Culture of Health Blog Our blog features perspectives from Robert Wood Johnson Foundation staff and guest authors about efforts to build a Culture of Health. Mon, 23 Mar 2020 08:45:00 -0400 en-us Copyright 2000- 2020 RWJF (RWJF) <![CDATA[Global Approaches to Curb the Health Impact of Climate Change]]>

A new $3M funding opportunity will give U.S. cities a chance to explore how solutions from abroad could improve health, equity, and climate in their own communities.

Global illustration.

In times of crisis, it becomes readily apparent how interconnected we are and that sharing learning around what works and what doesn’t is of utmost importance.

We are seeing this with COVID-19, as learning from Singapore, from Italy, from South Korea and from China is informing the efforts of other countries—including the U.S. response.

The same is true of climate change.

A recent survey found that the proportion of Americans who are concerned about climate change tripled over the last five years and is now at an all-time high. 

Whether it’s raging wildfires; stronger, bigger hurricanes and tornadoes; more extreme heat events; or worsening air pollution, people in cities across the United States and around the world are seeing, living and having to manage the impact.  

What’s worse is that damage caused by global climate change magnifies inequities, placing the most vulnerable communities and individuals at greatest risk. Historic and social factors, such as access to health care; where you live or work; your age; and your income can all impact how and how much climate change harms your health.

With everything we know about climate change and its consequences for health and equity, it’s easy to feel anxious and even powerless. But take heart—we can find inspiration and practical solutions for U.S. cities from beyond our borders.

Learning From Abroad

Equitable and sustainable approaches that curb the health impacts of climate change are being tried and tested in cities around the world. Their efforts can inspire us all to be resourceful, creative and inclusive as we work to tackle climate change and its consequences for health and equity in our own communities. 

Here are just three approaches from cities abroad that show us what’s possible:    

  1. Cape Town, South Africa, is retrofitting ceilings in low-income communities. Cape Town’s climate can be moist and cold, making its residents susceptible to tuberculosis and other illnesses, especially in low-income neighborhoods where housing often lacks the proper insulation. The city realized that by focusing on retrofitting ceilings in low-income communities, they could improve the health of the community and the energy efficiency of the buildings--reducing the fuel used to heat homes by up to 74 percent in the winter. To date, the city has retrofitted more than 10,500 homes in the outskirts of Cape Town, in areas that are vulnerable to heavy rainstorms, and wet and cold conditions. It is estimated that the total impact of these retrofits will save approximately 7,400 tons of CO2 each year. Knowing that it is more cost-efficient to design and build homes with the insulation, than to retrofit existing homes, in 2015 the city’s subsidy regulations for new low-income housing were changed to include properly insulated ceilings. Residents who received a new insulated ceiling reported significant improvements in health and happiness, as well as reduced stress levels associated with financial burdens because upgrades led to significant reductions in energy and health care costs.
  2. Chennai, India, developed a framework to restore water bodies and flood-proof the city. A devastating flood in 2015 claimed the lives of over 300 people in Chennai, displaced nearly two million people and destroyed billions of dollars worth of property, including infrastructure for ponds and other water bodies that help prevent flooding by holding excess water. The event spurred the creation of the Chennai Water Restoration and Resilience Framework, a plan to recharge its aquifers and flood-proof the city for the future. Some of the ponds affected were used as dump sites, while others were located in the most vulnerable communities in the city, where people live in informal settlements. As a result of the framework, each pond now has a customized and comprehensive restoration plan drawing on technical expertise from researchers and engineers. Community volunteers also bring their local knowledge to the maintenance and monitoring of the project. To date, the city has restored 210 water bodies, which has led to increases in biodiversity, reduced emissions of CO2 and increased space for exercise and physical activity. The next phase of the city’s plan aims to increase the number of restored water bodies to 460, and subsequently 1200+ more upstream from the city. As extreme weather events increase with climate change, Chennai is adapting to become more resilient to these impacts.
  3. Paris, France, has an app to help residents find cooling stations during heatwaves. In the summer of 2019, temperatures in Paris soared to a record-high 108.6°F/42.6°C during heatwaves that killed approximately 1,500 people across France. In response, the city of Paris began mapping its network of “cool islands.” These were 800, generally free sites like shaded parks, trees, and fountains, as well as buildings like swimming pools, museums and malls that served as a refuge for residents during periods of extreme heat. The project resulted in the creation of the EXTREMA Paris app, which geolocates the user to suggest the closest cool spots from their location. More than 7,000 Parisians have been identified as vulnerable during extreme heat—mostly elderly people and young children. Heatwaves also dramatically affect economic productivity, sometimes reducing productivity by one-third. Through the Extrema project, the city of Paris was able to inform residents about how and where to cool off, while maintaining their health and economic productivity. Developing an app also ensured the information is widely available for free. Thanks to the app’s accessibility, the city recorded increased downloads before the July 2019 heat wave in Europe.

Funding for U.S. Cities 

Our $3M funding opportunity will give U.S. cities the opportunity to bring proven approaches, like those from Cape Town, Chennai, and Paris, to their community. Because, when it comes to health, we know that good ideas have no borders.

We’re seeking  proposals from civic organizations and city leaders—including chief planning officers and city health officials—who are working to address climate change and health equity, and are ready to put an idea from overseas into action in their community.  We’re particularly interested in projects that address buildings and energy; land use and urban planning; transportation; waste; food systems and food security; and/or air quality and focus on improving health and well-being for people who already experience inequity and will be disproportionately  impacted by climate change.

We encourage proposals from both U.S. cities that want to learn from and adopt or adapt a successful foreign approach, and from non-U.S. cities and organizations with a successful approach that could work in the U.S. While approaches must come from outside of the U.S., the proposed project must be implemented in a U.S. city or cities. Complete details on applicant eligibility are provided in the Call for Proposals.

Big and small cities across the globe have so much to teach us about how to do this work most effectively, and ensure that everyone has a fair and just opportunity to live the healthiest life possible. I look forward to hearing about the lessons and solutions you want to bring to your community to improve the health of people and the planet.

Do you know of a solution from abroad that is helping address climate change and improve health for all? Think it might work here in the U.S.? Apply now to our new funding opportunity by April 30.


 About the Author

Sharon Roerty

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. Read her full bio.

Mon, 23 Mar 2020 08:45:00 -0400 Sharon Roerty Built Environment and Health International <![CDATA[Handwashing to Slow the Coronavirus Pandemic]]>

Among several steps to prevent the spread of coronavirus is one we can act on several times a day: frequently and thoroughly washing our hands. But how frequent and how thorough? And what about those whose living conditions make handwashing anything but easy?

Young boy washes his hands at the bathroom sink.

The simple act of handwashing has always been an important factor in preventing the spread of disease. As the coronavirus gains traction, it’s all the more critical. But a quick splash of water and perfunctory spritz of soap is nowhere near sufficient to keep the virus at bay, if you’ve been exposed. Now is the time to be sure we’re washing often enough and doing it right.

With that in mind, we want to share some resources. First, the Centers for Disease Control and Prevention (CDC) offers very specific guidance as to how often. Experts there say we should wash our hands:

  • Before, during, and after preparing food
  • Before eating food
  • Before and after caring for someone at home who is sick with vomiting or diarrhea
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage

Moreover, technique matters and we all need to take the time to do it right. The CDC recommends 20 seconds of solid scrubbing. To help make sure we spend the time we should, CDC offers a little life hack: singing “Happy Birthday to You” twice while we scrub. If you find that the musical selection doesn’t suit your ear, the Los Angeles Times offers up a number of worthy alternatives for accompaniment. And if soap and water are not readily available, the CDC recommends rubbing your hands together for twenty seconds with hand sanitizer that contains at least 60% alcohol and fully covers your hands. Hand sanitzers will not work however if your hands are dirty or greasy (such as after gardening or playing outside).

This video from Johns Hopkins Hospital breaks handwashing down step-by-step.

Unfortunately, many of us may have developed bad habits that we’ll need to overcome. In 2012, long before COVID-19 was on the horizon, RWJF published a blog post noting that surveys had concluded that the great majority of us have observed people failing to wash their hands at all after using a public restroom, much less for the 20 seconds recommended by the CDC.

From his days as ABC News' Chief Health and Medical Editor, Rich Besser puts hand santizers and soaps to the test.

There are health equity considerations too. Not everybody has ready access to soap and water. A recent story in the LA Daily News describes the initial steps Los Angeles County is taking to make sure homeless people have access to soap and clean water, as well as sanitary restrooms and health care. Tacoma, Washington, undertook a similar effort a few years ago, well before COVID-19, with important benefits for health and local pollution, as well as the comfort and dignity of the homeless.

And U.S. Senator Kamala Harris (D-Calif.) is among those calling on the Federal Bureau of Prisons to protect people in its custody, who are especially at risk for community spread due to crowded living conditions, poor sanitation, and the constant churn as inmates come and go.

Read an op-ed in the Washington Post by RWJF President and CEO Richard Besser on how past public policy failures are affecting our country’s ability to cope with Coronavirus.

The Robert Wood Johnson Foundation is closely monitoring the Centers for Disease Control and Prevention's (CDC's) guidance on the Novel Coronavirus (COVID-19). For more information, please refer to the CDC and National Institutes of Health (NIH) resources that are regularly updated.

Thu, 12 Mar 2020 12:00:00 -0400 Culture of Health Blog Public and Community Health National <![CDATA[Bringing the Research Home]]>

RWJF is funding new research that evaluates housing policies. Long-standing and complex barriers keep safe and stable housing out of reach for too many. We are seeking research partners to investigate the impact of housing policies and broadly share lessons learned.

Boy plays at public park.

For millions of people in America, having a home is an obstacle and a financial burden. Too many live in residentially segregated neighborhoods isolated from opportunity, making it difficult to break out of poverty and overcome the adversity that comes with it. 

The Robert Wood Johnson Foundation (RWJF) is offering funding for policy research aimed at overcoming deeply rooted problems related to housing stability and equity. We invite researchers, partnering with small cities or community-based organizations, to evaluate housing policies in hopes of turning up actionable lessons for other communities.

We Need Far-Ranging Solutions to Deeply Rooted Problems

RWJF president and CEO Richard Besser, MD, explained how safe and affordable housing supports positive outcomes across the lifespan—and how unsafe and insecure housing can deepen inequity and undermine a Culture of Health. Where we live can make it easier or harder for us to access opportunities: to get a good education, to have transportation options to living-wage jobs, to afford and have access to nutritious food; and to enjoy active lifestyles.

Yet, too little is known about policies that promote stable, affordable housing that ultimately translates to lifelong opportunities. For this reason, RWJF is announcing research funding to evaluate existing housing policies for their effectiveness in promoting equity. Because current problems are tied to decades- and centuries-old discriminatory policies and practices, this funding opportunity aims to identify promising policy solutions. Research proposals should foremost address equity and stability in housing.

Let’s first look at what evidence has taught us—so new research can effectively build on, and not replicate, what’s already been done.

To build more equitable, healthier communities, we need to boost people’s ability to afford a good place to live. Housing in America is expensive, and is getting out of reach in too many places. While housing costs have risen, incomes have not. More than half of all American households spend over 50 percent of their incomes on rent or mortgage.

As a result, many live in substandard and crowded housing and/or in unsafe neighborhoods—especially among low-income families. As our colleague Amy Gillman, MA, explains, “When we’re spending too much of our income on rent or a mortgage, that leaves little to pay for transportation to work or the doctor or to put healthy food on the table for our kids.” 

A recent RWJF-funded national poll revealed that large proportions of people from marginalized communities have experienced discrimination when trying to rent an apartment or buy a house: 45 percent of African-Americans, 31 percent of Latinos, and 22 percent of people identifying as lesbian, gay, bisexual, transgender, or queer.

Discrimination is often built into policies and practices, explains Harvard professor David R. Williams, MPH, PhD. Nearly half of black people, for example, say they have experienced discrimination when trying to rent or buy a house, limiting access to one of the most foundational needs.

Deeply rooted in American history is the practice of denying whole sectors of the population from grasping opportunities and building generational wealth. The cycle of poverty persists and accumulates through time. This is why where we live—and the policies that shape them—matter. To buck this unjust trend, it’s important to identify and address policies that shape inequality in our communities.

Who Should Apply

Ultimately, through this grant we want to find how housing policies allow greater, more equitable access to opportunity. We are offering up to $250,000 in funding to researchers who will evaluate policy interventions that address housing affordability, stability, and/or ways to reduce exclusionary barriers. 

