Culture of Health Blog

New research shows that seniors who participate in the SNAP program are much less likely to be admitted to nursing homes and hospitals, demonstrating the power of investing in social services to reduce health care costs and improve health outcomes.

Dinnertime is stressful for Ruiyi Li, a married mother of two who lives in San Francisco’s Chinatown.

She has to wait in line for almost an hour to use a communal kitchen in the building where her family rents a single room for $400 a month.

Then there’s the problem of how to eat the meal. The family’s tight dwelling is slightly wider and longer than the size of a double bed, with no space for a table. Li, her husband, son and daughter must sit one next to the other on the edge of the lower half of a bunk bed, balancing bowls in their laps.

“Dinner is quick and fast,” Li says using the dialect spoken in her southern Chinese hometown of Toishan. “It doesn’t even feel like the family is eating together.”

My change leadership journey was ignited by a spark of dissatisfaction when I was about 7 or 8 years old, growing up on the small island of Dominica. I walked into a doctor’s office with my mother, brother, and younger sister. My mother called the doctor from the phone in the lobby, and in minutes, we were whisked right into the consulting room, bypassing about two dozen other patients who looked tired and sick.

I imagined that these other families had driven for hours in a truck on dusty, potholed roads to get to this office in Roseau. They waited hours for medical care, only to be forced to wait longer to accommodate the needs of my family. That moment, jumping that line, felt awful. Right then, I decided to become a doctor so that I could make things better for people living in poverty.

The Columbia Gorge Region where I live is a vast rural area larger than Connecticut but with a population of only 75,000. While many people here are doing well, others live in poverty, or have to drive long distances to get to a doctor’s office. In this land of fruit orchards, one in five people regularly run out of food.

Mandi Rae Pope was once one of those people. A few years ago, during a difficult pregnancy at the end of her husband’s graduate studies, Pope says she was “counting pennies out of a Mason jar to pay for gas.” She struggled with migraines, and they were getting worse. In the midst of all that, our local Women, Infants, and Children nutrition program gave her a prescription for Veggie Rx, a program we started to provide free fresh fruits and vegetables to people struggling with food insecurity. This was a top concern that community members had identified. By using Veggie Rx, Mandi Rae was able to provide fruit to her toddler son, and the more nutritious diet also helped tame her migraines. Grateful for the help, she wanted to pay if forward and expressed an interest in promoting the program.

My passion for public health was ignited early on in my career in nursing, serving children and families in St. Louis’ Head Start program. I quickly realized that the health of the individuals for whom I cared depended on a complex mix of factors—including personal choices, the opportunities they had available to them (or not), and the resources within their communities. And my time in St. Louis set me on a career path in nursing that has shown me just how integral a role nurses can play in the health of not just their individual patients, but the broader population.

• View related RWJF analysis and perspectives on Nurses, Nursing and Population Health
  

Nurses have always played a key role in improving our nation’s health and well-being. We see people—not just at different stages of their lives, but also in all of the different places our patients live—using nursing skills and expertise to care for them in many different ways.

Fourteen-year-old Destiny remembers the spring day when she and a bunch of other kids planted rows of string bean seeds in the dark, loamy earth.

“There was nothing there,” she says, pointing at the dense green plants whose abundant leaves now shelter countless sweet, crunchy pods.

Today, Destiny is back here—with a couple dozen other children—to harvest the beans and bring them home for dinner. Later, the children will add freshly picked nectarines, cucumbers, and green peppers to their goodie bags. They’ll also go home with recipes for preparing those foods.

It’s one in a series of Kids Farm Days at America’s Grow-a-Row, a nonprofit farm in Pittstown, Hunterdon County, N.J., that provides fresh produce to people in underserved communities, as well as hands-on education to kids about healthy eating.

I grew up in southwestern Ohio, surrounded by woods, corn and soybean fields down the road from a small town. Although my childhood home fits what some might see as a stereotypical description of small town America, I never thought of it that way. Now, as a program officer at the Robert Wood Johnson Foundation (RWJF) working to promote healthy, equitable communities, I’ve had the opportunity to travel to a number of rural places and small town across the United States and see the vast diversity of these places and the people who live in them.

Encompassing about three quarters of our nation’s land and home to about 15 percent of the population, rural and small town America is not just one kind of place. It includes the Midwest like the area where I grew up, and nearby Appalachia. It’s also places like the Mississippi Delta and the “Black Belt” of fertile land in the South, unincorporated colonias and many places along the U.S.-Mexico border, remote and geographically isolated “frontier” areas across the West, and Native lands across the country.

From too early an age, Irma faced a seemingly endless series of traumatic events that life threw at her as best she could—on her own.

But after a domestic crisis left her hospitalized, homeless, jobless, and in danger of losing her infant son, Irma finally received help from a supportive housing program that changed her life.

Keeping Families Together (KFT)—the Robert Wood Johnson Foundation (RWJF)-supported model for the program that helped Irma turn her life around—has become my own personal touchstone for what building a Culture of Health should look like in the real world.

Irma’s story illustrates both the power of this model and the inner resilience that so many struggling families possess.

Forty-one years after graduating from Yale University, Clyde Murphy—a renowned civil-rights attorney—died of a blood clot in his lungs. Soon afterward, his African-American classmates Ron Norwood and Jeff Palmer each succumbed to cancer.

In fact, more than 10 percent of African-Americans in the Yale class of 1970 had died—a mortality rate more than three times higher than that of their white classmates.

That’s stunning.

I remember reading the story of a dying patient who, when asked who to call as his life was ending, he replied, “no one.” He had absolutely no immediate family or close friends. Dr. Druv Khullar who wrote the piece noted "the sadness of his death was surpassed only by the sadness of his solitude. I wondered whether his isolation was a driving force of his premature death, not just an unhappy circumstance."

This profoundly sad story struck me to my core.

Not everyone has a social network to call on when they need people by their side. Many people feel disconnected from society and from life, and that contributes to a host of physical, mental and emotional health problems. In fact, according to experts, social isolation is as bad for your health as smoking, obesity, elevated blood pressure, and high cholesterol.