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What Hurricane Katrina Taught Us About Community Resilience

Aug 27, 2015, 8:59 AM, Posted by Alonzo L. Plough, Anita Chandra

Hurricane Katrina left a path of destruction, death, and suffering in its wake. Its uneven recovery has taught us valuable lessons about community resiliency that will help us prepare for the next storm and beyond.

New Oreleans St. Bernard Housing project. Girl on scooter.

Ten years ago Risa Lavizzo-Mourey visited Gulfport, Mississippi, and witnessed firsthand the devastation and ruin wrought by Hurricane Katrina. “We may not be able to fix the broken levees, restore ruined cities, house the homeless, or feed the hungry,” she wrote soon after. “That’s not our job. But we most certainly can apply Katrina’s lessons to the wide range of good work that we support...”

On the 10th anniversary of Hurricane Katrina, we must reflect on valuable lessons learned from this cataclysmic event, the complexity of recovery, and the disastrous health outcomes that can result from a fundamental distrust between residents and government agencies. Katrina’s devastation and the Gulf’s uneven recovery also have served as an opportunity for studying resiliency—the capacity of communities to prepare for, respond to, and recover from adversity whether in the form of a natural disaster, economic downturn, or a pandemic.

This emphasis on community resilience represents a paradigm shift in emergency preparedness, which has traditionally focused on shoring up infrastructure (reinforcing buildings, roads, and levees),  improving detection of new hazards to human health, and being able to mount an immediate response to disasters. Katrina and subsequent threats such as Hurricane Sandy, the Florida panhandle oil spill and the H1N1 epidemic have taught us that to be truly prepared for the long-term impact of adversity communities must also develop a different set of assets: those that build strength through promoting wellbeing and community engagement.

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A Community Food Market Where Dignity is at the Center

Aug 25, 2015, 2:46 PM, Posted by Doug Rauch

The Daily Table’s model simultaneously addresses food insecurity and promotes health in a respectful, dignified manner for all customers who walk through their doors. Here's how.

The Daily Table Image via The Daily Table

When we opened the first Daily Table grocery store in Dorchester, Massachusetts this past June, I was eager for early customer feedback. I’ll never forget one of the responses we got:

I was able to check out your new store today and was very impressed. It was also the first time in a while that I didn't feel like crying at a grocery store.  Money is always tight and with kids I often have to settle for some not so healthy choices just because that's all I can afford right now. I just wanted to thank you and let you know that you are already making a huge difference for families!”

Nobody should face tears at the grocery store. Unfortunately, it happens more often than you might imagine, especially when single moms and low-income shoppers confront the daunting task of buying nutritious food to feed themselves and their families. That’s why I started Daily Table as a nonprofit community food market―to sell delicious, wholesome food at very affordable prices.

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Patient and Citizen Engagement for Health: Lessons from Jönköping County, Sweden

Aug 20, 2015, 12:00 PM, Posted by Galina Gheihman, Laura Leviton

What can a small Swedish county teach us about building a Culture of Health in the United States? We visited Sweden and brought back some valuable lessons on patient and citizen engagement.

Rooftops and landscape of Jönköping, Sweden Copyright Guillaume Baviere

Imagine a society where everyone has the means and opportunity to make choices that lead to the healthiest lives possible––a society where health is valued by all, and no one is excluded because of chronic illness or other limitations. This is what we call a Culture of Health, and it’s what, in collaboration with others, the Robert Wood Johnson Foundation is working to build in the United States.

We know that to achieve this ambitious vision, we must look to––and learn from––promising approaches across industries, disciplines and geographic borders. This is why we recently visited Jönköping, a small county in south-central Sweden, where patient and citizen engagement has brought about remarkable results: kidney failure patients operate dialysis machines on their own schedule, complex patients—such as people with schizophrenia—actively participate in designing their own care and children’s preferences and experiences are listened to, so services can improve from the children’s point of view.

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Want a Healthier Workforce? Investing in Community Health Can Pay Off

Aug 18, 2015, 10:40 AM, Posted by Marjorie Paloma

Regardless of what sector they occupy, businesses have a critical role to play in improving the health of their employees and in forging vibrant, healthy communities beyond their own walls.

