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Shaking Up Systems To Achieve Health Equity

Mar 17, 2016, 10:00 AM, Posted by Catherine Malone, Dwayne Proctor

In order to achieve greater health equity in America, we need to co-create solutions aimed at transforming the many systems that influence where we live, learn, work and play.

A parent reads to a group of children.

Babies born in the shadow of Yankee Stadium are likely to be lifelong fans of the Bronx Bombers. They are also likely to live seven years less than a baby born a handful of subway stops south near Lincoln Center. The same is true in Las Vegas, where a baby born near The Strip is likely to live nine or 10 years less than someone born west of town.

When it comes to health across cities, zip codes are unequal and so are health outcomes. For example, ethnic minorities continue to experience higher rates of morbidity and mortality than whites. Among the 10 leading causes of mortality in the U.S. (e.g., heart disease, cancer or stroke), minority populations experience the highest rate of death.

We write often about the disparities between population groups and the day-to-day experiences of individuals who, for a myriad of reasons—systemic, geographic or financial—do not have the same opportunity to live as healthy a life as their fellow citizens. Our goal is greater health equity in America, a process that begins with including those most affected and co-creating solutions to improve the systems that negatively impact health. The end result should be decreased health disparities.

Here at the Foundation, we know that health disparities are more often caused by systems related to non-medical determinants of health, which is why we’ve specifically invested more than $457 million since 2014 toward eliminating these pervasive gaps in health outcomes.

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What’s the Connection Between Residential Segregation and Health?

Mar 16, 2016, 7:00 AM, Posted by Donald F. Schwarz

Residential segregation is a fundamental cause of health disparities. We need to take steps that will reduce health risks caused by segregation and lead to more equitable, healthier communities.

Graphic illustration depicting residential segregation from 2016 County Health Rankings & Roadmaps.

For some, perhaps the mere mention of segregation suggests the past, a shameful historic moment we have moved beyond. But the truth is, residential segregation, especially the separation of whites and blacks or Hispanics in the same community, continues to have lasting implications for the well-being of people of color and the health of a community.

In many U.S. counties and cities, neighborhoods with little diversity are the daily reality. When neighborhoods are segregated, so too are schools, public services, jobs and other kinds of opportunities that affect health. We know that in communities where there are more opportunities for everyone, there is better health.

The 2016 County Health Rankings released today provide a chance for every community to take a hard look at whether everyone living there has opportunity for health and well-being. The Rankings look at many interconnected factors that influence community health including education, jobs, smoking, physical inactivity and access to health care. This year, we added a new measure on residential segregation to help communities see where disparities may cluster because some neighborhoods or areas have been cut off from opportunities and investments that fuel good health. 

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What Can Communities Do Now for Health Equity?

Jan 28, 2016, 1:21 PM, Posted by Joe Marx

The Culture of Health Prize communities demonstrate that there's no single formula to address health equity locally, but there are key lessons we can all learn from their success.

2015 RWJF Culture of Health Prize video

Our annual RWJF Culture of Health Prize honors and elevates communities across the United States that are making great strides in their journey toward better health. 

A scan of the 2015 winners reveals something we’ve seen in previous years: There is no single blueprint. Even when solving common problems, these Prize communities innovate in their own ways. Each brings fresh ideas to the forefront and offers a unique perspective on how to holistically address our nation’s most complex health issues. So it makes sense to turn to them to answer the question that is at the heart of our work today: How can communities come together to create places where health can happen – for everyone?

We ask that question a lot and sometimes our answers can be pretty lofty: work together across sectors, think about health broadly, and so on. While all true, communities looking to take action sometimes ask us to, well, be a bit more specific. What can we do tomorrow? Where do we start

Here, we dive in to look at how the 2015 Culture of Health communities approached that Prize-winning question. 

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Removing Barriers and Creating Opportunities for Young Men of Color

Jan 5, 2016, 10:00 AM, Posted by Maisha Simmons

A new toolkit is here to help us understand how to collectively build a path toward a healthy and productive adulthood for young men of color.

