Culture of Health Blog

If your organization is creating a healthier community through sport, learn about the RWJF Sports Award. Boston-based organization Doc Wayne, a 2015 Sports Award Winner, uses sports to transform the lives of youth suffering from trauma and its emotional aftermath.

Sport has the power to change the world...it has the power to inspire. It has the power to unite people in a way that little else does. It speaks to youth in a language they understand. Sport can create hope where once there was only despair. – Nelson Mandela

Pregnancy through early childhood forms a critical window of opportunity for ensuring children get a healthy start to life.

In March, our program Healthy Eating Research published the most comprehensive examination to date of factors that can increase a child’s risk for obesity early in life. It shows that women who weigh more before they get pregnant, gain excess weight during pregnancy, or use tobacco while pregnant, are more likely to have children who become overweight or obese.

There are a variety of factors beyond prenatal health that also influence a child’s weight. Children form their taste preferences early in life, which is why it’s so important to ensure that they have access to a variety of fruits, vegetables and whole grains―right when they begin eating solid foods. Play and physical activity are also essential for optimal development. And there’s no reason for young children to drink sugary drinks—milk and water are best. All of these habits, if learned in early childhood, can last a lifetime.

The good news is the country as a whole is making progress in helping more kids start life at a healthy weight: Obesity rates among kids ages 2 to 5 have gone down in recent years.

Babies born in the shadow of Yankee Stadium are likely to be lifelong fans of the Bronx Bombers. They are also likely to live seven years less than a baby born a handful of subway stops south near Lincoln Center. The same is true in Las Vegas, where a baby born near The Strip is likely to live nine or 10 years less than someone born west of town.

When it comes to health across cities, zip codes are unequal and so are health outcomes. For example, ethnic minorities continue to experience higher rates of morbidity and mortality than whites. Among the 10 leading causes of mortality in the U.S. (e.g., heart disease, cancer or stroke), minority populations experience the highest rate of death.

We write often about the disparities between population groups and the day-to-day experiences of individuals who, for a myriad of reasons—systemic, geographic or financial—do not have the same opportunity to live as healthy a life as their fellow citizens. Our goal is greater health equity in America, a process that begins with including those most affected and co-creating solutions to improve the systems that negatively impact health. The end result should be decreased health disparities.

Here at the Foundation, we know that health disparities are more often caused by systems related to non-medical determinants of health, which is why we’ve specifically invested more than $457 million since 2014 toward eliminating these pervasive gaps in health outcomes.

The students at Native American Community Academy, a member of the Alliance for a Healthier Generation’s Healthy Schools Program, believed their school should serve healthy lunches that incorporated foods indigenous to the Navajo culture. So, they set out to turn their idea into a reality.

The students had an ultimate goal in mind: convince their principal to hire a company that would provide these healthier, more traditional meals. But, first, they had to prove that this type of food service could be done.

They started with the basics. With a budget of no more than $2 per person, students headed to a local grocery store and purchased ingredients for a meal they would prepare on their own and serve to their teachers and administrators to demonstrate that offering healthy Native American food at school is both feasible and affordable.

Their menu for the day: vegetarian chili with beans, blue corn meal mush (a traditional Navajo dish), an organic fruit cup and a dish they called the “Beez Kneez,” which had squash, corn, green chili, garlic and onions. The meal received rave reviews. Not only did the principal agree to find a new food service company, she put the students in charge of the task.

This is just one of many stories that reinforce the important role schools play in teaching kids about nutrition and offering healthy meals, snacks and drinks. Among kids in underserved communities (like the students at Native American Community Academy), the role of schools is especially critical.

Alonzo Plough, PhD, MPH, is vice president, Research-Evaluation-Learning and chief science officer for the Robert Wood Johnson Foundation. Read more from his series.

Erin D. Maughan, PhD, MS, RN, APHN-BC, is director of research at the National Association of School Nurses and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2013 Cohort).

If we want to create a Culture of Health in America, a 2015 priority must be to focus on ways to break down the barriers that separate us and keep us from being as effective and efficient as possible. Currently, health care systems, education, housing, and public health work in siloes; they are funded in siloes, and workers are trained in siloes. Yet, people’s concerns and lives are not siloed and a community health culture/system cannot be either.  One of the places to begin coordinated cultural change is in schools.

Schools are a smart choice to target because nearly 98 percent of school-age children, in their formative years, attend school and schools provide access to families and neighborhood communities. The Department of Education’s Full-Service Community Schools Program and Whole School, Whole Child, Whole Community Initiative reminds us that, in order for children to be educated, they need to be healthy and there must be a connection between school and community.

There are many school health initiatives in place, such as healthy food choices, physical fitness, healthy policies, school health services, community support, and after-school programs. The potential is there—but so are the siloes. But when schools are appropriately staffed with school nurses, the nurses help break down the siloes; that is because school nurses are extensions of health care, education, and public health and thus can provide or coordinate efforts to ensure a holistic, resource efficient, healthy school community.

Carolyn Montoya, PhD, PNP, is associate professor and interim practice chair at the University of New Mexico College of Nursing and a recent graduate of the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing.

Human Capital Blog: Congratulations on your award from the Western Institute of Nursing! The award honors new nurse researchers. What does it mean for you and for your career?

Carolyn Montoya: In addition to being quite an honor, receiving the Carol Lindeman Award for new researchers from the Western Institute of Nursing motivates me to continue to pursue my research. I am sure people can relate to the fact that being in the student mode is so very intense that once you finish you need some recovery time. Then you start wanting to use the research skills you worked so hard to obtain, and this award has helped to re-energize my commitment to research.

HCB: The award recognizes your study on children’s self-perception of weight. Please tell us what you found.

Montoya: I was very interested to see if there was a difference between how Hispanic children viewed their self-perception in regard to weight compared with white children. Seventy percent of my study population was Hispanic, and my overall response rate was 42 percent. I found that Hispanic children, ages 8 to 11, are not better or worse than white children in their ability to accurately perceive their weight status. Most surprising, and a bit concerning, was the fact that one-third of the sample expressed a desire to be underweight.

Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.

Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.

The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).