Culture of Health Blog

Although smoking rates have dropped by more than half over the past 50-plus years, tobacco use remains the number one cause of preventable deaths in the United States.

And not everyone has benefited equally from reduced rates in smoking—there are deep disparities in tobacco use and quit rates, depending on where people live, how much money they make, and the color of their skin.

Tobacco products disproportionately harm people with lower incomes and less education; people with mental illness and substance use disorders; people who identify as lesbian, gay, bisexual, and/or transgender (LGBT); and racial and ethnic minorities.

What’s causing these inequities? Part of it is marketing. Tobacco control efforts have not focused on closing racial, ethnic and socio-economic gaps. In fact, we know that the tobacco industry targets certain populations—women, people who are black or Latino, and members of the LGBT community—with higher levels of marketing, exposing them to more tobacco product ads.

In addition, people in many of these groups are less likely to have health insurance—and, as a result, less likely to have access to smoking cessation products and services.

Health care delivery often involves a one-size-fits-all approach. As clinicians, we treat a patient with a particular diagnosis similar to the last patient we saw with the same diagnosis because it’s efficient—we think. But shifting that mindset is one of the best opportunities we have to help people truly thrive. An individual’s lived experience is rich, diverse, and complicated. And what it takes for each individual to live his or her healthiest life possible is as unique as each person is. In other words, a patient’s full life experience should inform how we shape their treatment.

To achieve a deeper understanding of our patients, it is essential for providers to practice “cultural humility” and acknowledge the unique elements of every individual’s identity. Many of us may be familiar with cultural competency—being respectful and responsive to the health beliefs and practices—and cultural and linguistic needs—of diverse population groups.

But cultural humility goes even deeper. It requires you to step outside of yourself and be open to other people’s identities, in a way that acknowledges their authority over their own experiences.

Weekend after weekend, the wave of emergency department (ED) patients would arrive. Oral and maxillofacial surgeon Jonathan Shepard would treat shattered jaws, knife wounds and other facial injuries at the hospital in Cardiff, Wales. These injuries stemmed from brawls in bars and nightclubs where broken glasses and bottles were wielded as weapons. Strangely, Dr. Shepard found that only 23 percent of these assaults treated in the hospital were reported to law enforcement.

Harnessing the Power of Data for Violence Prevention

Determined to find a way to stem the violence, Dr. Shepard mobilized health care providers, law enforcement heads, city officials and other local leaders in working together to address what was happening within their community.

Local hospitals agreed to gather basic anonymized information from each assault victim admitted to the emergency department, including the specific location of the violent incident, time of day, and weapon involved. They removed patient identifiers and shared the anonymous data with local law enforcement officials, who combined those data with their own records.

When our kids were around 5 months old, we knew it was time to begin nourishing them with more than breastmilk or formula. But the thought of where or how to begin was overwhelming to us first-time moms. We also understand that establishing healthy eating patterns in early childhood sets a foundation for sound dietary habits later in life. This is why we are sharing a funding opportunity for researchers who can help us better understand what and how our kids should be eating.

We have firsthand knowledge of how crucial the right nutrition information is. Despite seeking tips from pediatricians, friends and countless books and websites, we had no idea what to feed our babies. In addition, while options at the supermarket were endless, there wasn’t enough clear, objective information to help us make an informed decision about what to choose and why. (Ironically, the dog food aisle offered a wealth of thorough guidance on how to keep a dog’s coat shiny and her bones strong.)

At RWJF, we know that business plays a key role in shaping American culture and scaling innovative ideas. Part of my job is to help business leaders understand the value of, and state the case for, improving health—not just for employees, but also the health of customers and the people who live in the community more broadly.

We recognize that businesses must deliver on ROI. They need to be focused on how they are doing with respect to returns, profits, customer relevancy, market share—that’s their job. So investing in health can be a hard sell to CEOs, shareholders, investors or boards of directors—but it’s well worth it. Here’s why:

New menu labeling information will help families make healthier choices and may save billions of dollars in health care costs over the next 20 years.

