Culture of Health Blog

A Personal Journey

It's hard to describe water to a fish while it’s swimming in it. I was that fish, growing up in a working-class, majority Black community in southwest Ohio. For instance, it hadn’t occurred to me to question why my school had metal detectors and armed police officers at every entrance yet so few textbooks that students had no choice but to share. Or why we had to travel to find affordable fresh vegetables while unhealthy food nearby was as easily accessible as  payday loans and other predatory financial products. Having unmet needs was normal in these waters.

I was in high school when I began wondering why there were so many of these unmet needs in my community. It was an eye-opening experience being invited to attend a cancer research conference hosted at a neighboring public school. The school was one of the top-ranked in the state, nestled in a wealthy neighborhood with a well-stocked grocery store and multiple banks within walking distance. 

These waters were different.

That sense of unfairness filtered into my own life from another angle. I attended a school with limited resources, which meant that educational opportunity within the school was offered to a few, but not all. Since my mother was a powerful advocate for my education, I had access to after-school activities and advanced placement classes, while friends living on the same block did not. That bothered me, too.

For tens of millions of children in the United States, school isn’t just a place to learn, but a place where they can depend on receiving healthy meals. In March 2020, according to the U.S. Department of Agriculture (USDA), more than 31 million children participated in the National School Lunch Program (NSLP) and more than 17 million participated in the School Breakfast Program (SBP); the vast majority of children receiving these school meals are from families with low incomes.

So when COVID-19 swept across the nation this spring and forced at least 124,000 schools in the United States serving 55 million students to close, a public health crisis quickly became an education crisis and a nutrition crisis.

School districts responded quickly, creatively, and heroically, implementing “Grab and Go” models allowing parents to pick up meals in school parking lots or other community hubs; loading up school buses with meals and dropping them off at stops along neighborhood routes; and delivering meals directly to students’ homes. USDA did its part by issuing a series of waivers granting more flexibility in how meals could be prepared, packaged, and served. Particularly for students living in poverty and areas where healthy foods are typically scarce, the heroism of school officials and volunteers was a lifeline.

Today, there are more questions than answers about the 2020–2021 school year, which may be unlike we’ve ever experienced. But the last thing school officials should be worrying about upon reopening is how to process meal applications and figuring out who qualifies for free or reduced-price categories; their mission of educating and feeding students as safely as possible should be their primary concern.

Among the many lessons emerging from the COVID-19 pandemic is the impact of obesity. People with obesity and associated diseases tend to become sicker and are more likely to die when COVID-19 strikes.

We know childhood obesity is a powerful predictor of obesity in adulthood. It puts children at increased risk for developing numerous health problems later in life, including diabetes and heart disease. In addition to these chronic diseases, early research suggests that obesity may also increase their susceptibility as adults to serious illness like COVID-19.

In the Robert Wood Johnson Foundation's (RWJF) first-ever book of fiction, Take Us to a Better Place, published earlier this year, Dr. Karen Lord and nine other writers use the power of fiction to help us imagine paths that may lead to a healthier, better place for all--and those that may lead us astray.  

In her short story The Plague Doctors, Dr. Lord envisioned what life on a small island during a pandemic might look like. Now, she reflects on foreseeing some of today’s challenges and solutions in her latest blog post.

Note: The following post originally appeared on the William Temple Foundation Blog and has been republished with permission. 

Last year, I was asked to write a story about the future of health. Speculating about the future is my job, but for something this specific and important, I asked Dr. Adrian Charles to be my advisor for all things medical. We chose that perennial favourite of history and fiction—a pandemic—never guessing that within weeks of the story’s publication, history would become present, and fiction real life.

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.

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.

As a child, the United States Surgeon General Jerome Adams, MD, MPH, suffered from asthma so severe that he spent months at time in the hospital, even once being airlifted to a children’s hospital in Washington, D.C. During these stays he was struck by the fact that he’d never encountered a black physician. That finally changed when as an undergraduate he met a prominent African-American doctor who had overcome his own significant life obstacles. Seeing another African-American making important contributions to the field of medicine inspired the young Jerome Adams to decide, “I can do that too.”

With that resolve, he embarked on a path that led to becoming an anesthesiologist and culminated in his appointment as the nation’s 20^th surgeon general.  

Reflecting on his journey, Dr. Adams notes, “that’s why your efforts at the Robert Wood Johnson Foundation (RWJF) are so important. You’re providing mentorship and leadership opportunities to those who wouldn’t otherwise know how to navigate the world of public health.”

Three days before my regional gymnastics meet in Arkansas I landed awkwardly on a practice vault, clashing my inner ankle bones. The pain was excruciating—as was the prospect of an injury crushing my dream of competing nationally. I was determined to go on, so I decided to adopt the mindset that I could mentally overcome my physical injury. I diligently iced, taped and tended to it while visualizing myself making it to nationals in spite of the setback.

I competed and placed high enough to qualify, and was elated as well as surprised by how little the pain had affected me. Another surprise: An x-ray the next day showed that my ankle had been broken.

My experience at age 10 shows the power of mindset—the frame of mind through which we perceive, interpret, and organize an inherently complex world. The ability to make sense of the world through our mindsets is a natural part of being human. But the mindsets we hold are not inconsequential. In fact they change reality by influencing our attention, affect, motivation, and physiology. I had decided my injury wasn’t going to influence my performance, and almost impossibly, it didn’t.

Old Colony YMCA in Brockton, Massachusetts recently discovered something startling: a single neighborhood more burdened by poor health such as asthma, high blood pressure, and elevated cholesterol than surrounding areas. Most surprising, however, was that this particular area had a lower prevalence of unhealthy behaviors like binge drinking than other locations within Brockton.

In the past, public health officials may have expended limited resources on the entire Brockton metropolitan area because they wouldn’t have been able to pinpoint the specific neighborhood facing the spike and determine why it was happening.

There are countless examples of how policies, laws, and guidelines can help people in our society live better and healthier lives. For example, zoning ordinances can help keep dangerous manufacturing emissions away from homes and schools, ensuring that children aren’t exposed to toxic pollutants. Earned Income Tax Credits have been shown to improve infant mortality and birth outcomes. Healthy food guidelines can help our kids consume less sugar by recommending schools provide whole foods, like apples. These policies shape how we live, learn, work, and play.

But there is still too much we don’t know. If your organization is a non-profit or public research institution, this is where you come in.

Through the Policies for Action (P4A) program, the Robert Wood Johnson Foundation (RWJF) seeks to build a stronger evidence base for how policies, laws, and guidelines—in the public or private sectors—can help ensure everyone has the opportunity to live a healthier life.