Culture of Health Blog

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.

The opening of the Tops Friendly Market in East Buffalo was a triumph of community activism, a victory for residents who struggled for years against food apartheid. In a neighborhood that had long lacked a full-service supermarket, the store became a symbol of local empowerment in one of the nation’s most segregated cities.

This segregation is a contributing factor in why White people in Buffalo have a longer life expectancy than their Black neighbors living on the East Side. To counter these conditions, residents persevered in efforts to shape a healthier, more equitable neighborhood—residents like 67-year-old Church Deacon Heyward Patterson. Deacon Patterson volunteered at a soup kitchen and even drove his neighbors to Tops Friendly Market to access nutritious food when they didn't have transportation of their own. He was murdered while helping load groceries into someone's car.

The murder of Deacon Patterson and others sparked outrage across the nation. But when the initial shock fades away, we need to look harder at the role of racist systems and structures that endure in the United States and how they contribute to unbridled violence and lives that are cut short.

The pandemic and this past year’s racial reckoning have given us a decisive moment. We have an opportunity to build a movement for positive change and collective healing. Part of the national awakening is recognizing the urgency to improve public health and advance equity. Today, multiple organizations and people across sectors are eager to do their part in creating a better, more equitable future.

My colleagues at the Robert Wood Johnson Foundation and I, too, seek bold and lasting change. We believe our path forward must be rooted in the best available evidence. What we need now, urgently, is research on how to eliminate inequities in health outcomes by addressing structural racism. How do we create evidence-based policies and practices so everyone has fair and just opportunities to thrive? 

Long-established biases in our research field have determined who conducts research, and they tend to favor the same institutions and individuals. We also have deeply held beliefs about which types of research are valuable, and too often this constrains innovation.

Since we originally published this post in July 2019, more cities and countries are exploring ways of centering decision-making on human and planetary well-being—from Iceland, which revealed a new well-being framework, to Canada, which is exploring budget indicators that encompass happiness and well-being. 

Meanwhile, the COVID-19 pandemic is a reminder of how interconnected we are and always have been across lives, livelihoods, and well-being of communities and societies everywhere. In the United States, its spread has sharply illuminated inequitable conditions and ongoing systemic racism. Rates of infection and complications from the virus are significantly higher in communities of color, Native communities and tribes, immigrant communities, and other groups that live with higher rates of air pollution, spotty health insurance coverage, persistent health inequities, and lack of paid leave or a financial safety net to follow “stay home” public health orders. As we recover, prepare for potential future outbreaks and rebuild, we must prioritize equitable well-being as the ultimate goal. We might take a lesson from New Zealand, which adopted a well-being budget last year, has made significant investments in vital services like mental health and education as well as environmental protections, and has had an exceptionally low mortality rate and relatively rapid recovery from COVID-19.

Fifteen years ago the Robert Wood Johnson Foundation (RWJF) confronted a puzzling question that still resonates today: Why can some communities rebound after disasters, while others are unable to recover? We first studied this in the aftermath of Hurricane Katrina. Some parts of the Gulf Coast were irreparably damaged, while others were able to recover. Researchers at the RAND Corporation, with RWJF support, sought to identify the qualities that resilient communities shared after a natural disaster, such as the strength of collaborations among government and non-governmental organizations pre-disaster and robust plans to support those most affected. The same team later built on that research by examining community well-being after other types of disasters, including economic downturns and community violence. The researchers partnered with local governments and—time and again—found that prioritizing equity and building collaborative networks bolstered communities under extreme stress.

It’s been four years since the Robert Wood Johnson Foundation (RWJF), along with the RAND Corporation, began using a set of national measures to help track our journey toward a culture where every person has a fair and just opportunity to live the healthiest life possible—regardless of where they live, how much they earn, or the color of their skin.

Our goals were to offer some catalytic signals of change with a focus on broader social and economic drivers of health, well-being, and equity. The initial set of measures were used to track how diverse stakeholders, including those outside the traditional health sector, were advancing health and well-being—and if and how health equity was improving.

Developing a clearer picture of what is changing via the Culture of Health measures can guide those who are working collaboratively to accelerate improvements. We offer a few highlights from recent updates to the measures (see also rwjf.org/cultureofhealth) and share some data on our progress to date.

Hurricanes and tornados, Zika and Ebola, wildfires and flash floods, terrorist attacks and tainted water systems. Threats to American health security are on the rise and could hit U.S. communities at any time. The responsibility for preparing for potential threats and keeping people safe doesn’t fall on any one official or institution but on diverse and diffuse government agencies, health care organizations, public health, non-profit organizations, business leaders and community members.

Since 2013, the Robert Wood Johnson Foundation (RWJF) has been measuring how ready our nation is to face emergencies that threaten health and well-being through the National Health Security Preparedness Index (Preparedness Index).

It’s been nearly 10 years, but I still remember the deadly heatwave that hit California back in July 2006 and claimed hundreds of lives.

The blistering heat lasted for 10 days, with temperatures soaring as high as 119 degrees—the highest ever recorded in Los Angeles County. The number of heat-related deaths was estimated to be as high as 450 across nine counties, including Los Angeles County.

During the five years that I worked as director of emergency preparedness and response for the Los Angeles County Department of Health, we constantly battled the health effects of really hot days, wildfires and droughts.

These weather phenomena directly impact health—and they are all linked with global climate change. Just this past weekend, during a trip to Yosemite National Park, President Obama noted, “Climate change is no longer a threat—it’s a reality.”

The people at greatest risk of serious harm from these climate change-related events include children, the elderly, people with chronic health conditions, the economically marginalized and communities of color.

RWJF announces up to $1.5 million in new funding to create the evidence base needed for a new generation of policies that improve health, well-being and equity.

Our nation is at a critical moment. There is plenty of data that reveals discouraging health trends: We are living shorter, sicker lives. One in five of us live in neighborhoods with high rates of crime, pollution, inadequate housing, lack of jobs, and limited access to nutritious food.

But there is other data that gives us glimpses of an optimistic future. There’s increasing evidence that demonstrates how we can become a healthier, more equitable society. It requires a shared vision, hard work, and the tenacity of many, but we know it is possible.

Starting with a Vision

Last year, the Robert Wood Johnson Foundation (RWJF) shared our vision of a country where we strive together to build a Culture of Health and every person has an equal opportunity to live the healthiest life they can—regardless of where they may live, how much they earn, or the color of their skin.

As my colleagues and I traveled throughout the country, we met many of you and heard your views on an integrated, comprehensive approach to health. You told us that in order to achieve lasting change, the nation cannot continue doing more of the same. Realizing a new vision for a healthy population will require different sectors to come together in innovative ways to solve interconnected problems.