Culture of Health Blog

When the COVID-19 pandemic took hold in early 2020, the workplace almost instantly transformed. Many people began working remotely and long commutes vanished. Despite heightened anxiety and danger, the public health emergency ushered in unexpected benefits for some in the form of flexibility, accommodations to family life, and recognition of “whole person” needs.

In frontline settings, such as healthcare, grocery stores, public transit systems, and manufacturing sites, the situation was drastically different. While the workers who kept these essential services operating were rightly touted as heroes, many had little choice but to risk infection, hospitalization, and death to keep the lights on for the rest of us.

These very different experiences show the challenges we face as the structure and nature of work evolves. How the risks and opportunities are distributed in that emerging future will largely depend on the decisions we make as a society.

In 1966 our nation’s great civil rights leader, Dr. Martin Luther King Jr., proclaimed that of all the forms of inequality, injustice in health is the most shocking and inhuman. All these years later, this remains painfully true.

Study after study documents racism's brutal impact on health. Compared to White women, Black women are 3 to 4 times more likely to die in pregnancy, childbirth, or within a year after giving birth; Indigenous women face that prospect 2 to 3 times more often than Whites. Black and Latino adults disproportionately report being treated unfairly in healthcare settings because of their race or ethnicity and Blacks experience adverse patient safety events more frequently, even in the same hospital and with comparable insurance coverage. Even the consequences of climate change do their greatest damage to people of color, who are consistently exposed to higher levels of air pollution, live in hotter neighborhoods, and face greater food insecurity as agricultural patterns shift.

The impact of structural racism—the system in which our nation’s policies, institutional practices and cultural representation perpetuate racial inequity—became glaringly more visible during the COVID-19 pandemic and the racial reckoning that followed the anguishing murder of George Floyd. In an important step to advance racial equity and justice, many states and cities across the nation have declared racism a public health crisis.

“Children have the right to be in environments that are health promoting and free of unhealthy foods and drinks.” —Ana Larrañaga works with Salud Crítica, a public health advocacy organization based in Mexico City

Editor’s note: This post originally appeared on the State of Childhood Obesity website.

Last year, in the midst of the pandemic, legislators in Mexico moved swiftly to ban the sale of unhealthy foods and beverages to children.

Oaxaca was the first state to approve junk food bans.

This started as a true grassroots movement, ignited by the strong community advocacy of 13 different Indigenous groups who were determined to protect people from diabetes and obesity—and prevent the displacement of traditional foods that are deeply rooted in their culture. They fought to prohibit distributors from delivering sugary drinks and junk food to their local stores.

To mark National Rural Health Day, RWJF’s Maryam Khojasteh sat down with Janet Topolsky, executive director of the Community Strategies Group at the Aspen Institute, to talk about rural economic development, the challenges and opportunities facing rural America, and what the future holds for improving rural economies. Topolsky, who is stepping down after a 40-year career working on developing opportunities and capacity in rural America, oversees the development of the Thrive Rural framework, an effort begun by the Aspen Institute Community Strategies Group (Aspen CSG) in partnership with the University of Wisconsin Population Health Institute with support from the Robert Wood Johnson Foundation. The Thrive Rural framework aims to organize learning, strengthen understanding, and catalyze and align action around what it will take for communities and Native nations across the rural United States to be healthy places where everyone belongs, lives with dignity, and thrives.

The pandemic has exacerbated the struggles facing many who care for children, aging relatives, loved ones with disabilities, and family members who are sick with COVID-19 or other illnesses. With long-stalled federal investments in a care economy, paid family and medical leave, and other policy and workplace reforms under consideration, my colleagues and I weighed in on the role men can play in providing unpaid and paid care in a series of posts this year.

They are based on reports from New America that explore the cultural, legal, and other changes that would enable more men to do this essential work.

What happens when young men and boys of color aren’t able to be themselves in any setting? 

In San Diego, refugees from East Africa commonly experience discrimination, racism, and Islamophobia. Young men and boys, in particular, describe how they have to act one way in school, another way with friends outside of school, and another at home. It is important for the community to find ways to improve social connections, increase opportunities, and build resilience, since their social isolation can lead to unhealthy behaviors that put their health and futures at risk.

