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. Wed, 13 Oct 2021 13:00:00 -0400 en-us Copyright 2000- 2021 RWJF (RWJF) <![CDATA[What the United States Can Learn From Other Nations on Paid Leave Policy]]>

Policies like paid leave are working to advance gender equity at work and at home in other nations. We just need to expand them here in the United States.

Parents hold their infant child.

"We are one of the only countries in the world that doesn't offer paid family and medical leave to those who need it."  —Robert Espinoza, Vice President of the Paraprofessional Healthcare Institute

A study by Better Life Lab and the Robert Wood Johnson Foundation reconfirms that the U.S. status quo of gender roles, both at work and home, is not working for many families. Men are missing out on caretaking roles that enrich their lives and enhance the bonds with loved ones, while women are struggling with role overload, feeling unsupported and missing out on income and economic mobility.

In contrast to the U.S., many nations are advancing gender equity through solutions that benefit health, child development, family well-being, and advance racial equity, like paid leave. The United States can learn from the experiences of other nations that are implementing paid leave policies and find approaches that encourage fathers to take advantage of these policies.

A Vicious Cycle: Lack of Gender Equity at Both Home and at Work

Many gender inequities are rooted in deeply held cultural norms that also influence how men and women are treated differently in the workplace and in the expectation of who should be primary caregivers. In the United States, the gender pay gap starts early. Male-dominated fields, like computer engineering, pay far more than female-dominated professions, like care work. In addition, research continues to find pay gaps between men and women in the same role with the same education and experience levels. One study found that 38 percent of the pay gap is unexplainable, and could likely be the result of gender bias. On top of it all, the United States has a “motherhood penalty” and a “fatherhood bonus,” where men start making far more money and women start earning sharply less when they become parents.

Studies show that employers often perceive mothers as less committed, competent or available, and by extension, less financially valuable. Alternatively, men typically see a 12 percent increase in pay after they become fathers. In the end, married mothers with at least one child under age 18, earn 76 cents to a married father’s dollar. If a woman is unmarried, has more children, or is a woman of color, the gap only widens.

As a result, at home, women spend about twice the amount of time providing care and doing housework as men, while men spend more time at work. This “double shift,” where women work a full day at the office before returning home to hours of domestic labor, hasn’t budged in decades. Additionally, unlike every other advanced competitive economy, the United States does not have a paid maternity leave policy, and is one of only seven wealthy nations with no paid paternity leave policy. Private companies are not filling much of this gap. Eight in ten workers in the civilian workforce in the United States have no paid family leave benefits through their employers at all, with low-wage workers least likely to have access to any benefit.

Shifting Gender Norms Through Policy

In contrast, countries around the world are carefully designing public policy to shift antiquated gender norms, and the financial disincentives that reinforce them. For instance, when paid parental leave was introduced in Sweden, the first iteration of the policy was gender neutral, meaning that either parent could accept any portion of the leave. Yet, because of social norms around care, mothers wound up taking the bulk of the leave, which disadvantaged them at work. Some employers were reluctant to hire young women, and many women wound up working either part-time or in the public sector.

With an eye toward fostering true gender equity, lawmakers redesigned paid leave policies with individual entitlements. Rather than a gender-neutral default, each parent received a specific amount of leave. That meant that if fathers did not take their portion of leave, the balance could not be transferred to the mother, and the family would lose out on maximizing the overall amount of time a baby spent with their parents at home.

This “use it or lose it” policy change resulted in Swedish paternity leave acceptance rates skyrocketing from 5 to 90 percent within a few short years. Cultural norms began shifting as well. Being a good father came to mean spending time with family and using the paid leave allotment, rather than doubling down at work. Global gender equity rankings show that these and other reforms have narrowed the gender pay gap in Sweden, while the time men and women spend at work and giving care is becoming more equal.

Meanwhile, in Japan, good policy is only one piece of the gender equity puzzle. To affect change, cultural narratives, mindsets and workplace norms also must shift. Japan has one of the most generous paid leave policies for men, yet even after concerted efforts to get men to take it, only about 7 percent actually do. Even those who accept the benefit usually take it only for a few weeks, not the full year that’s guaranteed. According to some studies, these men are afraid that taking time to care for their families would damage their careers. This is where fielding surveys, discussing barriers, and sharing stories of pioneering men who normalize male caregiving can help. Research has found that, because gender equity is not openly addressed, men in Japan want to be more active caregivers, but are worried that they will be ostracized for doing so.

Other nations may want to take notice of Sweden’s nuanced approach, and design incentives that specifically account for the gender bias that makes so many men hesitant to be active caregivers. When the policies are carefully designed to account for the cultural resistance and stigma associated with men investing their attention and energy into their children, they are especially effective.

When cultural stigma and financial punishments are removed, men can and do engage in care work. For instance, our research found that men anticipate needing time off of work to care for a loved one at the same rate that women do. The difference, however, is that many men don’t feel they can follow through on fulfilling those caregiving needs, and women feel they have no choice, taking time off even when it’s unpaid because someone must give care.

As the world has already shown us, real solutions to support men, women, and people of all genders who care are not out of reach here. We—as a nation—just have to be willing to find them and make them a reality.

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 and gender equity 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 and resources to lead healthy lives, starting from a child’s earliest years.

Wed, 13 Oct 2021 13:00:00 -0400 Brigid Schulte Child and Family Well-Being Health Disparities International <![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.

EDITOR’S NOTE: A shocking 140,000 U.S. children lost a parent or grandparent caregiver to COVID-19 in just 15 months, according to a study in Pediatrics, with children of color much more likely to lose a caregiver than White children.

The harm can be long-lasting. These losses also dramatically increase responsibilities for the grandparents and other relatives who step in to provide care. In a powerful post last year, RWJF’s Jennie Day-Burget looked at what Generations United has learned about the challenges facing grandparent caregivers and the policies that would support them. As Congress debates budget reconciliation, we re-share her piece.

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 healthcare 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.

Tue, 12 Oct 2021 09:00:00 -0400 Jennie Day-Burget Child and Family Well-Being <![CDATA[Learning with Indigenous Communities to Advance Health Equity]]>

Tribal Nations, resilient stewards of the natural resources that give us life, can lead the way to a more sustainable and healthy future. Indigenous Peoples' Day marks the urgent need to embrace the expertise they’ve held since time immemorial.  

A woman speaks into a microphone at a dance show. A Tlingit Native welcomes an audience to a community house. The traditions and leadership of the Tlingit, the people indigenous to Sitka, are infused throughout the community, including through educational and environmental programs.

For generations, Indigenous Peoples have known that our health is intertwined with the health of our earth. Their worldview recognizes that being healthy means ensuring the natural resources that give us life are well cared for.

