Culture of Health Blog

In January 2018, the Hollis Innovation Academy, a K-8 school, opened a dental exam room. Though it may seem unusual to see a dentist’s chair in a school, its presence reflects years of learning within this Atlanta community. Hollis's students live in English Avenue/Vine City, an area with one of the highest poverty rates in Atlanta. They also reside in one of three zip codes with the highest oral cancer rates in the city.

Early in my career as an ear, nose and throat specialist, I witnessed a deeply troubling pattern: on my first visit with a patient, I would diagnose him or her with advanced head and neck cancers. There would have been good treatment options if these patients had been seen much earlier. But time and time again, all we could do was rush the patient into an operating room, put in a tracheotomy to control the airway, and set up end-of-life care. I kept thinking that someone needed to get to this issue much sooner so that people wouldn’t die from something that could be treated effectively if caught sooner.

Eventually, I decided that person was me.

It has been said that inspiration comes when you least expect it. My visit to Melbourne, Australia, inspired me to take an international look at place-making. I was standing in Federation Square, restlessly waiting for my daughter to finish her shift. I hadn’t seen her in nearly a year. I was wearing my mom hat, not my urban planner’s hat.

Nevertheless, as my eyes swept the Square, I had the sense of being in a very special place. And while I didn’t know it at the time, I was not surprised to later learn that Federation Square in the heart of Melbourne has been recognized as one of the best public squares in the world. Fed Square, built on top of a working railway, comprises sculpted and natural elements; it has small spaces like fire pits; and large and medium-size open spaces for planned and unplanned activity. There is a large TV screen that broadcasts international and national sporting events (it is not always on). The Square is open 24 hours a day; has free Wi-Fi for all; rest rooms; and no signs prohibiting activity or lingering. Restaurants open their doors to it; and transit lines and shops surround it.

I visited Fed Square daily for eight days, and what impressed me was how well it reflected Melbourne’s rich cultural diversity; how seamlessly it connected to the streets, buildings and facilities on its periphery; and how welcoming it always felt. It is a place for people—the well-heeled, the not-so lucky—and everyone in between. I should note, though, that Federation Square’s value as an open public space and cultural hub is currently being tested. Controversial changes to it are pushing forward sans public review and participation.

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.

With these data, police were able to map when and where violence might happen, and concentrate resources on hotspot locations such as specific streets, businesses, schools, or transit stations, and during particular times of the week, to help prevent incidents.

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?