We are particularly interested in research teams who will:

  • study policies that are already in place at the state, county, or local levels. We are not looking to research emerging laws or practices.  

  • analyze the policy’s impact on small cities. Although we will review all proposals, we are particularly interested in proposals that look at small cities of approximately 50,000 to 500,000 people. There’s been a fair amount of policy research on big urban areas, but little is known about how urban policies translate to improvements in areas with smaller populations.  

  • have secured data—or have forged partnerships with those who have it. Establishing connections and gaining access to data can take a long time, and this grant’s duration is only two years. Researchers with access to data will have an advantage because they can spend more time analyzing data and constructing the evaluation.

Although RWJF’s mission is dedicated to health, grant proposals need not address direct health impacts or health outcomes for this funding opportunity. We want to understand policies that alleviate high costs or bias, and other barriers to opportunity. We believe that by addressing these fundamental problems, in time, better health and more equitable outcomes will follow.

To understand this funding opportunity, we invite you to connect with our Policies for Action (P4A) program. P4A is a signature research program of the Robert Wood Johnson Foundation, administered through the Urban Institute. Since 2015, P4A has funded research identifying policies, laws, and other levers that can support healthier, more equitable communities. 

Take part in an informational Policies for Action webinar for this grant opportunity on March 30, 2020 from 2:00 p.m. to 3:30 p.m. ET and start your application today.


About the Authors

Headshot of Mona Shah

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

Priya Gandhi

Priya Gandhi, a research associate in the Research-Evaluation-Learning Unit, helps develop and manage research initiatives and evaluations that generate evidence around programs, policies, and practices that can lead to a Culture of Health. Read her full bio.

Thu, 12 Mar 2020 11:00:00 -0400 Mona Shah Public and Community Health National <![CDATA[New Narratives of Hope This Black History Month–And Beyond ]]>

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

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

Note: This piece was originally published in February 2018.

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

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

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

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

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

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

Over 50 Years After the Civil Rights Act, Discrimination Persists

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

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

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

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

Sharing Your Story With the World

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

How true that is.

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

And by telling our stories, we demand solutions.

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

Everyday Discrimination Measurably Diminishes Health

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

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

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

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

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

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

Specific findings from the survey include:

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

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

Shaping New Stories of Hope

Through our work to understand everyday discrimination and its impact on health, we’re also learning about communities across the nation that are striving to shape these new stories of hope.

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

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

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

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



Headshot of Dwayne Proctor

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

Wed, 5 Feb 2020 16:00:00 -0500 Dwayne Proctor Health Disparities Social Determinants of Health <![CDATA[Why Neighborhoods—and the Policies that Shape Them—Matter]]>

The Child Opportunity Index 2.0 uses contemporary data to measure and map inequities in all 72,000 neighborhoods in the United States. The tool helps researchers, city planners, community leaders and others identify and address inequities in their metros.  

Boys and girls run and play in the park. Image credit: iStock

The Tale of Two Boys Growing Up in Cleveland

Let’s ask two hypothetical 9-year-old boys a question: What is it like to grow up in Cleveland? 

Each boy attends school, and enjoys riding his bike and playing with Legos. Both live in Cleveland. Beyond these similarities, their life experiences are—and will continue to be—starkly different based on multiple, complex factors that lie within their neighborhoods.

Neighborhood A 

The boy living in Neighborhood A faces a host of obstacles to opportunity and well-being. 

Economic adversity is the norm. One in four families struggle with poverty, and nearly 83 percent of his peers in school need free or reduced-price lunch.

The boy does not have many adults in his life who can serve as role models for educational attainment and employment. Less than 20 percent of adults in this neighborhood have earned a college degree. Also, less than 20 percent have a high-skill job. Low education and employment levels among adults in his neighborhood may instill low expectations of his own employment prospects, and he will have weaker networks of employed adults to help him find a good job when he grows up. 

This boy is growing up in a neighborhood with signs of distress. Nearly 25 percent of housing units are vacant, which increases the risk of fires, crime and drug use. It also signals that his neighborhood is in disrepair and has been neglected, which has negative effects on home values. As a result, his neighbors have limited household wealth, which makes families and the community even more economically vulnerable.

Neighborhood B

Another boy lives a few blocks away in Neighborhood B. He enjoys a community in which economic security is the norm. Only 2 percent of people live in poverty, and less than 20 percent of his peers are eligible for free or reduced-price lunch.

This boy has adults in his life that bolster his aspirations and confidence in the future. Almost two-thirds of adults in his neighborhood have a college degree, and two-thirds also have a high-skill job.

The physical conditions in his neighborhood signal to this child prosperity and safety. Only 2 percent of houses are vacant, and homeownership is almost universal (94 percent).

How do the boys’ neighborhoods support their healthy development? 

While the boys are hypothetical, the conditions described here are real.

Child Opportunity Level map.

The map above illustrates the differences in conditions favorable to healthy child development between very low- and very high-opportunity neighborhoods. As you can see, Neighborhood A’s opportunity level is very low, indicated as light blue, while Neighborhood B’s opportunity level is very high, indicated by dark blue.

This map was developed and analyzed using the Child Opportunity Index 2.0. Our team at Brandeis University created the first version of the Index in 2014. The map uses the updated and improved version of the Index, released on January 22, 2020. The new Index helps us understand how children are growing up today in every neighborhood in the United States.

The Child Opportunity Index 2.0 is a tool that quantifies, maps and compares neighborhood opportunity for children across the United States; unlike similar tools that are retrospective, this tool uses contemporary data to measure and map all 72,000 neighborhoods in the United States. Our first analysis of the Index looked at inequities in neighborhood opportunity within the 100 largest metros in the U.S.

Each U.S. neighborhood and each metro are assigned a Child Opportunity Score on a scale of 1 to 100, according to its percentile in the national child opportunity distribution. The Index ranks opportunity by looking at a wide range of neighborhood conditions—like the quality of schools, the number of adults with high-skill jobs, availability of green spaces, and air pollution levels—that shape kids’ health and development.

Cleveland has an overall Child Opportunity Score of 61. However, this measure masks wide inequities. For example, Neighborhood A above has a score of only 7 (one of the lowest in the country) and Neighborhood B has a score of 99 (nearly the very highest in the country).

The Index also allows users to see where children of different racial/ethnic groups live in each metro area in relation to neighborhood opportunity.

Who lives in Neighborhoods A and B?

Racial inequities are vast and pervasive in Cleveland and nationwide.

Map of Cleveland depicting opportunity levels by neighborhood.

The map above was developed using the Child Opportunity Index 2.0. It shows the racial/ethnic composition of Cleveland neighborhoods. The areas with yellow dots are neighborhoods where predominantly black children live. We can tell from the map that those tend to be lower opportunity neighborhoods (light blue). In contrast, areas with green dots, where predominantly white children live, tend to be higher opportunity neighborhoods. Of the 451 children living in Neighborhood A (very low opportunity), 78% are black, while of the 1,139 children in Neighborhood B (very high opportunity), 67% are white.  

Neighborhood A and B exemplify a stark pattern of inequity across Cleveland: the majority of black children (84%) are growing up in very-low and low-opportunity neighborhoods, like Neighborhood B. Cleveland has the third highest opportunity gap between white and black children among the 100 largest metros in the nation.

How long and how well will the boys live?

The simple fact that the boy in Neighborhood A lives in a low-opportunity neighborhood puts him—and the rest of his peers—at a lifelong disadvantage. His day-to-day life, and his life expectations and outcomes, are far more stark than the boy in Neighborhood B. Because Neighborhood A lacks neighborhood resources, it may negatively impact not only his childhood experiences but his long-term education and income opportunities, health, and more. 

Meanwhile, Neighborhood B conditions are favorable and well aligned for supporting the boy and his peers to grow up healthy and reach their potential. The boy in this neighborhood will not have to think much about his neighborhood but will simply enjoy the resources it offers. Eventually, having grown up in such a supportive environment may have a favorable influence on his education, health, economic prospects, and even life expectancy.

RWJF Life Expectancy Chart  in metro Cleveland. Sources: Child Opportunity Index 2.0 database, U.S. Small-area Life Expectancy Estimates Project (USALEEP), Centers for Disease Control and Prevention.

As you can see in the chart above, residents in Neighborhood B, a neighborhood of very high opportunity, have a life expectancy of 81.7 years, while residents in Neighborhood A, a neighborhood of very low opportunity, can expect to live to be 72.4 years old. 

How can the Child Opportunity Index inform policy reform? 

Cleveland is just one metro area the Child Opportunity Index has mapped and measured; there are many more U.S. metros like it. The vastly different neighborhood conditions children experience, even though they might live right beside each other, aren’t happenstance. There are policies and practices in Cleveland and other metros nationwide that limit opportunities for all children to grow up healthy.

Communities are not islands. Economic forces (e.g., regional housing and labor markets) and federal, state, and local policies (e.g., land use zoning, public school funding) shape infrastructure and resources. Investment or disinvestment in communities reflects deliberate public policy and private decisions. 

The Child Opportunity Index is a tool that can help us understand where—and to what extent—inequities exist, so we can address them. 

Since it was first released in 2014, researchers, city planners, city and community leaders, and other stakeholders have used the Child Opportunity Index to identify current inequities in their metros and—most importantly—take steps to address these inequities so that children have more equitable opportunities. 

These solutions are happening across the country. 

For example, the Child Opportunity Index found that Albany, N.Y. ranked worst among the 100 largest metros in terms of the concentration of black children in very low-opportunity neighborhoods, so the City of Albany developed a capital improvement plan to increase access to ADA-compliant and cerebrally challenging parks and playgrounds in neighborhoods that had been long neglected and where predominantly black children live. Read more about Albany's efforts and its impact and hear about it on an NPR segment that ran in December 2019

The City of Chicago used the Child Opportunity Index as a key tool that informed its five-year (2016-2020) strategic plan, Healthy Chicago 2.0: Partnering to Improve Health Equity. The Department and its partners across the city now more effectively create both prevention and intervention strategies to address child health inequities across Chicago’s 77 neighborhoods. For example, some of the city’s health care institutions host job fairs in West Side neighborhoods, where unemployment rates are high and opportunity is very low.

We must invest in improving public policies that address the inequities that the Child Opportunity Index so clearly shows us. 

You can start by understanding what opportunity looks like in your own backyard at


About the Author

Dolores Acevedo-Garcia is professor and director of the Institute for Child, Youth and Family Policy at the Heller School for Social Policy and Management, Brandeis University. Her research focuses on the social determinants of racial/ethnic inequities in health; the role of social policies in reducing those inequities; and the health and wellbeing of children with special needs and their families. Read her full bio


Thu, 23 Jan 2020 14:00:00 -0500 Dolores Acevedo-Garcia Social Determinants of Health Child and Family Well-Being National <![CDATA[Community Health Resolutions for a New Decade]]>

Five things your community can do to ensure healthier, more equitable 2020s for all.

Group dancing in the street.

Have you noticed that most New Year’s resolutions are about developing healthier lifestyles? Most people want to eat better, exercise more, and find time for themselves. These are all worthy pursuits. But a few weeks into our new decade, for many, these resolutions will start to fade.

At the Robert Wood Johnson Foundation, we believe that good health is significantly determined by forces outside of ourselves—our health is greatly influenced by the places where we live, learn, work, and play. Having opportunities to get a good education and stable employment is foundational to our well being. Access to affordable housing and healthy foods, and feeling safe in our neighborhoods all create opportunities to help us live our healthiest lives.

This made me wonder: why not adopt community-wide New Year resolutions? Because fostering healthier communities sets individuals up for success!

Here’s a look back at some of what research has taught us over the last few years on what works to create healthier, more equitable communities. Let’s set a collective resolution to do what works so that the next decade and the next generation, can be the healthiest possible.

1.   Let a shared vision guide the way forward

A good first step can be prioritizing community needs by inviting everyone in the community to map conditions, strengths, and resources. Question who’s often missing from the table, and why, and find ways to make sure they’re welcome and there are no barriers to them in sharing their voice. See how this happened in Atlantic City or the more rural Columbia River Gorge on the Washington-Oregon border. Use RWJF’s Culture of Health framework to understand what success looks like, and how to get there.

2.   Use big data locally

Local health data can serve as a rallying point to help residents, community leaders, policymakers, and advocates come together to set common goals for improvement and change. We’re seeing a big uptake in U.S. Census tract data that provides a snapshot of life expectancy gaps from one neighborhood to the next and the City Health Dashboard, which provides data on 37 measures of health and well-being for the 500 largest U.S. cities. And the Opportunity Atlas shows how childhood experiences have a big impact on mobility through life. Data like these can be combined with your own local data to give a more complete view of challenges and opportunities for better health—including where there are gaps in opportunity by race, income, and neighborhood. This collection of Better Data for Better Health resources can help.

