Culture of Health Blog Our blog features perspectives from Robert Wood Johnson Foundation staff and guest authors about efforts to build a Culture of Health. Mon, 19 Jul 2021 10:00:00 -0400 en-us Copyright 2000- 2021 RWJF (RWJF) <![CDATA[Nurse Leader Shares Five Lessons on Breaking Down Barriers to Vaccination]]>

A nurse leader who has been vaccinating a diverse community offers a candid assessment of false starts, wisdom gained, and the best way forward.

Vaccine barriers illustration.

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.

Some worried about being a burden on their host country by taking a shot someone else might need more. Some feared that accepting the vaccine could make it harder to get immigration papers. Some were deterred by misinformation about a fee associated with the vaccine or visit to get the vaccine.

We learned to address all of this. We initiated conversations with everyone and tackled worries head-on. There was no wrong door to come through to talk about the vaccine. If you came to Mary’s Center for a child’s check-up, dental care, a pre-natal exam, or to pick up a check to pay the rent, you had a conversation about vaccines. By talking and listening, we learned what strategies made our clients feel safer and more comfortable with being vaccinated.

Lesson Two: No Wrong Messenger

We soon saw everybody as a vaccine messenger. As our staff and their family members were vaccinated, we shared the joy that came with their newfound freedom to move around more freely. When a teen came in for homework help, we suggested she encourage her grandmother to get a vaccine. Sometimes our best messenger was the person focused on mopping the floors, because the client she was chatting with had been doing the same thing at his job a few hours earlier.

People may not trust the medical establishment, but they trust their own doctor or nurse practitioner. It’s powerful when our clients see their doctor on Facebook or YouTube talking about the vaccine! I’m so impressed with what our Black community has been doing with barbershops and hair dressers; it works because there’s so much trust and the vaccinators are right there.

Mary’s Center has partnered with our local utility company, Pepco, in two ways. First, to administer their philanthropy commitment to keep the community connected to their utilities, and second, to vaccinate their line workers so they are safe when they are working in the community. We partnered with local chambers of commerce to reach small businesses that employ our clients. And we’ve learned the power of telehealth; it has saved lives and been especially important for the disability community and those facing mental health problems in the pandemic. Without telehealth, we would have lost many more people to drug overdose and suicide.

Lesson Three: No Wrong Moment

We believe fervently that there should be no wrong moment to get the vaccine. I’m convinced that it was a mistake to have limited vaccines only to seniors and people with certain pre-existing conditions at the beginning of the roll-out. We had to follow these strict rules or we would not have been allowed to continue vaccinating our community.

But I wish we didn’t have to turn away the young woman—and others like her—who struggled to take a day off of work to bring her grandparents in for a vaccine, but could not get vaccinated herself. Being forced to turn away people who wanted shots was painful. And, as we expected, now we are struggling, not always successfully, to get them back.

I hope when we look back at how we handled this pandemic, we will acknowledge that not doing so was a mistake we need to fix.

Lesson Four: Take Care of Your Staff

I’ve learned a lot about how to be an effective administrator during crisis. I learned that administrators need to stay out of the way, create a MASH unit, and give your team the tools and resources they need.

Being transparent has been essential. I cried many times with my staff. I admitted when I didn’t have answers. I stressed that we were in this together. I told them when we had enough money to stay afloat for the next week or month, and when nothing was guaranteed after that. I was in the trenches with them and made sure they saw me.

There were practical considerations. We had to feed our staff because nothing was open. And there was psychological stress. The social determinants of health were very real for our team. They have partners who are in construction, child care, sanitation and grocery workers who had to show up for work; some of them got sick and some died.

Never forget that your community is your staff—and you are nothing without them. Stay out of their way and they will deliver miracles.

Lesson Five: Time Is On Your Side

We’ve been rushing a lot over the last year. We rush to meet an established timeline, a goal set by the President, or a city directive. But sometimes people need time. Taking a vaccine can be a big decision. People need time to process it. In time, they will convince themselves to get the shot. When your grandpa has gotten the shot, you see that it’s safe. The 16-year-olds now getting their shots are the best voices for their parents. But parents also have a responsibility. We’re telling parents: You don’t give your child a choice to take showers, drink or smoke. Why give them a choice about whether to take a shot that can save their life?

As health care providers, scientists and leaders, we need to give our community time. I believe we will get there, to 80 or 90 percent of people being vaccinated, if we keep using social media, holding meetings, talking one on one, enlisting influencers like religious leaders and teachers, and doing all the things we know how to do best. It works. We just need to keep doing it and give people some time to normalize this activity, as we have with our childhood immunizations.

Dr. Rich Besser and Dr. Julie Morita shared why equity must be front and center in the distribution of vaccines. Read their op-ed.




Maria Gomez portrait.

Maria S. Gomez is president and CEO of Mary’s Center, and an RWJF Award for Health Equity 2019 winner.

Mon, 19 Jul 2021 10:00:00 -0400 Maria S. Gomez Public and Community Health <![CDATA[How Supporting Men as Caregivers Advances Gender Equity]]>

As the pandemic forced women out of the workforce in record numbers, a new survey reveals that men overwhelmingly value care work and want to share it equally with their partners. But the lack of supportive workplace cultures and public policies prevent them from doing so. Where do we go from here?

A father and son stand together in a field.

As pressure mounts to address the many challenges brought to the fore by the pandemic, our nation is experiencing a reckoning in caregiving, and what it means for families and our economy. A new nationally representative survey conducted by New America and funded by the Robert Wood Johnson Foundation, revealed that although our cultural norms have not caught up with our ideals of gender equity, men overwhelmingly value care work, and want not only to participate, but to share it equally with their partners. However, the lack of supportive workplace cultures and public policies keep them from doing so.

The pandemic has forced women out of the labor force in record numbers. Back in December, at the height of this trend in the labor market, 100% of job loss was attributed to women. According to Gallup, pandemic job losses show that an estimated 2.3 million women left the workforce, compared with about 1.8 million men. As our country begins to recover, and school and child care options become more predictable, experts say policymakers and business leaders must support women to help them once again make up nearly half of the labor force.

During the past year, many women have struggled to meet a drastic increase in responsibilities at home. This involved juggling the care of children, overseeing virtual schooling, caring for sick family members—all while continuing to work. Not only is this care uncompensated, but many workplaces don’t provide women with the flexibility—or schedule control—needed to balance it all. Many, particularly single mothers, had no choice other than to leave the workplace. Other women persisted, suffering increased stress, exhaustion, sleeplessness, and burnout. There is little public policy that supports for caregivers, resulting in these unfair and often impossible tradeoffs.

In the New America survey, we found that men agree it shouldn’t be this way. At the same time, many feel trapped by policies and cultural expectations that tie men to work, and women to care. In our focus groups, many men across race and ethnicity said that in order to be engaged in caregiving, feeling supported as caregivers at work, and being able to take paid caregiving leave, was critical. This helped them fulfill roles as the involved fathers, sons and caregivers that they aspired to be. It also helped their wives and partners combine work and care to live the kind of lives they hoped for, too. And yet this support—before and during the pandemic—is all too rare. The United States is the only advanced country that does not guarantee paid maternity leave, and is one of a handful that does not guarantee paid paternity leave. We are among the handful that do not guarantee paid sick or vacation days. We do not invest in universal childcare in the way that our peer nations do, nor give workers voice, say and autonomy over the time, manner and place of their work, as other countries with stronger trade unions or legislation that gives workers schedule control and flexibility.

These new findings show the ongoing need to counter the cultural narrative that caregiving is exclusively women’s work and advance equitable public policy solutions. Men are echoing this message.

Challenging Stereotypes, Broadening Horizons

Care work, both in family life and as a profession, is still viewed as “women’s work” and this outdated stereotype limits the potential of men as well as women. We spoke to men who are nurses, childcare workers, and home health aides. They are proud of their care work and find it challenging and fulfilling. Yet one in five reported feeling stigmatized as caregivers just because they’re men. Care professions, which are female-dominated and where women of color are overrepresented, are among the fastest growing as the population ages. Yet, unlike computer programming and data, another fast-growing, male-dominated industry, care work pays poverty wages and offers few benefits, if any. We need to elevate the value of these often invisible care jobs and make them good jobs for everyone.

We also found that, contrary to stereotypes, many caregiving men, particularly those who care for children or adults with special needs, perform many of the same “hands on” intensive, intimate care activities commonly associated with women, like bathing and dressing. About two-thirds of these caregiving men wind up needing to reduce work or drop out of the workforce, which is the same rate as women. Men with these more intensive caregiving responsibilities are also experiencing far greater work-family conflict, stress, and burnout, than are fathers of children with no special needs, or men with no caregiving responsibilities.

Traditional gender norms are powerful at work and at home. Women are still expected to serve as primary caregivers for family members—from infants to elderly family members. These outdated views harm men, women, children and entire families. They prevent women from advancing professionally, create stress, and overwhelm relationships and compromise personal wellbeing. As the pandemic has vividly revealed—with women taking on the bulk of caregiving and homeschooling—these views prevent men from being the active and engaged caregivers that our research affirmed they want to be.

We found that an overwhelming majority of men say that care work at home is as valuable as paid work, (more than 80 percent) and that men and women should share it equally (90 percent.) Yet, we found that it rarely works out that way. And that men and women have very different ideas about what sharing care equally means. Among adults over 18, four in 10 said that, when a family member needs care, the responsibility falls primarily on women. Men also tend to think they do more and share care equally—62 percent. Only 33 percent of women agreed. Rather, nearly two-thirds of the women surveyed said care duties fall to them, compared to 25 percent of men who thought women bore the brunt of care.  

Black Fathers Who Care

We also explored stereotypes about race and found evidence showing the strong role Black men play as fathers and caregivers, and how Black fathers face particularly difficult barriers to engaging in care.

There has long been a false cultural narrative about Black fathers, even though data suggest they are among the most active parents of any racial or ethnic group. What we found reinforces this fact pattern: there are no differences in the contributions of fathers or attitudes toward care based on race or ethnicity.

Similar to their counterparts, Black fathers and caregiving men valued care as much as paid work. They also thought men should share caregiving equally with women, and they said being engaged fathers and caregivers is important to their identity.

Our survey also found that more Black fathers than White fathers believe it's important for them to feed, dress, and provide care to younger children. We also found that Black fathers and caregiving men often face higher barriers to giving care, due to structural racism, discrimination at work, and the mass incarceration system.

All men, across race and ethnicity, anticipated needing time off work to give care. Three in 10 anticipated needing time off to care for an infant and nearly half of all men expected they would need time to care for an adult—again, the same rate as women.

This is where structural racism is again relevant. As we mentioned before, the United States does not have a national public paid family and medical leave policy. Only a handful of states mandate this benefit and companies voluntarily only cover about 20 percent of the workforce, mostly in white collar and large companies. We found that a similar percentage of Black and White fathers used savings to cover the costs associated with their recent leaves—paid or unpaid. However, twice as many Black fathers (30 percent) as White fathers (15 percent) used savings they had specifically set aside for health needs to fund their time off from work. This reveals real barriers to care that disproportionately burden Black fathers.

Envisioning a New Way

This research was built on exploring the perspectives and experiences of a wide variety of caregivers. The research team was very much steeped in the issues of gender equity, roles, and balance. And yet, many of us were surprised by what we heard from the survey respondents. It just goes to show that this area of social science is a rich one, with lots of stones still left unturned.

The attitudes and norms of breadwinner-homemaker families that were mainstream a generation ago clearly do not apply today, and by extension, many of the assumptions and expectations leaders use to inform decisions and design policies are often built upon a faulty foundation of stereotypes—ones that never really rang true for many in the U.S. in the first place. Having an accurate picture of how gender shapes care and caregiving at home and in the care economy, and understanding the motivations, goals, and barriers experienced by those who are engaged in these roles, are essential building blocks to creating the necessary new policies, workplace practices and cultural norms that will lead to a stronger, healthier and more equitable future.

Learn more about how men view their caregiving experiences and explore the many benefits of supporting male caregivers.


About the Authors

Brigid Schulte is the director of the Better Life Lab, the work-family justice program at New America, a nonpartisan think tank, that uses narrative to move public policy, workplace practice and culture so that people of all genders and racial and ethnic identities can thrive, with decent, dignified work and time for care and connection across the arc of their lives.

Jennifer Ng’andu, managing director–Program at RWJF, helps lead grantmaking activities to advance social and environmental changes that help ensure that all children and their families have the full range of opportunities to lead healthy lives, while providing a strong and stable start for every child in the nation.

Thu, 15 Jul 2021 13:00:00 -0400 Jennifer Ngandu Child and Family Well-Being Health Disparities <![CDATA[How Do We Advance Health Equity for Asian Americans?]]>

Advancing health equity for Asian Americans requires a new narrative and solutions that acknowledge our diversity. This can help address discrimination, poverty, poor health, and more.

Woman holding poster. Photo credit: Jason Leung, unsplash

Both of us are proud of our immigrant roots and the paths our families forged after coming to the United States. Mona’s parents arrived from India, and Tina immigrated from South Korea as a toddler with her family. As members of the Asian American community, the past year’s wave of hate crimes has been painful and traumatic. But it is not new. What is new, though, is the attention these incidents and the Asian American community as a whole are receiving.

At times, these crimes bring back terrifying memories. Mona was just 10 years old when a hate group in Northern New Jersey sent a racist letter threatening Indians to a local newspaper, and the newspaper published it. The deep societal racism that letter exposed was manifested through verbal abuse, brutal assaults, and murders that occurred time and again over many years. Mona grew up hearing racist comments from police officers and teachers and seeing South Asian businesses and homes, including her own, vandalized.

At times, they remind us how few people seem to consider the intergenerational trauma and challenges faced by Asian Americans. Tina’s parents grew up in South Korea during the Korean War and her father remembers his family losing everything. Arriving in a new country not speaking the language while trying to navigate a culture with a different set of values was incredibly difficult for her parents. Adding to their stress was the need to lean heavily on their children to negotiate, translate, and serve as intermediaries with authorities and agencies.

At times, they compound the numbness and hurt we feel in the face of sometimes-profound insensitivity and endless microaggressions that add up over time and contribute to chronic stress that undeniably harms health.

After a lifetime of enduring microaggressions and racism, and a year of publicized hate crimes, most Asian Americans feel a degree of othering. The past year has put these issues front and center in the public discourse, but it’s important to know that what our community is experiencing is not new.

From displacing indigenous peoples, to slavery, to internment camps, our nation’s history is characterized by racism against people of color, including Asian Americans. One case in particular fueled the modern-day movement for Asian American rights—the murder of a Chinese American man, Vincent Chin, which took place 39 years ago this June. Chin was bludgeoned to death during his bachelor party at a bar in Detroit by two white men who blamed Japan for losing their automobile manufacturing jobs. There are echoes of Chin’s murder in hate crimes we see today, and in the pain that is triggered for Asian American families who endured grave injustices.

In addition to race-motivated mass murders and acts of violence, the United States has a long history of anti-Asian policies rooted in systemic and structural racism. For instance, discriminatory immigration laws in the 1800s (such as the Chinese Exclusion Act) and U.S. Supreme Court rulings (e.g., United States vs. Bhagat Singh Thind) in the 1900s legalized bias and exclusion. In fact, it wasn’t until 1952 that people of Asian ancestry won the right to become citizens. This history has ramifications still, to this day, and has shaped current narratives and policies that impact Asian American and Pacific Islander (AAPI) communities and other people of color. Our Executive Vice President, Julie Morita, wrote about her Japanese American parents who suffered in U.S.-sanctioned internment camps during World War II and these days hear “all-too-familiar vitriol toward Asian Americans being spewed from the dark and angry corners of social media and beyond.”

So while the bigoted rhetoric about COVID-19 may have exacerbated hate against Asian Americans, it has been with us for generations. What may be changing, however, is the increasing political power of the Asian American community, unprecedented recognition of hate crimes against Asian Americans, growing solidarity across races, and increased determination to defeat white supremacy.

Working Toward Solutions

Our history and experiences fuel our passion for RWJF’s commitment to ensuring everyone in America has a fair and just opportunity to thrive. We are proud to work alongside others who are striving to dismantle structural racism. We know that doing so will require increased funding for AAPIs and a new narrative that acknowledges, rather than masks, the vast differences within our community. And as researchers, we understand that doing so will also require better, more nuanced data.

The pervasive and false “model minority myth” has driven misunderstanding, division, and inaction. Historically, the term “model minority” was used to pit Asian Americans against other communities of color, and it is harmful on many levels. Grouping together very diverse communities and conveying the falsehood that all Asian Americans are doing well masks grave hardship among segments of the population. In fact, the Asian American community has the greatest income inequality of any racial or ethnic group. The model minority myth erases the needs of those who do not fit the stereotype. It is a primary reason so few resources have been invested in Asian Americans. Quite simply, not everyone is doing well and suggesting otherwise disincentivizes investments and fosters division, rather than solidarity, among people of color.

The complexity of Asian American communities* has been a barrier to conducting the kind of research needed to understand and address discrimination, poverty, poor health, and other problems. Asian Americans include people from this country and those from more than 65 countries. We have very different life experiences, speak different languages, and are diverse in other ways. Too often we don’t ask survey questions or conduct focus groups in other languages. But with the resources and technology we have today, that should change. We should be able to improve language access and develop surveys in culturally sensitive ways.

Doing so allows for a closer look at the data—data disaggregation, in research parlance—that can reveal real-life problems and point the way to solutions. Instead of looking at overall results of a survey or study, breaking out the data into sub-categories can reveal patterns that would otherwise be masked. In one example, a National Nurses United report on COVID-19 deaths among health care workers found that 31.5 percent of the registered nurses who had died of COVID-19 and related complications were Filipino, even though Filipinos make up just 4 percent of registered nurses in the United States. Only by disaggregating the data was this shocking and tragic disparity revealed.

RWJF is supporting data disaggregation, community power, narrative change, and other research projects that help advance health equity. We are also working collaboratively with diverse communities of color; one example is a powerful guide for community leaders and advocates who want to advance health equity through changes in the way data are collected, analyzed, and reported.

Among other projects, the Foundation is:

  • supporting the Asian & Pacific Islander American Health Forum as it advances the health and well-being of Asian Americans, Native Hawaiians, and Pacific Islanders, as well as the AAPI Civic Engagement Fund to re-grant to organizations that are addressing hate crimes that target the Asian American and Pacific Islander community through education, data collection/analysis, narrative change, and other AAPI community-led initiatives;
  • funding studies to identify barriers that impede compliance with federal race and ethnicity data collection and reporting standards; and to examine and monitor opposition to data disaggregation from a social and social justice perspective; and
  • supporting the Native Hawaiian and Pacific Islander (NHPI) Data Policy Lab to demonstrate how its culturally grounded and community-driven research efforts to document COVID infection rates can serve as a model for other communities to counter their underrepresentation in data.

Fostering Racial Solidarity

In addition to this work, conversations across races are essential right now. We must recognize the unique needs of communities that are experiencing racism at the individual, institutional, and structural levels, in this country and by this country. Just as with other Black, Indigenous, and other people of color (BIPOC), Asian Americans suffer from housing and employment discrimination, high rates of uninsurance and low access to mental health services.

The national reckoning with race and the hard conversations it has driven are giving us hope that we can join together with others in acknowledging past wrongs—a first step in finding solutions and hope for the future. We stand in solidarity with all communities that have endured racism and discrimination.

*The authors recognize that Asian Americans are a distinct population from Native Hawaiians and other Pacific Islanders (NHPIs). The U.S. Office of Personnel Management recognized these are unique groups nearly 25 years ago, in 1997. However, we include NHPIs in our discussion of solutions in this post because, historically, many organizations have worked to support both communities under the term AAPI.

Learn about how we’re working to strengthen the evidence base that can guide our nation toward a more equitable future.


About the Authors

Tina Kauh

Tina Kauh joined RWJF in 2012. As a senior program officer within the Research-Evaluation-Learning Unit, she develops new research and evaluation programs, supports the development of team strategy, evaluates the work of grantees, and disseminates key learnings.

Headshot of Mona Shah

Mona Shah, a senior program officer in the Research-Evaluation-Learning unit, joined RWJF in 2014. Drawing on her deep commitment to research and its potential to impact health and health care, she praises the Foundation’s work in making its extensive research accessible to the public and policymakers alike.

Wed, 23 Jun 2021 13:00:00 -0400 Tina Kauh Health Disparities <![CDATA[Making Data Accessible For Small Communities]]>

An online resource is putting the power of data into the hands of small communities to help them see where they stand on key measures of health.

Medical graphic.

Editor’s Note: This piece was originally published in the Grantmakers In Health Bulletin.

In Clifton, New Jersey, data on children in poverty, data on obesity, and data on the percent of uninsured residents revealed such pronounced disparities among neighborhoods that the city approved a satellite health office. Now, residents who previously had difficulty getting health screenings, immunizations and other necessary public services have better access.

In Waco, Texas, a nonprofit organization used the COVID Local Risk Index, a measure of city and neighborhood-level risk of COVID transmission and mortality, to pinpoint the level of COVID risk by neighborhood. Comparing this data to the city’s COVID cases added vital context to community preparation for and response to the pandemic.

Both of these cities used data from the City Health Dashboard ("Dashboard"). Launched in 2018, the Dashboard addresses the problem of data inaccessibility for cities and communities.

Just as health disparities disadvantage people of color and those of less financial means or educational attainment, so does data inaccessibility. Based largely on a combination of where they live and how easy it is to access and use data, some people can get the data they need to advocate for better, more inclusionary practices and adequate resources necessary for healthy communities. Others can’t—either because they don’t know where to find the data they need, don’t have the expertise to use it, or it doesn’t exist. Low data capacity makes it hard to get information, interpret it, and then use that information to take the steps needed to improve public health.

The Dashboard recently partnered with New Jersey Health Initiatives (NJHI)—a statewide grantmaking program of the Robert Wood Johnson Foundation—to change that, by providing community organizations, their partners, and the communities they serve accessible data that can make a difference.

The Dashboard provides more than 35 health-related metrics and updates them regularly. The Dashboard is especially useful because it provides data at the census tract level (neighborhood-sized geographic areas of 1,200 to 8,000 people), essentially enabling health advocates to know what’s happening in individual communities. That is crucial, because—in part due to segregation by race, ethnicity, income, and other factors—stark health differences often exist in nearby neighborhoods, even in the same small municipality.