Beyond Four Walls

Nearly 80% of U.S. employers now offer workplace health promotion programs aimed at improving the health and productivity of their workers. The most comprehensive of these programs—mainly at larger companies—have employees doing yoga poses at lunchtime; 7-minute workouts during breaks, or spinning at the on-site gym. Cafeterias may offer salad bars and heart-healthy entrees while vending machines are stocked with wholesome snacks and water instead of chips and soda. Some companies provide free weight loss counseling or connect employees at risk of heart disease or diabetes with a health coach. The entire workplace may be smoke-free.

But what happens when employees leave the four walls of these healthy workplaces and go home? If they live in neighborhoods with scarce green space, poor access to active transportation, few nutritious food options, or in communities plagued by crime or pollution, it can be very difficult for employees and their families to continue making healthy lifestyle choices. For businesses, the desired impact of their workplace health promotion programs will necessarily be limited.

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How Food Marketing Can Help Kids Want What’s Good For Them

Aug 11, 2015, 2:45 PM, Posted by Victoria Brown

If we want to ensure that all children are able to grow up at a healthy weight, companies can play a role by continuing to reduce marketing of unhealthy foods and beverages and increase promotion of healthy choices.

A student drinking from a carton of milk.

When it comes to helping Americans eat healthier, the conversation often focuses on price and access. But, there’s a third, equally consequential, condition: desire. Preference is shaped by myriad factors and the effects of marketing and advertising are of paramount importance. Food and beverage companies spend hundreds of millions of dollars to market their products, and their investments produce results: adults and kids are swayed by marketing.

A new report from the UConn Rudd Center for Food, Policy & Obesity reveals that a majority of the largest food and beverage companies are spending a disproportionate amount of money advertising their nutritionally poor products to Black and Hispanic consumers, especially youth. While food marketing is not inherently bad—it appears Sesame Street characters could be great “salespuppets” for fruits and veggies—it becomes a problem when it features unhealthy products known to contribute to obesity and other poor health outcomes. And, with rates of overweight/obesity higher among Black and Hispanic kids and teens, this type of business approach is especially harmful.

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Reaping the Rewards of the Culture of Health Prize

Aug 10, 2015, 3:25 PM, Posted by Susan Dentzer

It's been a year since Brownsville, Texas, won the Culture of Health Prize for its engagement of leaders across sectors to improve local health outcomes. Here's what the community has been up to since.

Brownsville, TX 2014 Culture of Health Prize Winner

Brownsville, Texas, had plenty to celebrate when it became one of six communities to win the Robert Wood Johnson Foundation’s Culture of Health Prize in June 2014. This predominantly Hispanic city along the U.S.-Mexico border is one of the poorest in the country. Seven in 10 residents are uninsured, 8 in 10 are overweight or obese, and 1 in 3 has diabetes. Yet the community’s efforts to improve health—including new bike trails, community gardens, and a successful bilingual public health education campaign—have earned it wide respect and national recognition, along with $25,000 that goes with the RWJF Culture of Health Prize.

City officials are still discussing how to use the prize money. One option is commissioning a piece of artwork that could be moved around to highlight various initiatives, such as the periodic CycloBia events that make some of the city’s streets car-free for a day so that residents can bike, run, or engage in other physical activity.

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A New Approach to a Healthier New Jersey

Aug 5, 2015, 4:49 PM, Posted by Bob Atkins

New Jersey Health Initiatives is investing in grassroots solutions to local health challenges in our own backyard, with 10 New Jersey communities serving as laboratories to learn what it will take to build a Culture of Health.

New Jersey Health Initiatives

We’re trying a new approach to building a Culture of Health in communities across New Jersey. It’s a creative, grassroots, on-the-ground approach that could become a model for many other cities and towns across America.

For decades, folks in the health field have been working hard to turn around health inequities that mean some kids have a better chance of growing up healthy than others. They’ve done great work, but sometimes in isolation, and often making decisions based on best practices rather than authentic community engagement. Even more often, health organizations’ hands have been tied because the true causes of poor health sit in other sectors: poverty, unaffordable and poor quality housing, fractured or nonexistent transportation systems, and uneven quality education and access to jobs.

