Category Archives: Culture of Health
Earlier this year, Brownsville, Tex., was chosen by the Robert Wood Johnson Foundation as a Culture of Health Prize winner for its efforts to improve community health. As part of a new ongoing series, Health Affairs blog has featured a piece by local Brownsville leader Belinda Reininger on the community’s health successes.
Brownsville is a mostly Spanish-speaking town on the Texas border. The community, which is home to approximately 180,000 people, is also among the poorest metropolitan areas in the country. Approximately 48 percent of its children live in poverty, 80 percent of its population is obese or overweight, 30 percent have diabetes and about 67 percent have no health insurance.
However, over the last decade it has also become a “robust, bike-friendly city” that also promotes health through community gardens and the world’s largest Zumba class, according to Reininger. This is thanks in large part to the University of Texas’ decision to open its School of Public Health in Brownsville and the formation of Community Advisory Board that brings together 200 people and organizations, from private citizens and elected officials to business executives and nonprofits.
The board’s members “carry the message of wellness into their homes and businesses, and they’re able to affect policy and environmental changes by voting and leadership—and that’s how we have been able to include the community, by engaging them every single step of the way,” said Reininger, DrPh, to NewPublicHealth earlier this year.
Brownsville’s efforts include:
- Using data to assess the community’s health issues and then to engage with community members in a way that is both informative and beneficial to their health.
- Creating diverse programs — from Brownsville in Motion to promote physical activity through safe access to trails and bike lanes, to the Brownsville Farmers’ Market and Community Garden—to address the relationships between health, poverty, education and the economy.
To learn more about Brownsville’s prize-winning efforts to improve public health, read the Health Affairs blog post.
>>Bonus Content: Watch a NewPublicHealth video on Brownsville's efforts to build a Culture of Health.
Earlier this year, Taos Pueblo, N.M., was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to improve community health by declaring self-governance. As part of a new ongoing series, Health Affairs blog has featured a piece by local Taos Pueblo leader Ezra Bayles on the community’s health successes.
Taos Pueblo is a National Historic Landmark where Native Americans have continuously lived for more than 1,000 years. Approximately 1,350 people call it the sovereign nation home. Despite its concerted efforts to keep its ancient oral language, culture and traditions alive, the community faces serious public health issues that are rooted in high rates of poverty and unemployment. Approximately 47 percent of pueblo youth under age 20 are overweight or obese and 21 percent of its adults have diabetes.
As a means to address these troubling issues, in 2007 the Taos Pueblo Tribal Council took steps toward self-governance, which allowed them to reorganize and streamline community services.
“We’ve taken on even more responsibility and are taking on the programs, functions and services to serve our people,” said Shawn Duran, Tribal Programs Administrator for Taos Pueblo, to NewPublicHealth earlier this year. “We’re finding solutions that we’re familiar with and turning that into programs that work for our people.”
Taos Pueblo’s efforts include:
- Forming the Red Willow Community Growers Cooperative and the Red Willow Farmers Market in order to revive and celebrate the tribe’s agricultural heritage while also providing healthier food options.
- Serving children ages 1 to 5 with the Taos Pueblo Head Start and My First School, which incorporates healthy eating while also instilling a strong sense of community.
- Creating the Public Health Nursing Department, which sends a Native American nurse and two trained Community Health Workers directly to people’s doors as a way to make accessing care easier.
To learn more about Taos Pueblo’s prize-winning efforts to improve health, read the Health Affairs blog post.
>>Bonus Content: Watch a NewPublicHealth video on Taos Pueblo’s efforts to build a Culture of Health.
Earlier this year, Durham County, N.C., was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to ensure that its most vulnerable residents have access to the county’s repository of world-class health resources, high-skilled jobs and places to exercise. As part of an ongoing series, Health Affairs blog has featured a piece by local Durham leader Erika Samoff on the community’s health successes.
