Culture of Health Blog

Earth Day will be 51 years young this April 22^nd—and I have been a witness to every one of them. The environmental activism that it launched and inspired has shaped me as an individual, shaped culture in the U.S. and beyond, and shaped the planet we all share. And it continues to evolve, as evident by the present-day focus on environmental justice and disproportionate health impacts felt by low-income communities and communities of color. As a child of the 1970s, I have seen momentous changes—environmental policies and discoveries that pointed in the right direction, setbacks and disappointments, and profiles in courage.

As a youngster, I drew inspiration from the boldness of Jacque Cousteau, the brilliance of Jane Goodall, and the courage of Norma Rae. As an adult, I look to the power of local change agents like Majora Carter of South Bronx, NYC and Margie Eugene-Richard of Southern Louisiana. In my lifetime, I have seen the institution of recycling, lead removed from gasoline and paint, asbestos banned from buildings, and consumer preference shift toward plant-based cleaning products and chemical-free food. I am excited by the burgeoning international movement for green schoolyards. I have also seen devastating environmental crises in places like Love Canal, N.Y., Flint, Mich., the Gulf of Mexico, and Prince William Sound. All of these represent both the incredible harm and good we can do when we act collectively.

I hope in my lifetime to witness less David vs. Goliath battles for the environment and a reckoning of environmental injustices. I have hope to share.

Now that Congress has approved more than $46 billion in emergency rental assistance, will that money reach the millions of Americans who need it most—the lowest income and most marginalized tenants and small landlords?

The Centers for Disease Control and Prevention (CDC) recently extended the national eviction moratorium, which will prevent tens of millions from losing their homes through June 30. Beyond that, it’s crucial to ensure that emergency rental assistance funds from the two COVID relief packages passed by Congress are distributed swiftly and equitably to tenants with the lowest incomes and others who face systemic disadvantage in accessing public benefits such as Black, Indigenous and People of Color and immigrants.

When we imagine a caregiver, we often picture a woman: a mother caring for young children, spouse, and the daily household chores, a daughter nursing a father with disabilities, or a female child care provider. Historically, women have been expected to serve as primary providers of “caretaking” work, whether it’s parenting or caring for an aging family member or paid work in positions typically associated with women such as child-care providers, nurses, or health aide. Alternativley, men are often expected to be the primary breadwinners and play less of a role in the emotional or physical caretaking of a family. And men in caregiving professions that are most often fulfilled by women (e.g., nursing, child care) are often seen as the exception. While the role of women as caregivers may have been true for much of history, gender roles and intergenerational dynamics are shifting and as Ai-jen Poo, director of Caring Across Generations, notes ‘continuing to associate caregiving with one gender does more harm than good.’ 

Here is the reality: before and during the COVID-19 pandemic, men have been significant providers of care work, both within their families and in their careers. In fact, men actively contribute to the care economy. This is good for them—but, just as importantly, it benefits women and society broadly.

“The biggest hope every parent has for their children is for them to be healthy, happy, and educated.”

This quote sums up a universal sentiment, expressed by a mother living in New York, about what all parents and caregivers want and strive to provide for their children. But what happens when parents are doing everything they can to fulfill those hopes and it’s still not enough? More than meeting families where they are, we need to meet them at their aspirations.

We can begin by truly listening to parents and caregivers, and building from their wisdom. To help achieve this understanding, over the last 18 months, the Robert Wood Johnson Foundation (RWJF) commissioned in-depth research with parents and caregivers to learn about the aspirations they have for their children, the challenges they face, and the factors that help them thrive.

In Harlem, girls as young as age 6 are figure skating while receiving academic, social and emotional support. In Cambridge, people who were once incarcerated are now on a career path to become fitness trainers. In Atlanta, youth are playing soccer on previously unused land near train stations, repurposed as soccer fields. On both sides of the United States/Mexico border, youth are building friendships and getting professional tennis instruction coupled with academic enrichment.

All four of the unique programs doing this work have received the Robert Wood Johnson Foundation (RWJF) Sports Award for catalyzing and sustaining change and addressing social determinants of health. They and similar programs that have received this honor are made possible by professional teams, athletes, coaches, and community-based organizations that are using sports to make communities healthier places to live, learn, work and play. In doing so, they are reaching people who might not otherwise have the chance to engage in organized sports, with the physical and mental health benefits that come with it.