Until recently, that was not much help to smaller communities. The Dashboard initially launched with data from the 500 largest U.S. cities, those with a population of at least 66,000. However, in April 2020, the Dashboard added data on over 250 smaller cities across the United States, including 18 in New Jersey—10 of which are in NJHI’s newly launched Small Communities Forging Hyperlocal Data Collaboratives Initiative. NJHI’s grants to organizations in those communities, all located in southern New Jersey, will equip advocates with detailed measures of the factors that shape health to guide local solutions. This pilot project will be a model for other states and for regions within New Jersey.

Take a virtual tour to learn about all of the metrics, features, and resources the Dashboard has to offer.

What sort of data does the project make accessible? In Egg Harbor City, New Jersey, the cardiovascular disease death rate is 358 per 100,000 people, compared to an average of 211 per 100,000 across all 750-plus cities on the Dashboard. The city also has a relatively high uninsurance rate among residents—23.2 percent, compared to 11 percent across other Dashboard cities. This is priceless information for community health advocates and local governments.

With granular, easy-to-use data that includes categories such as percent uninsured, childhood poverty, housing cost burden, and walkability, concerned residents can identify actionable gaps in health and its drivers, so they can target programs and policy changes and build broad coalitions to address them. NJHI will also train advocates to develop expertise to interpret data and put it into action. The Dashboard welcomes these kinds of partnerships to build data capacity in communities.

In “A Study in Scarlett,” Sherlock Holmes observed, “It is a capital mistake to theorize before one has data.” But you can’t use what you don’t have. Putting more data—and the ability to use it—into more hands allows people to help their communities be places where everyone has the opportunity to live their healthiest possible lives.

By putting data into more hands, the City Health Dashboard is helping support communities where everyone has the chance to live their healthiest possible life. 


About the Authors

Ben Spoer, PhD, manages the data team at the City Health Dashboard.

Becky Ofrane, MPH, is a public health researcher leading partnerships for the City Health Dashboard.

Tue, 22 Jun 2021 12:45:00 -0400 Becky Ofrane Health Disparities <![CDATA[Reclaiming the Narrative of Black Fatherhood]]>

Fathers play a critical role in the healthy development of children and families. This is why it's important to address structural and systemic barriers that prevent Black men from being fully present in their children's lives—so that all families have a chance to thrive.

Black father holding his baby. Illustration by Cat Willett

My wife and I have been married since 2019, but we’ve known each other since we were 14-year-olds. We are raising a blended family. She has a daughter who is 9 and a 7-year-old son. I have a son who is 8, and together we have a 2-year-old son.

The pandemic has profoundly shaped my parenting experience in numerous ways. I had to transform my house into a combined virtual school, daycare, and work setting. The last year has negatively impacted our seven year old, who is autistic, mostly due to disruptions to the in-person support that he needs to truly thrive. Navigating these evolving dynamics, while working, running a household, and trying to stay sane has been extremely challenging. But being present in my children’s lives makes every moment worth it.

My father left when I was 3 years old. Because he wasn’t in the picture for my upbringing, in some ways, I am trying to reach an ideal as a father that I couldn’t actually see as a child. Something inside pushed me to be different, to counter the “absent Black father" narrative.

When I was younger, my perception of a father’s role was very different than it is now. I grew up in Newark, New Jersey, where norms for a Black child, a Black young adult, and a Black man could be stifling. The limits were very clear on what society deemed appropriate for a Black man, and how you were supposed to interact with others. I was never comfortable with those unwritten rules.

Dwayne Curry shares a powerful spoken word performance about his experiences as a father.

Once I began surrounding myself with other fathers of color, I started to realize I wasn’t alone. Media, television, and popular music perpetuate this idea that Black dads aren’t in their children’s lives, and that’s simply not true. Good Black fathers do exist, but it’s taken more time for our experience and contributions to be recognized.

It is so important and powerful for a child to have a father figure. I see that my kids’ view of fatherhood is being shaped by what they see in me.

Parenting in a Pandemic

Before COVID-19, my wife was working full-time at a university. After giving birth to our son, I supported her decision to leave her job so that she could dedicate more time to care for our children and our home. Caring for four children, including one with special needs and another who just learned how to walk, especially during the pandemic, is not a one-person job. It requires flexibility and patience. Even tasks as simple as taking out the garbage become complicated if the timing isn’t perfect.

One of our most challenging times during the pandemic was when my wife became ill and we worried that she may have contracted the virus. As we awaited her test results, she was quarantined in our room for several days while I took on the responsibility of caring for our children and for her. During that time, my family depended on me most as a father and husband, but I still needed to work in order to provide food and housing for all of us.

It’s difficult to give 100 percent of who you are to each of these distinct roles, and I struggled silently in fear of imposing guilt on anyone who depended on me. Even after my wife recovered, I suffered through many sleepless nights, anxious about who I was letting down each day—my kids, my wife, or my coworkers?

As I became better at expressing my feelings to my wife and colleagues, I also gradually began to better balance my roles. I didn’t want to be that dad who is always working and isn’t present in my kids’ lives, and they all understood that. I’m grateful to have the flexibility to be the best father, husband, and professional that I can be. Every day during my lunch period, I put my youngest down for a nap. Feeling his small hand grab my finger as he says “Dada, go to sleep?” is my signal that it’s time for the highlight of my day. My wife and I alternate helping our school-aged kids with their homework, preparing lunch, and taking the entire bunch outside to play. The silver lining in these times is how closely I get to watch my kids grow up before my own eyes.

Supporting Caretaking with Policy, Culture and Leadership

I recognize that I am blessed to be able to find balance. Many obstacles prevent fathers from being fully present in their family's day. Because of the environment I grew up in, I intimately understand the forces holding people back. I’m referring not just to a culture that only encourages men to pursue a very narrow set of traditionally masculine career paths, but also systems that make it difficult for men to take time off when they have a new baby or a sick parent. There is no question that policymakers can do more to break down those barriers with reforms like paid family leave.

There’s a role for employers here, too. It’s really important to build a culture that doesn’t just extend paid family leave benefits, but also encourages employees to use them when needed. I used to be nervous to take time off when someone in my family got sick. This added anxiety and stress made the situation even more difficult. I no longer feel that way, and wish others had that autonomy. I am grateful that I can take time off and be an active parent and caregiver during this devastating time. 

There’s also a cultural piece—caregiving responsibilities can impact someone’s career growth. It’s so important for those in senior positions of power to understand this. Even if you have the right policies in place, people may judge or subtly dismiss those who actually take time off to provide care. Supervisors must lead by example, and be aware of implicit biases. 

These false archetypes of what a leader looks like can influence decision-making. Even a well-meaning supervisor could ask themselves, “Should I avoid giving more responsibility to someone who is a caregiver?” They may have good intentions, but that outlook could hold someone back. It’s not just about having the right policies on the books, it’s making sure they are implemented equitably as well.

Bringing it Home

I’ve also seen what male caregiving can do to help a family grow and thrive. When my wife was raising her son who is autistic, as a single mom, her caregiving role was overwhelming. Depending on the resources available to you, based on where you live and your level of support from family or friends, single parenthood may be extremely tough. You may be constantly putting out fires, burned out, and strained. You may not have the flexibility to plan for the future if your present feels like a nightmare. How can you think about investing if you can’t even pay the bills? There were little to no resources available to her and her children in the city where she lived, so she relied heavily on her mother to navigate through that phase of her life.  

For me to take on the role as her partner has had a great impact on me. I also see that my wife now has more freedom to dream. She became a certified life coach, discovered her passion for psychology and is taking college courses. We launched a podcast together where we have real, honest, and transparent discussions about relationships, family, and careers. To hear her aspirations and see her grow is breathtaking. At the same time, our son’s development has gone through the roof. This has been so uplifting for all of us.

As someone who has been impacted by false narratives, and is working to bring about a new one, I’m grateful to be involved in this work. In my life at home, I know that I may not always have the perfect words to express how I feel on command, but my children know that I love them, and my wife does too, because I show them every day. There is nothing more important to me than that.

Like me, many men of color take pride in caring for their children and families. To read more about our experiences, check out the new brief A Portrait of Caring Black Men and Every Family Forward’s Man Enough to Care series, including their thought provoking survey of real men who care for others.


About the Author

Dwayne Curry Headshot 2650 DSC9336

Dwayne Curry joined RWJF as a program officer in 2019. Through his work he strives to ensure that all families, no matter their background, have access to the resources they need to raise thriving children.

Wed, 16 Jun 2021 09:45:00 -0400 Dwayne Curry Child and Family Well-Being Early Childhood National <![CDATA[Three Ways to Advance Health Equity Through Research]]>

Learn about how we’re working to strengthen the evidence base that can guide our nation toward a more equitable future.

A diverse group working on a project.

The pandemic and this past year’s racial reckoning have given us a decisive moment. We have an opportunity to build a movement for positive change and collective healing. Part of the national awakening is recognizing the urgency to improve public health and advance equity. Today, multiple organizations and people across sectors are eager to do their part in creating a better, more equitable future.

My colleagues at the Robert Wood Johnson Foundation and I, too, seek bold and lasting change. We believe our path forward must be rooted in the best available evidence. What we need now, urgently, is research on how to eliminate inequities in health outcomes by addressing structural racism. How do we create evidence-based policies and practices so everyone has fair and just opportunities to thrive? 

Long-established biases in our research field have determined who conducts research, and they tend to favor the same institutions and individuals. We also have deeply held beliefs about which types of research are valuable, and too often this constrains innovation.

To advance toward our goal of achieving health equity, we need to expand traditional research approaches to include more perspectives, ideas, and methodologies. When we do, I believe we will enhance our rigor and excellence. Here is what it might look like—and what we are practicing in our own work:

1.    Lived Experiences Are Valuable

Individuals who experience in daily life what researchers study as “societal problems” bring essential knowledge to our fields. We should value and encourage those with diverse life experiences to enter the research field because their experiences can help us understand where barriers exist and how to overcome them. We can then apply this additional knowledge into actionable evidence to improve health equity.

Achieving health equity requires that our research truly reflects the country’s demographics. And it’s not just researchers. It should be every institution that touches research, including academia, publishing, and philanthropy. At our foundation, we have made a diversity, equity, and inclusion commitment to recruit leaders and staff from diverse backgrounds, perspectives, expertise, and/or lived experiences. We have worked on this for years, and will continue to strive for fair representation. (You can see our latest demographic report that is inclusive of staff and trustees.) Diversifying who conducts research makes evidence stronger and helps us put that evidence into action.

2.    Research Should be Centered in Communities

Academia has long cherished randomized control trials as a gold standard of research (to name one example). But COVID-19 has underscored the need to address nuanced community conditions and dynamics through a broader set of methodologies in order to advance health equity.

That’s why we’re investing in research that either takes place within communities and/or meaningfully engages community members. We welcome eclectic, mixed methodologies connecting quantitative and qualitative data that can produce both authentic community partnerships and solid research evidence as well as actionable policy change.

Research should also be accountable to communities—and not simply extractive. What we learn from community-based research can be applied right back in communities, initiating an evidence-to-action pathway. RWJF invests many of its research dollars through our “For Action Programs,” namely Policies for Action, Evidence for Action, Systems for Action, Health Data for Action, and Health Equity Scholars for Action. I invite you to explore how emerging research from these centers is being applied in real life.

3.    Data Needs to be Complex and Nuanced to be Useful

Evidence is only as strong as its data. Yet too often we base evidence on data collection and reporting that itself carries elements of structural racism. 

One example is insufficient disaggregation of race and ethnicity in current data systems. Grouping all Asian populations without regard for the different cultures, languages, immigration histories, or wide variations in health, education, and wealth is problematic. Too often, race and ethnicity information for populations is not collected, analyzed, or reported, or it is discounted. Look at data collected for American Indian and Alaska Natives, Middle Eastern and North African peoples, and Native Hawaiian or other Pacific Island populations, for example. The lack of good population-level data on disability is another example. These flaws render populations invisible, mask unique needs, and hide strengths and assets. It leads to poorly informed decisions that affect lives and wellbeing. This lack of disaggregation was clearly part of the problem in our national response to COVID-19. 

Another example is siloed data. As the COVID-19 pandemic swept the nation, there was a delay in recognizing its impact on incarcerated populations. We had health data, and we had data on incarcerated people. Yet, criminal justice-related data are not routinely connected to population health data systems. The pandemic response could have been improved with better data interconnectivity and more comprehensive and equity-focused frameworks. 

To this end, RWJF has created a National Commission to Transform Public Health Data Systems. The commission will reimagine how data are collected, shared, and used, and identify what’s needed to update our public health data infrastructure to improve health equity.

Toward Bold and Lasting Change

When some groups lack equal opportunity to live to their full potential, our nation cannot achieve its full promise. Through our funding approaches, we are supporting the researchers to further develop action-oriented, mixed-method approaches that address urgent problems that constrain health equity. Here at RWJF, we don’t have all the answers but we are eager to continuously engage, have exploratory conversations, debate openly and, most importantly, to support the work to bring about change. I hope you will help us strengthen and accelerate the evidence that will help our nation achieve better health and equity for all.


About the Author

Headshot of Alonzo Plough

Alonzo Plough, chief science officer and vice president, Research-Evaluation-Learning, is responsible for aligning all of the Foundation’s work with the best evidence from research and practice and incorporating program evaluations into organizational learning.

Tue, 8 Jun 2021 13:45:00 -0400 Alonzo L. Plough Health Disparities <![CDATA[Why Discrimination is a Health Issue]]>

What does the pervasiveness of discrimination mean for health? Social scientist David Williams explains the physiological response to stress and why a good education or high-paying job doesn't necessarily protect from its effects. 

A patient sits in a doctor's office while a nurse looks over his chart.

EDITOR'S NOTE: A recent NPR story (May 18, 2021) highlighted expert insights on how stress from discrimination negatively affects the health of Black men regardless of income level or educational status. Our own RWJF Trustee Dr. David Williams was featured in NPR's story.

Dr. Williams shared a similar, powerful message in a Culture of Health Blog post originally published in October 2017 that we are re-sharing. In this post, he underscored the need for all of us to work together to make America a healthier place for all.

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.

But it’s true: African-Americans live sicker and die sooner than whites in America. Heart disease is the number one cause of death in the United States and middle-aged black males and females have death rates that are about twice as high as their white counterparts. Elevated death rates are also evident for cancer, stroke, diabetes, kidney disease, maternal death—the list goes on. In fact, every 7 minutes, a black person dies prematurely. That’s more than 200 black people a day who would not die if the health of blacks and whites were equal.

And, as the Yale example shows, even higher levels of education—which can lead to higher incomes and the ability to live in healthier neighborhoods and to access high-quality health care—can’t protect African-Americans from the disparities leading to higher mortality rates.  

Dr. David Williams discusses racism's impact on health during an April 2021 episode of 60 Minutes.

So What’s Behind This?   

A large and growing body of research shows that day-to-day experiences of African-Americans create physiological responses that lead to premature aging (meaning that people are biologically older than their chronological age). Or, as described in the American Behavioral Scientist, “experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioral patterns that increase health risks.”

Stress is a normal part of life, but when stress is a persistent, daily experience, it exceeds our ability to cope and the physiological systems designed to handle it fails. This resulting physical response leads to increased incidence of hypertension, diabetes, or other health issues.

The first thing we have to do is acknowledge that the everyday racial discrimination embedded in our culture is sickening and killing African-Americans, and make a new commitment to work together to make America a healthier place for all.

The first data from an unprecedented survey of 3,453 African-Americans, Latinos, Asian Americans, Native Americans, whites, and LGBTQ adults from the Harvard T. H. Chan School of Public Health, NPR, and RWJF explores experiences with discrimination. Every demographic group surveyed felt that discrimination against their own race or ethnic group exists in America today. This included 78 percent of Latinos, 75 percent of Native Americans, 61 percent of Asian Americans, and 55 percent of Non-Hispanic Whites. However 92 percent of African-Americans surveyed were most likely to agree with this statement.

Among African-American respondents when asked about their own personal experiences:

  • 32% say they have personally experienced racial discrimination when going to a doctor or a health clinic; 22% have avoided seeking medical care out of concern about discrimination;
  • 60% say that they or a family member have been unfairly stopped or treated by police; 31% have avoided calling the police when in need to avoid potential discrimination;
  • 45% say they have been discriminated against when trying to rent or buy a house;
  • 27% say they avoid day-to-day tasks like using a car or participating in social events.

It’s not just avoiding the doctor that can lead to poor health. Not calling the police in an emergency can risk safety and protection. Safe and stable housing is one of the most foundational needs for good health. And avoiding interaction with others can result in social isolation, which is also linked to poor health.

The word discrimination often brings to mind historical examples of denial of voting rights, hate crimes or discriminatory practices in housing and criminal justice. But not all discrimination is conscious, intentional or personal. It’s often built into institutional policies and practices such as mortgage lending, zoning or school funding practices—which, in turn, impacts where you live, the quality of education you receive or access to public transportation or good jobs—all of which are linked to health.

But when discrimination is a part of your day-to-day norm, even an Ivy League education can’t fully protect you from its effects.

So what do we do about it? Although there are examples of programs and policies aimed at increasing health equity, there’s really no simple answer. But the first thing we have to do is acknowledge that the everyday racial discrimination embedded in our culture is sickening and killing African-Americans, and make a new commitment to work together to make America a healthier place for all.

I hope to see my youngest daughter graduate from college in 2020. I look forward to that day. But beyond that, I hope that she and all her African-American classmates will go on to live healthier, longer lives than those who graduated from Yale’s class of 1970.

Learn more about the Harvard survey findings by accessing the on-demand recording of a forum that explored the poll results and their implications for a healthier, more equitable, and just society.


About the author

David R. Williams is the Florence and Laura Norman Professor of Public Health, Harvard T. H. Chan School of Public Health and professor of African and African-American Studies at Harvard University. Dr. Williams is an internationally recognized social scientist focused on social influences on health.

Wed, 26 May 2021 11:00:00 -0400 David R. Williams Health Disparities National <![CDATA[How We’re Working Toward Becoming an Antiracist Community]]>

What does it take to overcome systemic racism and become a community where race is not a predictor of success? An assistant county administrator shares the steps her community is taking to transform vision into reality.

A group stand in a circle waving their hands. A drop-in teen wellness center in Broward County, Florida (2019). Photo credit: William Widmer

I’m a Black woman adopted from the child welfare system by White parents, and I’ve been aware of the fight for racial equality all my life. But it wasn’t until five years ago that, in the course of my work, I started focusing on equity. This is the idea that we must adjust resources, transform systems and remove obstacles to create fair and just opportunities and outcomes for Black, Indigenous and other people of color (BIPOC) so that they are supported toward success.

As an assistant county administrator for the highly diverse Broward County in Florida, I was reviewing data from our child welfare system and was struck by the disparities and disproportionality. Black families were being decimated in two ZIP codes, with child removal rates two and three times higher than that of White families.

I knew right then that we had to identify the root cause of the disparities reflected in systems that perpetuate racism—while purporting to help people—and are often a barrier to health for BIPOC in this nation.

I reached out to the Urban League of Broward County, a social services agency that works with BIPOC communities, to ask for their help in addressing the child welfare disparities. That early partnership set our county on a path toward what might seem like an audacious goal.

But this goal is the only way for us to foster a healthier community for all: We aim to become an antiracist county where race is no longer a predictor of success within our service systems.

Beyond ‘representation’

Broward County is about one-third Hispanic, one-third Black, and one-third White. Within those racial categories are additional dimensions of diversity, with African Americans, Caribbean Americans of various national origins, and people with roots across Central and Latin America. The county’s workforce reflects this rich diversity.

But as the outcomes for children of color in the county’s child welfare system illustrated, a person of any race can internalize racist assumptions and implicit biases that, for example, make Black children more likely to be removed from their families, detained in secure facilities, or disciplined at school for behaviors that are normalized for their White counterparts.   

The terrible events of the past year sparked a national reckoning with structural racism. RWJF Culture of Health Prize communities have engaged in hard conversations about the historical wrongs that perpetuate today's inequities.

So, we implemented a comprehensive training program that goes beyond unconscious perceptions and implicit bias to directly address systemic racism, shifting the focus away from individual bigotry. Having a common analysis and language as our foundation allows us to communicate effectively as we craft new services, policies, and procedures using an antiracist lens.  

To date, we have trained over 3,000 people, including service recipients, business, law enforcement, social service agencies, the local school board (including staff and students), and the public health department.

Building an infrastructure to support long-term change

Racial equity training is just the beginning. We are building an “infrastructure of support” so that people can truly practice what they are learning and support long-term change. We hold a facilitated debrief session after each training workshop to help participants navigate new emotions they experience, such as excitement, anger, and sadness, and explore questions they may grapple with.

White, Black, and Latinx caucuses also meet each month to deepen their analysis on racism and race equity work by reading works or watching videos on racism and race equity. They engage in ongoing facilitated conversations about how an antiracist philosophy plays out in practice.

Here are additional ways in which the county is working to become antiracist:

  • We’re continually assessing our progress towards becoming antiracist. Then, each agency works to change policies and practices that unintentionally perpetuate racism or racist practices. For example, over the past several years Broward County Human Services examined its requirements for the nonprofit service providers it funds to ensure we’re not excluding any groups. In our current cycle of funding, we’ve encouraged organizations to take an antiracist approach when serving primarily BIPOC populations. That means committing to becoming antiracist by participating in training and conducting an organizational assessment. Our next funding cycle will require these steps.
  • Last December, the Broward County Commission approved the establishment of a race equity taskforce to hold the county accountable to its goals. The commission also has approved a criminal justice and police review board, called for in the wake of George Floyd’s murder last year. The board will examine and seek to rectify disparities in the criminal justice system, from arrest rates all the way to sentencing rates.
  • Our business community has also stepped up in a meaningful way. The Broward County Chamber of Commerce, the Broward Alliance’s Prosperity Partnership, and others have prioritized racial equity as an issue to address through improved access to resources such as jobs, education, and self-sufficiency.
  • “Equity liaisons” in all 250 of our public schools create plans to increase equity in each school. The school district is also training high school kids in antiracist analysis so as they mature they can bring an antiracist perspective to their places of education or work.
  • The Florida Department of Health in Broward County is continuing to focus on health equity through a racial equity lens, particularly within the context of COVID-19 response and mitigation strategies.

Groundswell across the nation

Broward County strongly supports antiracism efforts for several reasons. Our demographic diversity helps. When structural racism directly impacts enough people in a community, it cannot be ignored. In addition, we’re known as “collaboration county.” We have an extraordinary group of leaders from across sectors that comes together monthly to discuss the issues most prevalent in our community. They’re committed to investing resources toward dismantling structural racism—because doing so is not free.