3.   Practice resiliency

Over the past few years, our nation has witnessed catastrophic natural disasters, and it’s certain that more will hit. Some communities rebound quickly, while others struggle. The difference between them? The preparedness and social cohesion of a community before disaster strikes. Here are ways communities can collectively prepare, withstand, and recover from disasters.

4.   Foster radical collaboration

When sectors come together—even when they seemingly have nothing to do with one another—powerful things can happen. This is also the message from the U.S. Surgeon General when he visited RWJF. At the community level, here is a practical example of how collaborations foster safer spaces for kids. And when it comes to building healthy communities, it takes the power of partnerships and all people uniting to take on challenges and grasp the opportunities.

5.   Lift up marginalized communities

Cultivate equity, diversity, and inclusion by lifting the voices and the truths from marginalized community members. Collect culturally sensitive data. Read about what equity means from the very people who are often discriminated against. By building and sharing stories, perspectives, and data that lead to action, people from all walks of life will have a fairer chance at living safe, healthier, productive lives.

Has your community used these tactics? If so, please share your stories! We also encourage you to keep an eye on Robert Wood Johnson Foundation’s funding opportunities to learn how you can contribute to a growing evidence base on how communities can thrive.


About the Author

Headshot of Oktawai Wojcik

Oktawia Wójcik, senior program officer, joined the Foundation in 2014. A distinguished epidemiologist, Wójcik’s work at RWJF focuses on driving demand for healthy places and practices and building a Culture of Health through research that informs both grantmaking and broader health-related policy and practice. Read her full bio.

Tue, 21 Jan 2020 13:45:00 -0500 Oktawia Wojcik Public and Community Health <![CDATA[New Year, New Nutrition Facts Label]]>

The Nutrition Facts label just got its first big makeover in 20 years. Learn why the updates will be a game-changer for parents and families.

For many of us, January 1 brings New Year’s resolutions—and those resolutions often have something to do with a renewed commitment to better health. As we all know, of course, these resolutions can sometimes lose steam after a few months...or even weeks...or sometimes just days. Fortunately, for those of us who have made commitments to eat healthier in 2020, we’re all getting a hand to ensure those resolutions can stick for the long-term.

We’re all familiar with the Nutrition Facts label. This is the label that appears on billions of food and beverage products, giving us the lowdown on how healthy (or not so healthy) items are based on metrics like calories, fat, sugar, salt, carbohydrates, protein, and various vitamins and minerals. The label has been mandatory under a federal law enacted in 1990.

On January 1, an updated Nutrition Facts label took effect covering all food and beverage products from manufacturers with more than $10 million in sales (most manufacturers with less than $10 million in annual sales get an additional year to comply). This milestone is a long time coming—the previous label had been in effect for 20 years and it’s been six years since the U.S. Food and Drug Administration first proposed updates. RWJF submitted comments in support of the proposed changes, which will empower consumers and families to make healthier purchasing decisions.

Side-By-Side Nutrition Facts Label Comparison

You’ve probably seen the new label already—a number of companies have been using it voluntarily for some time now. But let’s take a closer look at some of the changes that are now mandatory and why they’re so important. The image below has the old label on the left and the new label on the right. Here’s what’s new:

  • New line for added sugars. Several studies have found that overconsumption of added sugars is associated with an increased risk of obesity and related conditions like Type 2 diabetes. As a parent of two young girls, it’s extremely helpful for me to know not only how much added sugar is in a product, but also the percent daily value. In other words, if one serving of a product provides 10 percent of what you should be consuming in a day (the daily value), that’s 10 percent of the maximum total amount of added sugars per day. Fortunately, the new label includes both pieces of information, which is a major help for families.
  • More realistic serving sizes. The Nutrition Facts label has always included serving sizes, and by law they must be based on how much people actually eat. Yet the serving size requirements hadn’t changed since 1993, even though the amount people eat—not to mention obesity rates in the United States—have increased dramatically since then. Serving sizes will now reflect how much people typically eat and drink today, instead of standards from more than 25 years ago. That change will help consumers be much better at estimating what they are actually taking in.
  • Taking care of the math. Under the previous label, people could sometimes mistakenly equate calories in a single serving for  total calories in a package (see this study); people could also incorrectly calculate percent daily value percentage of calories in a single serving (see this study). The updated Nutrition Facts label will help guard against ‘human error’ by literally doing the math for us. For instance, certain products that can be consumed in one or multiple servings—the FDA cites a 24-ounce beverage or a pint of ice cream as examples—will now feature “dual labels” that include the nutrition content of both a single serving as well as the entire package. The last thing busy parents need to do while they are shopping in the grocery store is math; with the updated labels, we will not have to!  
  • Refreshed presentation. Calories, servings per container, and serving size are among the most essential pieces of the Nutrition Facts label. Under the new design, they’re all featured in bigger and bolder font, making it much easier to see.

    The Nutrition Facts label has always been popular among consumers. More than three-quarters of U.S. adults report using the Nutrition Facts label to inform purchasing decisions, with half using it “always” or “most of the time,” while nearly 80 percent use it always or sometimes when purchasing a product for the first time. The new label is even more of a hit—a 2018 poll from the Center for Science in the Public Interest found that nearly 90 percent of Americans support implementation of the updated label. With all these important and helpful changes, it’s easy to see why. And when you consider that the new label will generate up to $78 billion in benefits to consumers over 20 years, according to the FDA, there’s simply no reason not to cheer that this day has come.

    Nutrition education, of course, is just one piece of the puzzle. To really turn the obesity epidemic around, we need all food and beverage manufacturers to commit to making and marketing healthier products, and ensuring those products are affordable and accessible to people in every community. But having information at our disposal to make the healthiest choices possible is also essential, and the Nutrition Facts label will help us do just that. For my family and millions more, this new label means a lot. And that gives us even more reason to celebrate the new year!

    Which of these changes matters most to you and will make the biggest difference for your family?


About the Author

Jamie Bussell

Jamie Bussel, a senior program officer who joined RWJF in 2002, is an inspiring, hands-on leader with extensive experience in developing programs and policies that promote the health of children and families. Read her full bio.

Thu, 9 Jan 2020 10:00:00 -0500 Jamie Bussel Childhood Obesity Public and Community Health National <![CDATA[A Holistic Approach to State Policymaking That Strengthens Families by Advancing Equity]]>

A multi-state laboratory explores the interconnectedness of programs and policies to find ways for all families to thrive.

Kids jumping on an interactive exhibit at a museum.

Families don’t live in silos—one silo for health care, one for child care support, and yet another for food assistance. They need all those things—and more—to build strong and healthy futures for their children.

That’s why at the Robert Wood Johnson Foundation (RWJF), we're supporting a multi-state laboratory for advancing policies that strengthen families across a range of issues. The Center on Budget and Policy Priorities (CBPP) is the hub for this initiative. We are administering $2.65 million in grants to state-based organizations working to ensure that children and families get the support and resources needed to raise healthy kids through policy and systems change.

That means instead of addressing one issue at a time—e.g., child care supports or family leave—an array of issues are beign addressed simultaneously. These include child care and family leave and minimum wage and job training and other policies that can help families get ahead. These policy levers are interconnected, playing off each other, which is why a holistic approach is needed to make real progress in families’ lives.

With technical assistance and other support from CBPP, states are working both offense and defense—driving policy conversations on, for example, the need to improve cash supports for working families while defending core safety net programs like SNAP that are under attack in many states.

Working Within an Equity Frame

Equity is key to this work. Every project in the initiative seeks to reduce disparities and structural barriers to opportunity while promoting inclusion across race, ethnicity, gender, socio-economic status, and citizenship lines.

In Virginia, the work of The Commonwealth Institute (TCI) is a good example of a state grantee working to advance equity across multiple issues simultaneously, including paid family and medical leave, a state refundable earned income tax credit (EITC), and a minimum wage raise.

“Virginia has made major strides in recent years in terms of improving health care access through Medicaid expansion, but more needs to be done,” says Laura Goren, TCI’s research director. “We’re looking across the social determinants of health for ways to help stabilize families—such as EITC and other types of income supports, which have big effects on the health of families and children.”

TCI has committed to an explicit focus on equity—addressing race and disparities across all its policy work.

“In Virginia, the conversation is always about race, even if nobody’s saying the word,” Goren says. “If we do not engage openly in that conversation, then we allow it to be used as the silent dog whistle. We are better off if we engage honestly and explicitly on policy changes that we can make to increase opportunities for communities of color and on how that helps all everyday Virginians.”

For example, Virginia’s “upside-down” tax system places unfair burdens on low-income African-American and Latinx families, who wind up paying disproportionately high shares of their income in state and local taxes—a result of Virginia’s sales and excise taxes, property taxes, and relatively flat income tax.

Refundable tax credits for families with low and moderate incomes, like EITC and the Child Tax Credit (CTC) can help correct this unfairness. These credits not only increase incomes and reduce poverty but have been linked to improvements in birth outcomes, maternal health, and, for children’s school achievements.

But Virginia doesn’t have a refundable EITC. As a result, working families in Virginia—and particularly families of color—can’t fully access these benefits or the full value of what they’ve earned.

Family and medical leave is another example. Everyone should be able to care for themselves and their loved ones without risking their jobs or financial wellbeing. But in Virginia, 70 percent of Latinx workers and 60 percent of African-American workers either don’t qualify for unpaid family and medical leave or can’t afford to take it. A statewide paid family and medical leave program would give more families a chance at a healthier and more prosperous future—especially families headed by women of color, who tend to earn low wages while often facing significant caretaking responsibilities.

Context is Key to Understanding Challenges

Freddy Mejia, TCI’s health care policy analyst, says legislators need to understand not only that racial disparities exist but why they exist.

“As a policy organization, it’s easy to just point out the differences in outcomes, but it’s vitally important to explain why those outcomes look they way they do,” he says. “We have to let people know who we’re talking about and the historical and present-day barriers they’re fighting.”

Most of TCI’s work involves educating policymakers, businesses, and other influencers, using its own research and real-life stories of the challenges so many families face.

In addition, TCI is holding a series of listening sessions in communities of color to get a better understanding of their everyday challenges and of the policy changes that would benefit them most. The first session engaged teenagers and young adults in Petersburg, an older, predominantly African-American city that has suffered from disinvestment in recent decades. Health outcomes there are poor and the high school dropout rate is high.

These kinds of meetings help researchers and advocates make the connection between policy and “real life.”

 “That’s hard for us as policy wonks to get sometimes—how to make policy problems that hit close to home feel more relatable to people,” says Goren.

That kind of understanding is also critical to reshaping the narrative about what working families need to live with dignity and set their kids on paths toward healthy and productive lives.

Through the multi-state initiative, RWJF has invested $1.64 million in 21 “rapid response” grantees around the country with resources and intensive, tailored technical assistance on policy opportunities at the state level. In addition, the initiative’s Focus State Fund supports three states—Georgia, Kansas, and New Mexico—with more intensive investments to strengthen their policy, organizing, and advocacy capacity to develop and drive longer-term safety net agendas.

Each state is a different story, with a unique set of challenges and historical and contextual factors. While the overarching goal is to build a Culture of Health where all families can thrive, the strategy and tactics for achieving that goal may differ from state to state.

We hope that, through this initiative, family advocacy groups at the state level can learn from each other’s experiences and successes.

We invite you to share your ideas and lessons learned about how policy and advocacy can advance equity with us.


About the Author

Monica Hobbs Vinluan

Monica Hobbs Vinluan joined RWJF in 2015 as a senior program officer, and has been a passionate professional advocate for health promotion and a distinguished government relations professional on a variety of health and well-being issues for two decades. Read her full bio.

Mon, 16 Dec 2019 13:00:00 -0500 Monica Hobbs Vinluan Child and Family Well-Being Social Determinants of Health <![CDATA[How Bitter Melon Improved Housing in Providence, Rhode Island]]>

Many housing projects focus exclusively on putting a roof over peoples’ heads. We sought a broader approach that integrates cultural values into kitchens, homes and neighborhoods.

Illustration of a neighborhood.

The literal translation of the word “sankofa,” from the Akan tribe in Ghana, means "go back and fetch it.” Figuratively, it captures an important belief in Akan culture: While the future brings new learning, knowledge from the past must not be forgotten.