While Durham is home to a wealth of health care resources—so much so that it’s been dubbed “The City of Medicine”—a 2004 health assessment found high rates of cardiovascular disease and other chronic conditions; HIV/AIDS and other sexually transmitted diseases; and infant mortality. In addition, a 2007 evaluation found that nearly one in three of Durham’s adults were obese, with the rate especially high in its African-American population, at 42 percent. Half of the adults surveyed pointed to a lack of opportunities for physical activity as a contributing factor to their condition.
County leaders responded to these findings by creating the Partnership for a Healthy Durham. It is an alliance of more than 150 nonprofits, hospitals, faith-based organizations and businesses. The partnership’s efforts include:
- Turning an empty, run-down junior high school into the Holton Career & Resource Center, which offers mentoring programs, internships and hands-on career training to high school students
- Creating new bike lanes, bike racks and sidewalks to encourage physical activity and help combat chronic obesity
- Creating Project Access of Durham County to provide access to specialty care for uninsured residents
- Passing smoke-free legislation
To learn more about Durham’s prize-winning efforts to improve health, read the Health Affairs blog post.
- Learn more about the 2014 RWJF Culture of Health Prize winners and read NewPublicHealth coverage of the prize announcement.
- Read Everyday Health’s post, “How Healthy Is Your Hometown?: What you can do to create a culture of health in your community – and win a prize for it.”
>>Bonus Content: Watch a NewPublicHealth video on Durham’s efforts to build a Culture of Health.
We’ve written extensively on NewPublicHealth on the importance of building a Culture of Health—an environment where everyone has access to opportunities to make healthy choices. In June, the Washington Post held a live forum—sponsored by the Robert Wood Johnson Foundation—titled “Health Beyond Health Care,” which looked at how creative minds in traditionally non-health fields are working together to build a Culture of Health in the United States. As part of our continuing coverage of this issue we spoke with Catherine M. Baase, MD, Chief Health Officer at The Dow Chemical Company, about workplace wellness programs.
NewPublicHealth: Why do you think workplace wellness is important?
Catherine Baase: I guess it depends on “important” in what way. I’ll tell you two things. One is if you were asking me why it’s important to a business or a corporation, I think it brings critical value to many different corporate priorities—things such as safety, human capital priorities such as attracting and retaining talent, manufacturing reliability, the capacity to positively impact health care costs. So there’s a landscape of corporate priorities where the achievement of healthy people is important, even including drug satisfaction and employee engagement.
But on another lens, I would say that I think workplace wellness is important to society for the achievement of public health objectives. The fact that we’re not doing really well on the achievement of health outcomes for our population as a whole, and the achievement of improved health will depend on a variety of sectors of society getting involved, and one of them is workplaces. Others are schools and communities and things like that, but the achievement of public health objectives depends a bit on workplaces being involved, as well.
NPH: Who is it that benefits from workplace wellness?
Baase: Well I think the individuals, the employees and oftentimes their families, because a lot of workplace wellness programs either directly or indirectly impact the family. It’s the community within which folks live because the culture is impacted, and the company certainly.
Earlier this year, Spokane County, Wash.,was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to improve community health by increasing graduation rates. As part of a new ongoing series, Health Affairs blog has featured a piece by local Spokane leader Ben Smith on the community’s health successes.
Just eight years ago, the high school graduation rate for Spokane Public Schools was below 60 percent and 18 percent of the county’s students lived in poverty. In addition, the students who did attend college or technical school often failed to earn their degree, leaving them unprepared to fill available positions in the county’s more technical fields.
To address these issues, Priority Spokane emerged from a collaboration of local businesses, educators, health organizations and community nonprofits—all committed to improving the future of Spokane County residents by improving education. A report linking lack of education to poorer health helped spur a dramatic change. Over the next several years, the county emphasized increased collaboration and a clear vision to improve the high school graduation rate to 79.5 percent overall.
Spokane County’s efforts include:
- Training teachers and childcare workers to mentor children who experience traumatic home events.
- Developing an early warning system for at-risk students.
- Establishing community attendance support teams that reengage truant students in school.
- Starting Spokane Valley Tech, a high school designed to help students build careers in science, technology, engineering and math.
To learn more about Spokane’s prize-winning efforts to improve health, read the Health Affairs blog post.