Launched in 2015, the RWJF program now gives up to five awards each year to organizations that bring a deep understanding of community needs, provide safe places to play, and help youth reach their potential by building meaningful relationships, life skills, resilience and more. Acknowledging that sports has a history of oppression and racism, the program also recognizes that it has the power to provide healing, prevent violence, and galvanize communities. We have seen evidence of that over the last year, as athletes and teams have used their platforms and megaphones to advance racial justice, oppose police violence, and more, and teams have turned their stadiums into voter registration sites, polling places and, in recent weeks, vaccination hubs.

On a typical day before the pandemic, school food service workers across America did far more than serve lunch to the nearly 30 million children participating in the National School Lunch Program, and the nearly 15 million participating in the School Breakfast Program. Many also served afterschool snacks and even dinners for students to take home to their families. These school meals are a lifeline for tens of millions of kids and families who are furthest from economic opportunity.

All of this changed in March 2020 when schools across the country began closing in droves in response to COVID-19. Students in Houston were getting ready for Spring Break just as lockdowns began. This timing meant that instead of being stocked to serve students for the week, refrigerators across the Houston Independent School District (HISD) were empty.

Upon facing the reality that millions of families across Houston would need food, Betti Wiggins, the nutrition services officer for the HISD, sprang into action.

Editor’s note: This piece was originally published in July 2020.

A Personal Journey

It's hard to describe water to a fish while it’s swimming in it. I was that fish, growing up in a working-class, majority Black community in southwest Ohio. For instance, it hadn’t occurred to me to question why my school had metal detectors and armed police officers at every entrance yet so few textbooks that students had no choice but to share. Or why we had to travel to find affordable fresh vegetables while unhealthy food nearby was as easily accessible as payday loans and other predatory financial products. Having unmet needs was normal in these waters.

I was in high school when I began wondering why there were so many of these unmet needs in my community. An invitation to a cancer research conference hosted at a neighboring public school was an eye-opening experience. The school was one of the top-ranked in the state, nestled in a wealthy neighborhood with a well-stocked grocery store and multiple banks within walking distance. 

These waters were different.

That sense of unfairness filtered into my own life from another angle. I attended a school with limited resources which meant that opportunities within the school were offered to only a few. Since my mother was a powerful advocate for my education, I had access to after-school activities and advanced placement classes while friends living on the same block did not. That bothered me too.

Author’s note, February 2021: My post below was first published in February 2018. Over the past harrowing year, the issues it explores have become even more urgent, as the murder of George Floyd triggered a racial reckoning during a global pandemic that has hit communities of color hardest. In the midst of it all, systemic racism continues to take a brutal toll. The death of Dr. Susan Moore, who called out the racism she was experiencing as a patient, is just one example. Moore’s death, and those of Clyde Murphy and Shalon Irving, which I wrote about in my blog, are painful reminders of the cost of letting such racism continue. In the words of RWJF Trustee Dr. David Williams: “The first thing we have to do is acknowledge that the everyday racial discrimination embedded in our culture is sickening and killing African-Americans, and make a new commitment to make America a healthier place for all.”

One of my earliest and most vivid childhood memories is watching from my bedroom window as my city burned in the riots that erupted after Dr. Martin Luther King Jr.’s assassination 50 years ago.  

The next afternoon, my mother brought me to the playground at my school in Southeast Washington, D.C., which somehow was untouched. As she pushed me in a swing, she asked if I understood what had happened the day before and who Dr. King was.

“Yes,” I said. “He was working to make things better for Negroes like you.”

My mother, whose skin is several tones darker than mine, stared at me in surprise. Somehow, even at 4 years old, I had learned to observe differences in complexion.

That is particularly interesting to me now, as I eventually came to believe that “race” is a social construct.

Of course racism and discrimination exist. They are deeply embedded in America’s history and culture—but so too is the struggle against them.

By harnessing trust, community health workers are becoming a powerful force for achieving health equity.

2020 was arguably one of the most difficult years in American history, challenging our resilience and surfacing enduring and systemic challenges to our collective health and well-being. As we continue to measure the pandemic’s impact on short- and long-term health, as well as other social and economic indicators, it is useful to note where we stood pre-pandemic. Understanding the conditions and trends that shaped our health before COVID-19 helps us assess whether the systems now being tested to respond to COVID-19 are robust. 

Last year, the Robert Wood Johnson Foundation (RWJF), along with the RAND Corporation, shared an update on the national set of measures that we have been using to track our journey toward a culture where every person has a fair and just opportunity to live the healthiest life possible. The goal of the Culture of Health measures is to offer signals of change with a focus on broader social and economic drivers of health, well-being, and equity, as well as the role all sectors play in influencing health outcomes. Developing a clearer picture of what is changing (or not) via the Culture of Health measures is useful for directing investments and identifying where, as a nation, we need to make progress.