy affordable healthy foods. Air quality will improve because there are fewer cars on the road. People may even lose some weight―a study in Charlotte showed that a year after that city opened a rail line, residents who used it regularly shed a few pounds.

But even as we celebrate the Green Line, we also want to solidify the lessons we have learned over the past decade and a half spent designing and building the project. Because a critical part of the Green Line’s story is how its planning and construction created the opportunity for communities to organize themselves, to ensure that this historic opportunity did not pass them by.

The Green Line could have played out like many massive public infrastructure projects: well-intentioned, but blind to the lives, histories, assets, and experiences of black and brown communities. Early on, the stops that would best serve the diverse neighborhoods of Rondo and Frogtown, with their rich history of resilient African-American and new immigrant communities, were left out of the plan.

These neighborhoods are also made up of many people who ride transit every day to live, work, and play. But even with all the community participation in the planning, the rules of the transportation financing game were rigged. It became clear that the process favored riders who use transit to commute, instead of those who rely on it every day, to access lots of different activities. The seeds of racial and economic inequity were embedded in almost every aspect of implementation, financing, and planning. So we organized.

Green Line

Local neighborhood groups, congregations and communities of faith, labor unions, transit advocates, civil rights organizations, policy experts, and public officials banded together to create the Stops for Us Campaign. We had to change the rules so we could build a light rail that was grounded in our history and values, and would be a catalyst for creating vibrant, thriving, healthy communities.

Once our diverse communities got organized, we got active. We engaged our Congressional delegation, we hit the streets, we wrote editorials, we knocked on hundreds of doors, we had mass public meetings, we designed new policy solutions and we built an effective, public, grassroots campaign to change the rules of the game. The light rail would not be built based solely on abstract decisions made in Washington, D.C. It would reflect the input of communities that knew best what they needed to thrive. That shift was an incredible victory. But what happened underneath was even better.

Communities became more united and more powerful. We strategized and argued, we came up against deep rivers of mistrust across race and class and location, we competed, we were afraid, we risked and lost, and risked and won. Homeowners, renters, pastors, lay leaders, community development organizers, and block club leaders became change-makers in a high-stakes public decision. We had the chance to build ourselves up as communities that can effectively advocate on our own behalf. And that advocacy was essential to ensuring that the Green Line was built in a way that supported equity, economic opportunity, and health.

Sometimes, especially in the worlds of public health and government, we evaluate a process on how smoothly it went or how much controversy it avoided. Or we think that health, transportation, and community development are all separate issues. The Green Line taught me that both of these concepts are false. Individuals and communities learn and gain strength from struggle. Transportation is tied to community development which is tied to health. And everyone, absolutely everyone, has the right and responsibility to be in this struggle, together.

Doran Schrantz is the executive director of ISAIAH.

Mon, 16 Jun 2014 20:43:00 -0400 Doran Schrantz Transportation Community benefit Urban Minnesota (MN) WNC <![CDATA[A Prescription for Solutions that Bridge Health and Health Care]]> MOYER_101203_06850_RET A former Health Leads volunteer who has since gone into practicing medicine hands Health Leads volunteer, Brittany Ashe, a Health Leads prescription at the Harriet Lane Clinic in Baltimore, Md.

When Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation, was a physician-in-training at a hospital in a disadvantaged area of Boston, she came to know a woman that she recalls now as "Patient Ruth."

Writing in the professional social networking site LinkedIn, Lavizzo-Mourey remembers Ruth vividly:

"Her feet were swollen, she wore flimsy house shoes, and raw leg ulcers made walking painful. She’d been to the hospital many times before, and we gave her the usual treatment—a few hours in a warm bed, some antibiotics, and a decent meal. The next morning she limped back to the same problems: No home, no job, lousy food, cast-off clothing, no family or friends to come to her aid. We were not equipped to protect her from the harshness of life outside the hospital, a life that was literally killing her."

If health care providers want to improve patients' wellbeing, Lavizzo-Mourey adds, "they must find a way to bridge the worlds in and out of the clinic."

Lavizzo-Mourey points to many splendid examples of projects and programs designed to address the social determinants of patient health—including Boston-based and RWJF-supported Health Leads, which prescribes basic resources for low-income patients—everything from food to job training.

Bridges between health and health care are "spreading across the nation," Lavizzo-Mourey writes, and she invites readers to suggest other examples, "so there will be no more Patient Ruths."

Read the blog post

Thu, 12 Jun 2014 13:44:00 -0400 Risa Lavizzo-Mourey Social determinants of health Social support services Enterprise Level From the President