An hour before his next client is due, Edgardo “Chino” Ortiz is in the glass-walled break room of InnerCity Weightlifting (ICW) in Cambridge, Mass., poring over a study guide to become certified as a personal trainer. Fiercely focused on achieving that goal, he is rarely separated from his worksheets.

“Prescribe RICE,” he says, circling the acronym for “rest, ice, compression and elevation” on a sample quiz question about injury.

All across America, men and women with similar ambitions are prepping for careers in physical fitness. But few share the unique drive that fuels 33-year-old Chino’s determination. For him, getting certified as a fitness trainer is a life-changing turning point, built on his smarts, his talent, and his grit.

Chino recently completed a sentence of five years in a Massachusetts state prison for shooting a man in the leg over drugs. For most former inmates, finding a good job is notoriously difficult. But Chino’s future looks promising because of his connection to ICW. 

My sons are both in college, one at Howard University in Washington, D.C., and the other at Knox College in Galesburg, Illinois. Raising African American boys into adulthood was often stressful. Despite the many advantages and supports we had as a family while they were growing up, I worried about their safety, whether their schools would see and nurture their greatness despite the color of their skin, and whether they would be able to live up to their potential.

As a public health practitioner, I’ve also had the opportunity to observe the amazing efforts of so many caregivers and families with limited resources who heroically “make a way out of no way.” I’ve seen what it takes, for example, for a mom to just get her children to a doctor’s appointment when they each go to a different school because the schools in their neighborhood are not the best she wants for them. I’ve seen the enormous emotional, physical, and mental energy families with fewer economic resources spend simply on surviving day to day—and I know that statistically, the burden of poverty falls particularly heavily on children of color.

I’m now director of University of Wisconsin’s Population Health Institute, which has for nearly a decade compiled the annual County Health Rankings. The rankings have helped communities across the nation see how where we live makes a difference in how well and how long we live. This year we’ve added a layer of analysis that hits home for me, highlighting the meaningful health gaps that persist by race.

We wanted to cover both place and race because county-level rankings can mask the deep divides we have in the health of different groups within communities. Even in counties with the best rankings—and the highest overall level of opportunity for good health—not everyone in every part of the county has access to opportunities for safe housing, adequate physical activity or a good education.

For me, knowing we still have gaps to fill is a call to action, especially as we mark National Minority Health Month. So how do we overturn the current reality and give everyone a fair shot?

As a child, the United States Surgeon General Jerome Adams, MD, MPH, suffered from asthma so severe that he spent months at time in the hospital, even once being airlifted to a children’s hospital in Washington, D.C. During these stays he was struck by the fact that he’d never encountered a black physician. That finally changed when as an undergraduate he met a prominent African-American doctor who had overcome his own significant life obstacles. Seeing another African-American making important contributions to the field of medicine inspired the young Jerome Adams to decide, “I can do that too.”

With that resolve, he embarked on a path that led to becoming an anesthesiologist and culminated in his appointment as the nation’s 20^th surgeon general.  

Reflecting on his journey, Dr. Adams notes, “that’s why your efforts at the Robert Wood Johnson Foundation (RWJF) are so important. You’re providing mentorship and leadership opportunities to those who wouldn’t otherwise know how to navigate the world of public health.”

We know that where we live, work, learn, and play greatly impacts our health. Especially important among these, and too often overlooked, is the impact of where we live. Housing is tied to health in powerful and inextricable ways. Think about the steps you take each morning to care for yourself, or each evening when you go to sleep. What would happen if you didn’t know where you would sleep that night, or weren’t sure how long you had until you were forced to find new shelter? Would you still take the time to go through your routines, if there was nothing routine about them? Would you set up relationships with health providers if you might not live in the same community next month—or even next week?

I faced homelessness twice and they were the most stressful experiences in my life. Lack of access to stable housing can feel like an insurmountable barrier to achieving good health and well-being—even more so when one is dealing with a chronic illness or other health challenges.