Culture of Health Blog

Maria S. Gomez is a public health nurse who received a Presidential Citizens Medal in 2012 from President Barack Obama. She along with other colleagues founded Mary’s Center in 1988 an innovative community health center in the D.C. region that has been using an integrated model of health care, education, and social services for more than 30 years. Today, it serves over 60,000 people each year. Here, Gomez shares lessons learned through Mary’s Center vaccination program.

Lesson One: No Wrong Door

Mary’s Center’s vaccination program didn’t have an easy start. Like the community we serve, our team was fearful and struggling in the pandemic. Suddenly, there was a vaccine that offered promise to keep us safe, but people were confused and anxious about it. It fell to us to provide information—but first we had to educate ourselves. There was no shortcut and no chance of success unless we did. So we put in the time, even holding Town Hall Meetings with our team of nearly 800, to learn and become effective messengers.

We learned that for some in the Mary’s Center community, a lack of trust stemmed from our country’s history of medical abuse—and not just horrors like the Tuskegee syphilis study but also more recent atrocities including involuntary sterilizations of Puerto Rican women and of women detained at the U.S. border. Many in our community have experienced those abuses well.

Go to the sink, turn on the tap, get yourself a glass of water. To most people in America, this sounds like the most routine of activities. But for the families I work with on the lands of the Navajo Nation in northwest New Mexico, it is not something we can take for granted. And so when water does flow from a faucet inside a home for the first time, the tears often flow with it. This is a moment of deep gratitude and joy for us.

Tó éí ííńá át’é. In the Navajo language, that means water is life. You’ll see these words painted onto our homes and graffitied across the landscape because we understand that life can not be sustained without water. In our culture, it is a sacred element, along with Earth, fire, and air.

And yet almost one-third of my tribe lacks running water. Pause for a moment to consider what that means. The U.S. Geological Survey estimates that people in America use an average of 80-100 gallons of water every day. Our families know how to preserve scarce resources, so we use a lot less than that—but meeting basic water needs is still a complex, time-consuming task. Imagine the difficulty of attaching a hose to a 55-gallon water barrel, filling a bucket, and hauling it inside every time you want to cook, bathe, do laundry, or clean the house. Add in the costs of buying bottled water to make sure that what you drink is safe.  

COVID-19 has been devastating for children and families.

Millions of parents and caregivers lost jobs and income, hindering their ability to put food on the table. School closures, remote learning, and limited-to-no access to child care has weighed heavily on many, especially those with lower incomes working essential jobs everywhere from grocery stores to nursing homes. The pandemic has also exacerbated existing housing challenges, from high rental costs to an ongoing eviction crisis.

In spite of these challenges, our colleague Jennifer Ng'andu recently noted that families are resilient and hopeful. Because the pandemic weighs so heavily on working families, a key piece of inclusive recovery is ensuring that caregivers and their children have the support they need to thrive.

As researchers, our job is to glean lessons from the data and understand what will help communities recover. Since 2016, we’ve been following 29 diverse communities to understand how they approach health, well-being, and equity. When the pandemic hit, we pivoted to focus on nine of these communities. Doing so allowed us to closely follow COVID-19’s impact and understand local response and recovery efforts.

Over the past few years, we have seen a growing number of states and cities adopting policies that restrict or end the sales of flavored tobacco products. For these policies to work for everyone, equity must be a central focus, and all populations must benefit from the movement’s success. This means we must push for comprehensive flavor bans and, above all, restrictions on the sale of menthol cigarettes and flavored cigars.

Tobacco companies rely on flavors because of how well they work to attract and keep new customers. For decades, the tobacco industry has specifically targeted Black people in America with advertising campaigns for menthol cigarettes and other tobacco products like flavored cigars. Like menthol cigarettes, flavored cigars have been designed to hook kids and have disproportionately harmed Black youth. After Congress banned all flavored cigarettes except menthols, cigar manufacturers increased their marketing of flavored little cigars—or cigarillos—which closely resemble cigarettes. Youth use of flavored cigars increased in subsequent years and has remained especially high among Black youth.

As a result of these pernicious marketing and sales tactics, tobacco use is the number one cause of preventable death among Black people in America, claiming 45,000 Black lives a year. Black people in America die at higher rates than other groups from tobacco-related causes like cancer, heart disease, and stroke.

When we imagine a caregiver, we often picture a woman: a mother caring for young children, spouse, and the daily household chores, a daughter nursing a father with disabilities, or a female child care provider. Historically, women have been expected to serve as primary providers of “caretaking” work, whether it’s parenting or caring for an aging family member or paid work in positions typically associated with women such as child-care providers, nurses, or health aide. Alternativley, men are often expected to be the primary breadwinners and play less of a role in the emotional or physical caretaking of a family. And men in caregiving professions that are most often fulfilled by women (e.g., nursing, child care) are often seen as the exception. While the role of women as caregivers may have been true for much of history, gender roles and intergenerational dynamics are shifting and as Ai-jen Poo, director of Caring Across Generations, notes ‘continuing to associate caregiving with one gender does more harm than good.’ 