In contrast, Western mindsets tend to view the natural world as an inventory of useful commodities—separate from, and existing only in service to, humanity. Overusing, polluting, and extracting without considering the long-term impacts has created conditions that fuel health inequities in our country: contaminated drinking water, food scarcity, air pollution, and extreme heat are contributing to poor health and driving up disease, particularly in low-income neighborhoods and communities of color.

Transforming our relationship with nature is key to building a sustainable, equitable, and healthy future for all. Through the forcible removal, violence, oppression, and other injustices Indigenous Peoples have experienced, they have remained powerful stewards for many of our natural resources. Their values, practices, and policies can show us the way to heal and reclaim the health of our earth and humanity.

Here are just some examples of Indigenous leadership in practice:


Tó éí  ííńá át’é. In the Navajo language, that means water is life. As sacred as Earth, fire, and air, the element cannot be taken for granted on the Navajo Nation lands in northwest New Mexico, where one-third of the tribe lacks running water at home.

A severe underinvestment in infrastructure in the Navajo nation—driven by structural racism—and mismanagement of the Colorado river by government agencies has left the Navajo Nation confronting major water resource problems. Cindy Howe, project manager at the Navajo Water Project, is helping to catalyze healing by addressing the immediate need to increase access to water with the DIGDEEP water system—plumbing that draws on a buried 1,200-gallon tank powered by solar panels to provide for a family’s basic needs.

“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,” says Howe. “That is what I wish for my tribe and indeed for all in America.”


Shortly after this video was published five years ago, Charlie Four Bear—the Native elder featured—passed away. His teachings about how to build resilience, however, continue to endure.

Horses have long been integral to Native cultures, a source of both abundance and spiritual connection. Indigenous Peoples have many stories to tell about how horses entered their lives and a rich tradition of art that honors the animal as a fellow creature of the Earth. For Charlie Four Bear, an elder on the Fort Peck Indian reservation in Montana, horses also became a way to reach young people who felt disconnected from their roots: a feeling many Native young people share as a result of our country’s colonial history and assimilation policies that have led to the erasure of Indigenous culture. 

His Youth Mentor Equine Program helped to rekindle a sense of identity as it taught boys and girls how to forge a relationship with horses. Sadly, Charlie Four Bear passed away in 2017, at the age of 59, but his efforts remain an inspiration. A story in Take Us to a Better Placean RWJF-developed collection of fiction that encourages dialogue about a Culture of Health, draws on his work. 


Dams, diversion techniques, and allotments for crops and electricity that treat water as a commodity rather than an ancestral gift are doing great damage to the nation’s rivers. Coupled with rising temperatures and drought, tributaries in Arizona that were once perennial sources of a life-sustaining elixir now flow intermittently and headwaters are running dry.

New Zealand is showing how things can be done differently, thanks to legislation championed by the Māori peoples and passed by parliament. Through those efforts, the Whanganui River was granted “personhood,” recognizing its right to be healthy and protected from harm. In 2020, tribal leaders from Arizona travelled to New Zealand to immerse themselves in the culture and customs of their Indigenous relatives and draw blessings from the Whanganui. In connecting with the spiritual authority of the waters, the visitors deepened their understanding that rivers can only be reinvigorated by changing the ways in which we relate to them.

LISTEN TO Aleena Kawe of Red Star International and Herminia Frias of the Pascua Yaqui Tribal Council share practical lessons for cultivating a reciprocal relationship with nature to advance health equity.



Staff photo of Karabi Achary

Karabi Acharya, who has drawn upon her expertise in anthropology, public health and systems thinking in working with the citizen sector in the United States, South Asia, and Africa, joined RWJF in 2015. She directs the Foundation's strategies for global learning as it identifies best practices in other countries and adapting them to improve the social determinants of health in communities in the U.S.

Thu, 7 Oct 2021 11:00:00 -0400 Karabi Acharya Health Disparities Public and Community Health International <![CDATA[How a Native American Tribe Found Healing Through Horses]]>

Bring horses and Native youth together, and connections are built that can change lives. 

Editor’s note: Shortly after this video was published five years ago, Charlie Four Bear—the Native elder featured—passed away. His teachings about how to build resilience, however, continue to endure.

Deep ties to the land and close connections with animals have long helped to define Native American culture and make their way of life possible. In Fort Peck, Montana, Charlie Four Bear reclaimed that legacy by helping young people develop enduring relationships with horses. Four Bear (Dakota and Lakota) was an elder on the Fort Peck Indian reservation and a former police officer.

 “First they took away our land,” he said, describing the destruction that occurred as White settlers pushed West. “And then they took away our buffalo. And then they took our horses away.” The theft of so much Native culture, and the inequitable distribution of resources and opportunity that continues to this day, have damaged lives and undermined communities. The scars are apparent in the substance use and loss of hope revealed in one horrifying statistic: in a single year, 28 of 223 students at the local high school attempted suicide.  

The Youth Mentor Equine Program that Four Bear ran at the time was one way that tribal leaders honored Native traditions while rekindling a sense of identity. It was one example of how community-power building can overcome the systemic harms that undermine health.  

Horses had always been in Four Bear’s life—“part of our family in every aspect of the word,” he said in a video describing his work, and it is that connection that has been shared with young people. Climbing on a horse for the first time is frightening, he acknowledged. “There is a thousand pounds of bone and hoof ready to step on you.” 

But that fear quickly gives way to a sense of belonging, recalls a young Native boy named Jay, who came to feel very much at ease with the animal. “It felt pretty cool. It felt cool to connect to the horse in every single way you possibly can.” When circumstances separated Jay from his horse for a few months, he recalled that “everything started going back to the way it was,” a downward spiral that landed him in juvenile detention. He jumped at the offer to get back to the horses.

The sense of hope Jay found among the animals is perhaps a harbinger of things to come. “It is foretold by ancestors that the seventh generation is one that is going to come and be in that time period where things are going to change to benefit the Native American getting back to who we say we are as Natives,” says Kenny Smoker, Jr. (Assiniboine & Sioux), who coordinates the Fort Peck Tribe’s wellness program. He believes that the tribal elders will point the way. “They provide wisdom for our tribe. We really need to tap into that to help address the suicide and the other health disparities that exist.”

Four Bear, too, saw the possibility. “We can help each other and become a healthy tribe again,” he declared in his soft-spoken, determined manner.

Four Bear’s story inspired a powerful work of fiction by author David A. Robertson. Read “Reclamation” in RWJF’s short-story collection, Take Us to a Better Place.

Wed, 6 Oct 2021 10:00:00 -0400 Culture of Health Blog Health Disparities Public and Community Health National <![CDATA[A Historic Day for SNAP]]>

October 1 ushered in the largest permanent benefits increase in the nearly 60-year history of what is known today as the Supplemental Nutrition Assistance Program (SNAP). 

SNAP benefits for health care.

A recent report from the U.S. Department of Agriculture (USDA) finds that approximately 10.5% of families experienced food insecurity in 2020—the same percentage as 2019.

That finding may not seem groundbreaking. But it is truly stunning.

