Culture of Health Blog

As coronavirus sweeps our nation it has brought deep-seated health inequities, including those linked to incarceration, to the forefront. Overcrowding and poor sanitation are putting prisoners at risk now more than ever. Scattered reports of guards and prisoners testing positive for COVID-19 are especially sobering since quarantines are nearly impossible among incarcerated populations. To address this, some jurisdictions are releasing select prisoners.

The Robert Wood Johnson Foundation (RWJF) has long recognized how incarceration adversely affects health and health equity for prisoners as well as families and communities. With some 2.2 million adults and youth in juvenile detention facilities, prisons, and jails, the United States incarcerates many more people—and a higher percentage of our population—than any other nation in the world. There is widespread agreement that incarceration has adverse effects on health and health equity, not just for prisoners themselves but also for families and communities. That’s why, in 2018, RWJF included it among 35 illustrative measures we are using to track our progress toward building a Culture of Health in America—that is, becoming a country that values health everywhere, for everyone.

The measures linked to RWJF’s Action Framework are intended to be viewed together to identify priorities for investment and collaboration, and to understand progress being made toward realizing our vision. We are also considering the impact each individual measure has on efforts to build a Culture of Health. Because mass incarceration is a pervasive problem that undermines health and health equity, tracking it allows us to examine how it compounds the persistent challenges associated with achieving health equity nationwide and affects communities.

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.”

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.

Providers need to be equipped with the tools to help patients make healthy choices. That’s why the Alliance for Healthier Generation is recognizing innovative training programs providing nutrition, physical activity and obesity counseling education to their students.

Even at the young age of four, Luke was overweight. In fifth grade, he tried out for the baseball team, and although he made it, he struggled that season. He was slower than the other kids as he rounded the bases, and he started having knee pain from the extra weight on his joints. Luke and his family knew they had to do something. But they dreaded going to the doctor, knowing he’d get weighed and then have to confront the escalating numbers on the scale. Year after year, the same thing would happen, and they’d have the same discussion with his doctor when they finally worked up the nerve to go. But the weight never came off.

Apprehension about a visit to the doctor is something we all face, no matter our age or health. Who among us doesn’t get a little nervous before our annual visit, knowing we might face a difficult conversation about losing weight, or flossing more, or stopping smoking? These are things we all know, but have a hard time talking about.

And even worse, if we do have these important conversations, they can lead to feelings of shame and disappointment.

But the reality is that it’s not necessarily your doctor’s fault. Even with the hundreds of thousands of hours of education your doctor gets in classrooms and hospitals, most receive little to no training in how to talk to patients about making healthy choices. In fact, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise recommended by the National Academy of Sciences, Engineering and Medicine.

Menu labeling in food retail establishments can help foster a Culture of Health in communities nationwide—here’s why this is great news for American consumers.

Today, First Lady Michelle Obama unveiled big news from the Food and Drug Administration: Consumers will soon begin to see an updated and increasingly useful Nutrition Facts Panel on packaged foods and beverages. This is the first comprehensive overhaul of the label since 1994.

Soon, those little black-and-white charts will inform you of the amount of added sugars in a product, and include a “daily value” to help you understand the maximum amount of added daily sugars recommended by experts. Serving sizes will also be revised to reflect the amounts of products that people typically consume in the real world. And, calorie counts will be listed in a much larger and bolder font to make them easier to spot.

Over the last year, public health crises near and far have captured our attention. From contaminated drinking water in Michigan, Colorado and West Virginia, to concerns about the potential Zika exposure throughout much of the Southeastern states, there doesn’t seem to be a day that these public health problems aren’t in the news.

We know that where we live often determines how vulnerable we are to public health disasters. If we want everyone—regardless of what neighborhood, city, or state they live in—to have access to health and well-being, we must work together to combat threats. And we must focus our resources on those that need them most. When we work together, our communities can be resilient and ready for inevitable challenges. Safeguarding and building our health security ensures the collective health and well-being of communities across the nation.

That’s where the National Health Security Preparedness Index comes into play.

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.