I am energized by knowing that communities across the nation have embarked on this work as well. Last fall, I had the privilege of speaking about this topic on a panel with representatives of three other communities that, like Broward County, have received the Robert Wood Johnson Foundation’s Culture of Health Prize.

In Richmond, Virginia, once the seat of the confederacy, they’re grappling with the historical wrongs that perpetuate today’s inequities, from slavery to redlining. In Kansas City, Missouri, the health department building now sits on the road that historically divided the city’s Black and White neighborhoods, serving as a powerful metaphor for the city’s current focus on reducing inequities and addressing the underlying causes of poor health. And Klamath County, Oregon, is taking steps to be more inclusive of its Tribal and migrant populations in its health promotion efforts.

Every community can tackle systemic racism. That’s the only way to ensure health equity for everyone in the United States.

Learn more about Prize-winning communities, visit


About the Author

A portrait of a woman standing in front of ferns.

Kimm Campbell is assistant county administrator at Broward County Government in Florida.

Thu, 13 May 2021 13:00:00 -0400 Kimm Campbell Health Disparities National <![CDATA[WIC Innovates to Support Maternal and Child Health During the Pandemic]]>

As unemployment and food insecurity rates soared, WIC adapted to protect access for the families it serves—but more support is needed.

A mother and child play outside.

During the early days of the COVID-19 pandemic, Bo-Yee Poon and her children left China, where she had been studying Tai Chi for 16 years, to return home to Vermont. What she thought would be a short stay before returning to her studies turned into a much longer one as all flights back to China were grounded indefinitely. With a home but no immediate job prospects in Vermont, Bo-Yee managed to access insurance through Vermont Health Connect, which fortunately made her and her family eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).     

WIC is a federal program that provides critical nutrition assistance to lower-income women, infants, and young children. In 2019, more than 6 million people participated in WIC each month, including roughly half of all infants born in the United States. 

WIC turned out to be just what Bo-Yee and her children needed. It provided access to healthy groceries and tips on how to feed her children vegetables and fruit. But more importantly, it helped alleviate her stress and anxiety around providing nutritious food for her family. She knew that even though she couldn’t work or afford childcare, her family would be taken care of. Today, WIC has helped millions of families like Bo-Yee’s eat healthy food on a lower budget, providing a sense of relief during particularly difficult times. 

Centers Adapt Rapidly to Keep Families Healthy During COVID-19

Since it began in 1974, the WIC program has helped millions of women who are pregnant, postpartum or breastfeeding, and infants and young children up to age five, eat healthier foods even on lower incomes. Through federal grants to states, WIC provides around $40 in monthly benefits to each participant to purchase nutritious groceries. WIC also provides referrals for health care and nutrition education. It’s widely considered to be one of the most successful nutrition intervention programs for improving maternal and child health. 

The onset of the COVID-19 pandemic brought unprecedented increases in unemployment; larger than those during the Great Recession. In part because of this rise in unemployment, food insecurity has grown, along with increases in food prices and shortages of staple grocery items such as milk, formula, eggs, bread, and beans—all items that participants have come to rely on as part of their WIC packages. The disruptions have been particularly profound for pregnant and postpartum women, infants, and young children, all of whom have unique nutritional needs.

COVID-19 has led to a significant growth in WIC enrollment. For example, in California, Kentucky, North Carolina, and South Carolina, participation grew by more than 10 percent between February and September 2020. Experts expect this trend to continue for years. This growth has forced WIC providers to adapt rapidly and to alter procedures. Traditionally, WIC supports had been conducted in person at community-based clinics. COVID-19 changed all that for participants, staff, and their families.

Thanks to a series of waivers from the U.S. Department of Agriculture (USDA), which administers WIC, providers were able to remove requirements for these in-person visits and to quickly implement remote services. State agencies are also now allowed to issue up to four months of benefits at once, reducing the need for physical contact. And in those states that couldn’t easily ramp up the necessary technological infrastructure, clinics began providing curbside services that reduced in-person contact while continuing to meet participant needs.

RWJF's Jamie Bussel and Brian Dittmeier, senior public policy counsel, National WIC Association, discuss how the pandemic has affected WIC.

Prior to the pandemic, most participants received their WIC benefits monthly. But to better support families during the sporadic food shortages in the early days of the pandemic, more states began providing benefits electronically, and expanded the list of WIC-approved foods. That gave families more flexibility in items they could choose--including around the fat content of milk, increases in the size of whole grain items and the count of eggs. And, WIC partnered with manufacturers and retailers to address disruptions to the supply chain. More states also began to provide benefits electronically instead of just on paper vouchers.

New Report Explores How COVID-19 Has Impacted WIC 

Now, more than a year into the pandemic, WIC continues to pivot to meet new challenges. But in order to remain the vital resource for families that WIC is today, it needs more support and resources. I spoke with Brian Dittmeier, senior public policy counsel at the National WIC Association, about their new report on how the pandemic has affected WIC, how WIC has adapted to continue serving its participants, and what is still needed to ensure that it can meet the needs of its participants.   

Federal Support Needed to Ensure WIC Continues to Support Families

The WIC program is a lifeline to millions of women, mothers and children across the country. In fact, right here in New Jersey, almost 135,000 people participated in 2019—that’s more than 53 percent of eligible residents. You can learn about how essential WIC and other child nutrition policies are in your state here. And listen to stories of parenting and how WIC is a necessary resource for moms to provide the best health and well-being for their young children.  

The COVID-19 pandemic has underscored existing inequities in our public health system and the need for federal support in providing families with healthy meals and nutrition support. As such, USDA and Congress should ensure the current waivers that are enabling families to access WIC services during the pandemic remain in place for as long as needed, and that states and WIC offices have the technical support they need to continue serving families effectively.

When the pandemic finally ends, we must ensure that support for WIC continues and expands. That means that Congress should increase WIC funding to extend eligibility to postpartum mothers through the first two years after giving birth and to children through the age of six to align with participation in school meal programs. There should also be efforts to enable infants and children to participate for two years before having to reapply, instead of 6 to 12 months as it is now. 

Policymakers must also work to increase racial equity in WIC participation, including making WIC packages more culturally inclusive, providing targeted support based on health disparities, and providing breastfeeding support that is inclusive and relevant for women of color. These and other updates to the program can help it build on its track record of success, and capitalize on how local WIC agencies across the country have responded to the pandemic. 

WIC is truly one of our country’s most vital programs, not just for the number of families it serves, but for the impact it has. Bo-Yee’s family is just one of many who have been able to eat healthier and access essential services thanks to WIC. But there are many more women, children and families who need WIC. We must ensure that WIC has the support to continue to innovate and reach all the families that need it.

Read our policy brief which analyzes research on how the Supplemental Nutrition Assistance Program (SNAP) and WIC impact the health and food security of young children.


About the Author

Jamie Bussell

Jamie Bussel, RWJF senior program officer, is an inspiring, hands-on leader with extensive experience in developing programs and policies that promote the health of children and families. Her work focuses on ensuring that all children have the building blocks for lifelong health.

Fri, 7 May 2021 13:00:00 -0400 Jamie Bussel Child and Family Well-Being Early Childhood National <![CDATA[Bringing Clean, Running Water to the Navajo Nation]]>

Broken promises and structural racism have deprived New Mexico’s Navajo Nation of safe, running water for generations. A Navajo woman shares how she is actively changing this reality, one family at a time.

Darlene Arviso fills water tanks for Navajo tribal members. The "Water Lady" Darlene Arviso fills water tanks for Navajo tribal members who do not have access to running water. Photo credit: DigDeep, 2019.

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.  

And then think about the steps to make even that possible. Many people drive two hours, twice a month, to reach the closest towns of Gallup or Grants for their water supply. A day or two after government benefit checks arrive, I see a familiar caravan of trucks bumping along rutted dirt roads. Usually, two large storage tanks are weighing down their cargo beds, one for water, the other for propane, because we don’t have natural gas out here either.

That is not the promise made to us when we signed a treaty more than 150 years ago pledging peace with the federal government in exchange for creating a permanent Navajo homeland and the basic infrastructure it requires. But promises made, promises broken has been a long tradition in Native communities and we know how to step forward to do things for ourselves. I’m honored to work as project manager for the Navajo Water Project, an initiative of DigDeep, a human rights organization committed to making sure everyone in America has clean, running water.

The DigDeep water system we bring to remote homes in this corner of the state is brilliant in its simplicity and the entire install takes just a day. Our crew first buries a 1,200-gallon tank deep enough into the soil so that the water won’t freeze, and then technicians plumb a sink, water heater, filter and drain line. After solar panels are placed to power the system, the tank is ready to be filled. That job usually falls to the inveterate Darlene Arviso, known to all as the water lady, who maneuvers a huge yellow water truck to the often-isolated site. Darlene is a personal hero to me and she’s out there no matter how cold the temperature or how muddy the road (read about Darlene in this wonderful picture book).

Then there is just one more step: gather the family around, open the faucet, and watch the water flow. The elders, many of whom have never lived with running water in their homes, sometimes seem overwhelmed. There are cheers, applause, and yes, those tears. A bowl of water may be quickly set down for the puppy.

Recalling that scene has kept me optimistic in this terribly hard year. The importance of clean water has never been clearer than when COVID-19 struck—here we are telling people to wash their hands and sanitize their surfaces yet many lack the most basic tools for doing so.

During the pandemic, many of our young people, who had scattered from their traditional lands, lost their jobs and returned home, putting more demand on the limited water supply. In the midst of all that, we had to hit pause on installing new systems, although we continued to fill existing tanks and gave some families 275-gallon, food-grade storage tanks to set up outside their homes.

We also prepared for a new round of installations when conditions permit and I’m proud to say we are expanding into a nearby region. A lot of trust-building has to happen as we grow so we are working closely with community leaders and the chapter houses that represent local governance within the Navajo Nation. Residents who meet us for the first time ask pointed questions about our plans and question whether we will follow through. Past experiences have left them understandably skeptical, but we make ourselves visible, request their support, and tell them we’re here—and that we’ll be back tomorrow.

My own family had running water when I was growing up, but many of my friends did not. I want to see that change. My hope is that one day the homes of every Navajo person will be hooked up to a water system, with indoor plumbing, a really nice shower, a commode, and a sink. That is what I wish for my tribe and indeed for all in America. There are two million people without running water in this country, most of them in communities of color, low-income communities, and tribal communities.

In Closing the Water Access Gap in the United States, DigDeep tells the story of six of those communities and lays out an action plan that asks us to reimagine the solution, deploy resources strategically, build community power, and foster creative collaborations. Read the plan and consider how a nation with so much wealth and opportunity can make it real.

For many people of color, rural and tribal communities, critical utilities are unavailable, unaffordable, unreliable and even unsafe. Learn how communities across the nation are confronting the issue by building health and equity into three essential utility services.   


About the Author

Cindy Howe

Cindy Howe is DigDeep's project manager in New Mexico, where she works to secure water access and rights for Navajo people.

Mon, 3 May 2021 12:45:00 -0400 Cindy Howe Public and Community Health Health Disparities Built Environment and Health National <![CDATA[How Communities Can Support Children and Families to Recover From the Impacts of COVID-19]]>

Communities nationwide are showing that helping families recover helps our society recover.

Family greets each other while wearing masks.

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.

The latest set of reports in the Sentinel Communities: COVID-19 Community Response series focuses on how these nine communities have supported children and families during the pandemic. The evidence is showing us that helping families recover helps our society recover. Though some see this as a divergent path, the truth is that health, social, and economic policies go hand in hand.

What We’re Learning

Families’ needs and science should drive local decisions.

No one had a playbook for how to manage a pandemic, so across the country, states, cities, school districts, businesses, and parents have approached managing COVID-19 in vastly different ways.

When the pandemic hit, Harris County, Texas, leaders were acutely aware of the challenges children and families faced. This was reflected in their response efforts, which prioritized public health and sought to advance equity. For instance, the Houston Independent School District kept an eye on virus case counts and waited until October 2020 to start in-person instruction to control the spread of COVID-19, even though state guidance allowed in-person instruction earlier. In January 2021, the district even began offering rapid COVID-19 testing for teachers, administrators, and some students. Harris County leaders focused on the experiences of their own community members and what they needed to stay safe and healthy.

Equity must be integrated into a community’s work from the ground up.

Achieving equity is a journey. At its core, this work is really about systemic change. In our research, we have observed that some communities have been intentional and vocal about integrating equity into their COVID-19 responses—particularly those that have a history of prioritizing equity. 

Although Milwaukee is one of the nation’s most segregated cities, COVID-19 has spurred even more work, investments, and conversations about supporting the city’s Black and Brown residents. For instance, the Wisconsin Early Childhood Association targeted grants to child care providers in eight Milwaukee zip codes with the highest concentration of Black and Latino residents and the highest rates of COVID-19. And in June 2020, Milwaukee County recognized Juneteenth as a holiday and issued an order declaring racism as a public health crisis.

COVID-19 has spurred incredible ingenuity that we can carry forward.

In spite of how challenging the past year has been, an overwhelming number of people view the pandemic as an opportunity for our society to improve. We’re hopeful that some of the solutions we’ve witnessed communities devise are glimmers of more long-term, positive change.

Recognizing how much our lives have shifted online, many communities have stepped up to ensure that people have access to reliable internet during COVID-19. In Finney County, Kan., where one-fifth of households lacked internet access pre-pandemic, a local grant program provided up to $10,000 per household to cover basic expenses, including internet. Through a local education foundation, Tampa, Fla., went a step further than providing students with tablets and hotspots. They also sent bilingual teams to families’ homes to teach them how to use their new technology. Communities like Finney County and Tampa are laying the foundation for bridging the digital divide for children and families.

Where Do We Go From Here?

Back in 2015, our colleagues Anita Chandra and Alonzo Plough reflected on what Hurricane Katrina had taught them about community resilience. The disaster spurred action at local, regional, and national levels to better prepare to respond to crises. In an eerie foreshadowing, they noted, “It would be a tragedy if all this happened [again] and we had learned nothing.” As it turns out, we’re living through a global tragedy.

The pandemic has caused more pain and hurt than any of us might have imagined, particularly for children and families. But our research is signaling that change is coming—maybe not seismic shifts, but change is happening.

At the national level, we can look to the American Rescue Plan, which Dr. Richard Besser writes is a “down payment on an equitable America.” Some experts are saying that the legislation could cut child poverty by more than one-third. And state, local, and tribal governments will receive $350 billion through the bill. With rumblings of new federal infrastructure legislation that would cover everything from housing to water access, more change may be on the way.

If the pandemic and our research is teaching us anything, it’s that when supporting families, prioritizing science and equity, and encouraging ingenuity, communities can be better prepared to respond to even the greatest storms.

Read the latest set of reports in the Sentinel Communities: COVID-19 Community Response series.


About the Authors

Staff portrait of Brian Quinn

Brian Quinn brings his extensive background in health policy analysis and innovative program development to his work as the Foundation’s associate vice president iin the Research-Evaluation-Learning unit.

Headshot of Carolyn Miller

Carolyn Miller, a senior program officer in the Research-Evaluation-Learning unit, brings to the Foundation a long and diverse career in private sector, government, and academic research.

Mon, 26 Apr 2021 15:00:00 -0400 Brian C. Quinn Public and Community Health Child and Family Well-Being National Community Health <![CDATA[It Is Time to End the Sale of All Flavored Tobacco Products]]>

Taking flavored tobacco products off the market would save millions of lives, reduce health care costs, and ensure an equitable approach to better health in the United States.

Smoke free signage is on display at a bustop.

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.

Why do tobacco companies rely so much on menthol? Menthol flavoring makes it easier to start smoking and harder to quit by reducing the harshness associated with traditional tobacco flavoring. Research shows that menthol cigarettes perpetuate tobacco-related disparities. Menthol cigarettes are used disproportionately by Black people, LGBTQ people, and people with mental illness—all groups that are disproportionately harmed by tobacco. Over seven out of 10 Black youth ages 12 to 17 who smoke use menthol cigarettes.

More than a decade ago, Congress gave the FDA authority to ban menthol cigarettes, recognizing that “menthol cigarettes may pose unique health risks.” In response, the FDA formed the Tobacco Products Scientific Advisory Committee (TPSAC) to review the public health impacts of menthol cigarettes. TPSAC concluded that “removal of menthol cigarettes from the marketplace would benefit public health in the United States,” estimating that the continued sale of menthol cigarettes would result in over 4,700 excess deaths among African Americans between 2011 and 2020. Since then, the FDA has continued to recognize, and new evidence has continued to demonstrate, that menthol cigarettes encourage smoking initiation and exacerbate health disparities. Yet these products continue to remain on the market, providing no public health benefit while putting millions of lives at continued risk.

The fact that products like menthol cigarettes continue to be sold is a sign of how many of the populations that are striving to overcome the greatest barriers to reducing tobacco use—including Black, American Indian, and LGBTQ communities—have been underrepresented in the broader movement to protect children and families from tobacco companies and their pernicious products. Organizations such as the African American Tobacco Control Leadership Council (AATCLC) and the Center for Black Health and Equity (CBHE) have done tremendous work to build support for state and local restrictions on the sales of menthol cigarettes and are bringing national attention to the issue. But there is more work to be done.

The U.S. Food and Drug Administration will respond by April 29 to a citizen petition urging a ban on the sale of menthol cigarettes. Taking these products off the market as part of a comprehensive end to the sale of all flavored tobacco products would be a major public health milestone. For years, tobacco use has been the number one cause of preventable death in the United States, with people of color among those paying the heaviest price. Taking flavored tobacco products off the market once and for all would save millions of lives, substantially reduce health care costs, and take an enormous step forward to ensure an equitable approach to better health in the United States.

Read Rich Besser’s op-ed on the need to prioritize health equity in tobacco prevention policies.


About the Author

Headshot of Matt Pierce

Matt Pierce, RWJF senior program officer, works in the areas of public health law and tobacco control. Pierce is interested in finding more equitable ways to promote health and well-being.

Fri, 23 Apr 2021 12:30:00 -0400 Matt Pierce Health Disparities Public and Community Health National <![CDATA[Climate Change, Environmental Justice, and the Rise of Local Solutions]]>

How can U.S. cities inspire us to tackle climate change and its health impacts? An urban alchemist-turned-funder shares reflections on where we’ve been and where we’re headed with the movement for environmental justice in the United States and abroad.

Volunteers work on an urban farm operating as a community project.

Earth Day will be 51 years young this April 22nd—and I have been a witness to every one of them. The environmental activism that it launched and inspired has shaped me as an individual, shaped culture in the U.S. and beyond, and shaped the planet we all share. And it continues to evolve, as evident by the present-day focus on environmental justice and disproportionate health impacts felt by low-income communities and communities of color. As a child of the 1970s, I have seen momentous changes—environmental policies and discoveries that pointed in the right direction, setbacks and disappointments, and profiles in courage.

As a youngster, I drew inspiration from the boldness of Jacque Cousteau, the brilliance of Jane Goodall, and the courage of Norma Rae. As an adult, I look to the power of local change agents like Majora Carter of South Bronx, NYC and Margie Eugene-Richard of Southern Louisiana. In my lifetime, I have seen the institution of recycling, lead removed from gasoline and paint, asbestos banned from buildings, and consumer preference shift toward plant-based cleaning products and chemical-free food. I am excited by the burgeoning international movement for green schoolyards. I have also seen devastating environmental crises in places like Love Canal, N.Y., Flint, Mich., the Gulf of Mexico, and Prince William Sound. All of these represent both the incredible harm and good we can do when we act collectively.

I hope in my lifetime to witness less David vs. Goliath battles for the environment and a reckoning of environmental injustices. I have hope to share.

A year ago, a national emergency was declared in the wake of the pandemic. To curb the spread of COVID-19, the world as we knew it was suspended. A short time in, it was hard not to notice how nature was emerging in places we previously wouldn’t have expected, how our roads grew quieter, and our air cleaner. Birds appeared everywhere—even in industrial neighborhoods. Demand surged for equitable access to green and open public spaces. Some cities expanded bike lanes and closed streets to traffic—all of this and more helped us see that the way we’ve always done things isn’t the way we must continue to do things. We have demonstrated that we can be more resourceful, creative, and inclusive in solving the competing crises of our time.

While I would never wish this pandemic on this or any future generation, there is value in assessing what we are capable of when we marshal our resources across borders and cultures to meet a common threat. It makes me wonder about our other existential threats, like climate change. How do we muster the same collective will to overcome this challenge and to do it with a commitment to equity?

How Cities are Taking Action to Address Health, Equity and Climate Change

At the Robert Wood Johnson Foundation, we know that good ideas have no borders and I’m excited that we’re supporting six projects in U.S. cities as they translate and adapt approaches tested in cities around the world to curb the health impacts of climate change. It demonstrates the power that we have to meet the challenges of extreme heat, climate displacement, and rising sea levels—that our communities are incubators of change. Here’s how a few of our grantees are taking action:



Vilma Martinez-Dominguez Vilma Martinez-Dominguez, Community Development Director and local activist, City of Lawrence

“In Lawrence, Mass., we’ve known that a lack of access to adequate and diverse transportation options, health care, green spaces, healthy food, and social connections—compounded by high poverty levels and environmental concerns—have given way to marked health inequities.

That’s why the city partnered with residents, the Conservation Law Foundation, and Groundwork Lawrence to look abroad—to Brazil, Italy and elsewhere—for innovations to create climate resilient parks and corridors in our city. It’s our opportunity to address health and climate inequities while capitalizing on our rich local natural resources and deep partnerships.”



Dominika Parry Dominika Parry, President/CEO, 2⁰C Mississippi

“Jackson, Miss., is the capital of the poorest and most unhealthy state in the U.S. It is also among the most segregated cities in the nation, where lack of health insurance, obesity, and diabetes are directly correlated with residence in Jackson's redlined areas. These inequalities dramatically increase vulnerability to climate change, a reality ignored or outright denied, by many state officials. By contrast, we are supporting climate action to address health vulnerabilities by developing heat-mitigating green infrastructure in our city. Inspired by innovative solutions developed in Japan and Spain, we are working to transform Jackson into the greenest, healthiest, and most equitable city in the South!”