Social isolation—the lack of significant social connections interpersonally and within a community—is a “deeply consequential” public health crisis, according to U.S. Surgeon General Vivek Murthy. He noted how “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness.”

Indeed, the health risks of social isolation have been compared to those of smoking and obesity, and it is linked to depression, impaired immunity, increased suicidal tendencies, and increased risk of death. 

Love and hate are not always words that come first to mind when we consider strategies to advance health and racial equity. But as I watch the divisions that continue to tear people in America apart—and bear witness, too, to the compassionate love that creates space for community—I have become convinced that these are foundational influences.

I have quoted the poet W.H. Auden on the brink of World War II to highlight the stakes. “We must love one another or die,” he wrote. Seven simple words that should guide us, both as individuals and as a collective force, in deciding what to say and how to act.

If talk of the redemptive power of love sounds abstract, let me explain just how directly it influences the Culture of Health at the core of the Robert Wood Johnson Foundation’s mission.

The first time I visited Elm Playlot was on a bright, sunny afternoon in May 2007.

Elm Playlot is a small, one-half acre pocket park in the heart of Richmond, California’s “Iron Triangle” neighborhood. It is one of the few city parks and playgrounds in the Iron Triangle. The park serves a densely populated, diverse neighborhood that I knew was chock-full of children. However, when I visited Elm Playlot that afternoon in May, I didn’t see a single child playing there.

It wasn’t hard to figure out why.

A group of men sat on Elm Playlot’s benches drinking alcohol. The play structure and swings were tagged top-to-bottom with graffiti and menacing gang slogans. Litter was piled up around the picnic tables, the slide, and the swings: broken glass, hypodermic needles, cigarette butts, used condoms, empty liquor bottles.

Later, in conversations with community residents, I would learn that parents had regularly told their children not to play at Elm Playlot; it was too dangerous.

"We are one of the only countries in the world that doesn't offer paid family and medical leave to those who need it."  —Robert Espinoza, Vice President of the Paraprofessional Healthcare Institute

A study by Better Life Lab and the Robert Wood Johnson Foundation reconfirms that the U.S. status quo of gender roles, both at work and home, is not working for many families. Men are missing out on caretaking roles that enrich their lives and enhance the bonds with loved ones, while women are struggling with role overload, feeling unsupported and missing out on income and economic mobility.

In contrast to the U.S., many nations are advancing gender equity through solutions that benefit health, child development, family well-being, and advance racial equity, like paid leave. The United States can learn from the experiences of other nations that are implementing paid leave policies and find approaches that encourage fathers to take advantage of these policies.

EDITOR’S NOTE: A shocking 140,000 U.S. children lost a parent or grandparent caregiver to COVID-19 in just 15 months, according to a study in Pediatrics, with children of color much more likely to lose a caregiver than White children.

The harm can be long-lasting. These losses also dramatically increase responsibilities for the grandparents and other relatives who step in to provide care. In a powerful post last year, RWJF’s Jennie Day-Burget looked at what Generations United has learned about the challenges facing grandparent caregivers and the policies that would support them. As Congress debates budget reconciliation, we re-share her piece.

Mel Hannah spent most of his life in service to others. He was the first African American member of the Flagstaff City Council and vice chairman of the NAACP Arizona State Conference. And, in service to his beloved family, Mel and his wife Shirley, now in their 80s, have been helping their daughter Ashley raise her three children these past years. Sadly, however, Ashley contracted and tragically died from COVID-19 in May. Ashley’s untimely death left the Hannahs as the sole caretakers for her young boys, ages 5, 4, and 1.

The Hannahs’ story exemplifies the heavy toll of the pandemic, and especially the unique and often overlooked impact it is having on “grandfamilies” or kinship families. These are families in which children live with and are being raised by grandparents, other extended family members, and adults with whom they have a close family-like relationship, such as godparents and close family friends. Astonishingly, about 7.8 million children across the country live in households headed by grandparents or other relatives. Of that number, 2.7 million do not have a parent living in the household.