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Getting to the Essence of Value in Health Care

Aug 3, 2015, 1:57 PM, Posted by Susan Dentzer

In this era of value-based payment, we need to consider how different players within health care approach the value equation.

2013 April Cost Test

How would you judge the value of your health care? A longstanding definition of treatment holds that value is the health outcomes achieved for the dollars spent. Yet behind that seemingly simple formula lies much complexity.

Think about it: Calculating outcomes and costs for treating a short-term acute condition, such as a child’s strep throat, may be easy. But it’s far harder to pinpoint value in a long-term serious illness such as advanced cancer, in which both both the outcomes and costs of treating a given individual—let alone a population with a particular cancer—may be unknown for years. And then there’s the complicating issue of our individual preferences, since one person’s definition of a good outcome—say, another few years of life—may differ from another’s, who may be seeking a total cure.

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Harnessing the Power of Shared Data Across Sectors

Jul 24, 2015, 9:47 AM, Posted by Hilary Heishman

Silos of data need to be opened up across sectors to reveal hidden connections with the potential to improve health outcomes. Here's how RWJF is investing in innovative solutions.

Shared data

A year and a half ago, the Robert Wood Johnson Foundation wrote about the groundswell of interest in connecting health care systems with other organizations and their local communities to build a Culture of Health. Since then, the Data4Health listening tour and the launch of Data Across Sectors for Health (DASH), have given more evidence to the importance of data—or the flow of information—in creating and benefitting from these connections. With work the Foundation and others across the country are doing, the “connections checklist” is increasingly taking shape.

In communities large or small, data can become a bridge between one organization’s need and a very different organization’s solution. In Rochester, New York, the business community took a hard look at a most alarming expense they faced—soaring health care costs. In 2009, the Rochester Business Alliance entered into a strategic partnership with the Finger Lakes Health Systems Agency to build a healthier workforce and lower costs. Analyzing data about community health issues revealed a shared concern about high blood pressure. The Agency developed community-based interventions that the Business Alliance and local businesses could use to help their employees and the wider community understand the importance of controlling their blood pressure. Working together, this collaboration has improved the county’s blood-pressure control rate by over 7%.

Underlying this community connection is a data connection between health care and the business community that brings root-cause analysis and rapid-cycle evaluation together to really focus attention towards groups of people who are at highest risk of uncontrolled hypertension. The Agency created a registry of information from electronic health records (EHRs) to fully understand the situation and monitor any changes brought about by their activities. Careful stewardship of sensitive information, real results, and the tantalizing promise of further benefits are sustaining and expanding this partnership.

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Three Things the United States Can Learn About Public Health From Around the World

Jul 23, 2015, 10:45 AM, Posted by Najaf Ahmad

When it comes to bridging health and health care delivery, the U.S. has an opportunity to learn from global innovations that link the public health, social services, and health care systems.

Globe Image via Joseph Li

It started with three hundred Boy Scouts from across Uganda being trained as “social monitors”. They were tasked with reporting the conditions of their communities to Uganda’s Ministry of Health through their mobile phones. In less than a year, these “U-reporters” grew to over 89,000. The U-report itself is a free SMS-based system that allows young Ugandans to share what’s happening in their communities and work with community leaders and government to affect positive change. The information gathered is disseminated through radio, TV, websites, youth events, community dialogue and other ways.

This system of real time surveillance is a vital new development for the world’s fifth-fastest growing country. Reliable health information in Uganda can mean the difference between life and death. As has been seen recently, epidemics like Ebola or West Nile thrive on information delays. Furthermore, U-reports are empowering Ugandans to share responsibility for creating healthier conditions within their communities.

The U-report is just one of the many exciting global innovations highlighted in a report by the Robert Wood Johnson Foundation (RWJF) and AcademyHealth. Written by Margo Edmunds and Ellen Albritton at AcademyHealth, the report showcases innovations that link public health, social services, and health care systems. These initiatives serve as examples of bridging otherwise disparate elements of health and health care delivery. The authors deliberately selected racially, ethnically and economically diverse regions around the world to ensure that their innovations were applicable to and reflected the diversity of the United States. A Google Hangout also convened several experts to discuss the report’s findings.  

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