Alberto J. Rodríguez Alberto J. Rodriguez, Strategic Advisor, Duwamish Valley, City of Seattle

“Seattle’s Duwamish Valley is a microcosm for how the combined impacts of existing health disparities and the looming threat of climate change disproportionately affect Black, Indigenous, people of color, and low-income communities. That’s why we’re working with community stakeholders to develop and implement a strategy to mitigate and adapt to sea level rise and other climate change impacts, while prioritizing keeping people and businesses in the areas they call home.

Drawing from solutions in Brazil, Puerto Rico, and New Zealand, our sea level rise adaptation strategy will be driven by the community, rooted in racial equity, and will foster health and equity today and into the future.”



Woods-Warren Jason Wood, Chief of Sustainability, City of Cleveland and Linda Warren, Sr. VP of Placemaking, Cleveland Neighborhood Progress

“In Cleveland, we’ve made tremendous progress in improving water quality and reducing carbon pollution, but we still have work to do in bolstering our resilience to climate change, creating green jobs, and scaling up social and racial equity. To accelerate our goals, we’re committing to an equitable transition to 100% renewable energy by 2050 and to building a circular economy in Cleveland, where solid waste and pollution management are redesigned to improve community health and economic opportunity. Inspired by circular initiatives in Toronto, we’re excited to join other circular cities from Europe, Asia and Latin America.”



Michelle Jackson Michelle Jackson, Executive Director, Sustainable Community Farms

"While the City of Detroit may be a little slow to act on climate change, health, and equity issues, we have a bunch of amazing people in our neighborhoods working to move things in the right direction. Through our Composting for Community Health project, our Detroit Compost Champions will advocate for policies that create a just environment where the benefits of our waste diversion efforts are kept in the communities—both in terms of the compost produced and the jobs that are created. Collaborating with our international partner, the Mother Earth Foundation in the Philippines, we will be able to accelerate the work that we need to do here by learning from their incredible example of community scale composting."  



The changemakers from these cities aren’t alone. In response to our funding proposal, Cities Taking Action to Address Health, Equity, and Climate Change, we learned of promising solutions to air pollution, heat stress, and food insecurity taking root in over 100 cities across 60 countries—from Accra to Athens, Seoul to São Paulo. It gives me hope to see that so many are centering racial equity in their work, increasing community power over the systems and environments where they live, and prioritizing the needs of those who are most affected by the climate crisis.

We can lead momentous change when we set our sites on a common cause—and we all have a role to play in improving health and equity where we live. There is much we will learn from these cities as they build power and marshal resources—both local and global—in the fight against climate change. Along with other communities we’re supporting to advance health and climate solutions, it feels that we are on the precipice of real and durable change.

When Rachel Carson published Silent Spring in 1962, decrying the unsustainable and environmentally degrading practices of industrial societies, she set a course for change and changemakers. We have great challenges ahead, but I have seen change and I have hope.

Learn about countless equitable and inclusive climate actions we can take today to propel change.


About the Author

Sharon Roerty Staff photo

Sharon Roerty, AICP/PP/MCRP, a senior program officer who joined the Robert Wood Johnson Foundation in 2011, is an urban alchemist who has spent a lot of time at the intersection of health and transportation.  

Thu, 15 Apr 2021 13:00:00 -0400 Sharon Roerty Health Disparities Built Environment and Health <![CDATA[What it Will Take to Address the COVID-19 Eviction Crisis]]>

Navigating a public health crisis without a home has been a stark reality for too many in the United States. The problem will intensify unless leaders ensure that federal rental assistance reaches those who need it most.

A man finds eviction notice on the door of the house.

Now that Congress has approved more than $46 billion in emergency rental assistance, will that money reach the millions of Americans who need it most—the lowest income and most marginalized tenants and small landlords?

The Centers for Disease Control and Prevention (CDC) recently extended the national eviction moratorium, which will prevent tens of millions from losing their homes through June 30. Beyond that, it’s crucial to ensure that emergency rental assistance funds from the two COVID relief packages passed by Congress are distributed swiftly and equitably to tenants with the lowest incomes and others who face systemic disadvantage in accessing public benefits such as Black, Indigenous and People of Color and immigrants.

However, there are challenges to distributing these funds. Congress left some details of the rental assistance program up to states and localities, which has led to unnecessary and burdensome restrictions or requirements in certain communities. Some programs provide outreach and assistance for tenants—online, in person, or over the phone—and allow for them to self-attest their eligibility and need, but others do not, leaving some tenants unable to navigate the application process. The amount of aid available by state is also inconsistent.

In Fresno, Calif., residents of the poorest neighborhoods, mostly people of color, face eviction at a higher rate than their White neighbors. Their risks of getting sick and dying are also strikingly higher.

If these funds aren’t distributed as they were designed to, the eviction crisis will intensify.

The CDC’s federal eviction moratorium has generally done what it was intended to do by keeping tens of millions of renters stably housed during the pandemic. But despite its protections, flaws in the order have still led to an alarming number of evictions. Just recently, close to 5,200 evictions were filed in 5 states and 27 cities tracked by the Eviction Lab despite the national moratorium on evictions for nonpayment of rent. Since the COVID-19 pandemic began, evictions have been filed in almost every state, including more than 36,000 in Indiana and 21,000 in Missouri. In Houston, more than 27,000 evictions have been filed during COVID-19.

Now, as we enter the pandemic’s 13th month, the threat of eviction looms over nearly ten million renters who have fallen behind on rent, affecting people in communities large and small, rural and urban. Hardest hit of all are communities of color.

Housing Insecurity and Inequity: A Decades-Long Problem

Just as Black, Indigenous and Latino people have endured higher rates of infection and death from the virus, they have also suffered the most from its economic effects. This is partly because they hold a disproportionate share of jobs in the service industry which has been hit especially hard by the pandemic.

But it is also because of structural racism’s enduring impact and our country’s long history of discriminatory housing and lending practices. Discriminatory policies throughout the 20th century—including the practice of redlining, the creation of White-only suburbs from the 1930s to the 1960s, the systemic denial of mortgages to people of color, and occupational segregation—led to widespread residential segregation by race. These practices have invariably led to differential access to health-promoting resources like clean air, high-quality schools, and job opportunities.

For example, in city after city, researchers have found that people of color who reside in neighborhoods once subjected to redlining are more likely to live shorter lives, have lower incomes, and be cost-burdened by rent.

Inequities stemming from structural racism have also compounded COVID-19’s damage in communities of color. Throughout the pandemic, Black and Latino people, many of whom struggled to pay rent before the pandemic, consistently reported low confidence in their ability to pay rent. They are also twice as likely as White renters to be behind on housing payments and twice as likely to report being at risk of eviction. All of this is in addition to facing a strikingly higher risk of catching and dying from COVID-19.

The threat of eviction falls disproportionally on Black women, who are more likely to face housing discrimination and other forms of racial and gender-based discrimination. This leads to the loss of a home, disruption of family and social networks, and numerous negative mental and physical health consequences. It also results in an eviction record that makes it harder to rent in the future. One assessment found that Black women renters had evictions filed against them at twice the rate of White women.

The Health Consequences of Evictions

Evictions carry profound health consequences and harm families in ways that will cast a shadow long after the pandemic has ended.

While a safe and healthy home is the first line of defense against COVID-19, evictions often lead to overcrowded housing conditions by forcing people to double up with friends or family. These arrangements make it nearly impossible to comply with public health measures such as social distancing and self-quarantining, creating a vicious cycle of housing displacement and health risks amid the pandemic. These risks persist in spite of the availability of vaccines since vaccine access lags for communities of color.

Recent research confirms this connection: evictions (and lack of eviction protections) are associated with increased COVID-19 cases and mortality. More broadly, being forced from your home is linked to a range of negative health outcomes, including depression, anxiety, suicide, emergency room visits, and exposure to violence.

Federal Action to Solve This Crisis

Although the national eviction moratorium has prevented the displacement of millions of families since taking effect last September, it has failed to protect thousands of others—pushing them deeper into poverty and poor health.

That’s because the CDC’s policy has been applied inconsistently across states, is riddled with loopholes, and has not been fully enforced.

Renters are only protected if they know about the moratorium and seek its protection. As a result, corporate and other landlords continue to evict renters who are unaware of the moratorium protections available to them. It is often the most marginalized renters, such as undocumented immigrants or seniors without access to the internet, who are both most in need of and least aware of the moratorium’s protections. Some landlords evade the moratorium by finding reasons to evict other than nonpayment of rent.

Because millions are behind on their rent, only bold action now will prevent an even worse crisis after COVID-19. That’s why the following federal action must happen quickly:

  • Enforce and strengthen the eviction moratorium by making its protections universal and automatic, applying to all tenancy types, and clarifying that landlords cannot initiate eviction proceedings during the moratorium. The intention of the administration to involve the Federal Trade Commission and the Consumer Financial Protection Bureau in enforcing the moratorium is encouraging.
  • Ensure that emergency rental assistance reaches the lowest-income tenants, people of color, and immigrants and their landlords to prevent evictions. In January 2021, more than 9 million tenants were behind on rent payments. Meanwhile, small and non-profit landlords, particularly those who are Black and Latino, are struggling to make mortgage payments and cover maintenance and operational costs. Key strategies include: making the application simple, partnering with community-based organizations on outreach, and tracking who is receiving rental assistance and refining tactics as needed.

But beyond this, we need change that guarantees housing as a human right. This can only happen by advancing anti-racist policies and achieving the large-scale, sustained investments and reforms necessary to ensure that people with the lowest incomes have a safe, stable, and affordable place to call home.

More than ever, lawmakers must push for long-term, structural reforms in our country, many of which are outlined in RWJF’s recent housing policy brief and NLIHC’s national advocacy work. These include the need to:

  • Make rental assistance and housing choice vouchers universally available. Today, only one in four households eligible for rental assistance receives it, limiting their ability to live in affordable, stable homes or in higher-opportunity neighborhoods.
  • Strengthen and enforce renter legal protections. The power imbalance between renters and landlords put renters at risk of housing instability and homelessness. There should be requirements for landlords to show just cause for evictions and a right to counsel for all renters facing evictions.
  • Expand and preserve the supply of affordable homes. Not one single state or congressional district in America has an adequate supply of affordable housing for families with the lowest incomes. Preserve and build more public housing, expand the national Housing Trust Fund, and use federal incentives or requirements to reform local zoning.
  • Increase community and nonprofit ownership of housing. This approach gives residents control over important community assets, keeps neighborhoods affordable, and makes it less likely that people lose their homes when there are dips in the economy.
  • Provide emergency rental assistance to households in crisis by creating a permanent national housing stabilization fund. Millions of households are just one financial shock away from economic hardship that could quickly leave them without a home.

In mere months, we witnessed the power and ingenuity of modern science to develop multiple COVID-19 vaccines. We need that same power and will to ensure housing stability and opportunity for everyone, or our collective health and economic well-being will continue to be in jeopardy.

Learn more about RWJF-supported initiatives and resources for communities working to ensure access to safe, stable, affordable housing for all.


About the Authors

Giridhar Mallya, RWJF senior policy officer, is a public health physician and health policy expert. Working to advance the role of policy in achieving a Culture of Health, particularly at the state and local level, he views the Foundation as “a national leader in marshaling the evidence used to shape policies that foster healthier people, communities, and institutions.”

Diane Yentel is the President and CEO of the National Low Income Housing Coalition, a membership organization dedicated solely to achieving socially just public policy that ensures people with the lowest incomes in the United States have affordable and decent homes.

Tue, 13 Apr 2021 09:45:00 -0400 Giridhar Mallya Health Disparities National <![CDATA[Normalizing Men as Caregivers Helps Families and Society]]>

Busting the stereotype of men as breadwinners and women as caregivers benefits families and our economy. New research reveals conditions and supports needed for men to fulfill their caregiver roles.

Father and daughter do laundry together.

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.

A series of reports produced by the New America Foundation and funded by the Robert Wood Johnson Foundation examine caregiving experiences of nearly 3,000 men as fathers, as caregivers to relatives, and in their professional careers. The goal is to understand men’s attitudes, beliefs, behaviors, desires, and motivations around caregiving. The most recent reports are:

Key findings reveal the importance of creating necessary conditions and supports that allow men to fulfill their roles as caregivers for their families. The findings also demonstrate the need for debunking societal stereotypes within caregiving professions—typically occupied by women—and significant policy and systems change such as expanding paid leave and eliminating traditional cultural norms related to men’s role in society.

Caregiving Encourages Men to Bond With Children, Family

Providing Care Changes Men shares the story of Ronald Taylor, an occupational therapist from Portland, Ore., who was laid off in March 2020 due to the pandemic. Almost overnight, he became the primary caregiver for his two young daughters while his wife worked remotely to keep the family afloat financially. However, for Taylor, providing hands-on care for his children 10 hours daily was not new.  He had already cared for his eldest daughter for 15 months after she was born while his wife continued her job. Like many fathers surveyed, he has been actively involved in his children’s lives since birth. 

During the pandemic, even more men are shedding the breadwinner identity and embracing the role of primary caretaker. Many say it is immensely rewarding. In a national survey conducted by NORC at the University of Chicago throughout 2019 paired with journalistic interviews with a variety of men during the pandemic, many rated “showing love and affection” to their children and “teaching the child about life” as “very important.”  

Black Fathers and Caregivers Work to Correct “Absent Black Father” Stereotype While Combating Racism

The “absent Black father” stereotype has persisted despite decades of research showing how Black fathers are often more involved with their children’s lives than their White and Latino peers. Most importantly, this stereotypical narrative conveniently ignores how Black fathers are greatly impacted by structural racism and the racist policies that lead to fewer employment opportunities and disproportionate involvement in the criminal justice system. Related, Black children experience a multitude of health and economic disparities—also the result of structural racism and racist policies—which are often blamed on the “absent Black father”. A Portrait of Caring Black Men surveyed 209 Black fathers and male caregivers, finding that Black fathers and caregivers actively participate in and value care work. Other findings include:

  • Sixty-nine percent of Black fathers say they comfort, soothe, and emotionally support their children, while 67 percent make meals and feed their kids daily—demonstrating how crucial they are to their families and to their children’s development.

  • Eighty-six percent of Black men surveyed assist family members with daily activities such as grocery shopping, housekeeping, and cooking. Almost two-thirds (65 percent) report performing medical-related tasks. 

  • Overall, 89 percent of Black men surveyed say they find care work satisfying and 87 percent feel respected in their roles. 

  • Nearly half of Black men (48%) who have cared for a child with special needs or for adults feel burned out.

  • Fifty-seven percent of Black male caregivers say that the time needed to meet work demands makes it difficult to fulfill their family or personal obligations.  

Families Benefit From Active Male Caregivers 

Men’s experiences of care work can be life-changing and increase their desire to share care responsibilities equally with women. Ninety-one percent of respondents said care and domestic labor should be equally shared between men and women. In the report, Christopher, a father of two boys in New York City, expressed a view more common among the men who provide care: ‘experience itself is the best teacher.' Fathers who were surveyed similarly noted that caring for their children—like discovering the perfect speed to rock your child or the temperature that they like their milk—can be learned. Like women, they too have a caring instinct and can equally succeed at care tasks. 

Research shows that a gender-equal household is a healthier environment for the entire family. Fair divisions of work and care mean women are less stressed and can be more present for their children and/or loved ones with disabilities. Children in turn benefit from having equal fun, academic, and personal time with dad—which also benefits them developmentally.  

For Men to Succeed in Caregiving Professions, the Culture Must Change

As society ages, caring professions include some of the fastest-growing jobs and most meaningful careers. These professions include nurses, home health aides, kindergarten teachers, and child care workers. However, men in female-dominated health and education industries face many stereotypes. Professional Caregiving Men find Meaning and Pride in their Work, But Face Stigma reveals how the stigma and pressures of providing professional care work discourage many men from entering those fields. Research shows society does not respect or trust men who give care, because of their gender. 

Men in the field say that in order to succeed in their careers, society must reject the stereotype that women are more suited to care work. According to the report, to retain and recruit more men as caring professionals, we must transform the perception of these jobs so that they are viewed as respectable careers for people of all genders.

We Must Invest in the Care Economy

Values around men and caregiving are evolving, and more change may be on the horizon. Key policy and workplace changes—including a significant investment in the care economy—can help break generational barriers, advance gender equality, and better support men who care for their children and relatives with disabilities, as well as for others in their jobs.

For men to share equally in care work, policymakers must:

  • Enact a mandatory and universal paid family and medical leave policy of at least 12 weeks.

  • Increase stability for working families by raising the federal minimum wage to a livable level.

  • Invest significantly in a high-quality care infrastructure and universal family care program.

  • Enact a paid sick leave policy that guarantees workers can take paid time off when they have short-term illnesses.

To transform the work culture and enhance family-supportive policy, employers must:

  • Create paid “parental leave” for men in workplaces that support more time with family. 

  • Support universal healthcare benefits. 

  • Allow flexible work schedules.

  • Set expectations that leaders will model use of paid leave policies. 

  • Create a safe space for open conversations about the importance of using paid leave from work.

  • Help normalize the idea of men as equal and fully capable caregivers to address stigma.

  • Create opportunities and job pathways for men entering professional caring professions.

  • Recruit men into caring professions early through apprenticeships and training.

Now more than ever, the need for more egalitarianism in care work is imperative. Men’s attitudes and experiences toward caregiving outweigh the traditional gendered beliefs that America has set. Despite the structural barriers they face, men have proven themselves as active contributors to the care economy, which has equally benefitted families and communities.

All reports were authored by Brigid Schulte, Jahdziah St. Julien, Emily Hallgren, and Roselyn Miller of Better Life Lab

Learn more about how men view their caregiving experiences and explore the many benefits of supporting male caregivers.

About the Author

Gina Hijjawi, PhD, senior program officer, Research-Evaluation-Learning, joined RWJF in 2018. With her deep commitment to bridging systemic gaps in children’s health and social services, she values “the opportunity to advance understanding of how child and family serving systems, environments, and policies can support the healthy development and well-being of all children.

Thu, 8 Apr 2021 14:00:00 -0400 Gina Hijjawi Child and Family Well-Being Public and Community Health National <![CDATA[Meeting Parents and Caregivers at Their Aspirations]]>

How can we shape a future in which ALL children and families thrive? New research explores the aspirations of racially and ethnically diverse parents and caregivers who are raising the next generation!

A smiling family shares a moment together during a summer event.

“The biggest hope every parent has for their children is for them to be healthy, happy, and educated.”

This quote sums up a universal sentiment, expressed by a mother living in New York, about what all parents and caregivers want and strive to provide for their children. But what happens when parents are doing everything they can to fulfill those hopes and it’s still not enough? More than meeting families where they are, we need to meet them at their aspirations.

We can begin by truly listening to parents and caregivers, and building from their wisdom. To help achieve this understanding, over the last 18 months, the Robert Wood Johnson Foundation (RWJF) commissioned in-depth research with parents and caregivers to learn about the aspirations they have for their children, the challenges they face, and the factors that help them thrive.

What makes this research unique is an intentional focus on parents and caregivers of different racial and ethnic backgrounds. Following more than 70 interviews and focus groups, this study culminated in a survey of more than 2,000 parents and caregivers. Respondents included the same numbers of parents and caregivers from five racial and ethnic groups: Asian American and Pacific Islander, Black, Indigenous, Latino, and White. By constructing the sample in this way, our research team sought to elevate the voices of populations that are not always heard in national opinion studies.

The survey findings

A few things especially resonated with me as I reviewed the findings. For one, families faced hardships prior to COVID-19 that have been further exacerbated by the pandemic. For example, during focus groups with parents and caregivers furthest from economic opportunity, we heard clearly about the financial constraints they faced and the burdens it placed on both parents and children. One mother in California poignantly described the impact on herself and her daughter:

There was a time that I was kind of stressing out a little bit economically and she noticed it, and then she went to her little piggy and is like; here mom, have this. I’ll give you money, just borrow it. So I was like oh no I’m okay, but she noticed it right away.

Since those focus groups took place in 2019, many caregivers, especially women, have lost their jobs and haven’t returned to work. When we conducted additional interviews during the pandemic in 2020, caregivers told us they were facing trade-offs between staying home to protect their families from the virus or going to a job that placed them and their family at greater risk. A father from Colorado shared:

It's readily apparent that it's a risk, but you know, I have to stick my neck out for my family to make sure we can pay the bills and keep everything cranking away.

This is why, even as vaccines roll out widely, we can’t return to where the country was before the pandemic. In some ways we must fundamentally rethink the investments that we make in the health and well-being of children and families.

Parents and caregivers share hope and optimism about their children’s futures

The survey findings reveal that we have the hope and strengths of families to build on. The overwhelming majority of respondents—from 91 percent of White parents to 97 percent of Black parents—reported it was likely that their children would experience more opportunity to succeed and thrive than they had during their own childhood and adolescent years.

Parents and caregivers also possess reserves of strength and support that they depend on to raise their families and endure challenging times. They are dedicated to working as hard as it takes. They rely on their resourcefulness and creativity to solve problems. And perhaps most importantly, they believe if given the opportunity, they have the power to change their family’s situation.

Concerns remain about how inequities can limit opportunity

At the same time, parents and caregivers are clear-eyed about inequities that could limit their children’s opportunities to succeed. They’ve experienced these limitations themselves. Most parents of color who were surveyed, from 68 percent of Indigenous parents to 93 percent of Black parents, reported that systemic racism and discrimination made it harder to get a good paying job, live in a safe community, attend quality schools, and access medical care.

The survey also reveals that parents and caregivers anticipate the impact racism will have on their children’s opportunity. Very few, from 9% of Black parents to 27% of Latino parents, say that all children have the same opportunity to grow up to be independent, financially stable, and healthy adults. And at least half of parents of color fear that racism will limit their children’s future opportunities.

Imagining a future where all families can thrive

We must help parents and caregivers do more than just survive: we need to foster conditions that help their families prosper. There are several fundamental principles that come to mind:

  • All parents and caregivers should have meaningful opportunities to earn adequate income and resources that will support their children’s well-being.
  • All parents and caregivers should have the time and opportunity so that nothing stands in the way of investing in their children. We heard how difficult it can be for parents to spend as much time as they’d like with their children. They often face tradeoffs with work and other responsibilities that force them to sacrifice that important family time.
  • Parents and caregivers should never have to worry that their racial and ethnic background will affect their ability to provide for their families or access opportunity. And yet, we know that the effects of both individual and structural racism are real concerns for them.

We can imagine a better future for families—one where parents and caregivers can see a way to reach their hopes for their children and inequities aren’t a given. The voices of parents and caregivers—their aspirations and challenges—must inform how best to create conditions within communities where all families can thrive.