This principle guided our efforts to transform 10 formerly blighted lots into a vibrant community of 50 modern “green” apartments in Providence, Rhode Island’s diverse West End community. The $13.5 million development is connected to 30,000 square feet of community garden space. Single fathers come with sons, pastors come with children and people sit under the garden’s pergola, which was built by local youth volunteers. It is, as one article put it, a “beehive of activity.”

A Holistic Approach to Health

We’ve come a long way from where we started nearly a decade ago. Then, residents of the West Elmwood Housing Development Corporation (WEHDC)—more than a third of whom are immigrants and refugees from Central America, West Africa and Southeast Asia—didn’t have much access to fresh, high quality, affordable food that both supported their overall well-being and allowed them to preserve their cultural values.

Food has a direct impact on health and is a critical component of cultural heritage within the diverse community. But WEHDC residents had trouble finding fresh produce native to their countries—places like Liberia, Nigeria, the Dominican Republic and Haiti. Instead, they relied on what canned goods they could find and resorted to high-fat, low-nutrition foods typical of the standard American diet, like hamburgers, pizza and so on, or traveled long distances to access foods native to their culture.

Neighborhood residents faced other systemic barriers to health and well-being: high crime rates, underperforming schools, large tracts of vacant lots and little access to green space, safe, walkable paths or community gathering spaces. The health of the community was in decline, with high rates of obesity, diabetes and other ills. Immigrants who arrived here in good health grew less healthy with each passing month.

Where you live matters to your health. RWJF President and CEO Rich Besser discusses how housing is linked to health and equity in America. Read the 2019 Annual Message

Community members raised concerns. We at the WEHDC listened—and began a coordinated effort to bring about structural change in housing, food access and the environment.

In 2011, we partnered with community leaders, scholars, nutrition and gardening experts and others to explore how to improve health and advance equity in the community. We conducted surveys, focus groups and interviews with members of the community—sometimes in their native languages—to learn how to best support health in the community, and we assessed offerings at local markets.

Most housing projects only emphasize housing—the more units the better. But we realized we needed to go beyond the number of apartments we build and pursue a broader approach to health and well-being—one that integrates people’s cultural values into their kitchens, homes and neighborhoods.

In addition to apartments, we imagined a housing development with community spaces where tenants could come together and build community ties; a community garden, with raised beds, a tree nursery and a greenhouse, where residents could grow food and enjoy nature; and a weekly market with affordable, culturally relevant foods that celebrated cultures around the world.

In our view, this initiative fit WEHDC’s motto and mission perfectly: We build homes, we build community, we build lives.

Still, it wasn’t an easy sell. We had to bring two separate and often siloed social movements together—those advocating for affordable housing and those advocating for urban green space. And we had to persuade funders to set aside a large swath of prime real estate to use as garden space rather than for more apartments.

With the help of partners in academia and the nonprofit sector, we convinced funders that a holistic project such as this would be greater than the sum of its parts: Not only would it improve public health and narrow health disparities, but it would expand economic opportunity and strengthen community ties.

Building Cultural Capital

In 2016, we completed the project. Housing units are now connected to community gardens, where tenants and other members of the neighborhood gather to grow crops, socialize and rest. They grow fruits and vegetables that are otherwise hard to find, like bitter melon, sweet potato greens, water spinach, amaranth, Asian corn and more.

They can also buy such foods at the local weekly market and cook them in the local community kitchen. As a result, they’re able to get the ingredients they need to prepare the healthy meals they love, and they don’t have to travel far to get them. Nor do they have to pay an arm and a leg for bitter ball or some other “exotic” item at a boutique grocery.

The project has blossomed in other ways too. In addition to selling international foods, the weekly “world market” features live music, hand-made goods, cooking demonstrations and exercise activities that cater to different cultural backgrounds. Volunteers and staff at the community development corporation teach financial literacy and food preparation to young mothers and others and support local food and social impact entrepreneurs. And vendors at our microfarm grow and sell produce, bringing economic vitality into the low-income neighborhood.

Our next project is a café that will provide a much-needed space to gather and do business and, at the same time, create jobs in the community and draw dollars into the neighborhood. The café was suggested to us by a member who was frustrated that he had to leave his own neighborhood to network with potential clients. He saw it as a missed opportunity to circulate dollars within the community. A professional in the food industry volunteered to help put together a business plan. Two years later, with the backing of a national funding partner and the local municipality, the Sankofa Café site is now under environmental review, with  construction slated to begin soon.

The impact of the Sankofa initiative has been profound. Easy access to healthy, culturally appropriate food has made a big difference in the health of the community, where one third of residents live below the poverty line. It has also built cultural capital and created a sense of community pride. The neighborhood has turned into a cultural mecca, and demand for more housing is high. Residents lobby their elected officials to continue supporting our services. Once regarded as a pass-through, the West End is now a destination.

Learn about RWJF Award for Health Equity program and meet the 2018 awardees.

The project is also drawing wider attention. In 2017, it won the Smart Growth Award from GrowSmartRI, and we are so proud that the National Civic League nominated us for an RWJF Award for Health Equity, which we won in 2018. These awards helped us spread the word about our holistic approach and legitimized our dream. We believe it is a model not only for our city but for the nation: It shows how we can create spaces that cultivate health and well-being, civic engagement and community pride.

National Civic League President Doug Linkhart says Sankofa “truly embodies” the spirit of the Health Equity Award, which celebrates systems change at the local level. “By engaging local residents, the project attracts the active participation of people in the community to build both physical and mental health, as residents gain access to healthy food and a social environment that encourages communication.”

We couldn’t agree more. We named this project Sankofa because we wanted to pay homage to the cultural needs of the community and the importance of drawing on the past to make progress in the future. We chose this word because it underscores our belief that culture—reflected in housing, in food, in music and more—is an essential ingredient in creating a culture of health, both here in Providence and around the world.

Learn more about the RWJF Award for Health Equity


About the Authors

Sharon Conard-Wells is executive director of the West Elmwood Housing Development Corporation, a nonprofit community development corporation.

Angela Bannerman Ankoma, executive vice president at United Way of Rhode Island, is immediate past president of the WEHDC and sits on its board of directors.

Mon, 9 Dec 2019 09:45:00 -0500 Sharon Conard-Wells Built Environment and Health Health Disparities National Rhode Island (RI) NE <![CDATA[Disability Inclusion: Shedding Light on an Urgent Health Equity Issue]]>

We cannot achieve a Culture of Health until our nation is fully inclusive. Yet systemic factors prevent many people with disabilities from thriving.

Next year will mark 30 years since the Americans with Disabilities Act (ADA) became federal law—first of its kind legislation that outlawed discrimination against people living with physical or mental disabilities. It was a culmination of decades of challenging societal barriers that limited access and full participation of people with disabilities.

And yet in spite of the ADA’s passage, we still have a long way to go before society is fully inclusive of the 61 million people living in this country with some type of disability. Judy Heumann understands that while the ADA is important, in practice, “we’re not done yet." She is currently a leading advocate for disability inclusion and has been an advisor to institutions like the U.S. State Department, the World Bank, and the Ford Foundation. As a child, Judy was barred from going to school because she used a wheelchair. Years later, she was denied a teaching license for the same reason. These obstacles to education and employment are just two of many barriers that stand in the way of inclusion. Judy understood the need for strong advocacy in partnership with others experiencing continuous discrimination because of their disabilities. This discrimination is also often compounded by class, race, ethnicity, religion, gender, age, or sexual orientation among other characteristics.

I had the chance to personally meet Judy at the first convening of the Presidents’ Council on Disability Inclusion in Philanthropy this year. Darren Walker of the Ford Foundation and I are co-chairing this group of 13 other foundation executives to champion inclusion of people with disabilities in our own institutions and within philanthropy. We have a lot to learn from Judy and many others who have challenged systems and paved the way to making our nation more inclusive.

Here at RWJF, we know that we cannot achieve a Culture of Health until everyone, including those living with disabilities, has a fair and just opportunity to achieve their best health. Yet these opportunities are impeded by many systemic factors. In this post, we take a closer look at three examples of glaring inequities that undermine the health and well-being of people with disabilities before exploring some efforts underway to address them:

1.  Barriers in health care leave the needs of people with disabilities unmet.

As a group, people with disabilities fare far worse than their nondisabled counterparts across a broad range of health indicators and social determinants of health. For example:

  • Adults with disabilities are 4 times more likely to report their health to be less than optimal compared to those without disabilities.
  • The Centers for Disease Control and Prevention reports that one in three people ages 18 to 44 with disabilities did not have a usual health care provider and had a health care need that went unmet in the last year due to cost.

Even visiting a health care provider often poses a variety of hurdles. Exam tables and chairs are frequently not adjustable, and scales fail to accommodate wheelchairs or require a step up. Visually impaired people may not be able to access patient portals, and care after a medical visit may be hindered by materials that are not available in plain language.

These inequities and disparities are worsened by inadequate training among health care providers in ensuring that patients with disabilities receive appropriate and effective care. Furthermore, many have reported a lack of dignity or respect shown by staff during appointments which adds to a psychological toll of being treated as “other” by the medical system. Disability awareness and competency training of the health care workforce would improve overall care and services for those with disabilities.

2.  Having a disability means you’re twice as likely to live in poverty.

We know that poverty creates greater obstacles to achieving health. Having a disability means you’re twice as likely to live in poverty as someone without a disability. And that poverty can be persistent—lasting over 24 months.

Reasons for this include lack of fair access to education, jobs, and housing. Before the ADA, students with disabilities were excluded from many educational institutions and opportunities. Still today, many are placed in alternative diploma programs, limiting their options for higher education and employment. In 2015, just 17 percent of people with a disability had completed a bachelor’s degree, compared to 35 percent of those without a disability.

And while more education often leads to higher paying jobs, in 2018, the unemployment rate for persons with a disability was more than twice the rate for those with no disability that year, according to the U.S. Bureau of Labor Statistics.

3.  Representation matters but is lacking.

Health equity cannot be achieved without actual lived experiences informing and advancing policies, regulations, laws and initiatives that address disability rights, accessibility and inclusion. And yet people with disabilities face barriers that make voting, let alone running for office, challenging. Problems range from the misperception and misplaced stigma that they are incapable, to financial challenges, and even physical limitations. Public attitudes may be starting to change, however. At one time, President Franklin Roosevelt hid his wheelchair. Today, Texas Governor Greg Abbott highlights his.

Another challenge is the misconception that people living with disabilities are a burden, not an asset. Yet people with disabilities are doctors, attorneys, teachers, artists, and productive workers in multiple fields. Both the health care and philanthropic fields have much to learn from the disability rights community and we should be engaging them in conversations, research and equity initiatives.

Working Together to Explore and Advance Solutions

Solutions begin with ensuring that the places where we live, learn, work and play, do a better job of including people with disabilities. There are efforts throughout the nation that provide hope and inspiration:

Work is being done to make private spaces more accessible. Sarah Szanton, PhD, ANP, FAAN, whose career was boosted by an RWJF fellowship, directs the Community Aging in Place—Advancing Better Living for Elders (CAPABLE) program. CAPABLE combines handyman services with nursing and occupational therapy to find solutions that permit low-income seniors to age safely in their homes and neighborhoods. Preliminary findings show that 80 percent of program participants, many of whom live with chronic physical, cognitive, and other disabilities, experienced improved quality of life and health.

Efforts exist to end social exclusion and build accessible, healthy public spaces. Building inclusive playgrounds and parks designed for children of all abilities is on the rise. Inclusive playgrounds and parks encourage physical, social, and sensory play while creating connections among children of different abilities. For instance, in San Antonio, children with disabilities play alongside others in a water environment. The creator of the first fully accessible water park undertook the project when he couldn’t find an inclusive place where his autistic daughter felt welcomed and others felt comfortable interacting with her. He brought together parents, therapists, doctors, and both people with and without disabilities to help plan facilities that accommodate a range of needs. He views Morgan’s Wonderland and Inspiration Island as places of inclusion “where everyone can participate together.” Visitors have come from 67 countries and every state.

Steps are being taken to train health care providers. This is a critical step in addressing the health care inequities people with disabilities face. RWJF Community Health Leader award winner Deb Jastrebski created Practice Without Pressure to ease the stress of medical visits for patients with disabilities. Jastrebski’s son who has Down Syndrome feared doctors and dentists. To help, she created a model of care delivery that uses lectures, role-playing, and disability-specific information to help providers offer care in ways that eliminate the need for sedation and restraint for patients with disabilities. Healthy People 2020 also includes a health objective that calls for increasing the number of public health programs with a course on disability.