How is it possible that rates of food insecurity did not increase during the worst pandemic in a century? After all, the economic upheaval caused by COVID-19 was swift and severe, with a perfect storm of factors—including massive job loss, significant wage reductions, widespread school closures, and marked increases in food prices—that one would naturally assume a sizable increase in rates of food insecurity across the board would occur.

It didn’t happen.

To be clear, a food insecurity rate of 10.5% is far too high. Rates are even higher among people of color and those with low incomes; we cannot accept that status quo. But major increases in economic and nutrition assistance, approved by Congress during the pandemic, prevented a dire economic situation from turning catastrophic. These types of strategic policy decisions offer a roadmap to not only navigate a public health emergency, but also to accomplish big goals—like ending hunger and poverty in this country for good.

October 1 marked a significant turning point in our efforts to achieve the healthier and more equitable future that is in our grasp. It ushered in the largest permanent benefits increase in the nearly 60-year history of what is known today as the Supplemental Nutrition Assistance Program (SNAP), the largest nutrition assistance program in the United States.

To explain the significance of this moment—both how we got here and where this road could take us—I had the privilege of talking to a wonderful colleague and terrific friend: Jamie Bussel, a senior program officer at RWJF who oversees our childhood nutrition work.

What has SNAP’s role been during the COVID-19 pandemic?

SNAP is extremely effective at increasing food security, improving children’s health and academic performance, supporting economic growth, and lifting people out of poverty. Because of that record, SNAP has been a key component of our economic response to COVID-19.

Jamie Bussell SNAP is extremely effective at increasing food security, improving children’s health and academic performance, supporting economic growth, and lifting people out of poverty. –Jaimie Bussel

When the economy went into a recession after COVID-19 hit, several million people turned to the program to help. Congress responded by increasing funding for SNAP to cover the additional participants and also providing a temporary 15% increase in monthly benefits. A new Pandemic-Electronic Benefit Transfer program was created to provide additional support to families that participate in SNAP who lost access to healthy meals when their schools or child care facilities closed. And regulatory changes eased eligibility requirements and made it easier for participants to use their benefits online. Combined with additional economic assistance like the expansion of the Child Tax Credit, this strategy reflects the connections between financial security and food security, and has already had a positive impact.

Looking forward, the Urban Institute estimates that the temporary increase in SNAP benefits—along with direct cash payments, enhanced federal unemployment insurance benefits, and the expanded Child Tax Credit—will contribute to an astonishing decline in poverty in 2021. But what about 2022 and beyond? How can we better utilize SNAP over the long-term? Because even with these short-term supports, we still haven’t been maximizing the full potential of the program to help those in need.

That’s an interesting point. What have we been ‘leaving on the table,’ so to speak, when it comes to SNAP?

SNAP benefits are a lifeline to program participants. But prior to the temporary 15% increase in benefits, in 96% of counties in the U.S., the average SNAP benefit wasn’t enough to cover the cost of an average meal, with the highest gaps seen in both higher-cost urban and smaller rural counties. And even with that bump, which expires at the end of September, the average SNAP benefit still isn’t enough to cover the average meal cost in more than 40% of U.S. counties, with dramatic differences in food prices still playing a significant role in how far a family’s benefits can go. No matter where participants live, SNAP benefits must be enough to cover food costs and ensure families can afford to make healthy purchases. And that’s a big reason why USDA seized this moment to take a truly game-changing step: updating the Thrifty Food Plan.

Tell us about the Thrifty Food Plan. I imagine a lot of people may not even know what it is.

I think you’re right: the Thrifty Food Plan is pretty obscure. But it’s actually incredibly important because this is the mechanism USDA uses to calculate SNAP benefits for participants. The Thrifty Food Plan takes into account a variety of metrics to make those calculations, from food costs to dietary guidance to the nutrition content of certain foods. It has been in existence since 1975, but as USDA notes, the purchasing power of the plan has never changed since its creation.

So USDA used the authority it had been given in the most recent Farm Bill to update and modernize the Thrifty Food Plan, and the results are transformative. Thanks to these updates, the average SNAP benefit will increase by about 25% compared to pre-pandemic averages, increasing the average benefit per participant from $121 to $157.

An extra $36 a month may not seem like much at first glance, and it’s by no means a panacea, but it will make a tremendous difference. The vast majority of SNAP benefits go to households with incomes at or below the poverty line. Many families run out of SNAP benefits before the end of a given month; more than 80 percent of SNAP benefits are spent within the first two weeks of receipt. That makes it exceptionally difficult to buy food in the latter half of a month before the next month’s allotment is distributed. These extra dollars will go a long way toward filling that gap, and keep families from being forced to make impossible choices between buying food, paying the rent, and purchasing medications.  

What does the future of SNAP look like? Where does the program go from here?

One of the lessons of the pandemic is that we can’t be satisfied with simply reducing poverty or hunger; our goal must be to eliminate these conditions for good. So while the impact of the permanent benefit increases that took effect on October 1 can’t be overstated, there’s still more we can do. The Robert Wood Johnson Foundation supports a series of additional steps to further strengthen SNAP, including ensuring that all eligible people—particularly immigrants, people of color, and rural residents—are able to easily access the program; broaden eligibility to cover more people; expand nutrition incentive programs that help participants make healthy food purchases; and eliminate the lifetime ban on SNAP participation for convicted drug felons.

I’m proud of the work RWJF has been part of over the past several years to advocate for SNAP participants and add to the research base showing how effective the program is. This week will mark a huge milestone for the program, and it should be rightly celebrated. But there is so much more to do to strengthen and modernize our nutrition assistance programs and policies.  And that’s why we’re just getting started.

Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, is funding research focused on how COVID-19-related relief and recovery policies and programs impact child obesity, diet quality, food security, and other relevant child and family health outcomes. APPLY FOR FUNDING  


About the Author

Jennie Day-Burget

Jennie Day-Burget, senior communications officer, provides communications support to RWJF initiatives aimed at ensuring children and families have the resources they need to thrive, including those that help improve policies, systems and environments to reduce rates of childhood obesity and improve health outcomes for those most impacted by climate change. 

Thu, 30 Sep 2021 13:00:00 -0400 Jennie Day-Burget Child and Family Well-Being Childhood Obesity <![CDATA[Healing Our Rivers and Ourselves: Learning with Indigenous Peoples of New Zealand]]>

Our health is inextricably connected to the health of land, water, and all living things. The ways in which Indigenous peoples live that connection offer lessons that could benefit all of humanity. 

A woman stands on a walking trail bridge over a river.

Our nation’s health is intertwined with the health of our rivers. And our rivers are unwell.

Drinking water, food, sanitation, clothing, transportation: almost everything we do involves an interaction with water. Yet many people in America take water for granted, not realizing that pollution, overuse, and climate change are putting a chokehold on the country’s natural water reserves—posing a direct threat to health, equity, and our way of life.