Listen to a mother who faced challenges with child care and similar stories of the types of supports child care providers give to families and their children. These stories and many more will help inform changes that can move every family forward.



About the Author

Headshot of Jennifer Ng' andu

Jennifer Ng’andu, managing director–Program at RWJF, helps lead grantmaking activities to advance social and environmental changes that help ensure that all children and their families have the full range of opportunities to lead healthy lives, while providing a strong and stable start for every child in the nation.

Mon, 5 Apr 2021 14:00:00 -0400 Jennifer Ngandu Child and Family Well-Being Health Disparities <![CDATA[Harnessing Sports to Build Healthier, More Equitable Communities]]>

The Robert Wood Johnson Foundation Sports Award is removing barriers to health equity through sports.

A smiling student holds a basketball while standing in a school hallway.

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.

RWJF Sports Award Winners Change Lives

Community-level work is taking place, too, as institutions are using sports to empower people who have faced discrimination, create new opportunities, build bridges, transform young lives, and advance health equity—with many stepping up to support youth and families during the pandemic. RWJF Sports Award winners include the philanthropies of well-known athletes, such as the Tony Hawk Foundation, now called The Skatepark Project, and the MaliVai Washington Youth Foundation, and professional sports franchises like the San Francisco Giants. Winners include innovative community initiatives, too:

Figure Skating in Harlem, a 2019 RWJF Sports Award winner, seeks to empower every young girl with foundational academic, social and leadership skills to achieve her dreams.
  • Figure Skating in Harlem is a pioneering youth development organization that combines the power of education with access to the artistic and athletic discipline of figure skating to help girls of color thrive. Its mission is to help girls transform their lives and grow in confidence, leadership, and academic achievement. Its vision is for every student, regardless of socioeconomic background, to develop the foundational academic, social and leadership skills to achieve her dreams, become an effective leader, live a healthy lifestyle, and be a global citizen. With 23 years of experience in New York City, Figure Skating in Harlem won an RWJF Sports Award in 2019.
  • InnerCity Weightlifting reduces youth violence by connecting at-risk young people with new networks and opportunities, including meaningful career tracks in and beyond personal fitness. A nonprofit with a unique business plan, the organization takes a skill that many develop while incarcerated—pumping iron—and turns it into a professional asset. With training, and lots of personal support, InnerCity Weightlifting helps people who were once incarcerated restore their standing in society while they earn a livable income and learn the ropes of the fitness industry. It won an RWJF Sports Award in 2016.
  • Soccer in the Streets has reframed health equity around transit hubs in the inner city by repurposing unused land in the heart of Atlanta to be more inclusive, safe, resilient and sustainable. With a mission to create young leaders who live rich lives and cultivate healthy communities, the organization is a city-wide community project built around a vision to create a network of mini soccer fields, anchored by MARTA transit stations. This innovative place-making project aims to connect communities and help cultivate healthy lifestyles through sport and transit. It offers soccer training, small group classroom sessions, hands-on experiences, and youth leadership councils. It won an RWJF Sports Award in 2020.
  • A binational youth development organization, Border Youth Tennis Exchange (BYTE) offers professional tennis instruction and academic enrichment to kids ages 8–12 on both sides of the U.S./Mexico border in Nogales, Arizona and Nogales, Sonora (Mexico). The program uses tech-based enrichment curricula, facilitated by bilingual local educators working in non-traditional teaching spaces, such as gymnasiums and public parks. A chapter of the United States Tennis Association’s National Junior Tennis & Learning network, BYTE strives to be a leader in sports-based diplomacy, earning it an RWJF Sports Award in 2020.

Other recent RWJF Sports Award winners include Running Medicine and the United States Association of Blind Athletes (USABA). Running Medicine is a family-oriented walking and running program for Native Americans in Albuquerque that is creating a Culture of Health available to all people regardless of ability, age, fitness level, or ability to pay. USABA uses adaptive sports to assist and support individuals who are blind and visually impaired, proving that ability should not dictate one’s health and well-being.

A Vibrant, Collaborative Community

The impact of the RWJF Sports Award goes far beyond the monetary prize the winners receive. The Foundation runs a “learning day” each year for current and past winners and finalists, with approximately 40 organizations represented. The community that has been created is vibrant and active, with participants often seeking advice from and sharing challenges and successes with each other.

In a survey of finalists and winners taken in 2019, 94% said connecting with other national and community leaders was a very or somewhat important factor in their decision to apply for the award. When asked how the process of applying for the RWJF Sports Award influenced their thinking, one respondent wrote: “We recognize the power of sport to keep youth engaged and transform a community. When thinking about health equity, we thought about changing systems to make the healthy choice the easy choice. Sport is a great tool to engineer play back into the lives of children, making an active lifestyle a default option.”

RWJF’s engagement with sports has helped other major national and state foundations recognize the power of sports and helped advance the field of sports philanthropy, which now includes sports team owners and leagues, media companies, local funders, foundations led by individual athletes, corporate supporters, and others.

“The RWJF Sports Award has, quite simply, raised the bar in the field of sports philanthropy,” said Sue Petersen, Executive Director of the San Francisco Giants Community Fund. “We were tremendously proud to receive this honor in 2017 and we recognized that it wasn’t something you get at the end of doing a good job; it was meant to be a launching pad and an expectation to do more. We’ve taken that responsibility seriously. Like the role that a pro sports foundation plays in its community, RWJF in an influencer in communities throughout our country. The foundation’s statements, partnerships, programs, grants and campaigns deliver solid information and help society change for the better.”

See more stories about how sports organizations are creating healthier communities.



Alisha Greenberg is an expert on sports philanthropy and director of the Robert Wood Johnson Foundation Sports Award.

Thu, 25 Mar 2021 13:00:00 -0400 Alisha Greenberg Child and Family Well-Being Public and Community Health National <![CDATA[How School Meals Help Families Impacted by the Pandemic]]>

School meals are a lifeline to tens of millions of families across the country. Learn about new research showing why healthy meals are so important—and opportunities to help schools ensure more families have access to the healthy foods they need.

Families gather in long car lines at a Houston distribution site. Families gather in car lines at a Houston meal distribution site. Photo Credit: Houston Independent School District

On a typical day before the pandemic, school food service workers across America did far more than serve lunch to the nearly 30 million children participating in the National School Lunch Program, and the nearly 15 million participating in the School Breakfast Program. Many also served afterschool snacks and even dinners for students to take home to their families. These school meals are a lifeline for tens of millions of kids and families who are furthest from economic opportunity.

All of this changed in March 2020 when schools across the country began closing in droves in response to COVID-19. Students in Houston were getting ready for Spring Break just as lockdowns began. This timing meant that instead of being stocked to serve students for the week, refrigerators across the Houston Independent School District (HISD) were empty.

Upon facing the reality that millions of families across Houston would need food, Betti Wiggins, the nutrition services officer for the HISD, sprang into action.

She knew the Houston Food Banka well-oiled meal distribution operationcould help. In spite of the short notice, they joined forces with Betti and her staff, along with other partners and volunteers. Using a warehouse the size of four football fields, they packaged thousands of bags of food. These meals were transported in long refrigerated trucks to distribution sites across Betti’s district as well as to 17 additional districts across Houston. As a result, she was ready to distribute food to car lines of families from across the city.

Feeding intergenerational families all year-long

Betti also understands that school meals do more than help kids. When preparing meals for distribution, she considers the intergenerational families that kids come home to. She aims to provide quality, nutritious meals to any person who needs food during the COVID-19 pandemic. Betti calls feeding families one of HISD’s “wraparound services” and considers providing meals vital to her mission.

That includes holiday meals, which she believes not only align with the district’s nutrition goals, but also the needs of students and families. Last fall and winter, many families in Houston and across the country were struggling to provide regular meals, along with holiday celebrations and gifts. So, working with HISD and No Kid Hungrya national campaign working to solve problems of hunger and povertyshe provided meal boxes, canned vegetables and turkeys, as well as hygiene kits and cleaning supplies. As a result, families enjoyed holiday dinners together without worrying about how to pay for other expenses, and students returned to school well-nourished and ready to learn.

Betti discusses the unique needs of intergenerational households in her own words in this 30 second soundbite: 

Providing critical nutrients for millions of families

The latest data project that in 2021, more than 42 million Americans, including 13 million children, will experience food insecurity, meaning they will not be able to afford enough food to support a healthy life. Before COVID-19, more than half of American students and their families relied on free and reduced-price school meals as their primary source of nutrition. In fact, many children consume up to half their daily calories at school.

Research underscores the importance of nutritious school meals for kids’ health. One study that examined the impact of updating nutrition standards for school meals starting in the 2012-13 school year found that by 2018, the prevalence of obesity among children in families with low incomes was 47 percent lower than would have been expected without the healthier standards. The researchers estimate that this translates to more than 500,000 fewer cases of obesity.

And a series of studies released earlier this year adds to the growing body of evidence that supports the stronger nutrition standards USDA put in place nearly a decade ago. I spoke with Mary Story, PhD, Program Director for Healthy Eating Research about the new studies that show serving healthier meals not only boosts students’ participation in programs, it also does not cost more money.

Expanding support for kids’ health beyond the pandemic

Innovative heroes like Betti Wiggins, and others like her all across the country, know that the meals they provide ensure millions of kids are getting the essential nutrients they need. It’s a critical service and support for families, especially during a pandemic. But the “Bettis” of the country cannot and should not do it alone. Our schools and families need support from all levels of government to ensure that nutritious school meals are available to every child who needs them now and in the months and years to come.

RWJF's Jaimie Bussel discusses new research findings on school meals with Dr. Mary Story, Program Director of Heatlhy Eating Research.

A recent report on the State of Childhood Obesity: Prioritizing Children’s Health During the Pandemic details how the pandemic has affected school meals, and how the U.S. government has responded and must continue to respond, so that these leaders can continue to provide healthy meals for kids.

COVID-19 relief measures passed by Congress since March 2020 enabled USDA to issue nationwide waivers that permit schools to serve meals to all students free of charge. In addition to ensuring that every child has a consistent source of good nutrition, universal school meals—which is now in place through at least September 30, 2021—also reduce time-consuming and expensive administrative burdens for states and school districts, guard against the additional accumulation of unpaid meal debt, and eliminate the stigma, bullying, and harassment that children who qualify for free or reduced-price meals can experience. The COVID-19 relief measures also enabled USDA to approve state plans to provide emergency assistance—through SNAP—to households with children who would otherwise receive free or reduced-price meals at school. The relief legislation has also provided $8.8 million in additional funding to cover food purchases and demonstration projects to increase flexibility for schools.

The pandemic has highlighted the importance of school meals, not only for preventing child hunger but also for ensuring millions of families have access to healthy food. Emergency measures that strengthen and improve school meals programs must continue and be expanded throughout recovery to ensure that all children have enough nutritious food. It has been more than a decade since Congress last reauthorized the Child Nutrition Act, legislation that covers school meals and other federal nutrition programs. Reauthorizing that law has never been more timely in light of the pandemic, and represents a significant opportunity for Congress to build on the critical gains ushered in by the previous reauthorization of that law, known as the Healthy, Hunger-Free Kids Act of 2010.

At the Foundation, we believe every childand every familyin this country deserves a fair and just opportunity to live the best, healthiest life possible. That means families should be at the center of policy discussions and every effort should be made to strengthen policies so families have the supports and resources they need to raise healthy kids. School meals have always had a critical role in helping kids grow up healthy. Throughout recovery from this pandemic and beyond, they truly will be a lifeline for millions of kids.

Learn more about our recommendations for improving access to healthy schools meals.



Jamie Bussell

Jamie Bussel is a senior program officer who focuses on ensuring that all children have the building blocks needed to promote lifelong health. Follow her on Twitter: @JBussel

Tue, 16 Mar 2021 13:00:00 -0400 Jamie Bussel Child and Family Well-Being Early Childhood National <![CDATA[Connecting Systems to Build Health Equity During COVID-19]]>

We’re seeking the best ways to work together to address racial inequities. Sign up for funding alerts to receive information on the next round of research grants.        

Demonstration sign.

Editor’s note: This piece was originally published in July 2020.

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. An invitation to a cancer research conference hosted at a neighboring public school was an eye-opening experience. 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 opportunities within the school were offered to only a few. 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.

It was some years before I learned the language that explained the difference. Studying law gave me a framework to consider racial inequality by exposing me to structural barriers such as red lining, the school to prison pipeline, and Black exclusion from wealth building opportunities such as the GI Bill. I carried this framing into my later work advocating for health equity in public policy and health services research. My early experiences clarified for me what was already intuited. Race-based inequities aren’t the result of personal choices. They reflect societal decisions that give blackness second-class status and normalize their unmet needs.

This knowledge has been empowering for me because it informs the pathway to change.

Understanding Systems

A strong evidence base confirms what many of us recognize intuitively—multiple systems influence health and must be aligned to improve lives. For example, one significant study found that when systems collaborate, there are fewer premature deaths from cardiovascular disease, diabetes, and the flu.  

Conversely, fragmented systems prevent us from treating the whole person. Urging a diabetic to eat nutritious food doesn’t mean much if she lives in a food desert. Providing someone else with job training but taking away his subsidized medical care once he is employed is self-defeating. Policies that keep people who have been involved with the criminal justice system out of public housing break the link between a secure home and positive health outcomes.

There are many tools to align systems—including integrated financing streams, joint governance bodies, inter-organizational agreements, pooled data, and shared workforce models. But we need to learn more about what works best and get that into wider practice.

At Systems for Action, we are supporting projects that test novel ways to repair pervasive fragmentation, including these:

  • In Chicago, the Comprehensive Care, Community, and Culture Program (C4P) pairs high-need patients with a single outpatient and inpatient medical provider. It provides systematic screening for unmet social service needs, access to a community health worker, and community-based arts and culture programming.

  • In Atlanta, Georgia State University researchers plan to test whether improving transportation for low-income patients with diabetes improves access to care while reducing health care costs. These improvements could include vouchers for public transit and ride-share apps, so they can more readily reach medical care and sources of fresh food. The research question: does enhanced mobility improve access to care, diabetes progression, and the use and costs of services? 

  • In Florida and Texas, hospitals and clinics are increasing screenings for social determinants of health so systems can work together to improve health outcomes more equitably. The screenings result in more referrals to nonprofits and other community-based organizations. It’s sometimes unclear the organizations’ capacity to absorb these increased referrals for services. New research sheds light on how to strengthen cross-system integration and expand effective partnerships.

COVID-19 Enters the Equation

The COVID-19 pandemic has heightened our sense of urgency. There’s a through-line from our ongoing work at Systems for Action across COVID-19 and the racial injustice that has sparked such an outpouring of protest. Black and Latino communities have borne the brunt of the pandemic—from the risk of infection and the severity of the illness to its economic reverberations. And the racist practices that have been so vividly documented in numerous locales have also sent a stark message about the need for system-wide change.

I’m not naïve enough to believe that if we could just align our systems, we would vanquish racial disparities but I am convinced the pressure we are seeing on communities of color foregrounds the power of better alignment. New data stemming from that same study I mentioned earlier about diabetes, heart disease, and the flu suggest that communities with strong multi-sector networks have fewer COVID-related deaths and lower infection rates. That information should certainly inspire action.


Black and Latino communities have borne the brunt of the pandemic—from the risk of infection and the severity of the illness to its economic reverberations. And the racist practices that have been so vividly documented in numerous locales have also sent a stark message about the need for system-wide change.


Some of our projects have pivoted to respond to the pandemic. The CCP project in Chicago, which is a sister program to C4P (described above), designed a communication campaign. It includes town hall meetings, videos and infographics, on how to care for oneself and help protect others during the pandemic. Researchers in Atlanta, as another example, recognize that public transportation may a pose high risk for some. They are looking at other ways to meet the needs of diabetic patients. One possible approach is improving access to broadband technology and measuring to see whether it reduces social isolation and the associated health effects.

My personal and professional journeys have led me to much the same awareness—systems need to work together to advance health equity. Let’s all join forces to push that alignment forward. Find out how cross-sector collaboration can help communities improve health outcomes for their residents

Researchers, sign up for RWJF’s funding alerts. We will notify you of our next round of funding.


About the Author

Chris Lyttle, JD

Chris Lyttle is the deputy director of Systems for Action, where he provides strategic direction on cross-system collaborations that address the social determinants of health.  

Mon, 1 Mar 2021 00:00:00 -0500 Chris Lyttle Health Disparities Disease Prevention and Health Promotion <![CDATA[New Narratives of Hope This Black History Month–And Beyond ]]>

More than 50 years after the civil rights movement we still have a lot to do to reduce discrimination and increase health equity. Dwayne Proctor reflects on the role of stories in the search for solutions.

An older student plays around with a younger student in a school auditorium.

Author’s note, February 2021: My post below was first published in February 2018. Over the past harrowing year, the issues it explores have become even more urgent, as the murder of George Floyd triggered a racial reckoning during a global pandemic that has hit communities of color hardest. In the midst of it all, systemic racism continues to take a brutal toll. The death of Dr. Susan Moore, who called out the racism she was experiencing as a patient, is just one example. Moore’s death, and those of Clyde Murphy and Shalon Irving, which I wrote about in my blog, are painful reminders of the cost of letting such racism continue. In the words of RWJF Trustee Dr. David Williams: “The first thing we have to do is acknowledge that the everyday racial discrimination embedded in our culture is sickening and killing African-Americans, and make a new commitment to make America a healthier place for all.”

One of my earliest and most vivid childhood memories is watching from my bedroom window as my city burned in the riots that erupted after Dr. Martin Luther King Jr.’s assassination 50 years ago.  

The next afternoon, my mother brought me to the playground at my school in Southeast Washington, D.C., which somehow was untouched. As she pushed me in a swing, she asked if I understood what had happened the day before and who Dr. King was.

“Yes,” I said. “He was working to make things better for Negroes like you.”

My mother, whose skin is several tones darker than mine, stared at me in surprise. Somehow, even at 4 years old, I had learned to observe differences in complexion.

That is particularly interesting to me now, as I eventually came to believe that “race” is a social construct.

Of course racism and discrimination exist. They are deeply embedded in America’s history and culture—but so too is the struggle against them.

Over 50 Years After the Civil Rights Act, Discrimination Persists

We are now more than 50 years beyond the civil rights movement, yet change has been excruciatingly slow. For example, despite passage of the Fair Housing Act in 1968, housing discrimination persists. Forty-five percent of black people surveyed in a 2017 NPR/Harvard T.H. Chan School of Public Health/RWJF poll say they have faced discrimination when trying to rent a room or apartment or buy a house.

While racial discrimination in hospitals nominally ended in 1964 with the signing of the Civil Rights Act, racial health gaps not only continue; in some cases, they have gotten worse. As recently as 2015, black babies are more than twice as likely as white babies to die before their first birthdays. And death rates from breast cancer are 42 percent higher among black women than white women, even though the prevalence is about the same.

I see inequity wherever it exists, call it by name, and work to eliminate it. Shalon Irving (July 9, 1980–January 28, 2017)

The numbers themselves are startling. But they take on added meaning when you consider the stories—millions of them—of real people, who face discrimination every day of their lives.

Sharing Your Story With the World

I’m reminded of the words of Carter Woodson, the black historian and educator who established Negro History Week, the precursor of Black History Month, which we are in the midst of celebrating.  “You must give your own story to the world,” Woodson declared.

How true that is.

Through our stories we call attention to racism and discrimination and assert our fundamental human dignity.

And by telling our stories, we demand solutions.

I see storytelling as essential to building a Culture of Health, where everyone—no matter where they live, how much money they make, or who they are—has the opportunity to live the healthiest life possible. By acknowledging each other’s stories, we recognize that racism and discrimination are monumental barriers to our goal of achieving health equity. We simply can’t have a Culture of Health without health equity. Dr. King himself noted that “of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Everyday Discrimination Measurably Diminishes Health

Take the tragic story of Shalon Irving, a brilliant epidemiologist at the Centers for Disease Control and Prevention. Shalon was working to understand how structural inequality, trauma and violence made people sick. She asserted her commitment on her Twitter bio, noting “I see inequity wherever it exists, call it by name, and work to eliminate it.” In a tragic irony, Shalon’s life was abruptly cut short at the age of 36 when she collapsed and died three weeks after giving birth. In the weeks leading up to her death, Shalon’s futile attempts to bring attention to concerning postpartum symptoms were dismissed by medical professionals according to Shalon’s mother. Shalon’s socioeconomic advantages and expertise in health inequity could not protect her from the reality that black mothers in the United States die at 3 to 4 times the rate of white mothers.

Higher educational attainment—which can lead to higher incomes and the ability to live in healthier neighborhoods and to access high-quality health care—can’t protect African-Americans from the disparities leading to higher mortality rates. This was also the case for Clyde Murphy, a renowned civil-rights attorney who died of a blood clot in his lungs 41 years after graduating from Yale University. Soon after Clyde’s death, his African-American classmates Ron Norwood and Jeff Palmer each succumbed to cancer. In fact, it turned out that more than 10 percent of African-Americans in the Yale class of 1970 had died—a mortality more than 3 times higher than that of their white classmates.

Clyde and Shalon’s disturbing stories and the stories of too many others force us to confront the injustice of discrimination—how the toll of incessant stress and implicit bias within the health care system can progressively erode one’s health.

Love means acknowledging and respecting the pain of others. When people do that, they can focus on how to heal and move forward, together.

Research shows how discrimination influences and determines how long and healthy our lives are. Experiencing discrimination day after day creates physiological responses that lead to premature aging (meaning that people are biologically older than their chronological age), as well as poorer health compared to other groups, and even premature death.

Through the 2017 NPR/Harvard T.H. Chan School of Public Health/RWJF poll we sought to gain a deeper understanding of daily personal experiences with discrimination from members of different ethnic, racial, and LGBTQ groups. As Woodson has suggested, this can help us better understand the reality of everyday discrimination that people face when looking for housing, interacting with police, seeking medical care, and getting a job.

Specific findings from the survey include:

  • Half or more of African-Americans say they have personally been discriminated against because they are black when interacting with police (60%); when applying for jobs (56%); and when it comes to being paid equally or considered for promotion (57%).
  • Four in 10 African-Americans say people have acted afraid of them because of their race, and 42% have experienced racial violence.
  • African-Americans also report attempting to avoid potential discrimination or to minimize their interactions with police. Nearly a third (31%) say they have avoided calling the police, and 22% say they have avoided seeking medical care, even when in need, both for fear of discrimination.
  • Similarly, 27% of black Americans say they have avoided doing things they might do normally, like driving a car or going out socially, to avoid encounters with police.