When it comes to representation we know we must do more. At RWJF, we acknowledge that philanthropy has fallen short in being fully inclusive which is unacceptable. That’s why the Presidents’ Council on Disability Inclusion in Philanthropy has created a fund to be used for disability inclusion over the next five years. Members of this group are at different stages of the journey toward true inclusion. But we are united in our commitment to learn together and make the changes needed to truly address systemic inequities in our communities. We believe philanthropy, in collaboration with movement leaders, can catalyze a cultural shift that goes beyond compliance and access, aiming squarely at true equity. And imagine the possibilities if our nation was fully accessible so that everyone has a chance to reach their greatest potential.

As a first step, we are listening because we have a lot to learn. We invite your ideas on what else philanthropy should be doing to improve access and inclusion for people with disabilities.


About the Author

Richard Besser, MD, staff photograph

Richard Besser, MD, is president and CEO of the Robert Wood Johnson Foundation, a position he assumed in April 2017. Besser is the former acting director for the Centers for Disease Control and Prevention, and ABC News’  former chief health and medical editor. Read his full bio.

Mon, 2 Dec 2019 11:00:00 -0500 Richard Besser Health Disparities National <![CDATA[Small Business, Big Impact: The Untapped Opportunity to Advance Health and Equity]]>

New report shows that small businesses create jobs and wealth and are imperative to healthy, thriving and equitable communities. Small businesses represent tremendous untapped potential to promote health equity and create opportunities for everyone to live healthier lives.

Four women laugh around a table in a coffee shop.

On a recent trip to Ferguson, Missouri, I visited a locally owned coffee shop that was filled with people working on laptops, visiting with friends, reading and studying. The walls were covered in fliers with community news and people were connected with neighbors. Sound familiar? It’s like thousands of other coffee shops. Across America, there are businesses like these where the owners and employees have their fingers on the pulse of what’s going on in the neighborhood.  

Small businesses of all types are in just about every community in the United States—in fact, companies with fewer than 100 employees make up 98 percent of all businesses in America and more than 43 percent are in low-income communities. They are helping to create healthy, equitable communities through the assets, income and jobs they create. People walk in their doors every day and share information or ask for advice—from barber shops and hair salons, to hardware stores and corner stores, to accounting firms and yoga studios.  

For those of us working to create a Culture of Health and advance equity, small businesses and their leaders could be ideal partners—so why don’t we engage them more often? 

Our team at Public Private Strategies spent a year interviewing almost 100 small business owners and their associations, along with leaders from philanthropy, community development, economic development, advocacy, and the public sector to explore this.

Growth Rate in Business Starts infographic.

What we found? Tremendous, untapped potential:

  1. Small businesses create jobs, build wealth and help close racial and gender wealth gaps, especially in communities where opportunities have been limited historically. Although the majority of business owners today are white, small business startup rates are highest among black and Latino business owners. And while more men own businesses than women, about one in four businesses is women-owned and the share is growing rapidly, especially among black and Latina women. Success stories from small business are inspiring millennials and other younger individuals to increasingly pursue entrepreneurial paths.
  2. Small businesses are the 2nd most trusted institution in America. In general, small business owners think deeply about community needs, have strong networks and are committed to the places they do business. Employees rely on them as trusted sources of information and many small business owners treat their employees like family, far surpassing the typical employer-employee relationship. Small businesses often provide employment for those who may otherwise struggle to secure good jobs: the formerly incarcerated, immigrants, seniors and others. And their leaders are already sharing knowledge on things like SNAP benefits, EITC, or tuition assistance. As one interviewee told us, “Small business owners can educate employees and help guide decision-making when laws are passed.”
  3. Small business owners can also play critical roles in advancing policy that’s good for business and for their employees. For example, in San Francisco, Los Angeles, and Washington, D.C., small businesses are working with community leaders to support innovative policies such as rent stabilization grants and other real estate financing so small businesses can stay in communities to ensure that jobs aren’t priced out of gentrifying neighborhoods.

Small business owners and employees represent a broad cross-section of American society who depend on and contribute directly and indirectly to health equity and healthy communities. Yet most calls for business to promote health improvements for employees, customers and communities focus on large business. Giving small businesses a seat at the table and asking them what their communities need to improve health and well-being offers a fresh perspective and new approach (yet it’s important to recognize that as entrepreneurs, they are often stretched thin and pressed for time).  

As partners to government, philanthropy, and community development, leaders of small businesses represent tremendous untapped potential to help promote healthy communities and health equity.

Read the full report to learn more about the power of small business and how you can help elevate this untapped partner to advance health, equity, and a more inclusive economy. 


Rhett Buttle is an expert working at the nexus of policy and market change. He is the founder of Public Private Strategies and NextGen Chamber of Commerce. Rhett previously served as a private sector advisor to the Secretary of Health and Human Services and The White House Business Council. He is a Senior Fellow at the Aspen Institute Financial Security Program.

Mon, 25 Nov 2019 10:00:00 -0500 Rhett Buttle Public and Community Health National <![CDATA[It’s Time to Connect Rural Health Equity with Community and Economic Development]]>

It’s time to think differently about investing in rural America and the way we approach health and equity across its diverse communities. New research and resources show the critical connection between health, rural community and economic development.

Farmland and street sign.

Thursday, November 21, was National Rural Health Day. You might expect the paragraphs that follow to be about hospital closures or opioids, struggling dairy farmers and falling life expectancy among rural women. These phenomena are true, so we could do just that. However, we want to challenge conventional wisdom and prompt fresh thinking about rural America, the drivers of health, and the role of community and economic development in both. From what we are learning, this broader lens is central to realizing health equity and a better rural futures.

In our predominantly urban nation, the words “rural America” often conjure images of farm country, small towns and white people living in places that once boomed and have since busted. But the real rural America is far more diverse and complex. Dr. Veronica Womack, a political scientist, advocate for black farmers, and RWJF Interdisciplinary Research Leader, whose work has helped bring new research and investment to her rural region, is case-in-point. Womack grew up in Greenville, Alabama—population 8,000—which is part of the “Black Belt,” a largely rural region in the coastal low-land south where black folks outnumber white folks. Economic opportunity is hard to come by—and health suffers as a result—in this region where poverty, racist policies and discrimination along with systemic disinvestment persist.

All the same, Dr. Womak grew up with the idea that you give of what you have, to help those around you. No matter if what you have is not much. In Dr. Womak’s words: “If you’re not willing to share it and work for the betterment of the community, then you know, why even have it?” Womak’s experience growing up with her single mom, who worked as a nurse and spent her weekends bringing medicine and other care to elders around the community, didn’t jive with how the nation viewed her region and her people. Where others saw deficits, Womak could see assets—people willing to work hard and support each other, strong ties, and innovative ideas to get things done.

Dr. Womak was featured in the opening episode of The Homecomers, a new podcast from Sarah Smarsh, journalist and author of Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth. Smarsh fills her new podcast with voices of people “fighting for the place that feels like home.” If we better understand rural places and their diversity, complexity, strength, innovation, and resilience, perhaps we can be better equipped to invest in their future leveraging each community’s unique assets to realize health equity and create economic opportunity for more people for generations to come.

“Rural America” is Not a Monolith

Here are two more projects that reveal a truer picture of “rural America” and what’s top of mind for the people who live there.

  • The American Communities Project’s “A New Portrait of Rural America,” helps to shed light on the diversity of places we call “Rural America," which includes Native American Lands, the African American South, Aging Farmlands and more. History, geography, demographics, economy, and policies—good and bad—all play a role in the differences between these places. For example, the median income for rural counties analyzed in this report—$46,600—is lower than the national median of $57,600. But these disparities mask some deeper complexities of race, class and place. In St. Francis County, Arkansas, a part of the African American South in this report, the median household income for blacks is only about $28,300, while the figure for whites is more than $10,000 higher at $39,500. While some rural places are thriving, others have experienced radical economic transition or decades of disinvestment; all too often these places are also low-income communities and communities of color where discrimination and lack of economic opportunity are compounding factors that persist. 

  • The Life in Rural America polls, produced in partnership with the Harvard T.H. Chan School of Public Health and NPR, similarly revealed complex rural realities. The poll also provides disaggregated data by race and place—for example, while drug addiction or abuse is the biggest overall community problem cited by whites living in rural America (27%), economic concerns are the most cited problem by African Americans (24%) and Latinos (22%).

Responsibility for Improving Health and Healthy Equity is Broadly Shared

There is more to health than health care. Whether our towns are walkable, the water is clean, residents are connected to one another and the local economy works for everyone—all of this has an impact on our opportunity to be healthy. Since health outcomes are closely tied to social, economic and physical conditions where we live as well as to income, wealth and education, health disparities are numerous and often intertwined with race, class and place. This means architects, economic development directors, city planners, city managers, county commissioners, businesses and civic-sector organizations of all stripes all play a role in creating opportunities for health—in rural places and across the country.

The Role of Community and Economic Development in Realizing Health Equity

If we see rural places in all their diversity and complexity and we see responsibility for realizing positive health outcomes as shared, then rural community and economic development becomes central to realizing health equity. Health outcomes in rural places lag less because of challenges in health care or individual behaviors than because of transformation in technology and the structure of the economy, systemic disinvestment, racism, structural inequalities and an outdated approach to economic development.

Aerial image of a rural town.

There is an urgent need to modernize policy and spread best practices proven to create vibrant and sustainable communities that enable people to reach their full potential and live healthy lives. We see signs of hope in communities across the country where innovation is underway and two specific projects provide insight on what’s working:

  • Rural Development Hubs: Strengthening America’s Rural Innovation Infrastructure, by the Aspen Institute Community Strategies Group, looks at the role of a specific set of rural and regional intermediary organizations—Rural Development Hubs—and finds them to be both at the heart of positive community and economic development practice and also an essential entry point for those looking to work or invest in rural places. The report finds Hubs to be the main players “doing economic development differently.” In addition to helpful primers on rural America and rural history, the report explains the importance of these civic-sector actors, what they do that sets them apart and articulates some of the challenges that Hubs and other rural institutions face that can stymie success. The report includes a set of recommendations for improving rural development policy and practice and realizing a better rural America that range from rethinking ‘impact’ to overhauling outdated federal policies.
  • Partners for Rural Transformation is a group of six trail-blazing regional organizations (great examples of the Rural Development Hubs mentioned above) focused on eliminating persistent poverty and advancing prosperity. Their paper, Transforming Persistent Poverty in America: How Community Development Financial Institutions Drive Economic Opportunity, highlights the ways in which race, place, and persistent poverty are inextricably linked; and how community development is strengthening local economies, generating wealth that sticks, and building power among those living in some of the most disinvested parts of our country. The report calls for increased philanthropic, bank, and federal investments in rural persistent poverty regions across our nation.

This year, in honor of National Rural Health Day, question any preconceived notions you may have about rural America and whose responsibility it is to improve health in America. Then consider how rural community and economic development policy and practice are essential to realizing health equity. Ready for action? Dive into the projects and resources we’ve highlighted in this blog and hone in on their recommendations for public, private and civic sector actors. For more ideas and a truer picture of the range of place, culture, people and economy in rural America, try outlets like the Daily Yonder, America’s Rural Opportunity Series of talks, Indian Country Today, and rural stories from the Solutions Journalism Network, and RWJF’s rural health page.

We hope you’ll continue to follow our work as it evolves—and keep an eye on new learning and coordination efforts across those working nationally and regionally to advance social and economic conditions in rural communities, which ultimately lead to better health and well-being. Those efforts will be led by the Aspen Institute Community Strategies Group, working closely with RWJF and the University of Wisconsin Population Health Institute.


About the Authors

Katrina Badger, MPH, MSW, is a program officer with the Robert Wood Johnson Foundation focusing on efforts supporting work building healthy, equitable communities. 

Katharine Ferguson, MPA, is associate director of the Aspen Institute Community Strategies Group (CSG) and director of CSG’s Regional and Rural Development Initiatives.

Thu, 14 Nov 2019 14:00:00 -0500 Katrina Badger Public and Community Health National <![CDATA[Listening to Families and Communities to Address Childhood Obesity]]>

Renee Boynton-Jarrett, MD, ScD, believes that children’s health and well-being are intricately and inextricably connected to their family and community.

Children and their parents participate in a school activity.

When a mother walked into my health clinic five years ago with her 13-year-old daughter, she wanted to know why her daughter had gained a significant amount of weight in a matter of months. She was concerned an underlying medical condition might have caused the sudden spike her daughter’s weight. I was concerned as well. Childhood obesity is an epidemic that affects far too many children and it is linked to other serious, chronic health conditions, including high blood pressure, type 2 diabetes, heart disease, and asthma.