Here is the reality: before and during the COVID-19 pandemic, men have been significant providers of care work, both within their families and in their careers. In fact, men actively contribute to the care economy. This is good for them—but, just as importantly, it benefits women and society broadly.

In Harlem, girls as young as age 6 are figure skating while receiving academic, social and emotional support. In Cambridge, people who were once incarcerated are now on a career path to become fitness trainers. In Atlanta, youth are playing soccer on previously unused land near train stations, repurposed as soccer fields. On both sides of the United States/Mexico border, youth are building friendships and getting professional tennis instruction coupled with academic enrichment.

All four of the unique programs doing this work have received the Robert Wood Johnson Foundation (RWJF) Sports Award for catalyzing and sustaining change and addressing social determinants of health. They and similar programs that have received this honor are made possible by professional teams, athletes, coaches, and community-based organizations that are using sports to make communities healthier places to live, learn, work and play. In doing so, they are reaching people who might not otherwise have the chance to engage in organized sports, with the physical and mental health benefits that come with it.

Launched in 2015, the RWJF program now gives up to five awards each year to organizations that bring a deep understanding of community needs, provide safe places to play, and help youth reach their potential by building meaningful relationships, life skills, resilience and more. Acknowledging that sports has a history of oppression and racism, the program also recognizes that it has the power to provide healing, prevent violence, and galvanize communities. We have seen evidence of that over the last year, as athletes and teams have used their platforms and megaphones to advance racial justice, oppose police violence, and more, and teams have turned their stadiums into voter registration sites, polling places and, in recent weeks, vaccination hubs.

By harnessing trust, community health workers are becoming a powerful force for achieving health equity.

2020 was arguably one of the most difficult years in American history, challenging our resilience and surfacing enduring and systemic challenges to our collective health and well-being. As we continue to measure the pandemic’s impact on short- and long-term health, as well as other social and economic indicators, it is useful to note where we stood pre-pandemic. Understanding the conditions and trends that shaped our health before COVID-19 helps us assess whether the systems now being tested to respond to COVID-19 are robust. 

Last year, the Robert Wood Johnson Foundation (RWJF), along with the RAND Corporation, shared an update on the national set of measures that we have been using to track our journey toward a culture where every person has a fair and just opportunity to live the healthiest life possible. The goal of the Culture of Health measures is to offer signals of change with a focus on broader social and economic drivers of health, well-being, and equity, as well as the role all sectors play in influencing health outcomes. Developing a clearer picture of what is changing (or not) via the Culture of Health measures is useful for directing investments and identifying where, as a nation, we need to make progress. 

The RWJF Culture of Health Prize honors communities—urban, rural, tribal, large or small—that are beacons of hope and progress on creating places that enable health and well-being for all.

RWJF recognizes Culture of Health Prize winners for their broad definition of health and strong collaboration between community partners and residents, and across many sectors and levels of power. In a Culture of Health Prize community, those facing problems participate in shaping solutions. These communities commit to sustainable systems change and policy oriented long-term solutions. They create conditions that give everyone a fair and just opportunity to be as healthy as possible. They use data to measure and share progress and results.

Throughout 2020, winners used the strategies and networks they built to tackle the coronavirus and America’s reckoning with racial justice. We drew lessons and inspiration from these communities. In future posts we look forward to sharing how several Prize winners have put addressing systemic racism at the center of their work to promote health for all and how in other Prize communities, young people are forging networks, leading by example and finding new ways to advance health equity.

When acclaimed Barbadian author Karen Lord envisioned life on a small island during a pandemic in her story The Plague Doctors, she never imagined that within weeks of its publication, “history would become present, and fiction real life.” Lord’s short story in the Robert Wood Johnson Foundation’s (RWJF) first-ever book of fiction, Take Us to a Better Place, was written months before coronavirus emerged. With chilling prescience, it imagines a deadly infectious disease besetting the globe and follows Dr. Audra Lee as she fights to save her 6-year-old niece. The heroine confronts not just the disease but also a society that serves the wealthy at the expense of others.

This latter point was especially relevant here in the United States where COVID-19 hit communities of color dramatically harder than others. Centuries of structural racism have created numerous barriers to health including difficult living conditions; limited educational opportunity; high-risk jobs; lack of access to paid leave and disparities in care. Historical trauma has also driven deeply rooted mistrust of the medical establishment. All of these interconnected factors have magnified risk for both exposure to COVID-19 and the worst possible outcomes from the virus.