These poll findings—along with stories of Clyde and Shalon—underscore an urgent need to join in working harder than ever to shape solutions—solutions that spawn new stories where everyone enjoys an equal opportunity to live longer, healthier, and happier lives without the constant fear of discrimination.

Shaping New Stories of Hope

Through our work to understand everyday discrimination and its impact on health, we’re also learning about efforts to shape these new stories of hope.

In one such story more than 60 community- and faith-based organizations are collaborating with the Campaign for Black Male Achievement to create better futures for young African-American men and boys. This coalition has created an initiative called “Zones of Hope” designed to restore a sense of place and connection for marginalized neighborhoods, families, and young people. The idea is to reduce violence among young black men and boys (ages 16–27 years old) by increasing high school graduation rates, improving access to after-school programs, and expanding job opportunities. As community leader Rashaad Abdur-Rahman noted at an RWJF-sponsored event examining discrimination’s effect on health, this project has transformed relationships; built new partnerships; and rallied the education, government, and justice systems—to invest in supporting boys and young men of color so they can achieve their full potential.    

This is the kind of comprehensive, community-based approach that fills me with hope for better, brighter stories in the future.

Not believing in race means believing in love—and love means acknowledging and respecting the pain of others. When people do that, they can focus on how to heal and move forward, together.

Take the time to listen to these stories of how communities are coming together to root out Discrimination in America.



Headshot of Dwayne Proctor

Dwayne Proctor, PhD, senior adviser to the President, believes that the Foundation’s vision for building a Culture of Health presents a unique opportunity to achieve health equity by advancing and promoting innovative systems changes related to the social determinants of health.

Tue, 9 Feb 2021 00:00:00 -0500 Dwayne Proctor Health Disparities Social Determinants of Health <![CDATA[Community Health Workers: Walking In The Shoes of Those They Serve]]>

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

Woman wearing protective mask taking groceries from caring volunteer.

It didn’t take long last Spring for Dr. Shreya Kangovi to realize that the COVID-19 pandemic would create a tsunami of inequity where inequity already long existed. Then the murder of George Floyd led to a national racial reckoning, too. Kangovi knew that community health workers (CHWs)—a field she is helping to pioneer and advance—are first responders on all those fronts.

A recipient of a 2019 RWJF Award for Health Equity, Kangovi is a primary care doctor in Philadelphia, a health policy researcher, and a professor who works to improve health equity. Kangovi developed IMPaCT, a community health worker program that relies on trustworthy individuals to help their community members improve their health and well-being. In randomized controlled trials, IMPaCT has improved chronic disease control, primary care access, mental health, and quality of care while reducing hospital admissions. It is the nation’s most widely disseminated CHW program.

Kangovi shared insights about the ways CHWs advance equity and better health, and the role they can play as we cope with and recover from the coronavirus pandemic.

Who are community health workers and how do they advance health equity?

There is tremendous variation, but CHWs are trustworthy individuals who share life experiences with those they serve. They understand what it’s like to face injustice or be overlooked. They also have a personality type defined in sociology literature as “natural helpers.” So it’s a combination of demography and ideology.

CHWs are trained to navigate systems, such as health, housing, and legal support, and to link community and clinical services to help people in their own communities lead healthier lives. They meet people where they are, get to know them as human beings, learn their life stories, then ask them how they want to improve their life and health. They may need help connecting to food assistance, planting a community garden, battling an eviction notice, running an anti-racism training for police, or navigating other issues.

Dr. Kangovi discusses IMPaCT, a standardized, scalable community health worker program which has been proven in three randomized controlled trials to improve chronic disease, primary care access, mental health and quality of care while reducing hospital admissions.

If you haven’t been in the shoes of the person you are working with, you are more likely to be biased. Clinicians may believe we know what our patient needs, and screen and refer her. That’s neither effective nor trustworthy. CHWs change this dynamic.

In rural Tennessee, a CHW might work at a faith-based organization. He will meet somebody at a church, food pantry or local hospital. He’ll take an hour to get to know that person—to learn where he was born, what happened in his life, what challenges he faces, his successes, and how he wants to improve his life and health. There is some shared life experience. CHWs always reflect back to the person and ask: What do you want to do about that? Then they create a step-by-step plan together. It might include battling an eviction notice, organizing a virtual funeral for someone who died of COVID, or going together to a doctor's appointment.

What role are community health workers playing in the pandemic and what role should they be playing?

COVID disparities are a symptom of an underlying pandemic of injustice that has persisted through history. Headlines have shown that Black and Brown people are disproportionately dying of COVID. Millions of Americans are going hungry in a new Great Depression while others are getting rich. Ultimately this all stems from the same problem: the trajectory of health inequities.

That’s why CHWs are an incredibly valuable workforce. They don’t just address symptoms or disease; they go straight to the root and identify solutions. We had a pandemic of racial and economic injustice long before COVID. So we need more than a vaccine. The hardest thing is to address the full range of social determinants of health but it’s the only way to advance health equity.

Can community health workers help overcome reluctance or resistance to vaccination?

As a public health scientist myself, I want to help people get better and vaccination is critical. CHWs can help with access and information, but they are trusted because they are trustworthy. Being trustworthy means not having an agenda and just offering help. It’s incumbent on us in public health to communicate the good science we have done in a very accessible way so people can make their own decisions about whether or not they want to take the vaccine.

What gives you hope right now?

On the policy front, I think this is our moment. This work began as grassroots and it still is. CHWs are meeting people on their porches and at their bedsides, asking them how we should build this workforce. Community-engaged scientists are doing strong randomized trials that not only demonstrate that CHWs can be effective, but also how. We’re working with the National Committee for Quality Assurance (NCQA) to translate that science into standards for the CHW workforce. So I think we're ready for scale.

There are approximately 50,000 CHWs in the county. That’s not nearly enough. President Biden’s proposal to create jobs for 150,000 CHWs would get us a lot closer to where we need to be. We helped inform the Biden proposal. We worked with bipartisan lawmakers on proposals to pay CHWs for the full range of work they do. We’ve had great conversations with the Centers for Medicare & Medicaid Services (CMS) about allowing Medicaid to fund the full range of supports CHWs provide. That’s the most momentum we’ve seen in this field. That gives me great hope.

Learn about how another RWJF Award for Health Equity winner is leading efforts to support mental health in communities of color during the pandemic.


About the Author

Headshot of Dwayne Proctor

Dwayne Proctor, previously senior adviser to the president at the Robert Wood Johnson Foundation, is now the president and CEO of Missouri Health Foundation.

Tue, 2 Feb 2021 10:30:00 -0500 Dwayne Proctor Public and Community Health National <![CDATA[Understanding Our Health Before the Pandemic Can Help Us Improve It Afterward]]>

Measuring health and the social and economic factors that influenced it before the pandemic helps us understand the kind of risks the nation faced previously. It can also inform how to move forward toward recovery. 

Man receives blood pressure test.

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. 

What was the nation’s health before the pandemic?

In 2019, when we updated the measures, we reported small, positive changes in appreciation for social determinants of health and the need for broader community health investments. However, we also found slow progress on education, housing and other systemic factors that influence health, well-being, and equity. Now, COVID-19 has added stress to many of those systems. 

In our 2020 update, we again had some notable improvements in areas likely susceptible to pandemic impacts (e.g., mental health, health care). Still, progress on social and economic drivers that influence health remained slow. Here is what we found.

  • Sectors that influence health are making some progress. To achieve a Culture of Health, sectors outside of health care and public health (e.g., media, business) must recognize and leverage their influence on health outcomes. For instance, youth exposure to advertising by the corporate food and beverage sector is associated with children asking parents to buy specific—and potentially unhealthy—foods. This challenge may have become more acute as families stayed home during the pandemic. In 2018, data from Nielsen Media Research indicated that young children viewed an average of 1.7 food product ads daily during children’s programming, which was down from 2.5 ads in 2015. Nearly 71% of the products advertised failed to meet federal guidelines for nutrition standards, down from 80% in 2015. While more improvement is needed, these pre-pandemic decreases indicate that the food and beverage sector is either making healthier products or reducing advertising of unhealthy products to children—which may improve equity in terms of healthy weight.
  • Progress on mental health and well-being is mixed. Adverse childhood experiences (ACEs) are linked to mental illness, chronic health conditions, and premature death. The physical, social, and economic environment in which children live can influence their exposure to ACEs. There may be signs of hope on this front. The National Survey of Children’s Health data showed that, in the most recent data (the 2017–2018 school year), 42% of children in the United States had one or more ACEs, such as family divorce, domestic violence, or drug or alcohol use problems in the household. That is a 3 percentage point reduction from what was reported in 2016–2017. While this finding is promising, it will be important to track whether the pandemic worsens and increases exposure to ACEs. In contrast, general well-being as measured by life satisfaction did not improve in the years prior to the pandemic, according to the OECD Better Life Index, which found no improvement in life satisfaction (reported at just 6.9 on a ten-point scale) among U.S. residents aged 15 years and older from 2014–2016 to 2015–2017. Now the pandemic is testing an already-low U.S. life satisfaction that likely is worsening due to COVID-19.
  • There are improvements in the health sector, but costs remain high and flexibility elusive.­
    • New payment and health care delivery models are intended to provide higher value care. Analysis by Leavitt Partners found that, as of the end of 2019, about 12% of the U.S. population had a health care provider who is part of a population-based alternative payment program, an increase of about 2% since 2018. This may mean that more people have better care at lower cost.
    • However, the news prior to the pandemic was not all rosy. According to Medicare beneficiaries’ data (Kapinos, 2020), in 2017 the average total health expenditures in the last year of life was $66,176. This number has gone up by an average of about $3,000 per year since 2013. The pandemic’s pending health care bills will only exacerbate rising health care costs.
    • Finally, removing scope of practice barriers for nurse practitioners can broaden their ability to provide diagnostic and treatment services, which can improve COVID response, particularly in medically underserved areas. But before the pandemic, there had been no increase in the number of states with full practice laws for these health care providers (holding at only 22 states since 2017).  
  • Progress to create healthier, more equitable communities remains slow. The community conditions that represent some of the most entrenched, systemic issues are usually not tracked with other health measures, even though they are key influences on health. There is no improvement in environmental protections such as the number of states with cross-sector climate action plans (in fact, Alaska rescinded its plan) or states with air quality protections in bars and restaurants. 2020’s reckoning on racial issues is occurring at a time when the nation still has significant racial residential segregation. And while there was no change in 2018 from prior years in the percentage of American households spending 50% or more of their income on housing (12%), there was some improvement since 2014 in the burden on communities of color (an average reduction of 3%). However, there remains a disproportionate housing cost burden on Black, Hispanic/Latinx, and American Indian/Alaskan Native households, which are communities being disproportionately affected by COVID-19.  

What do these changes mean and where do we go, given the pandemic?

Measuring health and the social and economic factors that influence it before the pandemic gives us a picture of the kind of risks the nation was dealing with before the devastation 2020 brought. In sum, the nation was making slow progress in some areas but was not moving the needle nearly as rapidly as many would hope to improve key aspects of our health care system, our environment, and our economic conditions. Critical systemic changes needed for more transformative health improvements have been slow or stalled and, as a result, inequities remain pervasive.

As we look ahead and capture more detailed information on COVID-19’s effects, it will be important to track whether these Culture of Health measures worsen or appear resilient to further stress. Even if it is unlikely that we will observe improvements in many areas of health, social status, and the economy during the pandemic, continuing to track the choices and investments various sectors make to cultivate healthier communities can inform the choices we make and directions we take going forward. In fact, it may be key to the nation’s ability to recover from 2020.

A fuller description of these measures and the data underlying them can be found at Making progress on them is imperative if we are to become a healthier, more equitable country.



Carolyn E. Miller is a senior program officer in the Research-Evaluation-Learning unit of the Robert Wood Johnson Foundation.

Anita Chandra is vice president and director of RAND Social and Economic Well-Being and a senior policy researcher at the RAND Corporation.

Fri, 29 Jan 2021 10:45:00 -0500 Carolyn Miller Disease Prevention and Health Promotion Public and Community Health Social Determinants of Health National <![CDATA[In a Worldwide Health Crisis, Lessons From Resilient Communities]]>

No community has had it easy during COVID-19. Those with a consistent health equity focus before the pandemic have found advantages in facing the crisis. 

Men distribute food.

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.

In this post, we highlight five examples of how Prize-winning communities—the Bronx, N.Y.; Lake County, Colo.; Santa Monica, Calif.; Shoalwater Bay Indian Tribe of Washington; and Spartanburg County, S.C.—are responding to COVID-19. They shared their experiences as part of a virtual panel session of the Culture of Health Prize learning event in October 2020.

Building Strong Relationships

In the Bronx, N.Y., long-established relationships with community members have positioned the local government and service organizations to offer social support when disaster strikes, said Fernando Tirado. Tirado is the director of new initiatives at Bureau of Bronx Neighborhood Center for Health Equity and Community Wellness, which provides health care, community space, and health and wellness classes.

Tirado said that the isolation that jeopardizes people at risk during a crisis like a heat wave would have been an even larger problem during the pandemic without the existing social supports. Informing people about how they can protect themselves and others, and enabling them to access the resources to do so, has been crucial. Thanks to their previous work, partners in the Bronx knew they could reach people without email or telephones by instead relaying messages at local food pantries, farmer’s markets, and senior events.

Rich Besser, RWJF’s CEO and former acting director at the CDC, hosted a town hall with Culture of Health Prize communities.

Before the pandemic, the 2015 Culture of Health Prize-winning community's “Be a Buddy” system sought to protect people from heat exhaustion by sending volunteers from local universities to check on, provide resources to, and build relationships with individuals who may distrust government programs. With strong relationships in place, once COVID-19 hit, the project morphed to assist people during the shutdowns.

“Resiliency takes practice,” said Tirado.

Finding Common Ground

Early in the pandemic, 2019 Culture of Health Prize-winning community Lake County, Colo., established a committee to address the needs of people who don’t qualify for government assistance, but still struggle with things like housing and utility bill payments. The committee funnels people in need to various service agencies, which review cases and offer financial support. The Unmet Needs Committee was on track to pay half a million dollars in housing and utility bills by the end of 2020, said Katie Baldassar, executive director of Lake County Build a Generation, which conducts research on social issues in the community, opens communication between stakeholders, and mobilizes funding for programs. The group has long-established partnerships with residents of the county’s manufactured housing communities who have organized for better health and safety where they live.

To be able to respond to the pandemic in an inclusive way, the county needed to bridge gaps between people and groups with varying political views. These groups included businesses, nonprofits, social service and other government agencies. For example, the owner of a manufactured housing community raised rents during the pandemic. In response, the committee asked elected officials to write a letter noting that it was not a time to raise rents, given how community members were struggling with lost wages or job uncertainty. Some officials initially didn’t believe the government should intervene in private business decisions. However, the committee persuaded policymakers to send the letter, based on a common desire to make the most of taxpayer dollars in the county’s rental assistance programs and to keep families housed.

“We realized we had really different ideas about how to solve these problems and different mental models about how the world works,” Baldassar said, “so we had to learn how to talk across those differences in a way that would deepen those relationships rather than breaking them. I think being able to do that has brought us closer as a community.”

Ensuring the Well-Being of a Community

Santa Monica, Calif., proved that developing health-equity tools in normal times can make operations move more smoothly during a crisis. Before the pandemic, the 2016 Culture of Health Prize-winning community designed a “Wellbeing Index” to measure how people are doing, from their sense of community to their opportunities for health and economic opportunity. For example, said Lisa Parson, special assistant for equity and community recovery, do they have frequent social contact? Can they afford medical services and housing?

Parson said the index, regularly used for long-term planning, also informed the city’s pandemic-response efforts. The data they had already gathered revealed where to direct aid and guidance. For example, in one neighborhood where residents had the lowest wellbeing rating in part due to food insecurity, the city started a food pantry. The city has also boosted communication with its local nonprofit and business partners. Together they’ve solved new problems that emerged during the pandemic, such as keeping restaurants open through open-air dining or offering food delivery to comply with pandemic guidelines.

Creating an Inclusive Response

At the onset of the pandemic, Shoalwater Bay Indian Tribe—a 2016 Culture of Health Prize-winning community—was already well-positioned to leverage the community’s strengths in order to respond in an inclusive way. The tribe’s location in the tsunami zone, an area of the Pacific coast that is at risk for tidal waves, has forced the tribe to focus on emergency preparedness and plan for most types of crises—including a pandemic.

In the early days of COVID-19, the tribe’s crisis planning enabled it to quickly open a food pantry so families could get food without leaving the reservation, amp up efforts at their community garden, and hire more kitchen staff to prepare and deliver meals to elders.

According to Shoalwater Bay Indian Tribe planner Jamie Judkins, another secret to the tribe’s success was quickly establishing communication. “Any communication is key—making sure you have opportunities for people to come in and share ideas and build good solid foundations for wellbeing,” Judkins said.

Addressing Economic Conditions

For about five years, Spartanburg County, S.C., a 2015 Culture of Health Prize-winning community, has emphasized race, equity and inclusion in its health and social services efforts, said Paige Stephenson, president and CEO of United Way of the Piedmont. So, when COVID-19 exacerbated existing inequalities in access to health care, education, and economic stability, she said, “We doubled down.”

The pandemic gave momentum to discussions that the community had long had, such as improving broadband infrastructure and access. “It’s become clear to our local leadership that that’s what we really need to hone in on,” Stephenson said.

Improving child care infrastructure has also gained new urgency for this community with a large workforce in manufacturing, which happens round the clock. Stephenson and others have consulted with other communities that have a track record providing reliable 24/7 child care.

“Child care is an invisible foundation for the workforce,” she said.

They show how important it is to provide not only immediate crisis relief, but to work toward long-term change by boosting access to affordable housing, good wages, food, child care, and broadband.

Inspiring Examples

Prize-winning communities shine a light on what’s possible when community leaders and residents unite to leverage community strengths and address the barriers to a fair and just opportunity for health for all. Their responses to COVID-19 demonstrate the importance of collaborating and taking data-informed and inclusive approaches. They show how important it is to provide not only immediate crisis relief, but to  work toward long-term change by boosting access to affordable housing, good wages, and food.

We are grateful that Prize-winning communities for sharing their stories with others who can learn with and from them. Since 2013, RWJF has worked with the University of Wisconsin Population Health Institute to carefully select places that meet our criteria for promoting better health for all. It’s a highlight of our year to showcase the winners, whose spirit of collaboration and commitment to change are truly inspiring. We love introducing these examples of how to build a Culture of Health to the rest of the nation.

This year, in light of the COVID-19 pandemic, we postponed awarding the 2020 Culture of Health Prize. Instead, we’ll choose them this year, alongside the 2021 winners.

Learn more about Prize-winning communities, visit We look forward to sharing more examples from Prize winners in future posts and hope you are inspired to take action in your community.


About the Author

Headshot of Katie Wehr / RWJF

Katie Wehr, senior program officer, focuses on discovering and investing in what works to promote and protect the nation’s health and to achieve the Foundation’s vision where we, as a nation, strive together to build a Culture of Health enabling all in our diverse society to lead healthy lives, now and for generations to come.

Fri, 22 Jan 2021 12:45:00 -0500 Katie Wehr Public and Community Health National <![CDATA[Five Experts Reflect on the Health Equity Implications of the Pandemic ]]>

As the novel coronavirus swept the globe, structural racism drove its disproportionate impact on communities of color in our nation. As we look ahead to a new year, experts weigh in with thoughts and hope for shaping a healthier, more equitable future.

Two people wearing masks facing each other.

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.

Photo credit: Henry Söderlund, Wikimedia Commons [O]ften what looks like prophecy is merely the skill of reading the signs of the past to guess at the challenges—and solutions—of the future. —Karen Lord (Read her post)

A series of polls also highlighted the heavy financial impact of COVID-19—with more than 40 percent each of Latino, Black, and Native American households reporting serious financial problems during the coronavirus outbreak—including using all or most of their household savings.

As we reflect on the year and the ongoing pandemic, we share observations by a range of experts featured on RWJF’s Culture of Health Blog in 2020. They provide important perspectives on the health equity implications of COVID-19, and offer some hope for the future.

We must keep equity at the forefront through activism.

Yolo Akili Robinson is the founder and executive director of the Black Emotional and Mental Health (BEAM) Collective and recipient of the RWJF Award for Health Equity. In a Q&A with Dwayne Proctor, Robinson explores how the pandemic's disparate impact on communities of color have strained mental health. Taking note of data demonstrating higher COVID-19 death rates for Black Americans, Robinson says the numbers are distressing, but not surprising:

Y. Robinson We now have to use our voices, through art, media, and politics, to keep issues of equity at the forefront. —Yolo Akili Robinson (Read the post)

We have already been living in spaces zoned so that Black and Brown people aren’t healthy—in food deserts, or where the water isn’t safe to drink, for example. And we endure untreated chronic conditions that lead to poorer outcomes from COVID-19, while struggling to access health care. So, when COVID-19 began spreading, we were already in distress because of systemic and structural failings.... When people of color actually do manage to receive care, doctors are more likely to minimize their pain and dismiss their symptoms. We have a long way to go in dismantling all of the “isms” within the system....

Speaking weeks before George Floyd’s murder touched off a national soul-searching on race, Robinson said:

I think back to the early days of the HIV epidemic and am reminded of all the ways advocates had to push the government to respond, over a period of years. They advocated and protested until finally the government put its weight behind finding effective treatments. That also had a very real impact on the structure of health care and the way programs were designed to help people with HIV. We, too, have to force a discussion and remind ourselves what started and energized national conversations that led to change. It was Martin Luther King, the Black Panthers, Gloria Steinem, Angela Davis, Fannie Lou Hamer, Black Lives Matter, ACT-UP. They got in our faces, even antagonized, and they got us past the collective amnesia and wishful notion that racism or sexism or homophobia don’t exist. We now have to use our voices, through art, media, and politics, to keep issues of equity in the forefront.

Maintaining social connections while physical distancing alleviates the pandemic’s impact.

Yolanda Ogbolu writes about families’ pre-pandemic self-isolation driven by fear of violence in her childhood West Baltimore neighborhood. Now a nurse researcher, Ogbolu is working to understand the effects of that “situational isolation,” which she defines as self-isolating behavior driven by circumstances in the social setting and built environment that make it difficult to get out and about or develop friendships.

To ease this isolation while combatting COVID-19, the community has rallied in many important ways ranging from taking decisive action to protect elderly nursing home residents from the virus, engaging trusted voices in community outreach and more.  