Young men work together to clean up their community.

Trayvon Martin. Manuel Diaz. Rexdale Henry. Michael Brown. Some names may be more familiar to you than others. But all share a common fate of life lost too soon.

What happens when you hear their names? Do you think about the circumstances that prematurely ended their lives? Or do you regret losing the chance to benefit from the great contributions they could have made?

It's clear that young men of color face daunting barriers to health that directly impact their potential to succeed and thrive. Access to a series of supports and conditions specifically designed to address these barriers can dramatically change their life course trajectory. That is why the Robert Wood Johnson Foundation launched our Forward Promise initiative a few years ago.

As part of this work, the big question we are always asking ourselves is what would it look like for every young man of color to grow up in a Culture of Health? We know for example that there would need to be positive school environments, access to role models, job training, support to understand and heal from trauma in their lives, and pathways to college and career, to start.

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Closing Health Gaps: The Oklahoma Example

Dec 7, 2015, 8:00 AM, Posted by Andrea Ducas

With the right data to inform priorities, and a powerful commitment to equity, places like Tulsa, Okla., are making progress to close health gaps.

Adult and child reading a book in the classroom.

What would your ideal future look like? For me and my colleagues at the Foundation, it would be one where everyone has the opportunity to live the healthiest life they can.

An unfortunate reality in this country, however, is that while we continue to realize substantial gains in health, the things that help people become and stay healthy are not evenly distributed across states or even metropolitan areas. Access to healthy foods, opportunities for exercise, good-paying jobs, good schools, and high quality health care services may be readily available in one area, and difficult to come by or nonexistent in another just a few miles away.

Sometimes the differences are particularly stark: In some communities, two children growing up just a short subway or car ride apart could be separated by a 10-year difference in life expectancy.

So how do we square this reality with the Culture of Health we’re working hard with others to build? An important first step is recognizing those disparities and what’s driving them, and ensuring that people in communities across America have strategies – and the data – they can use to proactively close health gaps.

Let’s use Oklahoma, and within it the city of Tulsa, as an example.

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Mapping a Path to Longer and Healthier Lives Across Atlanta

Jun 10, 2015, 2:52 PM, Posted by Dwayne Proctor

The Atlanta skyline on a sunny day. Image via City Clock Magazine

Two Atlanta neighborhoods, Buckhead and Bankhead, are separated by a mere five miles. Even their names are just two small letters apart. And yet the high-end shopping mecca dubbed Buckhead boasts an average life expectancy of 84 years, while in Bankhead—a neighborhood in transition that’s home to a newly burgeoning arts community—its residents face a life expectancy that’s a full 13 years shorter.  

This map of Atlanta—one of a series from the Center for Society and Health at Virginia Commonwealth University (VCU), funded by RWJF, shows that our zip codes might be a better predictor of health than our genetic codes. Why? Because where we live affects our health and wellbeing in complex ways. Among them, according to VCU, are a scarcity of jobs and quality schools, and fewer opportunities to access healthy affordable foods and safe places to be active.

This isn’t the first time Atlantans have bore witness to to inequity in their community, and today, community leaders are drawing inspiration from their past. Here in the city that served as the capitol of the Civil Rights Movement, community leaders are responding just as previous generations once did—by bringing together a diverse coalition to advance health equity and serve as a model for communities far beyond the Peachtree State.

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Data, Meet Curiosity: Finding Bright Spots in Appalachia

Apr 1, 2015, 9:20 AM, Posted by David Krol

There are so many opportunities to connect the wealth of data we have at our fingertips and to start asking new questions. David Krol tells his story about how he took this approach to find bright spots in Appalachia.

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If you close your eyes and picture Appalachia, what do you see? The images that often arose first in my mind were those from LIFE Magazine’s 1964 photo essay on the war on poverty. Photojournalist John Dominis gave the nation a face to the plight of Appalachian communities in Eastern Kentucky, and poverty and economic hardship have long been central to an outsider’s understanding of the region ever since. But through my work at the Foundation, I knew this narrative was only one part of the region’s rich and diverse story. I knew there was a different story to be told, and so I wanted to shine a light on these bright spots that demonstrate how health can flourish across Appalachia.

