Today, the effect that people’s living circumstances have on their health is a subject of vigorous research and discussion among scholars and academics. But a decade ago, exploration of such “social determinants of health” was considerably less common. The increased attention to the subject is due in great measure to the Robert Wood Johnson Foundation (RJWF) Health & Society Scholars program, which this year marks its 10th anniversary. The program invests in young scholars, training them to conduct health-related, cross-disciplinary research.
Michael McGinnis, MD, MPP, a former senior vice president at RWJF, is credited with initiating the Health & Society Scholars program during his time at the Foundation, before becoming a senior scholar at the Institute of Medicine. The program he left behind has made its mark. He says that the initiative sprang from RWJF’s desire to broaden its effort to promote health and health care. “To address the needs of underserved populations,” McGinnis says, “it gradually became clear that the work had to focus increasingly outside the clinic doors.”
With that goal in mind, a decade ago, McGinnis and his RWJF colleagues set out to encourage the study of health and health care through the lens of population health, a then-nascent, interdisciplinary field focused on the broad determinants of overall health. Instead of focusing on how to treat individual patients, population health researchers began applying sophisticated research and analysis techniques to the exploration of the societal causes of poor health, and then devising policies to address problems.
In RWJF’s vision, to make the most of this budding field of research, scholars from a range of disciplines needed to be trained to draw on the best elements of each. Each year, the highly competitive program selects postdoctoral scholars to train for two years at one of six leading universities: Columbia University; Harvard University; University of California, Berkeley and San Francisco; University of Pennsylvania; University of Michigan; and University of Wisconsin, Madison. Over the course of the decade, the program’s 169 Health & Society Scholars have explored various factors that influence health, including financial debt, sexual orientation, race, environment, poverty, and others.
“The social-determinants-of-health work helped establish a new perspective of interdisciplinary inquiry, a new perspective on health policy that’s interested in what keeps people healthy,” says Jo Ivey Boufford, MD, who co-directs the Health & Society Scholars program with Christine Bachrach, PhD. “The program trains scholars to conduct top-notch research across multiple disciplines…. It also prepares them to become leading scholars and change agents, understanding and acting on factors that can help make our nation healthier.”
10th Anniversary Conference
The program’s commitment to developing a generation of population health researchers was on full display in April, as the two current cohorts and many alumni of the Health & Society Scholars program gathered in Princeton, N.J., to celebrate the program’s anniversary, network with one another, and share their current work. Over the course of four days, participating scholars heard from program leaders, made presentations about their ongoing research, and gathered feedback from their colleagues.
A highlight of the April 18 to 21 annual meeting was a plenary session featuring remarks from McGinnis, as well as RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA; RWJF Senior Vice Presidents James Marks, MD, MPH, and John Lumpkin, MD, MPH; RWJF Senior Program Officer Pamela Russo, MD, MPH; and the directors of all six of the program’s university sites.
In discussing the growth of the program, Russo made clear that expanding the conversation about health to include social determinants was a specific goal of the program. “We were looking,” she said, “for leaders who would change the questions that were asked, expand the conceptual frameworks, and find solutions that could reduce population disparities in health.”
Lisa Berkman, PhD, co-director of the Harvard Health & Society Scholars program, emphasized the importance of bringing disciplines together in pursuit of population health. Reflecting on the decade, she observed that, “As the fields started to work together…there was more and more energy, and the distinct fields were no longer detached…. Population science used to be the domain of demography and epidemiology. Now, it includes economists, sociologists, biologists, and others. The era of fighting is over. People now take the best of the sciences from each other, and the best methods, in a way that’s productive.”
Marks and Lumpkin discussed the importance of the program to RWJF. “Founding the Health & Society Scholars program was an act of prescience,” Marks said, “but it was also a natural outgrowth…of the growing recognition that social forces are huge drivers of our health.”
“This is a critical program for us,” added Lumpkin. Human Capital programs, including the Health & Society Scholars program, are “essential to us as a foundation as we seek to create a diverse, well-trained workforce. It’s our largest area of investment, one in which we make a generational commitment, recognizing that you can’t just solve problems today, you have to plant trees for the future.”
Lavizzo-Mourey noted that the program reflects three lessons about effective philanthropy that have guided RWJF over its first 40 years: the importance of involving “strong, creative and innovative” people in the work of improving health and health care; the vital role of solid evidence about problems and solutions; and the value of allies, particularly unlikely ones.
Overcoming Barriers, Looking Ahead
Looking toward the program’s next decade, Boufford sees a bright future. “We hope the knowledge and evidence the scholars are creating will be used to shape policy…. An important challenge we face in the United States is balancing our ‘investment portfolio’ so that we’re investing in the broader determinants of health. Our current results for the investment we make are not all that good, and part of the reason is that we’re over-invested in personal health care at the expense of broader investments in public health and the broader determinants of health.”
Boufford also sees fostering still more interdisciplinary collaboration as an ongoing challenge in the program’s second decade. “Academics is organized into silos,” she says, “people [are] in specific disciplines, with departments of this and schools of that—and training is in particular disciplines. Population health is more interdisciplinary than that, because the determinants of health have multiple influences. A single discipline working in isolation can’t really be expected to provide good answers to the complex questions around population health.”
Such cross-disciplinary collaboration can be a challenge for institutions, Boufford explains, and one that only systemic change can overcome. “To have a career as an interdisciplinary scholar in academia, you need to get rewarded, not disadvantaged, in your efforts to get tenure and full-time appointments. Similarly, publishing articles in interdisciplinary journals needs to be rewarded. That all goes against traditional patterns in academics. We’ve seen a lot of changes at the universities that are host to the Health & Society Scholars program, including more interdepartmental connections, and interdisciplinary faculty hires. They’re really moving toward interdisciplinary scholarship, because they recognize the value and the quality.” Moreover, she says that the scholars are working their way toward exercising increased influence on such systemic issues, noting that “many of the scholars will be moving into tenured positions in their universities, so should become quite influential in their institutions.”
Meanwhile, the scholars who will breathe life into that cross-disciplinary vision in the coming years are launching their research careers with vigor. Over the course of the conference, first- and second-year RWJF Health & Society Scholars presented their ongoing research in dozens of break-out sessions. Presentations focused on a broad range of research topics, including childhood obesity, the health effects of neighborhood design, the impact of the economy, prevention of community violence, mortgage default and its relationship to health, education status and mortality, tracking and identifying environmental triggers for asthma, the effect of highways on community health, social media and health, and more.
Like their colleagues from the program’s first decade, the current cohorts of Health & Society Scholars are taking on some of the nation’s most vexing and deeply rooted health challenges. But because of all the program has accomplished so far, they’ll do it with a better developed culture of cross-disciplinary collaboration, and a clearer recognition that effective health policy must look beyond questions of insurance, funding, health care structures and the like, accounting as well for the broader social determinants of health.