Measuring What Matters: Introducing a New Action Framework

Nov 11, 2015, 11:30 AM, Posted by

It's time to change our culture into one that values health everywhere, for everyone. Introducing a new Action Framework and Measures to help us get there.

A Culture of Health is where communities can flourish and individuals thrive.

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. 

A First Friday Google+Hangout discussion on "Measuring What Matters in Building a Culture of Health" took place on Friday, November 6

The Culture of Health Action Framework

We listened, and today I am proud to share our new Culture of Health Action Framework to turn data into action. This Action Framework was developed in collaboration with the RAND Corporation using scientific evidence and valuable input from the many individuals, leaders, and organizations we talked to across the country. The Framework translates the broad range of sectors and people involved in building a Culture of Health into four interconnected Action Areas:

Culture of Health Action Framework graphic
  • Action Area 1: Making Health a Shared Value

We’ll work to create communities where health is a shared value—where people appreciate the importance of achieving, maintaining, and reclaiming health as a shared priority.

  • Action Area 2: Fostering Cross-Sector Collaboration

We’ll support cross-sector collaboration so that health systems, businesses, local health departments, community organizations, individuals, and federal agencies all see opportunities for alignment and success.

  • Action Area 3: Creating Healthier, More Equitable Communities

We’ll work to achieve healthier and more equitable communities by addressing head-on the chronic environmental and policy conditions that hold back too many Americans from living in good health.

  • Action Area 4: Strengthening Integration of Health Systems and Services

Finally, we’ll work to transform our $2.7 trillion health care system so it’s driven by a focus on prevention, the integration of health services and systems, and the delivery of comprehensive, high-value care for all Americans.

Each Action Area includes a set of corresponding Drivers and Measures. The Drivers provide a set of long-term priorities, while the measures will help us track our progress. As we make progress in the Action Areas, we firmly believe we will improve population health, well-being, and equity.

Measuring What Matters

We wanted to develop measures that matter that will help us understand how to get to greater well-being and health equity for all. And as a country, we recognize that we can do a better job developing measures that engage sectors beyond health.

But we also have a sense of excitement and urgency about doing things differently, trying new things to fuel impact. We want to move away from business as usual. All too often, the existing data sets that ostensibly measure health—for instance, morbidity and mortality measures—really measure illness. We want to move that upstream to truly address the social determinants of our health.

So, we selected our 41 national Measures which accompany the Framework based on the availability of national data. We didn’t want Measures solely focused on children or the aging population, but reflective of all ages; a focus on Measures that address the broad determinants of health and upstream drivers affecting our ability to attain the highest level of well-being; Measures that appeal to multiple audiences, including those on both sides of the aisle; and last but certainly not least, we focused on Measures that call attention to systemic inequities affecting well-being.

The Measures we selected also serve as a major catalyst to improve health equity. When we measure residential segregation—by determining the evenness with which different racial and ethnic groups are distributed in a given community—we can get a handle on a community’s susceptibility to marginalization.

That marginalization can impact our health in many different ways. Consider, for instance, the following: We know that children who attend preschool are more likely to stay in school, go on to hold jobs, and earn more money—all of which are linked to better health. That’s why one of our measures tracks the number of states where 60 percent or more of three and four year olds attend pre-school.

We also know that our health is closely tied to the physical spaces where we work and play—the built environment of sidewalks, bike paths, and other amenities. But we can only take advantage of that infrastructure if we feel comfortable where we live. This is we chose to measure the number of middle and high school students that report feeling safe in their communities using data from the National Institutes of Drug and Alcohol Monitoring the Future survey.

Ultimately, we know that we can only achieve a Culture of Health when our public health, social services, and health care systems are working hand in hand. We know that when these systems are integrated intentionally—which we will measure through the percent of hospitals that collaborate with local government or state or community agencies—that we see improvements in the quality of care people receive. This sort of collaboration is the counterpoint to the isolation we know we must overcome.

We also want to address well-being, not just sickness. So what does that mean? Ultimately, if we’re going to truly address well-being, we must develop measures that don’t just identify gaps, but truly catalyze action to fill them.

Signs of Progress

Communities, individuals, and organizations across the nation are already working together to solve common public health problems—and addressing the impact that social and economic drivers can have on health. We know, for instance, that more equitable housing policies translate to better health. Greater access to early childhood education and care correlate to fewer chronic health problems later in life. Transportation systems that provide access to economic opportunities also provides access to health care. The Framework details drivers that can catalyze better health and wellness and demonstrate measurable outcomes.

We’ve seen success stories, but they too often remain isolated examples of how to create better population health. The task that lies before us now is to develop and evaluate models of collaborative approaches to health improvement and spread those effective practices so that residents of every community have a chance at leading their healthiest lives possible.

Looking Ahead

We need to create much greater public will to change our culture into one that values health everywhere, for everyone. We can realize better individual and community wellbeing. We can help Americans manage chronic disease and reduce toxic stress. We can lower health care costs.

To do so, we need the partnership, the passion, and the promise of colleagues like each of you. I invite you to join with us in this effort. Here are a few things you can do:

  1. Visit the new website to learn more about the promise of better population health and explore the Action Framework. Find connections to your work and start conversations with others about how to catalyze drivers in your community.
  2. Watch my conversation with Georges Benjamin of the American Public Health Association, Renée Buyck Romberger from the prize-winning community of Spartanburg, and Susan Dentzer. We discuss how to build a Culture of Health by sharing a common vision and taking collective action.
  3. Submit a proposal on how to turn research into action. To learn more, please visit to read about our Evidence for Action program that spans the full range of topics and methodologies needed to build an evidence base for a Culture of Health
  4. See our current funding opportunities. This month, among other calls for proposals, we are looking for high-value innovations from low-resource communities. If you can identify, evaluate, or help disseminate innovations, we want to hear from you.
  5. Sign up for our funding alerts to learn about the forthcoming calls for proposals from Systems for Action—a program that will specifically explore ways to better align and integrate public health delivery and financing systems with health care, social services, and other community systems, as well as Policies for Action, a program that will explore how policies, laws and regulations in both the public and private sectors can support a Culture of Health.

Together, we can turn research into action, and vision into a reality where everyone can live the healthiest lives possible.

Alonzo Plough

Alonzo L. Plough, PhD, MPH, is vice president, Research-Evaluation-Learning and chief science officer at the Robert Wood Johnson Foundation.