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A TED Dare: Here’s Reality. Now Do Something About it.

Mar 19, 2015, 12:31 AM, Posted by Jessica Mark

A poster for TED 2015 about ensuring healthy communities.

Everyone in America deserves a chance to live the healthiest life possible. The reality is a bit more complicated: A person’s ZIP code, after all, can be as important as their genetic code when it comes to determining health. A true Culture of Health in the United States won’t be possible unless we address the inequities that allow some full access to a healthier life, while others are left to struggle.

This week, RWJF arrived at the TED conference in Vancouver, British Columbia, with a challenge for attendees: Try to understand what millions of people face in their pursuit of a healthy life. And in the spirit of the conference’s “Truth & Dare” theme, we dared the TED participants to envision a future in which everyone had access and a path to a healthier life. How might that happen? So far we’re hearing incredible ideas: let’s get to a place where we can celebrate justice rather than seek justice. Let’s make smarter choices about where we spend our health care.

We’ve enlisted five talented—brilliant, really—young filmmakers to help us. We asked each of them to tell the stories of their lives and to document the challenges that sometimes seem distant, but that are all too real for the people in their worlds. Check out their remarkable stories:

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Investing in Systems Changes to Transform Lives

Mar 10, 2015, 10:00 AM, Posted by Catherine Malone, Najaf Ahmad

We know that in order to address health disparities head on, we'll have to implement changes to the systems that influence where we live, learn, work, and play. Oscar and Jose's stories show us that it's possible.   

I was looking at somebody who could be a great person...who could do something great in his future. I also knew that if I sent him to prison, I’d knock him off of that road to success.

In the quote above, Steven Teske, a Juvenile Chief Judge in Clayton County, Georgia is describing the first time he encountered 15-year-old Oscar Mayes as he entered the courtroom in handcuffs. Judge Teske noticed that Oscar was an extremely bright young man and that he had no prior run-ins with the law. Yet Oscar was facing five years in the state’s long term lock up—five years that could have ruined his future.

Fortunately, Oscar literally got a Second Chance. This Clayton County initiative gives youth facing prison an opportunity to redeem themselves through intensive supervision, participation in evidence-based treatment programs, and weekly check-ins with the court. Judge Teske and others in his community had realized that too many of their students were falling out of school and heading into the criminal justice system. To address this, the Juvenile Court partnered with local schools and law enforcement to find ways of disciplining youth while keeping them “in school, out of court, and onto a positive, healthy future.”

Interventions like this have yielded impressive statistics in Clayton County: School arrests have gone down 83% and school attendance has gone up 86%. Clayton County’s approach to juvenile justice reflects the transformational impact that changing a system can have.

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A New Approach to Eliminating Health Disparities

Feb 10, 2015, 2:13 PM, Posted by Dwayne Proctor

Children smiling at a school playground. Last year, Spokane County received the Foundation's Culture of Health Prize for improving community health by addressing the critical link between poverty, education, and poor health. Here, children play at St. Anne's Center in Spokane, where teachers are trained to catch and address early warning signs that may indicate future problems in school.

I, like many others, have made a commitment to living healthier this year. I am resolved to find and eat a new fruit and vegetable each month, decrease my consumption of meat to a few times a week, and drink at least a half-gallon of water each day. I also plan to laugh more and spend more time outdoors. My personal goals aside, I also find myself more hopeful than at the start of many past years about the state of health in our nation as a whole.

  • More Americans than ever before have access to the health care they need because of the Affordable Care Act;
  • States throughout the nation are making significant progress in helping kids achieve a healthy weight;
  • The disparities gap between black and white Americans’ life expectancies is narrowing.

These bright spots indicate that America is heading down the road to better health—but they only begin to address the challenges many Americans continue to face in accessing good health. As highlighted in a recent article in the New England Journal of Medicine, significant gaps and unmet needs remain.

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