Culture of Health Blog

If a picture is worth 1,000 words, having the right picture is worth even more. When conveying a concept as nuanced as the difference between equality and equity, developing a visual that effectively engages diverse audiences and helps generate meaningful conversations can take time and a great deal of input, thought, and care.

The Robert Wood Johnson Foundation has long recognized that graphics are an important educational tool, especially given how people consume information in our fast-paced world in which nearly everyone struggles with information overload. That’s why, in 2017, we developed what we refer to as our “bike” visual, to help people understand the difference between equality and equity.

That visual, available in English and Spanish, has proven to be extremely popular. We heard from elementary, middle school and high school teachers, schoolbook authors, pediatricians, human resource department personnel, and people all across the United States as well as in other countries. They told us they were using our visual to introduce and explain the concept of equity to students, colleagues, family members, and friends. It quickly became one of the most widely used visuals this foundation has created.

My 25 years of experience in public health have made it clear: it’s time for new thinking, investments, practices, and approaches in research if a healthier and more equitable future is to be possible for all. 

I was born at a time when Black families were denied care in most hospitals. In my hometown of Kansas City, my mother gave birth to me at the Frederick Douglass Hospital, the first Black hospital West of the Mississippi and the only place my family could go for medical care. The hospital was founded by the local community—a solution to a need that the community identified. The hospital was designed to offer care to anyone in need of it. It included a teaching hospital to train medical professionals to serve the communities from which they came.

Growing up, I witnessed the Civil Rights movement gain momentum and eventually take down the Jim Crow laws. My parents brought me to sit-ins and demonstrations to demand justice. These early experiences shaped my career in academia, public health, and now in philanthropy, where a mountain of research evidence revealed ongoing and worsening health and longevity gaps. Equity belongs at the heart of our work. As evidence during the pandemic clearly showed, we cannot thrive as a nation unless everyone has a fair and just opportunity at health.

I will never forget late June 2021 in Portland—not because it was filled with family time, trips to the Pacific coast or even because of the pandemic—but because of the extreme heat beating down on the region. A “heat dome” trapped hot air over my home state of Oregon and the Pacific Northwest, killing almost 1,000 people as temperatures soared to a whopping 120° F. Scientists have found that this wouldn't have happened without climate change.

As a researcher working at the intersection of climate change, cities, and the people who live in them, I am well aware that these heat waves and extreme weather events will become more frequent and intense. This year, 2022, was no exception, as temperatures rose yet again. In fact, we ended an event held to commemorate lives lost and people harmed by the 2021 heat wave early, due to record high temperatures yet again. 

A 2022 poll from the Robert Wood Johnson Foundation, Harvard T.H. Chan School of Public Health, and NPR found that about three-quarters of people in the United States have experienced an extreme weather event in the past five years and almost a quarter of them have serious health problems as a result. What makes this work so challenging is recognizing that while we all experience harms from climate change, those who face social injustice and the repercussions of poor policy decisions are hurt the most.

For example, extreme heat not only leads to heat stroke and dehydration, but it also affects mental health and chronic pain. This impact is felt disproportionately by people of color. Native American, Latino, Asian and Black adults were more likely than their White counterparts to experience serious health problems as a result. My research has shown how socially unjust policies like redlining, which segregated neighborhoods, has made many communities of color and communities with lower wealth more vulnerable to the harms of climate change. During the 2021 heat dome, neighborhood temperatures varied by 25° F, and some of the hottest neighborhoods were redlined neighborhoods.

While data are critical in guiding policy and allocation decisions, it’s important to understand what data are and what data are not. Data are too often seen as objective, neutral, and accurate representations of reality. But the data points guiding our decisions are produced through human decision-making—and the bias and error that inherently comes with those decisions.

For example, while patient ratings and reviews of physicians can provide important insights, they are not an exact science and are subject to human bias on what to report and what to leave out. In fact, studies have found that patient reviews tend to be biased against physicians of color. This awareness of limitations and biases should inform decisions about how we use patient ratings as data. If we are not clear-eyed about these limitations and the conclusions that we can draw from these kinds of data, there will ultimately be consequences for healthcare organizations’ government reimbursement rates, decisions about salary and raises for individual physicians, diversity of the medical workforce, and ultimately health equity.