Yolanda Ogbula The one lesson I hope we’ve learned from standing together with family, friends, and community is how feeling connected can help all of us to not only survive but thrive. —Yolanda Ogbolu (Read her post)

She writes:  

In Baltimore, food, housing, and electricity are considered basic needs and are being urgently addressed for many. The digital divide that has been a barrier to equitable education is narrowing slightly through gifting of electronic devices and free internet services to the most vulnerable. The state has halted prosecutions for drug, prostitution, and some other offenses to protect vulnerable citizens in prisons. Baltimore ministers have created virtual “freedom schools” and are delivering free food to community members. The city’s schools have served over 50,000 meals to children and their families in need.

Others in the community are working and providing essential services, including health professionals, grocery workers, truck drivers, and hospital environmental health service workers. Caregivers, mothers and fathers, like those in my study, are reporting through social media that for the first time they can spend quality time with their children, serving as teachers and health promoters. They are making collages of the best moments of their lives, having dance parties, and building relationships with family and neighbors in new ways.

She concludes, “The one lesson I hope we’ve learned from standing together with family, friends, and community is how feeling connected can help all of us to not only survive, but thrive.”

Health care, public health and social services must work together to overcome the racial inequities that COVID-19 has intensified.

Chris Lyttle, deputy director of Systems for Action (S4A), focuses on the social determinants of health and how the pandemic has exposed race-based gaps in the nation’s health system.

Chris Lyttle [S]ystems need to work together to advance health equity. Let’s all join forces to push that alignment forward. —Chris Lyttle (Read his post)

Lyttle points out a “through-line” between S4A’s work, the failed response to the pandemic, and “the racial injustice that has sparked such an outpouring of protest. Black and Latino communities have borne the brunt of the pandemic—from the risk of infection and the severity of the illness to its economic reverberations."

"[F]ragmented systems prevent us from treating the whole person," he writes, continuing,

Drawing on 16 years of data from hundreds of communities across the country, an RWJF-supported study found that deaths from cardiovascular disease, diabetes, and influenza fall significantly when collaborative mechanisms are in place to promote population health....

I’m not naïve enough to believe that if we could just align our systems, we would vanquish racial disparities, but I am convinced the pressure we are seeing on communities of color foregrounds the power of better alignment. Early findings from that 16-year data set suggest that communities with strong multisector networks have fewer COVID-related deaths and lower infection rates. That information should certainly inspire action.

He concludes, “My personal and professional journeys have led me to much the same awareness—systems need to work together to advance health equity. Let’s all join forces to push that alignment forward.”

Data drives meaningful action.

Ericka Burroughs-Girardi, an action learning coach at County Health Rankings & Roadmaps, provides strategic guidance to communities that want to use data for meaningful action to improve health and advance equity. This year, the County Health Rankings team spoke with leaders from Black, Latino and Native American communities.

Ericka Burroughs Girardi Equity-focused decision-making is key for a future ripe with opportunity for every person in America, no matter the color of their skin, how much money they make, or where they live. —Ericka Burroughs-Girardi (Read her post)

One key lesson emerged: Used strategically, disaggregated data (local-level data broken down by race, ethnicity, gender, and age) can help facilitate a faster response, making it easier to see where resources like new testing sites are needed most. Data also can guide community responses in a fraught environment where politics and public health collide, but its availability varies greatly from state to state and community to community.

She writes:

Local-level data broken down by race, ethnicity, gender, and age are critical for understanding community challenges, with COVID-19 being no exception. Since the arrival of the virus, quickly expanding access to disaggregated data has been paramount for evidence-informed decision-making.

As response and recovery efforts evolve, communities will continue requiring precise, accurate, and transparent data to make informed decisions about resident needs. However, it is also important to recognize that these data may not capture the full story in a community. Not every community has access to universal testing.

Additionally, many residents fear how their information may be used—or do not seek care due to lack of health insurance, immigration status concerns, and more. All of these factors impact the data collected and their availability.

Check back in 2021 to read more perspectives on supporting an equitable COVID-19 recovery. In the interim, explore the Robert Wood Johnson Foundation’s collection of resources and perspectives on COVID-19.


About the Author

Najaf Ahmad

Najaf Ahmad is managing editor of the Culture of Health Blog where she highlights perspectives about how the Foundation is advancing health equity in communities across the nation.


Tue, 1 Dec 2020 12:45:00 -0500 Najaf Ahmad Health Disparities Public and Community Health <![CDATA[Sesame Street Offers Support to Families Coping with Pandemic Stress]]>

Navigating the holidays amid a pandemic is stressful. Sesame Street in Communities is offering support to help families cope with both common and new challenges.

Sesame Street Photo Credit: Sesame Workshop / Zach Hyman

Both of us, like many in America, are feeling anxious and unsure about what the upcoming holidays will look like for families. It’s difficult to know how to prepare or talk about this, and really all that is going on, with the young children in our lives.

Throughout this year our kids have continuously faced several changes. Suddenly their routines and schedules are different. Many are not seeing friends, family, teachers, and classmates in person as often or at all. They miss what felt normal and comfortable and they have all sorts of questions about what is happening and why. They struggle with what to do with all the “big feelings” they are experiencing.

They can also sense increased stress that the adults in their lives are facing. Adults are juggling care for their children, often adding homeschool teacher or “videochat technical support wizard” to already increased workloads. Those who are teachers, work in health care, or have other “essential” positions face significant danger and stress in their jobs every day. Others have lost jobs or are trying to protect or care for aging parents during a pandemic. Through all of this uncertainty and loss, parents and caregivers need ways to care for themselves, and children need to know they are going to be safe.

Sesame Workshop Offers Support 

In addition to teaching kids numbers, letters and some of their favorite songs, Sesame Street and the lovable Muppets have a history of tackling tough topics with a compassionate, evidence-based and age-appropriate approach and this year is no exception. Not only were caregivers helping children cope with the effects of the pandemic, but they also had to respond to the many questions brought on by the nation’s reckoning around racial justice.

In June, Sesame Workshop teamed up with CNN for a Town Hall to help families answer children’s toughest questions about racism. And in October, a new TV special, “The Power of We,” sought to teach children that they are never too young to be ‘upstanders’ for themselves, one another, and their communities. Additional resources to support families will be available in the coming months.

Also this fall, the  Sesame Street in Communities (SSIC) initiative released a new video special funded by RWJF. It focuses on building young children’s coping skills and fostering nurturing connections between them and the caring adults in their lives—whether parents, caregivers, or community providers. The video special, “Little Children, Big Challenges,” offers caregivers tips on how to help children cope with uncertainty by building resilience.   

With some of our favorite friends from Sesame Street and insights from early childhood education specialists and community service providers—including partners in three new SSIC communities, Miami, Baltimore, and Maricopa County, Arizona—the special offers tools and tips to families as they face each day with courage, optimism and hope. Suggestions include things that almost all of us can try, like sticking to a routine, talking about our feelings, and reaching out to friends and family we miss even if we are not able to see them in person.

The special also addresses common stressors families were already dealing with that the pandemic has intensified. These include challenges such as parental addiction and trauma. SSIC has an array of free, bilingual resources on these and other topics to equip parents and caregivers with the tools to help children navigate these difficult issues and make sense of their experiences.

For example, during the special, one of the Sesame Street Muppets, Karli, shares about her mom’s addiction and says, “My mom was doing a lot better, but now she seems really worried and I’m scared she’ll get sick again. What do I do?”

The host of the special, Sesame Street’s Alan, counsels, “There are many kids like you Karli” and connects her with the head of Arizona Recovers, one of the lead SSIC partner organizations in Maricopa County, to hear about how kids can cope with these challenges.

Muppet Karli talks to Sesame Street’s Alan and Angie from Arizona Recovers about how to deal with worries about her mom’s addiction issues.

Sesame Street in Communities’ Partners “Localize” the Initiative

Like communities and organizations across the country, SSIC’s new community partner organizations will also be integrating the resources including videos, interactive activities and print materials into their programs to better serve families.

For example, in Arizona, our partners, including Arizona Recovers in addition to the Arizona Department of Health Services; Arizona Governor’s Office of Youth, Faith and Family; and First Things First, will be training staff and integrating resources into therapy, child care, home visiting and family recovery programs in addition to bringing the tools into the emergency department at Chandler Regional Hospital, where they connect with families in crisis.

Thriving Mind, our lead Miami-based partner, will incorporate the resources into local healthcare provider organizations that support families. Their services include multidisciplinary outpatient care (including in-home visits), outpatient therapy, residential care and prevention programs. And, SSIC trauma and parental addiction resources will be embedded into early childhood services across Miami-Dade County, including within schools, public safety, and court systems. In Baltimore, our lead community partner, the Family League of Baltimore, will embed SSIC in efforts to support families struggling with substance use and new parents enrolled in Baltimore’s home visiting network, an intervention designed to improve health and development outcomes for babies.

Bouncing Back Together

This kind of support is especially necessary as we head into a holiday season that will look different for many of us. For some families, that might mean some of their favorite familiar faces are not with them at the holiday dinner table this year. Maybe they won’t get to travel, gather in their religious community, or participate in other familiar holiday traditions. But for other families, it could mean they don’t have enough food for a meal.

There are no easy solutions to the problems families are facing right now. But, we do know that children are incredibly resilient. And the most important thing we can do for them is make sure they have caring adults in their lives who will give them the space to talk about what’s on their mind and suggest ways they can feel better and “bounce back” stronger. Together, we can help children build the resiliency they need to face and overcome challenges big and small.

Learn more from Sesame Street in Communities about how you can help young children build resilience this holiday season and all year long.


About the authors

Katie Wehr, senior program officer, focuses on discovering and investing in what works to promote and protect the nation’s health and to achieve the Foundation’s vision where we, as a nation, strive together to build a Culture of Health enabling all in our diverse society to lead healthy lives, now and for generations to come.

Dr. Jeanette Betancourt is the Senior Vice President for U.S. Social Impact at Sesame Workshop, the nonprofit organization behind Sesame Street. She directs the development and implementation of community and family engagement initiatives making a difference in the lives of vulnerable children and their families. 

Mon, 16 Nov 2020 10:45:00 -0500 Katie Wehr Early Childhood Child and Family Well-Being <![CDATA[Grandfamilies and COVID-19: Families of Unique Origins Face Unique Challenges]]>

Raising a child can be hard at any age. Doing so in one’s golden years during a global pandemic introduces an array of unique challenges.

Grandfather carries grandson on his shoulders.

Mel Hannah spent most of his life in service to others. He was the first African American member of the Flagstaff City Council and vice chairman of the NAACP Arizona State Conference. And, in service to his beloved family, Mel and his wife Shirley, now in their 80s, have been helping their daughter Ashley raise her three children these past years. Sadly, however, Ashley contracted and tragically died from COVID-19 in May. Ashley’s untimely death left the Hannahs as the sole caretakers for her young boys, ages 5, 4, and 1.

The Hannahs’ story exemplifies the heavy toll of the pandemic, and especially the unique and often overlooked impact it is having on “grandfamilies” or kinship families. These are families in which children live with and are being raised by grandparents, other extended family members, and adults with whom they have a close family-like relationship, such as godparents and close family friends. Astonishingly, about 7.8 million children across the country live in households headed by grandparents or other relatives. Of that number, 2.7 million do not have a parent living in the household.

Often these families come together because of serious circumstances—including death, trauma, deployment, incarceration or substance abuse, and since March, the death of parents due to COVID-19. Raising kids is hard at any age, but doing so in one's “golden years” like the Hannahs’—particularly during a global pandemic—comes with its own unique challenges.

A report from RWJF grantee Generations United sheds light on families like the Hannahs, including the particular challenges they are facing as the world grapples with the coronavirus. The report found:

  • Almost half of grandparent caregivers are age 60 and older and at heightened risk for COVID-19.
  • More grandparent caregivers have disabilities than parents and also are likely at heightened risk for COVID-19.
  • Children being raised in grandfamilies are more likely to be Black or Native American than white. These are the same populations that are much more likely to be impacted by the pandemic and die as a result.
Racial Overrepresentation in Grandfamilies Caregivers in grandfamilies are disproportionally Black or Native American. These are the same populations that are more likely to be impacted by COVID-19 and die as a result. Source: Facing a Pandemic: Families Living Together During COVID-19 and Thriving Beyond, Generations United 2020 State of Grandfamilies in America Annual Report, September 2020

Kin Caregiving Poses Unique Challenges

The report also features the first nationwide survey of grandfamilies during COVID-19, conducted in partnership with GrOW (Grandfamilies Outcome Workgroup) and Collaborative Solutions, which revealed heightened needs related to housing, food insecurity, and alternative care plans:

  • 38% are unable to pay or are worried about paying mortgage or rent
  • 43% fear leaving their home for food
  • 32% arrive at food pick up sites after they have run out of food
  • 30% have no caregiving plan for the children if the caregivers die or become disabled
COVID-19 Challenges Facing Grandfamilies Grandfamilies are being forced to reckon with unprecedented challenges and tough realities and oftentimes with limited support systems in place. Source: Facing a Pandemic: Families Living Together During COVID-19 and Thriving Beyond, Generations United 2020 State of Grandfamilies in America Annual Report, September 2020

We all have heard that older adults should keep their distance from children because of the heightened risk of infection from COVID-19. For grandfamilies, that distance is impossible.

Also, kin caregivers do not always have automatic legal authority to access support and services for the children in their care. That becomes especially problematic when it is time to enroll in school, access health care, or find another adult to care for the child if the caregiver dies. Obtaining legal authority has been complicated by the pandemic for many families as courthouses are often closed, lawyers are in high demand, and the need to establish alternative care plans is urgent because of unexpected deaths from COVID-19.

Finally, most kin caregivers did not plan to be raising children at this point in their lives. Often, their homes do not have extra room to accommodate children, and they live on fixed incomes so supporting children can be difficult.

Benefits of Kin Caregiving

Decades of research show that children raised by loving family members have much better outcomes than children raised by unrelated parents in foster care. Children living with relatives have more stable and safe childhoods with a greater likelihood of having a permanent home. These children have fewer school changes, experience better behavioral and mental health outcomes, and, perhaps most importantly, are more likely to report that they “always feel loved.” They keep better connections to their brothers and sisters, extended family, and cultural identity.

There are also significant savings to taxpayers—estimated to be $4 billion a year because grandfamilies are caring for children who would otherwise go into foster care.*

*Generations United calculated this figure based on the federal share of the 2011 national average minimum monthly foster care maintenance payment ($511) for 1.1 million children. The number of children is less than one-half of the children being raised in grandfamilies outside of the formal foster care system. We use this number in the calculation due to a conservative estimate that the others may already receive some type of governmental financial assistance, such as a Temporary Assistance for Needy Families (TANF) child-only grant. Generations United also knows that a number of children in grandfamilies have special needs that would warrant higher monthly foster care maintenance payments. The cost of 1.1 million children entering the system would represent all new financial outlays for taxpayers.

Policy and Practice Recommendations to Support Grandfamilies and Kin Caregiving

The report contains robust policy and practice recommendations that would provide better support to these families. A few that are especially important are to:

  • Increase funding for Temporary Assistance for Needy Families (TANF) and encourage states, tribes, and localities to increase the monthly child-only grant amount to mirror foster care maintenance payments in each jurisdiction.
  • Coordinate COVID-19 response efforts across systems—including aging, education, housing, and child welfare—to ensure that grandfamilies can obtain services and support such as legal assistance to make alternative care plans; child care and respite; hardware and technology support; financial and housing assistance; help with court orders and child welfare case plans mandating visitation with birth parents; and caregiver training and other support.
  • Improve access to TANF child-only grants through simplified applications and more community outreach so kin caregivers can meet the needs of the children they did not plan or expect to raise.
  • License more relatives as foster parents by responding to delays caused by the pandemic with innovative virtual and other known solutions.
  • Use inclusive language and images in outreach materials, such as “caregiver” or “family member.”

Grandfamilies Must be Included in an Equitable, COVID-19 Recovery   

The health of our nation depends upon the health and well-being of our children and families—all our families. All parents and caregivers strive to provide what’s best for their kids. But in today’s America, families do not have the same access to opportunity—and the COVID-19 pandemic is making those gaps even wider. Families are making impossible choices between putting food on the table, providing shelter, and getting quality health care when a child gets sick. A recent poll released by RWJF, NPR and the Harvard T.H. Chan School of Public Health reveals how households with children experienced widespread, serious financial and health problems since the start of the COVID-19 pandemic, including problems caring for children and paying bills.

These challenges are often exacerbated for grandfamilies. For example, when Mel and Shirely Hannah’s daughter Ashley was living with them, she worked and was able to help with household expenses. They have struggled financially since her death. They have a hard time covering their $400 a month energy bill and had to give up their internet connection, making it difficult for their five-year-old to participate in online classes.

It is important to understand stories like the Hannahs’ and others like them, which you can listen to on Every Family Forward, so we can better consider, discuss, and design equitable policies and systems that support all families, including grandfamilies, who have lived unnoticed and under-resourced for far too long.

Learn more about the unique challenges that grandfamilies like the Hannahs' are facing by reading Generations United’s 2020 State of Grandfamilies in America Annual Report, Facing a Pandemic: Families Living Together During COVID-19 and Thriving Beyond.


About the Author

Jennie Day-Burget

Jennie Day-Burget, an award-wining public relations and communications professional, joined RWJF in 2015. She provides communications support to RWJF initiatives aimed at strengthening vulnerable children and families and programs that help all children achieve a healthy weight.

Thu, 12 Nov 2020 10:45:00 -0500 Jennie Day-Burget Child and Family Well-Being <![CDATA[Help Us Learn How Public Policy Can Advance Racial Equity]]>

We’re announcing $2 million in grants for policy research. Send us your ideas for studying the impact of local, state, and national policies designed to promote racial equity.

Woman wearing face masks and holding hands.

EDITOR'S NOTE: This funding opportunity is now closed.

When Harris County voters approved a $2.5 billion bond to pay for more than 500 local flood-control projects, it seemed like a sound response to Hurricane Harvey. In 2017, the storm dropped 50 inches of rain in the Houston region, flooding some 166,000 homes. Based on a traditional return-on-investment analysis, it might also have appeared reasonable to spend that bond money in neighborhoods with the most expensive properties.

But county officials understood what that would mean—little protection for communities living with the most inadequate social, physical, and economic resources—many of whom are communities of color. And so, they chose a different policy approach. They gave preference to projects that ranked higher on the Centers for Disease Control and Prevention’s Social Vulnerability Index, which uses socioeconomic status, racial and ethnic status, household composition, housing, access to transportation, and other metrics to uncover potential vulnerability. The result: funds for flood control prioritized towards low-income communities and communities of color, those least able to recover from disasters.

An Opportunity to Gather and Share Evidence

Actively confronting assumptions that allow public investments to favor wealthier and whiter communities can help dismantle the legacy of racism. In a new call for proposals, the Robert Wood Johnson Foundation (RWJF) and its Policies for Action (P4A) program are inviting researchers to study the impact of local, state, and federal policies intended to promote racial equity in Black, Indigenous, and People of Color (BIPOC) communities. You will be helping us gather and share evidence in support of racial justice.

The Urgent Need to Dismantle Racism

We already know a lot about the harm public policy can do. The legacy of housing discrimination is but one example. Early in the 20th century, the Federal Housing Administration redlined neighborhoods with majority Black populations, refusing to insure mortgages there. Fast forward a century and racial disparities in home ownership rates continue, diminishing the ability of families to build wealth across generations. Discriminatory housing practices and health-damaging segregation also persist, as RWJF CEO and President, Richard Besser, MD, highlighted in his 2019 annual message.

Less is understood about solutions that will root out racism, but many policy experiments are underway. California recently began requiring that levels of COVID-19 infection be reduced in the hardest-hit communities before allowing the entire county in which they are located to proceed with reopening. Elsewhere, bold policies advancing racial justice are being tested and implemented in early childhood education, housing, health care, and public health. Promising mechanisms to propel racial justice include Medicaid waivers, equity principles, and wealth-generating strategies.

Through this funding opportunity, RWJF will support impact studies in these and other areas to determine what works. These grants recognize that intentionally applying a racial equity lens can uncover structural barriers that might otherwise remain hidden. Whether it is expanding a transit system, developing affordable housing plans, or implementing a plan to distribute a new vaccine, analyzing the impact of policies on people of color can detect harms that a broader population-level approach might miss. To identify such consequences, some cities like Seattle require that a “racial equity audit” be conducted before any new policy is finalized.

Research Criteria to Keep in Mind

We expect that researchers gathering actionable evidence under this initiative will engage community representatives. We cannot do this without voices from communities of color and the organizations that represent them. Whether ideas are solicited from a housing justice group, an NAACP chapter, community organizers, or other advocates, explicit interactions and partnerships will reassure us that the questions you are asking matter to those who can benefit from the answers. We also want to know how your findings can be translated into messages that resonate with affected communities and shared with legislators and policymakers to inform policies that create equitable communities.

We are flexible about methodology. While randomized clinical trials are valuable, we honor the power of interviews, surveys, focus groups, and other qualitative methods that can also generate rigorous data. And just as researchers expect economic and professional rewards from their work, we think those who allow their data to be collected should be compensated in some way, and we’ll be looking for that commitment in your research design.

Attracting a new crop of investigators is important to understanding policy impacts. We encourage applications from young and early-career researchers, especially from communities of color because they bring fresh perspectives and innovative ways of thinking to the work.

In the wake of the COVID-19 pandemic and the inequities it has laid bare, coupled with the racial reckoning triggered by the murders of George Floyd, Breonna Taylor and so many others, the imperative of dismantling structural racism is clear. Until we act, the vision of a just society that offers everyone the opportunity to be healthy cannot be realized.

Learn more about what our Policies for Action research program has funded in the past.


About the Author

Headshot of Mona Shah

Mona Shah, a senior program officer in the Research-Evaluation-Learning unit, joined RWJF in 2014. Drawing on her expertise in research and policy, she is committed to making research more equity-focused and accessible to the public, advocates, and policymakers.

Wed, 28 Oct 2020 12:30:00 -0400 Mona Shah Health Disparities Public and Community Health National <![CDATA[Global Approaches to Well-Being: What We Are Learning]]>

What can we learn from other countries about advancing well-being—a notion of health that extends beyond the absence of disease? A new, free book will offer examples and actionable ideas. 

A father and mother hold their baby.

