Culture of Health Blog

It felt like a nightmare to watch the floodwaters rise across New Orleans in August 2005. Yet as the hours turned into days, our nation realized we were watching reality–the reality of a great American city coping with a disaster for which city, state and country had not fully prepared.

The good news is that in the decade since, New Orleans has worked towards a new reality by not just rebuilding what was lost, but by asking how it can rebuild better. In so doing, the city is setting an example for us all.  

Rebuilding better means repairing critical infrastructure (roads, hospitals, businesses, levees), and reforming the organization and interpersonal relationships that are essential to promoting well-being and community engagement. As has been well chronicled, such efforts include fostering neighbor-to-neighbor ties, using data to guide community health strategic planning, and encouraging multi-sector partnerships between government, business and community organizations. In New Orleans, initiatives such as Fit NOLA and NOLA for Life have united the city’s health department, schools, community-based organizations, and businesses in ways that were unimaginable before the storm.

New Orleans’ efforts align closely with the recommendations of the report, “Healthy, Resilient and Sustainable Communities after Disasters: Strategies, Opportunities, and Planning for Recovery,” intended as a call to action and an action guide. The Institute of Medicine and the National Academy of Science was commissioned to produce this report by the Robert Wood Johnson Foundation. I was honored to serve as chair of the committee, which was composed of disaster planning, and health and human service experts. We were tasked with identifying ways in which local and national leaders can work together to mitigate disaster-related health impacts and optimize the use of disaster resources to create communities that are healthier and more resilient.

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. 

My aunt, a teacher in Connecticut, likes to say that her students carry more into their classrooms than just their backpacks. As some 50 million students enter the classrooms of our nation’s public elementary, middle and high schools this month for a new year of learning and growth, it’s important to remember that schools are more than places of academic achievement. They’re also key community institutions that influence the health and wellbeing of our nation’s children.

We already know that schools are important places to promote kids’ health. That’s why, for nearly a decade, RWJF has worked to improve food choices and increase physical activity in schools nationwide. Through our longtime support of the Alliance for a Healthier Generation’s Healthy Schools Program—which this year celebrates its 10^th anniversary—we have helped students in nearly 30,000 schools eat better and move more. This is important because research shows that health has an impact on kids’ academic and lifelong success.

But schools also teach kids social and emotional skills like sharing, cooperating, and engaging positively with each other and with adults. These are critical skills—a recent study shows that kids with better social emotional skills are more likely to graduate from college and secure good-paying jobs later in life. The opposite holds true as well. Kids with weaker social skills are more likely to drop out of high school, abuse drugs and alcohol or spend time in jail.

Brownsville, Texas, had plenty to celebrate when it became one of six communities to win the Robert Wood Johnson Foundation’s Culture of Health Prize in June 2014. This predominantly Hispanic city along the U.S.-Mexico border is one of the poorest in the country. Seven in 10 residents are uninsured, 8 in 10 are overweight or obese, and 1 in 3 has diabetes. Yet the community’s efforts to improve health—including new bike trails, community gardens, and a successful bilingual public health education campaign—have earned it wide respect and national recognition, along with $25,000 that goes with the RWJF Culture of Health Prize.

City officials are still discussing how to use the prize money. One option is commissioning a piece of artwork that could be moved around to highlight various initiatives, such as the periodic CycloBia events that make some of the city’s streets car-free for a day so that residents can bike, run, or engage in other physical activity.

How a section of Birmingham, Alabama is redeveloping and offering greater opportunities for people at multiple income levels. The secret? Engaging the community throughout the process.

It’s a memory aid. It’s truth serum. Using it can transform relationships forever. These may sound like come-ons for the type of product typically hawked on late-night television. But in fact, they’re some of the things people are saying about OpenNotes.

OpenNotes isn’t a product, but an idea: That the notes doctors and other clinicians write about visits with patients should be available to the patients themselves. Although federal law gives patients that right, longstanding medical practice has been to reserve those visit notes for clinicians’ eyes only.

But Tom Delbanco and Jan Walker, a physician and nurse at Beth Israel Deaconess Medical Center in Boston, have long seen things differently. Their personal experiences with patients, and inability to access care records for their own family members, persuaded them that the traditional practice of “closed” visit notes had to change. So, with primary support from the Robert Wood Johnson Foundation, they launched what has now become a movement.

If you want to understand the texture of a large city, drive from its downtown and make your way out to the suburbs. With few exceptions, you’ll encounter pockets of poverty transitioning into mixed income neighborhoods and, finally, wealth and privilege in the suburbs.

I have lived in Philadelphia—the nation’s 5^th most-populous city and 21^st most populous county—for most of my adult life, and that is her reality. As a former public health official, I can tell you that such income gradients have a profound impact on the health of our populations.

The 2015 County Health Rankings released today are unique in their ability to arm government agencies, health care providers, community organizations, business leaders, policymakers, and the public with local data that can be applied to strengthen communities and build a true Culture of Health.

Washington, D.C.’s Shaw neighborhood is named after Colonel Robert Gould Shaw, who commanded the famed 54^th Massachusetts Volunteer Infantry, the all-black regiment that fought for the Union during the Civil War. Today, the multi-ethnic neighborhood is home to the U Street Corridor, a revived commercial district known in the early 1900s as “Black Broadway"; Ben’s Chili Bowl, a celebrated city landmark; and Seaton Elementary, a public school whose students are mainly Hispanic, African-American, and Asian.  

It’s also home to the young goalie of Seaton’s soccer team, sixth grader Kevin Alvarez.

Like many kids in his neighborhood, Kevin, age 13, never played sports until recently, and was seriously overweight. Then his school was fortunate to become home to Soccer for Success®, a program managed locally by DC SCORES, a Washington, D.C., nonprofit.