I knew I would run tests and order blood work, but I also wanted to know what factors in her social world could have sparked the weight change. We sat down together to look at her daughter’s growth chart, see when the growth trajectory started to accelerate, and what could have been happening then. “Did anything change in your family? Do you recall anything that happened around that time?”

The mom suddenly realized that the changes started shortly after the girl’s father was incarcerated. That’s information I could not have gotten from a blood test. Nor if I had rattled off recommendations without first sitting down to listen.

Understanding Impacts of Adverse Early Life Experiences

I began my career as a primary care pediatrician. I also trained as an epidemiologist with a focus on social factors in community environments that can contribute to health and well-being. As a result, my perspective on what impacts health and strategies to improve it that go beyond clinical treatment and prescriptions; we must also consider the environments where children learn and play, and structural conditions that impact opportunities to achieve health. Through my work in public health and primary care, I know that children who are exposed daily to struggles like food insecurity, unstable housing, and violence in the home or community face long-term impacts on their health.

The experience of the young girl in Boston was not unlike countless of others’ experiences across the United States. Nationwide, 4.8 million young people ages 10 to 17 have obesity, according to data released by National Survey of Children’s Health and highlighted in the State of Childhood Obesity report.

Image of Renee Boynton-Jarrett. Dr. Renee Boynton-Jarrett at Boston Medical Center’s rooftop farm.

The national rate of obesity for young people ages 10 to 17 is 15.3 percent, a rate that has remained fairly steady for the past few years. Rates among black and Hispanic youth (22.2 percent and 19.0 percent, respectively) are significantly higher than for white and Asian youth (11.8 percent and 7.3 percent, respectively). These racial and ethnic disparities have persisted over time and are demonstrated by other major obesity surveys.

Helping children maintain a healthy weight from an early age is essential to preventing a wide range of health problems, particularly for communities of color. But obesity is complex. It can’t be solved reactively or prevented through health care interventions alone. My philosophy around keeping children and families healthy has changed from playing a traditional educator/practitioner role to more of a listener/facilitator role where I work collaboratively with patients and families. They have their own insights, are familiar with neighborhood conditions and resources, and know what goals and solutions are feasible for them.

Adverse childhood experiences and socially adverse neighborhood conditions are not one dimensional. Social adversities can impact biology, behavior, development, and health. For example, addressing food insecurity offers a significant opportunity to prevent obesity. The population of children who experience food insecurity is also the population of children most likely to experience obesity or a less than optimal weight or growth trajectory, but approaches to end hunger and approaches to prevent obesity operate independently of each other.

Boston’s Community-Based Approach to Address Adverse Neighborhood Conditions

In Boston, we work collaboratively to break down these silos and address issues like food insecurity more holistically and at the community level. For example, at Boston Medical Center in 2010, I founded the Vital Village Community Engagement Network, a grassroots network of residents and organizations committed to maximizing child, family, and community well-being, to build the capacity of communities to work collectively with caregivers and residents to promote well-being. The Vital Village Data Workgroup, a group of resident leaders, recently developed the concept and designed the Abundance app, which enables people in the Boston community to map the closest food resources. It’s a way of identifying food deserts as a first step in addressing food insecurity in that particular area.

I believe that we have to not only listen to our communities, but also engage them in shared decision-making, governance, and leadership in promoting well-being and health. We also have to think about integrating policies and collaborating across sectors—including education, health, crime, housing, and the built environment—to truly create an environment that supports healthy growth and development for kids.

Learn more about my perspective and how the city of Boston is helping to ensure that more children have consistent access to healthy foods from the earliest days of life to help them grow up at a healthy weight at


About the Author

Renee Boynton-Jarrett, MD, ScD, is a pediatrician and social epidemiologist. Her work focuses on the role of early-life adversities as life course social determinants of health.


Thu, 31 Oct 2019 14:00:00 -0400 Renee Boynton-Jarrett Childhood Obesity Early Childhood National <![CDATA[Researchers: How to Leverage Personal Data and Still Protect Privacy]]>

The popularity of app-based research studies has soared, although plunging public trust in commercial technology companies could dampen enthusiasm and upend science if researchers don’t act quickly. 

A patient goes over app-based data with her clinician.

Nefarious cases of data sharing and data breaches are in the headlines on an uncomfortably regular basis. One recent exposé found period tracking apps were sending extremely personal information about millions of women directly to Facebook without their knowledge. This comes in conjunction with all-too-frequent corporate hacks—from credit cards to electronic health records and more—that leave consumers vulnerable and scrambling to reset passwords and freeze accounts. 

It’s a constant drumbeat that is feeding a climate of concern around our data: who has it, how safe it is, what it is being used for. 

Against this tumultuous backdrop, researchers around the world are launching studies that rely on smart phone apps and other digital devices to collect data. The hope is that these digital tools—and the data we provide through them—will enable more people to participate in studies and help accelerate medical discovery. But if researchers don’t act quickly, this turmoil around data privacy could upend their work.

There’s an App for That

Smart phones and devices such as the Apple Watch are proving to be valuable data collection tools for researchers. They’re enabling easy collection of information from people as they go about their lives, offering insight far beyond what’s reported in the doctor’s office. And they do this data collection at a fraction of the cost of more traditional studies.

A great example of this is mPower, an app-based study of Parkinson’s disease which was built with Apple’s ResearchKit. People make use of the phone’s sensors to track their symptoms—from memory to speech to balance.

More than 16,000 people are enrolled in the app study, sharing millions of data points on the daily changes in symptoms and effects of medication for people with Parkinson’s. This staggering amount of data is a stark contrast to most Parkinson’s studies which typically rely on data from fewer than 100 people.

Excited by their potential to help us understand more about health and speed up progress toward better treatments and cures, RWJF funded a number of projects beginning in 2013 that enabled people to contribute their data to research efforts.

Privacy Concerns Could Prove to Be a Major Stumbling Block for Research

Judging by the thousands of people who have signed up to participate, app-based studies are particularly attractive, though current events are creating new challenges for this young field. 

In today’s environment, people may think twice or thrice before signing up for a study that uses an app on their phone to collect data from them. In fact, some researchers say that prospective research subjects have been “scared off” by all the recent data breaches and violations of privacy.

Even when researchers have successfully recruited people to contribute data, the portion who drop out has been staggering—as high as nine out of 10. This should not be a total surprise. Marketing research shows the longer people own activity trackers, the less they use them and fully one-third have stopped using them altogether by six months. Add to that the cloud of mistrust and repeated assaults on privacy, it’s easy to imagine why there’s so much drop off.

Three Things That Researchers Can Do Now

So what can researchers do?

Conversations with leading app-based scientists suggests three things researchers can do to ensure their studies are not thwarted by privacy concerns:

  1. Give back. Getting people comfortable with sharing their data requires more than a simple tech fix. The relationship between the researcher and the participant is important. Depending entirely upon app interactions to cement long-term engagement has its limits. One way to both get around this, and to build trust, is to give people back the knowledge that you’ve gleaned from their data. But this doesn’t mean send them the study results or an excel chart full of data points or wait months for a research study to be published before you share any feedback with them. When you’re running an app-based study, the terms of engagement with participants need to change. People have expectations based on their experiences with commercial apps, where feedback is instant. So should app-based studies. From the start, apps should be designed to collect and share data that’s meaningful to the participants as well as data that’s meaningful to researchers. These have to be first-order thoughts, not afterthoughts.
  2. Hand over control. Commercial health apps routinely share users’ personal data often without their knowledge. Yet, researchers are finding that if you simply ask, many people are willing to have their data shared with a third party, especially when they control who their data is shared with. Take the mPower app: participants are able to choose whether to share their data with researchers associated with mPower, or to share it with qualified researchers worldwide. So far, more than 75 percent of mPower participants have chosen to share their data broadly. Of course handing over control over data-sharing decisions means more work for researchers. But the trade-off for science is worth it.

    When crafting data-sharing options, be transparent about what these options really mean. Don’t cloak them in jargon, promising to “de-identify” and “anonymize,” or only use “aggregate data” without fully explaining all of the implications. We’ve heard of organizations who describe the mere removal of an individual’s name or email address as ‘de-identification,’ despite retaining other highly identifying elements such as birthdate, profile photo or personal biography; if that’s the data you’re planning to share, you must alert people and give them the option to say no.
  1. Security, security, security. Many researchers have simply relied on copying industry approaches to managing data, which could leave people vulnerable to security breaches and the risk of sensitive information about their health falling into unwanted hands. Getting it right isn’t easy, but it can be done: encryption, firewalls, multi-layered surveillance, and identity verification systems are all established methods to keep user information secure and prevent unauthorized use of data. Researchers sometimes lack the technical knowledge needed to build such protections into the architecture of smartphone apps and their corresponding research networks, and cost can certainly be a deterrent. But the investment must be made.

This is a new way of thinking for most researchers and they’ll need to develop some new muscles. CORE is a platform where researchers can learn from one another about what is working and what is not in this still-young world of digital research.

Finally, a word of advice for consumers: When signing up for an app-based study or downloading a health app, be aware of the privacy pitfalls. Pay close attention to what you’re giving the app access to; check reviews and ratings and seek alternatives if you have any cause for concern.

Read the report Reinventing Discovery to learn more about these challenges and how researchers are responding.  

And if you’re already exploring how to make data sharing more meaningful for consumers and research participants, share your thoughts below.


about the author

Headshot of Paul Tarini

Paul Tarini, senior program officer, focuses on exploration, discovery, learning, and emerging trends that are important to building a Culture of Health, as well as fostering connections between health and health care. Read his full bio.

Thu, 24 Oct 2019 14:00:00 -0400 Paul Tarini Health Care Quality and Value National <![CDATA[How Communities are Promoting Health and Responding to Climate Change]]>

Across the United States, people are recognizing that climate change is a major threat to any vision of a healthy future. They are responding by developing solutions to not only avoid the health harms from climate change, but also actively improve health and limit climate change.

A city park offers a walking path for the community.

In Austin, Texas, city officials have grown increasingly concerned about their residents enduring more days with extreme heat. In particular, they worry that extreme heat events prevent young people from getting physical activity and harm people’s overall well-being.  

Austin leaders decided to respond by increasing green space and tree shade around some of the city’s public schools, especially those that largely serve students of color or those in lower-income neighborhoods. More trees create cooler spaces for physical activity. They also help address climate change by decreasing the need for air conditioning, which use about 6 percent of all electricity produced in the United States. Trees are effective because green space and shade reduce temperatures over heat-storing concrete.

At first glance, planting some trees may seem like a limited and short-term approach in the face of a changing global climate. Trees, however, are an important climate solution because they remove carbon from the atmosphere. Increasing levels of carbon in the atmosphere causes climate change. We need more trees—lots more.

The effort in Austin is just one of the countless creative solutions that communities across the United States are implementing—from Portland to rural Alaska to parts of the Navajo nation.  

How We’re Learning from Solutions for Health and Climate Change in Communities

Through its Health and Climate Solutions program, the Robert Wood Johnson Foundation (RWJF) has funded seven grantees, including the City of Austin, in an effort to assess and learn from programs developed by innovative communities to address the health impacts of climate change while building a better, more equitable future. Each grantee seeks to achieve three goals: create opportunities for better health, advance health equity, and focus on climate adaptation or mitigation. We have a lot to learn from these communities because we know our rapidly warming planet is changing our air, water, food and weather, which is harming human health. We know that climate change is a major threat to any vision of a healthy future. 

Fundamentally, human health and the health of our planet are intertwined.

While every part of the United States is experiencing the health harms from climate change—including extreme heat, wildfires, more frequent and intense hurricanes, insect-borne diseases like Lyme disease or West Nile spreading to new regions, and toxic algal blooms—some people and communities are affected sooner and more directly. Where you live or work, your age, your pre-existing health conditions or chronic illnesses, as well as your race or income all influence what health harms from climate change you experience—and how strongly you feel them.  

For example, low income and communities of color are more likely to live near pollution producing power plants. People with pre-existing health conditions like asthma or heart disease face greater threats from air pollution and reduced air quality from hotter days. Climate change magnifies the inequities that prevent all people from having a fair and just opportunity to live a healthier life.  

Climate change doesn’t just harm our health, it deepens inequities. 

That is why we are looking for community-driven solutions to understand how people on the frontlines of climate harms are creating solutions that improve health and support their communities.  

Drawing on Local and Indigenous Knowledge for Health and Climate Solutions

Many Indigenous people, for example, have knowledge and experience to shape some of the most effective solutions. This is critical because Indigenous communities are also at greater risk for the health harms of climate change.  