This is the final post in a series that explores the double-edged sword of preemption. Here we examine how states have used preemption to impede local decision-making on popular, family-supporting, evidence-based policies.

Paid leave and a living wage are tremendously popular public policies proven to advance health equity for working people, families, and businesses. Yet why do millions in states across the nation lack access to these policies? One reason: preemption, which continues to be used to block progress time and again. 

Paid leave provides undeniable short- and long-term benefits for families including more time to bond with a new child, which is key to healthy development; reduced infant hospitalizations and lower infant mortality rates, particularly in households with lower incomes; and improved rates of on-time vaccinations, with the strongest impact on families below the poverty line. 

Research demonstrates that family-support policies also benefit business. A 2018 study revealed the financial return on investment and productivity gains of paid leave for companies across a range of industries and sectors. A 2021 study shows that employers’ perceptions of public paid leave programs improved during the pandemic. Paid family and medical leave can help businesses reduce costs and level the playing field for employers of all sizes while providing workers with needed flexibility to keep their jobs while meeting their health needs and caregiving responsibilities.

Access to clean, safe water is a basic human right—a right we strive to protect in our Chicago neighborhood. These important lessons we've learned along the way may help other communities facing similar challenges.

The Flint water crisis prompted anxious school districts nationwide, including ours in Chicago, to test water in our public schools. The results were alarming: Thirty-seven percent of schools had levels of lead in the water fountains that were far above the federal limit.

This was the beginning of our journey toward water justice in Little Village.

Little Village is a small, culturally and economically vibrant Chicago neighborhood that is home to many Latine families and children. But industrialization and climate change have posed stark threats to our well-being. To build a healthier community, through the years we have worked alongside courageous local leaders to wage tireless grassroots campaigns. For example, one community-led effort transformed contaminated land into open green space—the first public park to be built in Little Village in 75 years. Another effort succeeded in shutting down a coal plant that was polluting our air with toxic fumes.

The 2022-2023 school year will be the fourth marked by COVID. With schools facing unprecedented challenges, school nurses are preparing for a demanding year.

No one is more familiar with these challenges than Robin Cogan, MEd, RN, NCSN, FNASN, FAAN, who has spent more than two decades of her 35-year nursing career as a school nurse in Camden, New Jersey. She is New Jersey Director for the National Association of School Nurses and faculty at Rutgers University-Camden School of Nursing. Here, she discusses the essential role nurses play in advancing health equity in schools and communities as well as what they need in order to continue caring for children.

The spread of body positivity is at an all-time high. Celebrities and influencers are celebrating larger bodies. Models of a variety of sizes are promoting beauty and consumer products. And a flood of social media posts and TV shows urge us to love our bodies as they are.

Despite this positive rhetoric, weight bias and fat shaming remain rampant. Thinness is a Western ideal that has had enormous influence around the world, spread first through colonization and echoed today through social media and pop culture. It's an ideal that has racist roots: during the slave trade, middle and upper class white women were told to eat “as little as was necessary in order to show their Christian nature and also their racial superiority” in the words of sociologist Sabrina Strings. Body size became associated with discipline and self-control and used to suggest who did and did not deserve freedom.

Childhood Obesity and Weight Discrimination

While unintentional, anti-fat attitudes have also made their way into public health policy. Take efforts to address childhood obesity: there is no shortage of interventions that concentrate on diet and exercise, based on conventional wisdom that weight gain results from more calories consumed than expended. But this focus on individual behavior feeds into biases that being overweight is the result of a lack of self-discipline or a moral failing. 

During these tumultuous times, the sweltering heat need not slow our determination to achieve health equity. In fact, these remaining summer days give us all a chance to step back and consider the many intersecting influences on health in a larger context.

One way to do that is by delving into a good book! Reading can inform and deepen our commitment to shaping communities that give everyone in America a fair and just opportunity for health and wellbeing. Several of our colleagues have authored or contributed to books that mix personal stories, on-the-ground experiences, and insightful ideas to remind us of the opportunity to make a difference.

Find space during your next getaway or staycation to delve into this sampling of works!