>>Bonus Content: Watch a NewPublicHealth video on Spokane's efforts to build a Culture of Health.
Google Hangout Convenes Culture of Health Prize Winners to Discuss Lessons Learned in Creating Healthy Communities
This past June, the Robert Wood Johnson Foundation (RWJF) announced the six winners of its 2014 Culture of Health Prize, which honors communities that place a high priority on health and bring partners together to drive local change. Each community, selected from more than 250 across the nation, received a no-strings-attached $25,000 cash prize in recognition of their accomplishments.
Last week, RWJF brought together representatives from two of this year’s winners and one from last year in an online discussion, “Building a Culture of Health: What Does it Take?” Each community representative spoke about the barriers they’ve faced, how they overcame them and the role partnerships play in their ongoing success.
The discussion was moderated by Julie Willems Van Dijk, co-director of the RWJF County Health Rankings & Roadmaps and director of the RWJF Culture of Health Prize.
Alisa May, executive director of Priority Spokane and representing 2014 winner Spokane County, Wash., said that as a largely rural community of 210,000 people they’ve placed an emphasis on improving education at all levels. And they took a data-centric approach.
“Priority Spokane—which is a collaboration of community leaders—looked at the data, pulled community members together to talk about the issues that were most important to them, and educational attainment rose to the surface,” said May.
This week, David Fleming, MD, MPH, stepped down as public health director of Seattle and King County in Washington State after seven years leading the public health agency. Over that period, among many other accomplishments, he led the department’s efforts to sign up more than 165,000 residents under the Affordable Care Act and oversaw a 17 percent drop in obesity rates in partnering schools.
NewPublicHealth spoke with Fleming about his views on the mission of public health.
NPH: How has public health changed since you began your career?
David Fleming: The mission of public health has not changed—and that's to prevent unnecessary illness and death—but what has been changing is what the nature of that prevention is. Increasingly, it is in chronic diseases, injuries and, importantly, the driving force of underlying social determinants of health. So public health has changed from being more of a direct service agency where we have frontline public health workers who are out there providing treatment to people and preventing infectious diseases, to really more of a collaborative kind of agency where we need to be working with a wide range of partners outside of the traditional domains of public health to help them implement the changes that need to happen. It's a fundamental shift, I think, in the business model of public health that we're in the process of witnessing today.
NPH: When you point to some of the achievements that you've had, whether they're specific changes in the state or specific models of examples that you've given to other states, what would you point to?
Fleming: First off, I think it's important to say that public health is a team sport, and so when I talk about accomplishments, I'm talking about accomplishments of the department in which I work on this and the staff that work here. I think that we have been successful at pivoting to that future that we were talking about a moment ago, at looking at how health departments can attack the underlying social determinants of health.
Increasingly, it is health disparities that are driving poor health in this country. We have been successful here in beginning to figure out how to partner with other sectors—the education sector to reduce obesity in our poorest school districts, for example. We’ve also worked with the community development sector to begin making investments in our poorest neighborhoods to increase the healthiness of our communities, so that people who live in them can be healthy, as well. At the end of the day, I think that we have been trying to lead this new path where public health is a partner in communities with all of the other entities that are capable of influencing health and figuring out how to make that happen.
For the last several years, the U.S. Centers for Disease Control and Prevention (CDC) has been promoting a concept called “Total Worker Health,” which combines safety programs to prevent accidents on the job with health promotion programs such as smoking cessation. The idea is that emerging evidence recognizes that both work-related factors and health factors that are often beyond the workplace together contribute to many health and safety problems for employees and their families.
A new report in the CDC’s latest Morbidity and Mortality Weekly Report (MMWR) shows why the combination can be critical, finding that the risk for coronary heart disease (CHD) and stroke is higher for blue-collar and service workers than it is for white-collar workers. Studies have suggested that before, but the new MMWR recommends strategies that companies can implement to reduce that risk.