While many may think that new technology and innovation can resolve our water crisis, I believe that the solution lies with Indigenous practices that have fostered a holistic approach to living in relationship with the natural environment for millennia. Let me explain.

Our Relationship with Nature

Indigenous peoples share a common worldview of our relationship with the natural world. One that is guided by Indigenous values and principles of respect, cooperation and responsibility. These principles govern our individual and collective beliefs, behaviors and relationships—as given to us from our ancestors. While our customs may differ, our lived connection with our environment is universal. In sharp contrast, Western mindsets tend to view nature as a commodity, maintaining a relationship that is centered on resource-taking.

Rivers are an excellent example. The Māori peoples of the Whanganui River in New Zealand view their ancestral river, Te Awa Tupua, as an indivisible whole, incorporating its tributaries and all its physical and metaphysical elements from the mountains to the sea. This catchment-wide approach ensures that all of the waterways that form the Whanganui River are viewed and managed, not in isolation, but with reference to the whole river as an interconnected ecosystem.

In the United States, and in particular the Colorado River Basin where I grew up, we create laws that slice up our rivers with little regard for their health. These laws divide our rivers in half between the upper and lower basins, separate out the groundwater from the surface water, and apportion the tributaries—cutting them up into allotments measured in cubic meters for the taking. We wield control over our rivers, damming and diverting their flow to water our crops and power our electricity. This approach leads to over-allocation, poor water quality, and rivers that are sucked dry.

Historic Roots

American’s view of nature as “property” run long and deep—and can be traced all the way back to the colonial settler attitudes. For the last 175 years, federal policies have systematically disrupted traditional life ways among the 30 tribes with historic ties to the Colorado River Basin. In the mid- to late 1800s, many river tribes were confined to small reservations, and in some cases, forcibly removed from their ancestral homes, dismantling their relationship with the rivers as their original custodians.

A similar colonial history is shared with Māori. In New Zealand, more than a century of laws, regulations, and actions of the government also fragmented the Whanganui River, diverting its headwaters, building hydroelectric dams that stem its flow and threaten its health. Since 1873, local Māori had sought to obtain legal protections for the Whanganui River, catalyzing “one of New Zealand’s longest running court cases.”

Five years ago, all of that changed when the New Zealand parliament passed unprecedented legislation granting ‘personhood’ to the country’s Whanganui River. Contrary to American law which defines nature as property, legal personhood recognizes the rights of the river to be healthy and to be protected from harm. It is also the framework by which the innate relationship of the River to the People and the People to the River is upheld.  

The Te Awa Tupua (Whanganui River Claims Settlement) Act 2017 also created the office of Te Pou Tupua, which comprises two people—one of which is Matua Turama Hawira—to act as the face and voice of the river.

Learning From the World

The victory achieved by Māori iwi (tribes) for their Te Awa Tupua (ancestral river) inspired me to bring tribal leaders representing four tribes from my home state of Arizona, to Aotearoa (New Zealand) in 2020 to meet with Whanganui River iwi for a cross-cultural exchange.

The road to the Whanganui River wove through verdant forests that framed the river’s glistening waters, a sharp contrast to the red earth and towering rock formations of our desert home. We arrived at Hiruhārama Marae, a traditional meeting grounds nestled in a bend of the river, where, meeting us for the first time, Turama along with the local Māori community welcomed us as relatives.

We spent the next three days on the river, fully immersed in the culture and customs of our new relations. We stood before Te Awa Tupua and bowed our heads in reverence as our Māori guides acknowledged the river’s spiritual authority with prayer and invocation. We cupped our hands in the river’s flow and blessed ourselves with it. It was a sensory experience; one of love, connection and awe. Our relationship as one with the river had begun.

As desert people, it was the most time many of us had ever spent in and around so much water. For centuries, our rivers in Arizona were perennial. Today, their flow is now intermittent at best. For the past hundred years, legislation and water policy have allowed seven states to legally use more water from the Colorado River Basin. To make matters more dire, rising temperatures and drought have exacerbated the problem, drying out the headwaters and eroding tributary flows. The last time the Colorado River reached the sea unencumbered was 1963. The shortage has forced the federal government to take the unprecedented step of introducing water cuts. More than 40 million people and nearly 4 million acres of American and Mexican crops now depend on a water supply that is quickly dwindling.

Healing our Rivers and Safeguarding our Health

We are at a critical juncture where an innovative approach is needed to guide water resource management; one that reinvigorates our rivers from the mountains to the sea and guarantees a future where our rivers are healthy and access to clean water is certain for the coming generations.

It starts with changing the way we relate and think about our rivers.

We must begin by seeing our rivers as interconnected, living systems that incorporate not just physical but also metaphysical elements. We must approach our rivers with respect and care for them the same way we protect and care for our families. Only then will our decisions about water use be responsible and contribute to the vitality and longevity of our rivers.

In essence, we must prioritize the river’s health in our decision-making at the national, state, and local level. If we change now, we can heal our rivers—and safeguard our own health. Tribal Nations, the original stewards for many of our natural resources, can show us how and lead the way to a more sustainable future.

JOIN ME in conversation to learn more about how Indigenous approaches to water and land stewardship can help us build a healthier future for all.



Aleena Kawe headshot.

Aleena M. Kawe is CEO of Red Star International, Inc. and enrolled member of the Texas Band of Yaqui Indians.

Wed, 22 Sep 2021 10:00:00 -0400 Aleena M. Kawe Public and Community Health Health Disparities International <![CDATA[Why Building Black Wealth is Key to Health Equity]]>

To dismantle structural racism, says a renowned economist, our nation needs a new narrative—and systems and policies that advance racial and economic justice.

Illustration for racial wealth gap. Illustrator: Cat Willett

Darrick Hamilton, the Henry Cohen Professor of Economics and Urban Policy at The New School, has gained national recognition for shaping policy solutions to close the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black families of resources that accumulate and transfer from one generation to the next. The typical White family has 10 times the wealth of the typical Black family and seven times the wealth of the typical Latinx family. This stark and persistent racial wealth gap has harmed generations, driven disparities and appears to be growing, even after controlling for household characteristics and long-term education and income gains by Black people.

Hamilton’s early experiences provided an ethical orientation toward justice that shaped his career as an economist. Growing up in Bedford-Stuyvesant while attending the Quaker-run Brooklyn Friends School exposed him to two worlds in which fundamentally similar people experienced markedly different life trajectories—primarily due to one group benefitting from greater resources than the other.

In this Q&A, he shares powerful insights on the impact of the racial wealth gap, strategies to address it, and reflections on how events of the past year are shifting narratives and providing hope for change.

What impact does the racial wealth gap have on health?