For example, leaders in the Swinomish Indian Tribal Community are blending the CDC’s public health approach—the Building Resilience Against Climate Effects (BRACE) Framework—with traditional Indigenous values, understanding and practices. In Finland, Minnesota, and Navajo communities in New Mexico, farmers are using regenerative farming practices—a number of farming practices like crop rotation and different grazing practices—to improve the quality of crops, foster soil health, reduce the climate footprint of agriculture, and improve the ability of crops to withstand flooding, drought and heat.

The work in Austin, the Swinomish Indian Tribal Community, Minnesota and New Mexico are four of seven new grants to learn what is working on the ground. The other three projects are:

  • Buffalo, New York: People United for Sustainable Housing, Inc., (PUSH) Buffalo is helping weatherproof houses in cities to improve energy efficiency, community development and resilience and improve health, while boosting the local economy. 

  • Portland, Oregon: Friends of Trees is planting trees in low-income, ethnically-diverse neighborhoods to improve the health and well-being of local communities. 

  • Anchorage, Alaska: the Alaska Native Tribal Health Consortium (ANTHC) has developed an innovative, portable water sanitation system for homes in rural, Native Alaskan communities where climate change impacts on infrastructure and the environment makes it nearly impossible to access safe, clean water.

We can’t build a Culture of Health if we aren’t responding to both known and emerging threats to health—and taking steps to prepare for those that we know are coming. 

Learn more about how health and climate change are related—and how we can create solutions for health and climate together—by visiting


about the authors

Michael Painter

Michael Painter, a senior program officer, is a physician, attorney and health policy advocate. His work includes identifying cutting edge ideas and investments that could help build a Culture of Health. Read his full bio.  

Priya Gandhi

Priya Gandhi, a research associate in the Research-Evaluation-Learning Unit, helps develop and manage research initiatives and evaluations that generate evidence around programs, policies, and practices that can lead to a Culture of Health. Read her full bio.

Mon, 30 Sep 2019 13:00:00 -0400 Michael Painter National Environment <![CDATA[Policy Should Never Put a Child’s Health at Risk]]>

Here's why the proposed cuts to SNAP really hit home for me.

Mother bottle feeding her young son.

When I was a full-time pediatrician, I worked at a practice in the City of Philadelphia whose primary patients were teenage mothers and their children. Most of their parents were low-income with little to no outside support. Their lives were hard. Very hard. Many of the parents (grandparents to the newborns) were forced to choose between paying rent some weeks and having enough food to feed their children and grandchildren.  

I remember in particular one mother and her infant son who came to see me after he was born. She was scared because the baby was having trouble gaining weight, due in large part to the family not being able to afford much food. His grandmother was worried; given all the research showing how critical nutrition is to developing brains, I was concerned as well. Fortunately, the practice I worked in was a collaborative one, meaning that not only did we doctors work side-by-side with nurse practitioners, but also closely with social workers. And one of our social workers immediately went to work to get this family, in which the grandmother—who was the head of the household—worked full-time, enrolled in the Supplemental Nutrition Assistance Program (SNAP).

These are the types of situations and circumstances where SNAP is an absolutely essential lifeline. SNAP is the largest nutrition assistance program in the United States, helping to feed some 36 million people each month. SNAP provides temporary but critical support to help people who are struggling to gain access to nutritious, affordable food; nearly two-thirds of SNAP participants are children, older adults, and people with disabilities. It has a proven track record of helping families avoid poverty and hunger during difficult times, such as after losing a job or suffering a major injury or illness, while helping families achieve self-sufficiency and reducing health disparities.

Unfortunately, our social worker faced one bureaucratic challenge after another to get this family the food assistance it so desperately needed. The administrative burdens were significant—even for someone who had helped enroll multiple families previously—and as a result, the family’s eligibility was delayed by several months. While our practice worked hard to connect the family to food resources in the community to fill the gap, the little boy continued to have an extremely difficult time. The situation became so dire that we were on the verge of having to bring in the child welfare authorities to have the child removed from the home.

Child Food Insecurity Rate

Then, finally, a breakthrough. A new policy in Pennsylvania, known as broad-based categorical eligibility (BBCE), allowed people, particularly working families, enrolled in the Temporary Assistance for Needy Families (TANF) program to automatically qualify for SNAP. As it turned out, the baby’s grandmother was enrolled in TANF, meaning that when she automatically qualified for SNAP as a result, the baby and his mother were immediately enrolled as well. As the family started receiving that crucial extra support to buy the food it needed, the baby’s weight and well-being improved markedly. And just as importantly, the family was able to stay together. 

There are millions of families just like this one who depend every day on the support SNAP provides. Yet, inexplicably, a proposed new rule could take that support away. 

Earlier this summer, the U.S. Department of Agriculture proposed a rule change to SNAP that would eliminate states’ ability to adopt or maintain BBCE policies. The effects of this rule would be completely devastating to families across the country. An RWJF-funded analysis from our partners at Mathematica found that the rule would cause approximately 1.9 million SNAP households—coming out to nearly 3.6 million people—to lose program eligibility.  

The Urban Institute followed with a closer look at who would be impacted, including:

In fact, some of the most significant anticipated consequences of this rule come straight  from USDA’s own regulatory impact analysis, which predicts potential increases in poverty and food insecurity; billions of dollars in increased administrative costs for both the federal and state governments to administer the program; and millions of dollars in increased administrative costs for current and new SNAP applicants. USDA also estimates that approximately 500,000 children will also lose automatic access to free school meals if this rule takes effect, further exacerbating food insecurity for vulnerable children and making it harder for them to succeed in school. 

Data released this month from the U.S. Census Bureau confirms just how effective SNAP is at turning participants’ lives around. SNAP cut the U.S. poverty rate from 14.3 percent to 13.2 percent between 2016 and 2018, lifting 3.1 million people out of poverty in 2018 alone.  

Yet the department’s own conclusions show that this rule is fundamentally at odds with the mission and purpose of SNAP. Rather than providing people with access to nutritious food, this rule would take it away. Rather than making it easier for people to sign up and enroll, this rule would make it far more complicated. Rather than making it simpler for federal and state agencies to administer the program, this rule would make it more difficult.  

I remember vividly the faces and stories of my patients. And since the day this rule was introduced, I have often thought of that young mother and her baby son, struggling mightily to get enough food to eat and make ends meet, until they were finally saved by a social worker with compassion and a state policy with heart.   

The first rule of being a doctor is to do no harm. The same principle should apply to public policy, yet this proposal clearly fails that test.

Learn how many people would be impacted by this rule in your state.


about the author

Headshot of Don Schwarz

Donald Schwarz, senior vice president, guides the Foundation’s strategies and works closely with colleagues, external partners, and community leaders to build a Culture of Health in America, enabling everyone to live their healthiest life possible. Read his full bio.

Thu, 26 Sep 2019 09:30:00 -0400 Donald F. Schwarz Child and Family Well-Being National <![CDATA[Expert Guidance on What Young Kids Should Drink and Avoid]]>

The nation’s leading health and nutrition organizations have issued evidence-based recommendations for parents, caregivers, health professionals and policymakers.

Young girl drinking from a cup.

“Should I be giving my toddler milk?”

“What’s the difference between fruit juice and a fruit-flavored drink?”

“I thought fat was good for my kids. Why should I switch my 2-year-old to low-fat milk?”

Every day, parents, caregivers, child-care providers and others struggle with questions like these about what kids should drink—and what they shouldn’t. They’re trying to do their best for kids’ health, but it’s not as easy as it may sound.

Ensuring that kids grow up healthy includes paying attention not only to what they eat, but also what they drink, especially during the early years when they are establishing their eating patterns. To do that, parents and caregivers need clear, consistent advice from health professionals about what drinks are healthiest for their kids. And policymakers need guidance so that they can create the strongest policies possible to help all children grow up healthy.

But, faced with an array of product choices and inconsistent messages about what’s healthy and what’s not, it can be challenging to know which beverages kids should drink, especially since recommendations seem to change every few months as kids get older.

Not only that, but until now there have been no healthy beverage guidelines for kids under age 2. The U.S. government’s Dietary Guidelines for Americans include recommendations for children ages 2 and older.

Coming Together for Kids’ Health

That’s why the Robert Wood Johnson Foundation funded Healthy Eating Research, a leading nutrition research organization, to bring together experts from four prominent health organizations—the American Academy of Pediatrics, the Academy of Nutrition and Dietetics, the American Heart Association, and the American Academy of Pediatric Dentistry—in an unprecedented collaboration to develop recommendations to help parents and caregivers choose what drinks are best for young kids.

It’s hard to imagine a group with better credibility on this subject—providing parents and caregivers with nutritional guidance they can trust. Just as important, we expect that this collaboration will improve the consistency of healthy beverage advice they receive from health professionals, like pediatricians and dentists, as well.

Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations is designed for children from birth through age 5 and should help inform:

  • Health professionals who help shape children’s diets, including pediatricians, family doctors, dietitians and nutritionists, nurses, dentists, and child-care providers
  • Food and nutrition programs that serve children, such as the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), as well as the upcoming revision of the Dietary Guidelines for Americans
  • Parents and caregivers who make choices for children every day
  • Child-care centers and homes, schools, and afterschool programs that provide meals and snacks to children
  • Food banks that assist families with children
  • Restaurants and food companies, which can adjust their labeling, marketing, and serving sizes so that the beverages they offer children are healthier

The goal is to ensure that kids are served healthy beverages, whether at home, child care, school, or at a restaurant, and that parents and caregivers feel confident that they’re making the healthiest choices for their young kids.

The recommendations grew out of a 2017 workshop convened by the National Academy of Sciences to identify policy strategies for reducing consumption of sugar-sweetened beverages among young children.

During the workshop, we heard evidence that patterns of sugary drink consumption begin early in life—and disproportionately among black, Latinx, and American Indian children and those from families who have lower incomes. These families often have less access to consistent nutrition guidance as well as to affordable healthy food choices in the places where they live. Not coincidentally, children from these families are also at higher risk for developing obesity and tooth decay and, later in life, diabetes, than white children and those from families with higher incomes.

But the problem is across the board: Too many kids consume too many sugary drinks like fruit-flavored drinks, sodas, and other beverages with added sugars. The Feeding Infant and Toddler study found that, on any given day, nearly one in three (29 percent) children ages 12 to 23 months and nearly half (46 percent) of children 36 to 47 months have a sugary drink. Further, sugary drinks are the number one source of added sugar from all foods and beverages for children 12 to 47.9 months of age.

What the Recommendations Say

For most kids, the following guidelines can help set children on the path for healthy growth and development:

  • 0-6 months: Babies need only breast milk or infant formula.
  • 6-12 months: In addition to breast milk or infant formula, offer a small amount of drinking water once solid foods are introduced to help babies get familiar with the taste—just a few sips at meal times is all it takes.
  • 12-24 months: It’s time to add whole milk, which has many essential nutrients, along with some plain drinking water for better hydration. A small amount of juice is ok now, but make sure it’s 100% fruit juice to avoid added sugar. Better yet, serve small pieces of real fruit, which is even healthier.
  • 2-5 years: Milk and water are the go-to beverages. Look for milk with less fat than whole milk, like “skim” or “low-fat.” If you choose to serve 100% juice, stick to a small amount, and remember adding water can make a little go a long way!

We need to put our children on a path to drinking healthier beverages early, and these evidence-based recommendations are a perfect place to start. We are confident that these guidelines will supply parents, health care providers, child-care providers, and other caregivers with consistent information, messages, and tools for providing the right beverages for children at the right age and setting them up for optimal health. And they provide policymakers and industry leaders with the information they need to set policies and make products that better support children’s health.

Learn more about the recommendations and share with your networks.


about the authors

Mary Story, PhD, RD, is professor of Global Health and Community and Family Medicine, and associate director of Education and Training, Duke Global Health Institute at Duke University. She started this position in January 2014. Read her bio.

Tina Kauh, PhD, senior program officer, RWJF, develops new research and evaluation programs, supports the development of team strategy, evaluates the work of grantees, and disseminates key learnings. Read her bio.

Thu, 19 Sep 2019 10:00:00 -0400 Tina Kauh Childhood Obesity Early Childhood National <![CDATA[New Data on How We’re Measuring a Culture of Health]]>

Four years ago, we introduced a Culture of Health Action Framework and measures to help us track the nation’s progress toward becoming a country that values health everywhere, for everyone. Today we share progress to date.