Since we originally published this post in July 2019, more cities and countries are exploring ways of centering decision-making on human and planetary well-being—from Iceland, which revealed a new well-being framework, to Canada, which is exploring budget indicators that encompass happiness and well-being. 

Meanwhile, the COVID-19 pandemic is a reminder of how interconnected we are and always have been across lives, livelihoods, and well-being of communities and societies everywhere. In the United States, its spread has sharply illuminated inequitable conditions and ongoing systemic racism. Rates of infection and complications from the virus are significantly higher in communities of color, Native communities and tribes, immigrant communities, and other groups that live with higher rates of air pollution, spotty health insurance coverage, persistent health inequities, and lack of paid leave or a financial safety net to follow “stay home” public health orders. As we recover, prepare for potential future outbreaks and rebuild, we must prioritize equitable well-being as the ultimate goal. We might take a lesson from New Zealand, which adopted a well-being budget last year, has made significant investments in vital services like mental health and education as well as environmental protections, and has had an exceptionally low mortality rate and relatively rapid recovery from COVID-19.

Blue Marble Quiz Blue Marble Quiz—How may the rest of the world shape your thoughts and behaviors? Take our quiz to find out!

Stepping back a bit, four years ago, it dawned on me that the concept of “well-being” might lead to a world of learning opportunities that could deepen and broaden the Robert Wood Johnson Foundation's (RWJF) work to build a Culture of Health. I was in Copenhagen, at the World Health Organization Regional Office for Europe, for a meeting about the United Nations Sustainable Development Goals and developing measures for well-being. As I listened, I realized that many of us in the United States who were working toward improved well-being were not considering what others around the globe were learning as they incorporated well-being into policy and practice.

We were missing out on insights, for example, from years of research and community engagement underpinning New Zealand’s well-being indicators and recently announced national well-being budget. Officially introduced in 2018, the country’s Living Standards Framework redefines the national government’s priorities and measures of progress. It expands beyond economics to also consider policy impacts on human and environmental well-being. (Of note: As of this writing, New Zealand has had few deaths from COVID-19. The New Zealand Treasury puts well-being on equal footing with economics in its response planning, noting on its website: “The Treasury is also taking a longer-term view, providing ongoing advice to the Government about how the evolving global situation might impact New Zealand’s economic resilience—and the intergenerational wellbeing of New Zealanders—and the options for recovery.”)

And just a week after the New Zealand budget made international news, the United Arab Emirates was in the headlines with its National Strategy for Wellbeing 2031, which aims to promote social cohesion and prosperity by improving quality of life.

The idea of well-being has been integral to RWJF’s vision for a Culture of Health from the outset. In the spirit of the World Health Organization’s 1948 definition of health as a “state of complete physical, mental and social well-being, not merely the absence of illness or infirmity,” we have used concepts of well-being to broaden mindsets and strategies to improve health.

For RWJF, well-being includes people’s physical, mental, and social health, and the opportunities they have to create meaningful futures. It considers basic needs, like food, housing, education, employment, and income. It includes social and emotional needs, like sense of purpose, safety, belonging and social connection, and life satisfaction. And it is tightly linked with the well-being of our communities, our environment, and our planet.

But my Copenhagen trip prompted my colleagues and me to dive even deeper into what well-being means around the globe. Knowing that good ideas have no borders, we sought to identify promising practices that could help advance well-being in our own country. We were especially interested in building equity, as well-being approaches require inclusive processes and corresponding shifts in power. Well-being is also an important framework for equity because it is not a finite resource. While economic prosperity for some is often related to growing poverty for others, higher levels of individual well-being tend to increase group well-being.

As we continue our learning journey, we are seeking to understand the impact of these approaches. What do they add to efforts focused on social determinants of health, like income and education levels?

Here are some early considerations to share.

A Holistic Vision

By laying out a wide range of indicators that cross disciplines, a well-being driven approach demands collaboration and yields more holistic, integrated strategies. Rather than focusing narrowly on economic and health outcomes, well-being helps us see a more comprehensive picture, including early warning signs of crises to come.

Think of the isolation, disconnection, and deep worry that preceded the opioid crisis here in the United States. While we focused on job losses and economic declines and time-lagged vital statistics, we overlooked early signs of despair. Had we been measuring indicators of well-being, we might have focused on mental health support and community connection in addition to job creation, which may have led to dramatically different outcomes.

Tailored Approaches

Though every well-being effort is multidisciplinary, formulas for success vary and are customized to account for geographic, cultural, and political context. In Singapore, for example, decades of economic growth resulted in a strictly financial definition of personal success. As people focused solely on building wealth, their health declined. Even the Ministry of Health couldn’t capture attention when it declared a “War on Diabetes.” Eventually, the Ministry of Health and two universities recognized that reversing health crises required a shift in mindsets. Their new “health and wealth” narrative initiative aims to cultivate a cohort of university graduates who embrace this value system, leading to different personal, organizational, and societal decisions.

In the radically different context of Occupied Palestine, most people have spent their entire lives in warlike conditions. There, Birzeit University and its cross-sector partners are using community-based pilot programs to address the trauma of war and its impact on collective well-being. By addressing trauma as a holistic, socio-political issue, rather than an individual “problem to be treated,” advocates are alleviating social isolation and stigma and developing new indicators related to suffering, such as humiliation, insecurity, and deprivation.

Subjective Experience

To truly promote thriving individuals and communities, well-being approaches incorporate insights from psychology, sociology, economics, public health, and other disciplines. Metrics used to assess well-being encompass not only objective factors like income, but also people’s self-reported life satisfaction. Looking beyond objective data is vital, because simply checking off data boxes does not mean that an individual will experience well-being.

For example, according to one recent study, what people most want from the U.S. Medicaid system is not different interventions or coverage; rather, they want to be treated with respect and dignity regardless of their income, ethnicity, or insurance status. Unfortunately, these lived experiences, which have an undeniable impact on well-being, are not always measured or prioritized.

To ensure that subjective experience is taken into account, an NGO in the United Kingdom—Happy City—combines an objective Thriving Places Index with a simple, five-minute online survey. The Happiness Pulse employs user-friendly technology to measure the emotional, behavioral, and social well-being of individuals, groups, organizations, and communities. This tool is used to map strengths and needs and to evaluate impacts across projects and places.


The idea of well-being draws our attention to the fact that that we are essentially all in this together, even when we do not recognize it. Well-being approaches—including their sensitivity to the profound impacts of issues such as social isolation and injustice—shift our attention and action toward our interconnectedness.

Policies grounded in well-being also draw our attention to interconnection between people and the larger natural world. In Bhutan, for example, since the 1970s, Gross National Happiness (GNH) has provided a more holistic definition of progress than Gross Domestic Product (GDP) can alone. A key component of GNH is the recognition that all beings in the natural world are interdependent, and that the well-being of non-human life on Earth has intrinsic value. Using well-being assessments to guide decision-making, Bhutan has developed innovative natural resource and tourism policies and become the world’s first carbon-negative country.

What RWJF is Doing

In 2018, one of RWJF’s first steps on our learning journey was to convene thought leaders from five continents and 19 countries at the Rockefeller Foundation’s Bellagio Conference Center. The examples I cited above are all based on the work of people we met there. Recently, we published a book, Well-Being: Expanding the Definition of Progress, detailing insights from that gathering in order to spark thinking about well-being approaches in the U.S.

The book, which is part of our Culture of Health series with Oxford University Press, explores how leaders, cities, and countries worldwide are centering decision-making on a well-being approach—that is, on human and planetary well-being as well as economic growth, through policy, budget, and practice change, and by recalibrating narratives about what matters most.

Through essays, case studies, and academic papers, the book is meant to inspire city leaders, policymakers, economists, researchers, reporters, and others with ideas and actionable suggestions for advancing well-being approaches.

We are continuing to observe, test ideas, and explore how to integrate these insights from around the world into how we build and measure a Culture of Health across the United States, from our most rural communities to our largest cities. In fact, well-being is now an ongoing focus area for our Global Ideas for U.S. Solutions team. We are continuing to research measurement, narratives, policy, and other applications of a well-being approach.

Questions to Expand Well-Being Thinking

We encourage you to consider how these insights apply to your work and place. How are you, your organization, your city, or your country defining and pursuing progress? Does that encompass well-being? Who is missing from decision-making about what we value as a society? How does what we measure and report shape our narrative about what matters?

Learn more about this work and sign up to request a free copy of the book Well-Being: Expanding the Definition of Progress, which offers instructive examples and actionable ideas from around the world for advancing well-being approaches in the U.S.


About the Author

Headshot of Alonzo Plough

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

Tue, 13 Oct 2020 14:00:00 -0400 Alonzo L. Plough Public and Community Health International <![CDATA[Research Shows the Importance and Paradox of Early Childhood Care and Education]]>

Dependable child care is critical for healthy development—and for the nation to return to work. However, costs are often unaffordable even while many child-care workers are not making a living wage. Ultimately, the entire nation faces the consequences of a system in crisis.

Young girl coloring in a daycare facility.

While working from home and caring for our families as we wait out the COVID-19 pandemic hasn’t always been easy, it certainly is a privilege that we value during these unprecedented times. We’re fortunate that our organization recognizes the importance of families and caregiving. In addition, the nature of our jobs allows us to work remotely and have flexible schedules. This helps us support our families during a global pandemic. Unfortunately, the vast majority of working parents in America today, especially women of color, don’t have this choice.

Instead, as pressure mounts to reopen the country, many working parents face an impossible dilemma. Those without the option to telecommute are forced to return to work while struggling to find safe and affordable child care. Or they must stay at home to care for their children and face financial ruin. This burden falls disproportionately on women of color who are on the frontlines of many essential jobs. Many are also child-care providers who face the monumental feat of juggling their low wage, high risk jobs with caring for their families and themselves in the midst of a pandemic. Ultimately, the entire country faces the consequences of an inequitable childhood care system in deep crisis.

Our nation’s health depends on the health of our children and the early childhood care and education (ECCE) providers that nurture them.

As America recovers from the pandemic and reopens the economy, rebuilding our ECCE system in a way that prioritizes equity and well-being is critical. We cannot reopen and recover without a stable and affordable child care system.

Several new studies funded by the Robert Wood Johnson Foundation (RWJF) support this. They show that ECCE is a public good that requires sustained investment, equitable access, and compensation that reflects the value and risks faced by frontline ECCE providers.

High-Quality Care is Critical for Healthy Development Into Adulthood

We’ve known for a long time that health and education are closely linked, and that people with higher education live longer. But a new study reveals that ECCE interventions may improve health outcomes later in life. Researchers have been studying long-term economic and health outcomes among children who had access to preschool education in the 1940s compared to those who did not. They found that children with access to nursery school had better long-term education and economic outcomes.

Early Childhood Care and Education Providers Face a Deep Crisis

While we know that ECCE is critical to children’s health and well-being, fewer studies have shed light on the 2.2 million providers, many of whom are women of color who care for the 10 million children in early childhood care. These child-care providers are in a double bind. They are responsible for caring for their own children and the children of others. They are both producers of ECCE and also consumers of it. In spite of risks to themselves and their families, they show up to their jobs every day. Ultimately, the health and well-being of these providers is one of the most important factors in ensuring safe, nurturing and appropriate ECCE care for all children.

Studies have shown that healthy brain development during early childhood increases the likelihood of success later in life. Supportive and nurturing environments set children up for a lifetime of good health.

Yet, a new study highlights the deep crisis ECCE providers and teachers face and how low wages force many to the brink of poverty. Many lack access to health insurance or paid sick or family leave.

This research shows that early childhood providers experience disproportionate mental health well-being challenges and face remarkably high rates of food insecurity. The very people caring for our children don’t have enough food to feed themselves and their families.

Messaging Shapes Perception of the Problem

So why aren’t we doing more to support the people and the system that cares for and nurtures our children during their formative years? The evidence is so clear that early childhood care and education is a public good. Why aren’t we making the investments needed to create a more equitable and affordable system that helps working families, including single-parent families.

Part of the problem is how the issue is framed. Another recent study shows how strategic messaging can build public acceptance for policies to support affordable, accessible and appropriate child care. But ongoing challenges remain in generating support among a sizeable subgroup of elected officials who oppose public funding for early childhood education.

Narratives that are rooted in sound evidence on the links between affordable and safe ECCE and economic benefits could help. Evidence shows that child-care subsidies for low-income families provide double value by creating healthier outcomes for children and higher economic benefits for families. A recently published policy brief by RWJF argues that sufficiently funding the Child Care and Development Block Grant (CCDBG), the primary public child care program in the United States, can play a critical role in supporting the health and well-being of children and families.

New Resources Offer Data on Costs

While no single entity is responsible for collecting data on the inequities of ECCE two new resources make reliable data on the costs of ECCE more accessible for advocates and policymakers. Project Hope’s Selecting Indicators for Early Childhood Systems Change Projects, is a new reference guide. It is a compilation of data sets that can help identify where inequities exist in order to set goals and mark progress on ECCE policy.

And a new database released by Child Care Aware now provides the most up-to-date data on ECCE cost for researchers and policymakers. The interactive database creates a real time assessment and picture of child care access and affordability in all 50 states. The database examines different factors that influence affordability, such as cost of living by region, median income for different types of families and household size. 

One shocking fact: Even before the outbreak of COVID-19 and the associated closures of child-care programs, the supply of child care was decreasing. Between 2018 and 2019, 53% of states reported a decline in the number of child-care centers and 79% of states reported a decline in family child-care providers.

We have the data, now we need to change how we talk about the positive health outcomes of early childhood care and education. More importantly we need to change a system that perpetuates inequality and neglects the providers who deserve basic benefits like health insurance, paid sick leave and better wages that account for the risk and value of the services they provide.

ECCE Workers are Essential—They Deserve a Living Wage

COVID-19 has made it abundantly clear that ECCE providers are essential to our society's livelihood. They deserve to be treated as such. Safe, affordable, accessible and appropriate ECCE that values providers shouldn’t be a choice. It is critical to our country’s overall well-being and to our economic recovery. In order for businesses to reopen, parents need safe, affordable child care. At the same time, the child-care workforce needs additional resources to provide safe, developmentally appropriate, care. We are seeing in real time how the current system cannot meet the needs of families, communities or our nation’s economic recovery. Let’s not miss this opportunity to improve the system and ensure equitable access to child care and early childhood education for all.

Learn more about how we’re expanding the evidence needed to build a Culture of Health through Evidence for Action, a national program of the Robert Wood Johnson Foundation, and our commitment to Healthy Children and Families.


About the Authors

Tina Kauh

Tina Kauh is a senior program officer with the Research-Evaluation-Learning Unit at the Robert Wood Johnson Foundation where she focuses on supporting the health and well-being of children.

Krista Scott bio image.

Krista Scott is a senior program officer at the Robert Wood Johnson Foundation where she works at the forefront of child health policy, advocacy, and equity.

Thu, 8 Oct 2020 10:30:00 -0400 Tina Kauh Early Childhood Social Determinants of Health National <![CDATA[COVID-19 Research at the Community Level]]>

What investments, priorities and values are shared by communities that are faring better in the COVID-19 pandemic?

Contact tracers. Contact tracers in Harris County, Texas, discuss a COVID-19 case. (AP Photo/David J. Phillip)

Fifteen years ago the Robert Wood Johnson Foundation (RWJF) confronted a puzzling question that still resonates today: Why can some communities rebound after disasters, while others are unable to recover? We first studied this in the aftermath of Hurricane Katrina. Some parts of the Gulf Coast were irreparably damaged, while others were able to recover. Researchers at the RAND Corporation, with RWJF support, sought to identify the qualities that resilient communities shared after a natural disaster, such as the strength of collaborations among government and non-governmental organizations pre-disaster and robust plans to support those most affected. The same team later built on that research by examining community well-being after other types of disasters, including economic downturns and community violence. The researchers partnered with local governments and—time and again—found that prioritizing equity and building collaborative networks bolstered communities under extreme stress.

Today, this team is studying how communities are faring during a global pandemic. The patterns that are starting to emerge align with earlier research findings: Communities that practice health equity principles before disasters fare better afterward.

How Research Supports and Promotes Healthier, More Equitable Communities

It has been several years since the Robert Wood Johnson Foundation made a commitment to build a Culture of Health in America—where every person has a fair and just opportunity to live the healthiest life possible, regardless of where they live, how much they are paid, or the color of their skin. As part of this work, RWJF introduced a Culture of Health Action Framework and measures to help track the nation’s progress toward becoming a country that values health everywhere, for everyone.

Our Action Framework includes 35 exemplary measures that, taken together, can create meaningful change and provide useful signals of progress for the nation. We invite communities to use the framework as a starting point for discussion and recognize that each community will find its own path to a Culture of Health depending on its unique situation and context. We have been working with the RAND Corporation to continuously refine and update these measures, which include access to health insurance, substance abuse treatment, family and medical leave, voting, public libraries, reducing incarceration rates, and more. We believe that highlighting these measures as examples of areas needing focused attention and action will help to catalyze health equity. RWJF and RAND are continuously updating the Culture of Health measures to reflect new realities and to place greater emphasis on reducing collective trauma and racism.

To inform and complement this work, RWJF is using the Sentinel Communities Surveillance Project, which we launched in 2015, to better understand how the Action Framework can propel health equity and well-being in 29 diverse communities across the country. We are studying each community through the lens of the Action Framework to examine whether and how different sectors, organizations and local leadership in each community are working together; how priorities, policies, and investments strengthen health equity; and how each community is engaged in these processes. This surveillance project turns research into concrete, meaningful evidence about what communities are doing to improve population health, well-being, and equity. 

The Urgent Imperative COVID-19 Created

Then, everything changed this year when the COVID-19 pandemic hit. It has been the ultimate stress test for our health care and public health systems, our communities, and our country. It has cost us dearly in lives diminished and lost, not just due to the pandemic, but also to health care system gaps and inequities we’ve failed to erase. The pandemic makes the work to promote health equity and build a Culture of Health even more crucial and the consequences of not doing so excruciatingly clear.

Faced with this new challenge, RWJF leaders realized that, with surveillance already underway, the Sentinel Communities Project could provide a window into the impact and consequences of pre-pandemic investments. It could yield valuable data about which responses to the pandemic mitigate its impact and which exacerbate the harm and the health inequities it causes. Given the likelihood that many health care and social service systems will be re-built, often with greater attention to racial justice, after the COVID-19 crisis ends, the insights gleaned from this study can help communities rebuild stronger than before. So RWJF decided to closely monitor nine of the 29 Sentinel communities as they try to mitigate and recover from the pandemic in order to share and compare real-time information about the impact of these communities’ responses.

A Closer Look at Community Response to COVID-19

This project will report findings every few months on the following nine Sentinel Communities: Finney County, Kan.; Harris County, Texas; Milwaukee; Mobile, Ala.; San Juan County, N.M.; Sanilac County, Mich.; Tacoma, Wash.; Tampa, Fla.; and White Plains, N.Y. The first report (July 2020), available on COVID-19 Community Response: Emerging Themes Across Sentinel Communities, covers activities from March through early June of this year.

It concludes that pre-pandemic investments in holistic approaches to health, cross-sector collaborations, investments in data systems, and actions to promote health equity are key. It identifies four themes that differentiate community response:

  • Value of a community’s interest and focus on health and well-being before COVID-19;
  • Role of cross-sector collaborations for health and well-being in responses to the pandemic;
  • Use of data and systems to effectively monitor and track the course of the disease; and
  • Role of a community’s perspective on and actions to address health equity and meet the needs of historically underserved populations.

In Milwaukee, city and county governments responded swiftly to COVID-19, directing support to vulnerable populations, the report finds, even though the city was forced to furlough some employees. Governments posted a crisis hotline, offered resources to prevent infection spread in dementia care, and offered free meals and Chromebooks to students in need. Milwaukee is one of the most racially segregated cities in the country, and it has long experienced significant income disparities based on race. Nonprofits addressing health and economic challenges before the pandemic were able to ramp up by providing housing guidance, information on teleconferencing options for some court appearances, and emergency funds for food, housing, and health during it. Strong neighborhood revitalization programs already in place pivoted to tracking COVID-19 cases and deaths by race/ethnicity, and members of the Black community mobilized to address differential access to health care. Still, there are gaps in community response and many in Milwaukee are struggling.

In San Juan County, environmental damage, poverty, and lack of medical care have long been pervasive, and County residents have high rates of diabetes, alcohol-related injuries, and mental health problems. The County’s population is largely American Indian and Hispanic; oppressive policies have long stoked tensions with the Navajo Nation and anti-immigrant sentiments with the Latino community. COVID-19 hit this County hard, with the Navajo Nation surpassing New York City’s infection rate in May. The County’s unemployment rate more than doubled. Even when the state lifted parts of its stay-at-home orders, San Juan County was excluded from the relief because it was designated a “hot spot.” The County consolidated COVID-19 information and resources on one website, and worked with assisted living centers, hospitals, schools, and detention centers to help control the virus. The San Juan Safe and Healthy Communities Initiative (SJSCI) and other nonprofits have shared resources with residents and businesses.

In Tampa, the report finds, the pandemic has taken a toll not just on residents’ physical health, but also on their economic well-being and mental health. The community is in a state that has become one of the country’s worst “hot spots” for COVID-19. Florida has not expanded its Medicaid program and has a high uninsured rate. Still, Tampa-area officials adopted several policies to provide relief to those affected by the pandemic, including blocking evictions and suspending mortgage payments, providing food and housing assistance, and assembling an Economic Relief Task Force to identify business relief efforts. Hospital and health care systems formed a new collaborative to give health care leaders access to real-time data and help patients find care, but whether this and other collaborations can be sustained is unclear. Although the county has made strides to advance health equity, this work is new and the leaders have not issued specific equity guidance during the pandemic.

COVID-19 Community Response provides many more details on the pandemic’s impact in these and six other communities and looks at how these communities are responding. The next report on these nine communities, Collaboration in Communities to Address COVID-19, will be posted later this month. In both of these reports, we examine how community collaborations that existed before the pandemic are being leveraged to meet emerging needs and describe how health and equity concerns in communities are catalyzing new partnerships and cross-sector collaborations. Over time, this information is designed to inform a stronger, healthier, and more equitable recovery from the pandemic within communities.


About the Authors

Headshot of Carolyn Miller

Carolyn E. Miller is a senior program officer in the Research-Evaluation-Learning unit of the Robert Wood Johnson Foundation.

Alonzo Plough Headshot

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

Tue, 6 Oct 2020 10:45:00 -0400 Carolyn Miller Public and Community Health National