The racial wealth gap has a clear and direct impact on health. The wealth position a child is born into will shape opportunity, outcomes and health throughout life. Adults living in poverty are more likely to be uninsured and forgo medical care due to concerns about cost, missing work, or finding affordable childcare. While medical debt is the number one reason for bankruptcy, those with wealth have access to resources that support health and can pay for expensive health interventions.

The racial wealth gap is also part of the reason the COVID-19 pandemic drove down life expectancy for Black and Latinx people in the United States, even more than for those who are White. White people in America were better resourced and had greater agency to withstand the pandemic’s effects than Black, Native American and Latinx workers.

What many don’t consider, however, is the everyday stress of living paycheck to paycheck without the benefit of a nest egg to buffer against an unexpected event. Adding to this stress is the psychological burden of race-related stressors tied to every transaction for Black people.

How does the ‘American Dream Narrative’—which centers personal responsibility—harm communities of color and the nation as a whole?

Darrick Hamilton The wealth position a child is born into will shape opportunity, outcomes and health throughout life. —Darrick Hamilton

The nation’s dominant narrative, which states that people can achieve the American Dream of economic success through resilience and grit and by taking personal responsibility, causes great harm. We have stigmatized poverty with racist and misogynistic language such as “welfare queens and deadbeat dads,” instead of acknowledging our history. This narrative perpetuates White privilege and tells those in stigmatized groups that opportunity is there if they seize it and work twice as hard.

Working twice as hard to overcome systemic and structural barriers harms health. Evidence shows how disparities in health outcomes increase with education and income, which contradicts a narrative that emphasizes personal responsibility and hard work.

For example, racial differences in infant mortality actually worsen with higher levels of both education and income. It’s clear that the stigma and burden of overcoming racist structures leads to pernicious health consequences.

Are there solutions to counter this narrative and address the racial wealth gap?

We must move away from incentivizing people to adopt attitudes, norms, and behaviors largely considered beneficial and instead empower them with resources that provide agency to achieve success. And we must recognize government’s responsibility to ensure access and adequate wealth.

To address this, the two anti-racist policies I support are reparations and baby bonds. Reparations are direct and retrospectively acknowledge dignity and redress while addressing resource deprivation. Acknowledgement is critical for dignity and government must take responsibility for state-facilitated exploitation.

However, given our egregious history and especially the on-going ways that capital tends to consolidate and iterate for some at the exclusion of others, a onetime redress is not enough. Everyone has an economic right to wealth and that’s where baby bonds come in. Baby bonds are trust accounts for children. The money is held in public trust until a child becomes an adult. Funds can then be used for buying a house, starting a business, and/or financing education. To redress wealth disparity and advance racial equity, this year Connecticut became the first state to pass a Baby Bonds type program for each child whose birth is covered through Medicaid. The laudable goal is to allow children who don’t have the benefit of inherited wealth to pursue the same asset-building opportunities as others.

How have the past year’s events—the pandemic, economic fallout, racial reckoning and political unrest—shifted the dominant narrative?

The events of the past year have created a pivotal moment when we can change the narrative. The pandemic, the summer of protest in response to George Floyd’s murder, the many dimensions of political unrest, the in-fighting within political parties, all suggest that the system is ripe for change. For example, a silver lining of the pandemic was how it led to unprecedented government interventions like sending people $1,200 checks. When lawmakers decided it was necessary to distribute money broadly and did so, they changed views about what government can do.  

The attitudes of youth are also creating momentum to change the narrative. Young people are speaking up and saying: The status quo isn’t working. We want an economy grounded in justice and sustainability.

That makes this the moment when the system we’ve had in place for 50 years is on the brink, and real change is possible. It’s a moment for social movements and philanthropies to boldly commit to economic justice, a new narrative, and to our values, without pessimism. This is the moment to recognize that economic justice includes wealth, health, the right to a job and to an income, to mobility without threat of incarceration or violence because of one’s identity, and to free mobility without stigma, constraint and fear. A moment, I hope, when we will commit to economic and racial justice for everyone.

How can the New York City Racial Justice Commission influence other communities that want to dismantle structural racism?

The New York City Racial Justice Commission has been charged with remaking the city’s Charter and shaping policy to dismantle structural racism for all in New York City.

One of the biggest impacts we can have is establishing values that emphasize inclusion, belonging, power, equity, access along race and gender as a responsibility of all aspects of government in New York City. Through this commission, I believe that our city, given its size, influence and media, can set an example for other cities, states, and the nation as a whole. That, in and of itself, is valuable.

Dr. Darrick Hamilton is on the National Advisory Committee for RWJF’s Policies for Action. Learn more about the program’s research findings on building an inclusive pandemic recovery for all.


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.


Thu, 9 Sep 2021 11:00:00 -0400 Najaf Ahmad Health Disparities <![CDATA[Closing the Medicaid Coverage Gap is a Health, Economic, and Moral Imperative]]>

Closing the Medicaid coverage gap would save lives, reduce costs, and help eliminate the racial and ethnic health disparities that have persisted for generations.   

Illustration of the U.S. highlighting states without Medicaid expansion.

“I am grateful for Medicaid because I can live on my own,” said Theresa, who has Spastic Quadriplegia Cerebral Palsy. Medicaid covers the costs associated with Theresa’s physical and occupational therapy, a wheelchair, and personal care attendants.

“I wouldn’t be alive if it wasn’t for Medicaid,” said Laticia, who received Medicaid coverage while growing up in the foster system that allowed her to receive care for both physical and mental health conditions.

“Medicaid has been a blessing,” said Regina, who relies on Medicaid to cover her daughter’s routine medical and preventive care that would otherwise be unaffordable.

There are approximately 75 million people in the United States enrolled in Medicaid, making it the largest health care provider in the country. And while each participant’s story is unique, Theresa, Laticia, and Regina have at least one thing in common: each lives in a state—Montana, Missouri, and Iowa, respectively—that has expanded Medicaid under the Affordable Care Act (ACA) to provide quality and affordable health care coverage to more of its residents. In fact, 38 states have done so since that landmark law was enacted.

But 12 states have refused to expand their Medicaid programs under the ACA, denying health care coverage to more than two million people—disproportionately people of color—who would qualify for the program if expansion was implemented in those states. These holdout states have refused to budge even as the federal government would cover the vast majority of expansion costs; even as Medicaid expansion states reap a variety of health and economic benefits; and even as the United States remains in the throes of a deadly pandemic.

Statistic card from Medicaid Report.

This is an ongoing injustice that must be corrected as soon as possible. Fortunately, Congress has an incredible opportunity to do so right now. The House and Senate have passed the framework of a $3.5 trillion budget resolution for Fiscal Year 2022 that has the potential to dramatically reshape the health care landscape in the United States. As Congress finalizes this framework over the coming weeks, a permanent closure of the Medicaid coverage gap must be at the top of the priority list.

The Past

Medicaid was created in 1965 and is jointly funded and administered by the federal government in all 50 states. At its inception, the program provided health coverage to those who qualified for other forms of government cash assistance. Over the years, the program expanded to serve not only families with low incomes, but also pregnant women, people with disabilities, and those who require long-term care.