In the new report, CDC researcher Sarah Luckhaupt, MD, analyzed National Health Interview Survey data for 2008-2012. She found that the prevalence of a history of CHD or stroke among people ages 18 to 55 was 1.9 percent for employed adults, but among the employed the risk was 40 percent higher in blue-collar workers (e.g. construction workers and truck drivers) and 53 percent higher in service workers (e.g. hairdressers and restaurant servers). Luckhaupt says that job stress, shift work, exposure to particulate matter, noise and secondhand smoke are all likely contributing factors to the higher rates of CHD and stroke.
In a conversation with NewPublicHealth, Luckhaupt said that employers can help improve the health profiles of employees by using the Total Worker Health program, launched by CDC and the National Institute for Occupational Safety and Health three years ago as a guideline for workplace wellness programs. CDC now publishes quarterly reports on effective Total Worker Health programs established by employers across the United States. Recent examples include:
- Live Well/Work Well at the Dartmouth-Hitchcock Medical Center in N.H., which aims to improve worker safety and health at the medical center.
- Hearing loss prevention at the Domtar Paper Company in Kingsport, Tenn., and the 3M manufacturing plant in Hutchinson, Minn., which address both noise reduction exposure on the job and in the community.
- A “Culture of Health” at Lincoln Industries, a manufacturing factory in Lincoln, Neb., which includes companywide stretching for 15 minutes every day to help prepare the muscles that will be used on the job; massage therapists who assess and treat people who may be at risk for injury; an on-site clinic for health maintenance, wellness coaching and acute care; counseling and support programs; and social and fitness events.
A 2012 report from the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health concluded that if the adult and childhood obesity rates in 2011 continued to increase at their steady paces, then by 2030 nearly two-thirds of U.S. adults would be obese and every single state would have obesity rates above 44 percent.
Data now show that childhood obesity rates have stabilized. In fact, for the first time in a decade the obesity rates among young children from low-income families in many states is trending down.
Helping lead the way in this important public health issue has been the city of Philadelphia, Penn., which has worked to improve access to healthy foods and opportunities for physical activity.
“We were very fortunate in Philadelphia to have colleagues...who have developed a better understanding of childhood obesity,” said Don Schwarz, former Health Commissioner and Deputy Mayor for Health and Opportunity, City of Philadelphia, and will also soon take on the role of director for RWJF’s Demand Team. “What that has meant is that Philadelphia was able to take a body of knowledge and bring it to scale. The partnership in Philadelphia that has allowed that to happen goes across government and between government and the private sector and community organizations—just everyday Philadelphians. So that kind of partnership, that wonderful knowledge base, has I believed turned the corner on childhood obesity, particularly for children who are of disadvantaged communities.”
Schwarz’s comments came during the Tuesday, July 22 Google Hangout TEDMED Great Challenges: A Candid Conversation About Childhood Obesity. The panel was moderated by Richard Besser, Chief Health and Medical Editor for ABC News.
Every member of the panel echoed the importance of partnerships, and Besser succinctly explained their critical role in not just obesity prevention but all public health efforts.
“The more creatively you can think and the wider variety of partners you can pull in, the more likely you are to be successful,” he said.
At the heart of Philadelphia’s success has been the important role that schools play in that community partnership. According to Schwarz, for the past decade the city’s schools have worked to reshape how they approach children’s health and wellbeing, including comprehensive nutrition policies, a new food environment that emphasizes healthy choices and more opportunities for kids to be physically active. One can’t be successful without the other.
Building a Culture of Health means building a society where getting healthy and staying healthy is a fundamental and guiding social value that helps define American culture...and it’s a mission that communities across the country are eagerly taking on. They include the six communities honored by this year’s Culture of Health prizes from the Robert Wood Johnson Foundation (RWJF), who are coming together today and tomorrow at RWJF’s Princeton, N.J. campus to celebrate their efforts and share the lessons learned. Picked from more than 250 submissions, these six communities are leading some of the nation’s most innovative public health efforts.
The RWJF Culture of Health Prize was launched to further the work of the County Healthy Rankings & Roadmaps program, which aims to educate the public and policy makers on the multiple factors that influence community health—such as education, economic conditions and the physical environment—and to provide solutions that will improve community health. The prizes honor communities that place a high priority on health and bring partners together to drive local change.