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How Public Health Sharing Arrangements Fit Into the Value Equation

Oct 6, 2015, 11:05 AM, Posted by Meshie Knight

In recent years, cross-jurisdictional sharing has been a focus for policymakers and public health officials wishing to increase effectiveness and efficiency in the delivery of public health services. Measuring its impact is next.

public health nursing banner

Well-functioning, high-value public health departments are critically important to ensuring the conditions for good health in communities. In recent years, however, health departments have been faced with exceptional financial challenges mostly in the form of repeated reductions in state and local funding for public health budgets. At the same, expectations for their roles and responsibilities-- as monitors and chief health strategists for communities and as partners within and beyond the health sector—are growing.

In 2012, RWJF launched a program to investigate a potential strategy for strengthening health departments that could be especially effective in times of financial or administrative hardship, and importantly, could also help to augment the capabilities of health departments serving particularly small or rural jurisdictions: cross-jurisdictional sharing (or more simply, publicly authorized sharing of public health services across jurisdictions). The Center for Sharing Public Health Services (CSPHS) was designed to help build the evidence for how cross-jurisdictional sharing (CJS) arrangements can be planned for and implemented in different environments.

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Collaborating Across Sectors to Grow Healthy Kids

Sep 30, 2015, 1:21 PM, Posted by Alonzo L. Plough

Schools are usually considered to be part of a system separate from the health care system, but they play an important role in building a Culture of Health. See how cross-sector collaborations can ensure children strong starts to healthy, productive lives.

A child eats his lunch at school.

At Cincinnati's Oyler School, I watched as a third-grader received a free eye exam and then pored over the selection of eyeglasses, trying on several pairs, eventually settling on a pair of funky blue frames. He shared that he was looking forward to receiving his glasses, which he'd be able to take home for free the following week. The student’s teacher had noticed that he was having trouble seeing the board in their classroom and was empowered to do something about it. By forging partnerships with nonprofits and government agencies, Oyler has created a vision center, health clinic and dental clinic—all within the school.

Oyler has undergone a transformation over the last decade—from a school plagued by increasing poverty and declining enrollment to a school that is boosting graduation rates and helping improve the surrounding community. Oyler ensures students and their families have access to healthy meals by providing kids breakfast, lunch and dinner and sending them home with food on the weekends. It is part of a movement to create "community schools" that address kids' health needs and get them access to resources that allow them to succeed in the classroom and for years to come.

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Bringing the Technology Revolution to Caregiving

Sep 17, 2015, 10:32 AM, Posted by David Adler

The Atlas of Caregiving is using new methods to uncover the unique challenges and rewards that caregiving presents, from economic, emotional, and mental stressors to the moments of compassion, joy, and intimacy.

An elderly couple, the woman in a wheelchair sitting in front of a large window showing a view of mountains.

We are at a moment in history when technology is allowing us to collect information about ourselves more effectively and reliably than ever before, from the cell phone in our pocket to the Fitbit on our wrist. This technology can help us device wearers—and even the health care providers, researchers and designers we share our data with—track behaviors related to health and figure out how to improve them. But how can this technology be used to help all of us understand and shape the work of family caregivers?

It is widely believed that family caregivers frequently underestimate how long they spend caring for loved ones and the level of stress induced. This is why RWJF is supporting the Atlas of Caregiving project, which will work with 12 families to collect data using technology with the goal of getting a more accurate picture of how caregivers spend their time, and the physical and mental impact of those activities.

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Three Lessons on Improving Quality of Care in Communities

Sep 15, 2015, 10:16 AM, Posted by Anne Weiss

Aligning Forces for Quality not only transformed care in 16 communities, but it provided insights to help shape efforts building a national Culture of Health through high value care.

In a Culture of Health, how can communities improve the quality and value of health care? What happens when people who get, give, and pay for health care locally work together? In 2007, the Robert Wood Johnson Foundation (RWJF) set out to answer these questions when it launched Aligning Forces for Quality with an audacious goal: To transform the quality, equality, and value of regional health care markets.

Along the way, we explored what happens when the people who get, give, and pay for health care locally, work together. Our investment sparked deep and meaningful change in 16 very different communities across America, and important lessons learned in each and every one. But three lessons in particular helped drive success and can be applied to our work to build a national Culture of Health.

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Redesigning the Hospital as a Community Health Network

Sep 10, 2015, 3:35 PM, Posted by Shannon Kraus

Cleveland's MetroHealth Medical Center has reimagined itself to embrace community and build in thoughtful improvements to its programs and design that focus on everyday wellness and well-being.

MetroHealth Medical Center Image via HKS Architects

In a room filled with architects, acting Surgeon General Rear Admiral Boris D. Lushniak shook up the common definition of our profession by saying that “if you are an architect, you are a public health worker.

And many architects were already with him. We have been expanding our thinking beyond typical individual buildings to create healthy blocks, corridors and neighborhoods by shaping what they do within the property line so it’s responsive to what’s happening outside the property line. This in itself is not new, but doing so to improve health and wellness, while leveraging the resources of large civic-minded institutions, is a new approach to a traditional problem.

MetroHealth Medical Center in Cleveland, Ohio has taken on this mindful, responsive approach while morphing from an isolated hospital into an inclusive community health center. This process flips the paradigm of health delivery; instead of focusing on the hospital as the first line of defense in the care and wellbeing of a population, it is now the last stop.

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Building Healthy, Safe, and Nurturing Schools

Sep 8, 2015, 4:44 PM, Posted by Jennifer Ng'andu

Promoting good health for kids early in life and in their learning environments can provide all children with the foundation they need to achieve their potential—now and throughout their lifetimes.

A group of children writing words on a blackboard with a teacher watching.

My aunt, a teacher in Connecticut, likes to say that her students carry more into their classrooms than just their backpacks. As some 50 million students enter the classrooms of our nation’s public elementary, middle and high schools this month for a new year of learning and growth, it’s important to remember that schools are more than places of academic achievement. They’re also key community institutions that influence the health and wellbeing of our nation’s children.

We already know that schools are important places to promote kids’ health. That’s why, for nearly a decade, RWJF has worked to improve food choices and increase physical activity in schools nationwide. Through our longtime support of the Alliance for a Healthier Generation’s Healthy Schools Program—which this year celebrates its 10th anniversary—we have helped students in nearly 30,000 schools eat better and move more. This is important because research shows that health has an impact on kids’ academic and lifelong success.

But schools also teach kids social and emotional skills like sharing, cooperating, and engaging positively with each other and with adults. These are critical skills—a recent study shows that kids with better social emotional skills are more likely to graduate from college and secure good-paying jobs later in life. The opposite holds true as well. Kids with weaker social skills are more likely to drop out of high school, abuse drugs and alcohol or spend time in jail.

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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 well-being 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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