Under the original Affordable Care Act enacted in 2010, states were required to expand their Medicaid programs to any residents whose income levels were up to 138 percent of the federal poverty line (in 2021, the federal poverty threshold is $26,500 for a family of four); substantial federal funding was included in the law to cover the vast majority (currently 90 percent) of states’ expansion costs. However, a 2012 Supreme Court decision eliminated the mandate and instead left the expansion decision up to each state. States have had the option to do so since 2014.

The Present

An overwhelming body of research shows that Medicaid expansion under the ACA has been an unqualified success. In states that have taken this step, the rates of the uninsured have dropped significantly, particularly among communities of color and those with low incomes; participants have experienced improved health outcomes, including reduced incidence of premature deaths and fewer cases of maternal mortality; and state economies have seen lower health care costs along with increased economic activity due to healthier populations. And thanks to subsequent legislation, there are additional federal funding incentives for states to take this step.

There is no health or economic rationale, then, for the holdout states’ ongoing refusal to expand. Ultimately, it is a question of whose lives we value in our country and whose we don’t, and right now, policymakers in 12 states have decided that the lives of more than two million people don’t have value. It should not come as a surprise, then, that the populations most affected by the holdout states’ refusal to expand are the same ones that have been disproportionately affected by COVID-19 and the structural racism and discrimination that have been baked into our country for centuries. People of color represent more than 60 percent of the coverage gap population, and relative to their overall percentage of the U.S. population, both Blacks and Hispanics are disproportionately counted among this group: Black people in America, for instance, represent 14 percent of the U.S. population but 28 percent of the coverage gap population. And while more than 60 percent of those in the coverage gap are employed, many are in low-wage jobs that are more likely to not offer health insurance. For the working poor, there is often no other health care coverage available than Medicaid, and that option is being foreclosed on them in too many places.

As a Black woman and a Black mother, I am also particularly attuned to our nation’s abysmal rates of maternal mortality, and Medicaid’s potential to change the trajectory for Black families. Per the Center on Budget and Policy Priorities, more than 800,000 people in the coverage gap are women of childbearing age. The United States has the highest maternal mortality rate of any developed country in the world, with Black women at the greatest risk for dying before, during, or after the birth of a child. Expanding Medicaid coverage would make it easier and safer for Black women to have healthy pregnancies that result in healthy deliveries and healthy children.

The Future

Prior to my time at the Robert Wood Johnson Foundation, I spent more than a decade as a congressional staffer. I would often hear stories from my constituents—people not all that different from Theresa, Laticia, and Regina—who were forced to make impossible choices due to their limited or nonexistent health care options, from rationing care to deciding whether whatever funds they may have had in a particular month should be used to either pay the rent, buy food, or afford their medication. I suspect Theresa, Laticia, and Regina would be the first to agree that access to health care coverage shouldn’t come down to luck, or good fortune, or living in the “right” state.

Fortunately, there is movement in the right direction. There is growing momentum toward the federal government stepping in to close the gap unilaterally. In holdout state after holdout state, local residents are leaning on state policymakers to finally step up and do the right thing. That gives me hope that we’ll get this over the finish line.

To be sure, our nation’s health care woes go well beyond the Medicaid coverage gap. A recent report from The Commonwealth Fund finds that among 11 wealthy nations, the United States ranks first on health care spending by an astonishingly wide margin yet ranks last among more than 70 health care performance measures—lending more credence to the fact that our current health care system can be more accurately described as a sick care system. In a country as wealthy as ours, we can and must do better. Ensuring that each and every person living in the United States—irrespective of skin color, income level, geography, occupation, or immigration or disability status—has access to quality, affordable health care must be a national priority. There are many steps we need to take to achieve that vision.

But closing the Medicaid coverage gap is the most important step we can and should take right now. It would provide millions of people with health care coverage that would save lives and reduce health care costs. And it would be a significant moment toward helping to eliminate the racial and ethnic health disparities that have persisted for generations, but must no longer be tolerated in our pursuit of a fairer and more just nation.  

CLICK HERE to access a variety of resources that underscore the urgent need to expand Medicaid coverage.



Avenel Joseph

Avenel Joseph, PhD, joined RWJF in early 2020 as the vice president for Policy. She brings a wealth of government, management, and political expertise to leading the Foundation’s Policy office and heading its Washington presence.

Tue, 7 Sep 2021 11:00:00 -0400 Avenel Joseph Health Care Coverage and Access Health Disparities <![CDATA[The Case for Having Health Equity Guide Community Preparedness]]>

The coronavirus pandemic has exacerbated long-standing inequities in communities across the United States. To prepare for the next crisis, communities must build health equity infrastructure now.

Health equity and community preparedness illustration.

We can’t prevent disasters, but proactively developing strategies to address health equity can ease some of their most harmful effects on people and communities. 

In our research, we’ve found communities that developed these strategies before and throughout the pandemic were better positioned to target resources to address health disparities that were highlighted and exacerbated by COVID-19.

Take Harris County, Texas, for example. In 2014, Harris County Public Health (HCPH) developed a health equity framework that was tested by an outbreak of the Zika virus in the county two years later. This experience informed HCPH’s management of the COVID-19 vaccine rollout and decision to collect vaccination data by race. While the state of Texas’ vaccination strategy emphasized mass vaccination sites, mobile vaccine clinics administered the one-shot Johnson & Johnson vaccine in parts of Harris County that were hit hardest by the pandemic.

Since the pandemic began, we have been studying nine communities as they navigate the challenges posed by the crisis while striving to promote health and well-being. The latest set of reports in the Sentinel Communities: COVID-19 Community Response series, examines the communities’ response to the pandemic over the last year. We hope this research will contribute to a broader understanding of the strategies that can create lasting, equitable change.

Both Harris County, Texas, and Tampa, Fla., had strategies and structures in place to holistically address community health and prioritize health equity before the pandemic. These communities have faced disasters like extreme weather events and disease outbreaks in recent years. They were able to leverage tools and infrastructure from past emergencies to quickly mount a response to the pandemic and its ripple effects—from food shortages to housing crises. 

Using Policy to Address Local Disparities

Before the pandemic hit, efforts to build a more resilient, equitable community were well underway in Tampa. The city has welcomed an influx of newcomers in recent years, pushing residents with low incomes farther away from the city center to neighborhoods where housing costs are lower but public transportation is inadequate. Tampa has been directing resources to address these challenges, which Mayor Jane Castor has identified as priorities for her administration. In 2019, Mayor Castor convened advisory groups of experts to develop priorities and strategies to expand access to affordable housing and improve Tampa’s transportation infrastructure.

Work to improve economic opportunity in Tampa has continued throughout the pandemic. Mayor Castor established the Economic Advisory Committee in August 2020. This diverse workgroup of 23 community stakeholders was tasked with developing recommendations to reduce poverty, reduce gender and racial disparities in income, and expand economic diversification. Their recommendations, released in April 2021, focused on four key areas: promoting inclusive economic growth, reducing poverty, committing to racial equity, and emphasizing educational opportunity. These recommendations have spurred initiatives to close the digital divide and address the racial unemployment gap.

The intent of these actions is important, but communities also need to measure their impact. Last year, our colleagues launched COVID-19 U.S. State Policy database (CUSP) to assess the equity implications of state-level policies similar to those that Mayor Castor has enacted. 

Having Equity Drive Collaborations 

Equity has been at the center of Harris County’s pandemic response, informing decisions around COVID-19 testing strategies and communication with residents of color. HCPH stood up its Incident Command System and within it, a Resilience and Equity Branch which used the Social Vulnerability Index from the Centers for Disease Control and Prevention (CDC) to prioritize testing locations to enhance equity. Outreach teams were deployed daily to community events in areas with high percentages of residents of color.

Harris County’s focus on combating health disparities stems from the health equity framework the county established in 2014. Since then, this explicit commitment to equity has shaped day-to-day public health operations, including efforts to utilize data to target policies to areas of the community most in need.

Where Do We Go From Here?

Leaders in Harris County and Tampa have made health equity a priority in regular policymaking and in their response to the pandemic, but they are limited in their authority. While state leadership in Texas and Florida pursued aggressive reopening policies, local public health officials developed more cautious approaches to reopening, guided by CDC recommendations. 

The tension between state and local leaders played out north of Harris County, in Dallas. After the city prioritized racial equity in their vaccine strategy, the state threatened to send fewer vaccine shipments.

Local efforts to promote health equity are also limited by state inaction on Medicaid expansion. Texas and Florida are among the 12 states that have refused to expand Medicaid, exacerbating health disparities for people of color and adults with low incomes. As Dr. Richard Besser writes, “...populations disproportionately affected by COVID-19 are the same populations most likely to be uninsured. These are not coincidences, but patterns that reflect our nation’s past and present.”

Our research has made it clear that the time for prioritizing equity is now, before the next disaster strikes, whether it is a health crisis, a natural disaster, the effects of climate change, or social injustice. For the health and well-being of our communities, we must integrate equity planning into normal routine operations so we are better prepared to weather the next crisis—and address inequities communities face every day.

We can't afford to ignore the hard-learned lessons of COVID-19.

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



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

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

Tue, 24 Aug 2021 13:00:00 -0400 Carolyn Miller Public and Community Health Disease Prevention and Health Promotion National <![CDATA[How Taking a Simple Quiz Reaffirmed My Love For Global Learning]]>

Can the bold ideas needed to advance health equity be found beyond our borders? A global learner reflects on the value of looking abroad for solutions and the 12-question quiz that can help us all get started.

The Blue Marble

One out of four people living in the United States today are either immigrants or children of immigrants. That’s approximately 85 million people, all of whom have connections to other countries and cultures. I’m one of those people. While I was born in Michigan and call New Jersey home today, I’ve spent considerable time visiting, living and working in Mumbai—the city my parents migrated from and where my public health career kicked off.

My connection to my country of origin—through ties to family and friends, time spent living and visiting there, language and culture—has profoundly shaped me and made me the person I am today. Perhaps most importantly, though, it has fostered a deep appreciation for the many different ways people experience, live day-to-day and move through the world—and the great possibilities for learning this brings. Years ago, as a new mother in the United States, I benefited enormously from Indian postpartum food traditions, lovingly prepared for me by my mother and mother-in-law. Now, with school-age children, I wonder which Indian teaching methods could be helpful, trading notes with my cousins and their kids.

These types of exchanges have enriched my life, and I often hear the same sentiment from friends and colleagues with immigrant backgrounds from various other countries. Moreover, they remind us that the way things are done in the U.S. isn’t the only way to do things. Countries around the globe, from Brazil to Malawi, are finding creative ways to overcome similar health challenges to the ones we’re facing in the U.S. By looking beyond our borders, we can uncover new inspiration for advancing health and health equity across our communities.

An Intriguing Proposition

Knowing we have so much to learn from other countries, I was excited when a group of colleagues and I were asked to beta test RWJF’s now fully launched Blue Marble Quiz. We were told the quiz had been designed to help more people discover the value of global learning.

As someone who sits on the Foundation’s Global Ideas for U.S. Solutions team and shares in this mission, it was a promising proposition. But I did wonder how it could be done in just 12 questions. It seemed too good to be true, knowing how challenging it can be to spark this type of interest. In fact, just last year, 73 percent of U.S. foundations surveyed by Candid said their grantmaking was rarely or not at all inspired by solutions from around the globe. Could a quiz help change that?

The first question flashed on the screen: How are you connected to various cultures and countries? Quickly checking off several of the answer choices, I was delighted by the questions that followed, all of which invited quiz-takers to reflect on how global learning shapes how we think and what we do. I felt like many of my own life experiences were showing up in the questions. At the same time, the quiz also recognizes that living in another country—or even visiting one—is not a requirement for global learning: having friends from different cultures, listening to music of other countries, watching global news, trying new cuisines—all of which can happen right in our own backyard—can shape our thinking, too.

I was having a lot of fun reflecting on each question. Was the rest of the beta testing team having a meaningful experience with it too? I couldn’t tell. All I could hear was the quick, off-beat sound of mouse clicking. I took that as a good sign and continued on my exploration.

The Blue Marble

Once I answered the last question, the quiz tallied up my score to reveal my result: Blue Marble All the Way.

Blue Marble All the Way.
Earth seen from Apollo 17. The earth seen by the Apollo 17 crew in 1972.

This category and the quiz’s name are inspired by the Blue Marble image of the Earth taken by the Apollo 17 crew in 1972. It was the first photo to capture the world in its entirety and forever changed the way we see it. The astronauts described a profound shift in their perspectives as borders and divisions vanished and one fully connected entity came into view.

Similarly, when we take a step back from our own country—either literally or figuratively—we start to see our home, our work, our challenges and potential solutions with new eyes.

I enjoyed reading about the other categories I could have fallen into as well—from Buy Local to I’ll Cross That Bridge. Each one celebrates the different places our ideas can come from, recognizing that all perspectives hold immense value on the journey toward health equity.

While not a scientific survey, the questions in the quiz are informed by resources and research that speak to the benefits of looking abroad for inspiration, ideas, and solutions. The quiz makes all of these materials available at the end—they range from articles to podcasts to a spinning globe of radio stations you can tune into. I enjoyed this TED talk by Angela Oguntala, who encourages us to consider visions of the future by looking abroad, with examples from Kenya, Bangladesh, and the Caribbean. I also learned that, according to an MIT study, having close interpersonal relationships with people from different cultures can actually spur creativity, innovation and entrepreneurship.

“Creativity is about connecting dots,” I read in an MIT Sloan interview with the lead author of the study, Jackson Lu. “When someone enters a close relationship with a person from a different culture, they collect more dots to connect to the ones they already have.”

How could these connections benefit us in workplace settings? How might they prove useful as we seek solutions to social challenges? I thought back to my ties to India and wondered how my own interpersonal relationships there might continue to fuel outside-the-box thinking, personally and professionally.

A Journey for All

Suddenly, I noticed the sound of mouse clicking had petered out and my colleagues were starting to look up from their laptops. A robust discussion ensued. Some pointed out how the quiz helps people see they have more exposure to global ideas than they realize, others reflected on the resources that stuck out to them—demonstrating that this simple tool could spark provocative conversations about how we learn from the rest of the world and the value those insights hold for advancing health equity.

Since the quiz was launched, we’ve heard from people whose curiosity has been similarly sparked, like the co-chair of a sorority committee who used the tool to lead a teen youth group discussion about how to be a global citizen and peers who have been inspired to add more international news stories to their daily reading.

Global learning can often be seen as exclusive and distant, but the quiz opens up pathways for it to be inclusive and accessible for all.

What if the key to advancing birth equity could be found within Rwanda or the bold approaches needed to address the climate crisis were taking root in New Zealand? Twelve simple questions might kick-start a learning journey that could surface the solutions you’ve been looking for.

Take the quiz and explore the intriguing resources to see where in the world your ideas come from.



Headshot of Shuma Panse

Shuma Panse, senior program officer, joined the Robert Wood Johnson Foundation in February 2016, bringing extensive experience in business engagement on health, public-private partnerships, and global health.

Thu, 12 Aug 2021 13:00:00 -0400 Shuma Panse Public and Community Health Built Environment and Health International <![CDATA[Database Tracks Health Equity Implications of State COVID-19 Policies]]>

A publically available database is helping researchers, policymakers, journalists, and others understand how over 200 state policies implemented during the pandemic are impacting health equity.

COVID-19 U.S. State Policies image.

Rapid response is synonymous with moments of crisis. From first responders to communication experts, responding quickly to a crisis is critical for community health and well-being. But what about rapid response research? 

COVID-19 has epitomized a complex crisis of infectious disease, food and housing insecurity, and mental distress. People who are Black, Latinx, Native American, and living in low-income households are the most vulnerable to these conditions. It is clear that health and social policies enacted during the pandemic will affect communities for decades to come. 

To inform rapid response research and policymaking, my team at Boston University and I developed the COVID-19 U.S. State Policy database—also known as CUSP—in 2020. This resource aims to inform health and social policy decisions that promote health equity and focuses on policies that affect vulnerable and historically excluded populations. Now over a year after its inception, we are assessing what we have learned and where we have yet to go.

How It Started

States responded to the pandemic with a wide range of polices, from stay-at-home orders and closing businesses, to unemployment insurance and minimum wage changes. Many of these policies were aligned with the Robert Wood Johnson Foundation’s (RWJF) health equity principles for recovery during the pandemic. With support from RWJF's Evidence to Action program, we started the CUSP database.

As we saw the pandemic exacerbate disparities stemming from structural racism and inequitable policies, we wanted to document policies so researchers could evaluate their impacts on populations most affected by COVID-19 and its repercussions. 

While Black and Latinx people were more likely than White people to die of COVID-19, in the database we captured some policy decisions that explicitly disadvantaged Black and Latinx people. For instance, the Advisory Committee on Immunization Practices recommended prioritizing essential workers for vaccines, and most states planned to do so. But after a federal government recommendation to prioritize people aged 65 and older, most states shifted to age-based vaccine priorities. While 21 percent of the White population is older than 65, just 12 percent of Black people and 8 percent of Latinx people are over 65. Age prioritization is then, by design, saying Black and Latinx will be less likely to get the vaccine.

Tracking multiple social policies at once also revealed a pattern of exclusion. CUSP captured how state minimum wage policies systematically excluded some people such as tipped workers. These workers are predominantly Black, Latinx and Native American. We saw a similar pattern with unemployment insurance; without federal intervention through congressional action, many people may be excluded from unemployment insurance because they earn too little to qualify or because they are independent contractors. The same pattern of exclusion emerged with paid sick leave; even in states with paid sick leave, the policy typically only applies to full-time workers and excludes contract or gig workers.

The CUSP database is designed to facilitate research to inform policy action around responses to the pandemic and beyond. By merging CUSP policy data with outcomes data from datasets such as the Household Pulse Survey, SafeGraph mobility data, or the Understanding COVID in America study, researchers can evaluate and inform policies that shape enduring improvements in health. Because of systemic racism, it is especially important to evaluate outcomes disaggregated by race and ethnicity. The policies that can be evaluated go well beyond COVID prevention, to policies that support food and housing security, paid sick leave, and unemployment insurance. We regularly update the database, prioritizing policies most relevant to people’s health and well-being in the present moment.

Where It's Going

Over a year into the project, it’s clear that the need for rapid response research is bigger than any one team can undertake and manage. Public health researchers and economists must join in thinking about how best to design policies that simultaneously protect people from COVID-19 and from economic precarity.

Currently, a larger emphasis has turned to focusing on strategies for increasing vaccine equity. Increasing vaccine access takes on greater importance in a context in which many remain unvaccinated and there are no OSHA (Occupational Safety and Health Administration) standards to protect low-income workers with mask mandates or other measures. As we document in CUSP, few states have workplace safety standards either. 

Researchers working on CUSP also continue to focus on policies that have historically left people vulnerable in our country, even before the pandemic. For example, 3 percent of households experience food insecurity every year, and Black families in the United States have experienced food insecurity two to three times the rate of White families over the course of the pandemic. CUSP data on state policies such as unemployment insurance amounts and the dates and types of eviction freezes can inform the extent to which these policies reduce the number of households that experience food and housing insecurity.

Where We Must Go

COVID-19 highlighted that our health is inextricably linked to our neighbors, co-workers, health care providers, delivery service workers, teachers, and our communities. More so, it crystalized that our health and economic policies do not adequately or equitably protect our well-being as a nation. There’s an urgent and continued need for more research on which policies have been most effective for supporting people to inform federal and state actions. What we learn from the CUSP database and how we apply that knowledge to federal data sets is critical to supporting a culture of health, dismantling racist policies, and building a future where all can thrive.

I invite you to explore the CUSP database and share with members in your community. Together we can ensure our policymakers center equity in all decisions.


About the Author

Julia Raifman, ScD, SM is an assistant professor at the Boston University School of Public Health, where she conducts policy research on health disparities and population health.

Wed, 28 Jul 2021 14:00:00 -0400 Julia Raifman Health Disparities Health Care Coverage and Access <![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.

I invite you to sign up for RWJF’s funding alerts. We will notify you of our next round of funding.


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

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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