RWJF - Allen County Kansas

It’s been four years since the Robert Wood Johnson Foundation (RWJF), along with the RAND Corporation, began using a set of national measures to help track our journey toward a culture where every person has a fair and just opportunity to live the healthiest life possible—regardless of where they live, how much they earn, or the color of their skin.

Our goals were to offer some catalytic signals of change with a focus on broader social and economic drivers of health, well-being, and equity. The initial set of measures were used to track how diverse stakeholders, including those outside the traditional health sector, were advancing health and well-being—and if and how health equity was improving.

Developing a clearer picture of what is changing via the Culture of Health measures can guide those who are working collaboratively to accelerate improvements. We offer a few highlights from recent updates to the measures (see also and share some data on our progress to date.

What Has Changed?

Since 2015, what do the data tell us about our progress in creating a Culture of Health in America?

We are seeing small but positive changes in the appreciation of the social determinants of health and the need for broader community health investments. However, there has been less movement in many of the structural and systems-level factors that critically influence health, well-being and equity.  

Here are just a few examples:

  • There is greater understanding that diverse factors influence health. A critical component of a Culture of Health is the shared understanding that we’re all in this together—that we recognize our health is interdependent with others around us. We measured these values and beliefs about health as part of National Survey of Health Attitudes. In 2018, 37 percent of surveyed adults (vs. 34% in 2015) believed that one’s surroundings (both other people’s behaviors—and factors like physical environment, social support, and community safety) strongly influence health and well-being.
  •  Consumer experience with health care is improving. According to the most recent Consumer Assessment of Healthcare Providers and Systems Survey, 18 states earned the highest consumer experience rating (five stars) in 2017. This reflects improved subjective consumer experience in care, including ease of navigation, transparency, and communication within and across health systems.
  •  Access to care is still a struggle for too many. On the other hand, we have seen little change with respect to access to care and services. There have been no improvements in access to dental care (about 39% continue to report receiving dental care in the past year). Treatment rates for mental illness and substance dependence or abuse also show no improvement, having held steady for the last four years with only 40 percent of those needing treatment having received it.
  •  Progress is stalled on key conditions that create healthier, more equitable communities. These conditions that represent some of the most entrenched, systemic issues are usually not tracked with other health measures even though they are key influences on health. There has been no change, for example, in the number of states with cross-sector climate action plans. At a local level, there has been little change in racial residential segregation in neighborhoods, which is linked to poorer health and economic outcomes. This degree of racial segregation is largely unchanged from 2015, with white residents in America still living in the least diverse neighborhoods.

What Do These Changes Mean?

To summarize, people are expanding their views of what influences health and there have been some targeted improvements in health care and public health access. A key objective of the newly updated Culture of Health measures is to catalyze more discussion and action across sectors. We welcome growing interest in areas that these measures represent—from a focus on community health amenities like public libraries—to the importance of managing the effects of toxic stress in childhood reflected in the appointment of the California surgeon general.

Yet, the critical systemic changes needed for more transformative health improvements have been slower to follow.

Looking Ahead

RWJF will continue to monitor changes in structural determinants of health because doing so is essential to truly understanding progress in health equity. We also will support further work to spur progress in health care and social, economic, and environmental drivers of health. A fuller description of these measures and the data underlying them can be found at Exploring them can illuminate trends and help to pinpoint areas where targeted efforts may pay dividends. For instance, our failure to make significant—or any—progress in addressing decreased life expectancy; continued challenges associated with high rates of chronic disease; and increasing rates of maternal mortality are gravely concerning and demand investigation.

RWJF and its partners are committed to building public will to change our culture into one that values health everywhere, for everyone. With so much at stake, this imperative should be widely recognized as a national priority.

Success is within reach, but it will take a real commitment to turning research into action, and vision into a reality where we can all live the healthiest lives possible.

Learn how to take action and be part of the solution at



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

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


Thu, 12 Sep 2019 10:00:00 -0400 Alonzo L. Plough National <![CDATA[Using GIS Mapping for Better Health]]>

This 2018 Culture of Health Prize winner uses geography-based technology to quantify, and solve, a range of challenges.

A woman wears a helmet while riding a bike.

Since at least the 1600s, people have used maps to track and manage diseases and other health effects, and to pinpoint their causes. From plague and cholera to cancer and heart disease, this approach has been a vital tool in the public health toolbox. Maps, combined with data, are powerful because they help people visualize where disease clusters and how it interacts with the physical places in which we live. 

In the digital age, technology can be tapped to promote healthy communities in ways that have would have been impossible a decade ago. Geographic information system, or GIS, mapping is lighting new paths forward. In my rural community of Klamath County, Ore., we’ve used GIS mapping to better understand our community’s challenges and the possible solutions. Here are two case studies that illustrate how Klamath County has used GIS mapping in the past, and a third that shows how we’d like to use it in the future:

Making the Case for a Protected Bike Lane

About six years ago, the leaders of Sky Lakes Medical Center’s wellness center in Klamath Falls, which helps people manage their chronic illnesses, wanted to identify parts of town where people struggled with health. Professor John Ritter, of nearby Oregon Institute of Technology, used anonymized data for 60,000 Sky Lakes patients to create maps that revealed something surprising: Adult residents living along a corridor on the west side of town had a high incidence of obesity, a low incidence of diabetes, and tended to be on the younger side. 

We saw the opportunity to help prevent residents from developing diabetes by creating a protected bike lane to give people a healthy and safe way to get around. The maps helped us persuade city and county officials, who approved the plans, and helped us raise money for construction from private foundations and individual donors who funded the project.

The two-mile-long bike lane opened last June. We won’t know its impact on people’s health for several years, but we plan to study it.

Keeping Cigarettes Out of Young People’s Hands

In Klamath County, nearly one in four adults smokes. Almost a quarter of 11th graders have ever smoked a cigarette and about 40% have tried other tobacco products or vaping. Because tobacco addiction commonly starts in adolescence, we were concerned by the fact that in 2015, inspections by Klamath County Public Health found 35% of tobacco retailers illegally sold products to minors. 

Using public addresses of schools and retailer addresses provided by the public health department, Professor Ritter created a map that showed many of the county’s 80 or so tobacco retailers were within steps of schools. 

Klamath County Public Health was able to use that information to support our argument for tobacco sales licenses that retailers must apply for annually. That policy went into effect in January 2018, the same month Oregon officially raised the age of purchase for tobacco and vaping products from 18 to 21. The licenses make it easier for us to enforce tobacco sales laws and educate tobacco retailers if they struggle to comply. This year, the percentage of inspected tobacco retailers who illegally sold products to minors has gone down to 17%. That means we’re keeping tobacco products out of teens’ hands. 

Creating Safer Routes to Schools

A new project Professor Ritter is working on is putting data about the safety of the routes students take to school into an online map the public could access. That involves converting paper maps that show where sidewalks need to be repaired or installed into a digital format, then using a computer to predict the best, shortest path to school for every student.

To make those maps, he’ll need to figure out how to work with schools get student addresses in a way that protects privacy. If he succeeds, his maps will help the city prioritize work on sidewalks and roads along routes to school so students can more easily walk to school, working physical activity into their daily routines.

We’re fortunate that Klamath County is home to the Oregon Institute of Technology, where Professor Ritter teaches. But any community can find the resources to use GIS mapping. Many cities and counties have a GIS office. Your state health department may have GIS capabilities, too. And many private GIS contractors are ready to assist. However you go about it, GIS mapping can be an enormous boon if your community wants to study, understand and begin to solve its unique health challenges.

Read more about Klamath County and learn about how to become an RWJF Culture of Health Prize-winning community.


About the Author

Jennifer Little directs Klamath County, Oregon’s public health department.


Thu, 5 Sep 2019 12:00:00 -0400 Jennifer Little <![CDATA[How Can We Advance Equity, Diversity, and Inclusion in Policies and Laws?]]>

Post-doctoral researchers: We need your life experiences and academic background to inform inclusive and equitable policies. We’ll provide funding and support.

Law and policies should address, not compound, inequities. This is personal and something I carry with me.

I was 10 years old when a man in my northern New Jersey community was beaten to death outside a neighborhood cafe. Soon after, another community member was beaten and sustained brain damage. The number of victims—all of whom were of South Asian descent—grew over the years. The violence ranged from verbal abuse to brutal assaults and murder. It wasn’t uncommon for my home and other South Asian homes to be vandalized while having to hear racial slurs.

Officials denied that these attacks were hate crimes and ethnically motivated. Research and data on discrimination and hate crimes against South Asians simply did not exist, and there wasn’t much diversity among local officials. It was therefore difficult for community members to get the protection we needed. It wasn’t surprising that there were subsequent and repeated acquittals of people who perpetrated the violence. Even living in the shadow of the Statue of Liberty, we didn’t feel a sense of freedom to live our healthiest lives because our laws didn’t do enough to stop racially motivated violence. It was years later when hate crime laws took effect.

The chronic stress stemming from discrimination and unsafe communities has an undeniable impact on health. At the Robert Wood Johnson Foundation (RWJF), we are working to broaden the discussion about what shapes health. We believe that includes deepening our understanding of how policies and laws can be more inclusive. We need more representation among lawmakers and researchers, as well as more diverse and disaggregated data to improve policies that support health equity. By building and sharing evidence, people from all walks of life will have a fairer chance at living safe, healthy, productive lives.

It’s in this spirit that we announce a new funding opportunity: Advancing Equity, Diversity, and Inclusion in Policy and Law Research.

Funding Opportunity

Policies for Action, an RWJF research program, has issued a call for proposals to study an existing policy or policy change from a new lens. We seek to elevate diverse perspectives in policy and law research.

The policy or policy change that you examine should have long-term impacts on health and well-being for a population of people. For example, policies increasing Medicaid access may affect children’s life trajectories for years to come. Workplace family leave policies may also have an indelible effect on lives. We welcome all research ideas but will prioritize studies that align with RWJF’s focus areas.

In addition to research funding, this opportunity includes working with mentors of your choosing as well as receiving professional development support from Policies for Action.

An important part of this grant is to usher the research findings into real change. By publishing, speaking about, or otherwise sharing your research, you will help to spread what works so many others can benefit.

Two-year grants of up to $250,000 each will be awarded to six researchers (two of whom will be New Jersey residents).

What Do We Mean by Laws and Policies?

We are interested in any type of law, legislation, policy, or governing rule that impacts a significant population. This could be a local, state, or federal law. It could also be a corporate workplace policy. It has to be an existing policy or a policy that is being revised. It can address a troubling inequity, but it doesn’t have to; the policy can be studied from an equity lens. I invite you to review our previously funded projects to understand the scope of what we study.

Who Should Apply?

The ideal candidate will bring personal experience that sheds light on the health implications of a policy or law, coupled with an academic background to inform the research.

Eligible candidates include, but are not limited to, individuals from underrepresented ethnic and racial groups in research disciplines, first-generation college graduates, people from low-income communities, and individuals with a disability. Make a case for how you bring a diverse perspective; we will consider all proposals.

We seek junior faculty members (with fewer than 10 years’ experience) on a tenure-track at an accredited college, university, or independent research institution.

You should name two mentors on your application. The first is a senior researcher at your institution who can guide you in your career, and the second is a senior academic in your field who can guide you in your research.

It’s our intention that by working with early-career researchers with diverse backgrounds, we can help inform what makes laws—and the research field at large—more inclusive.

Learn more about this funding opportunity by reading the call for proposals and watching our informational webinar.


About the author

Headshot of Mona Shah

Mona Shah, a senior program officer in the Research-Evaluation-Learning unit, joined RWJF in 2014. Drawing on her 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. Read her full bio.

Tue, 3 Sep 2019 14:00:00 -0400 Mona Shah Health Disparities Diversity <![CDATA[The Power of Local Data in Action]]>

With the City Health Dashboard, communities across the United States are using data presented on a feature-rich website to create healthier and more equitable communities. Lessons learned will help more community leaders pinpoint local health challenges and close gaps in U.S. cities and neighborhoods.

A meeting facilitator refers to a bar chart.

If you knew children born and raised in one neighborhood of your city tend to live 10, 20 or even 30 years longer than those raised in another, what kinds of questions would you ask?

Local data on social, economic, and health factors can help city planners, policymakers, and community advocates illuminate approaches to such challenges and drive change.

We heard from city leaders that there was a lack of data at the city and neighborhood level clearly showing which factors have the greatest influence on their community’s health and well-being. So we got to work and created the City Health Dashboard. Launched in 2018, the Dashboard integrates city- and neighborhood-level data from multiple national sources, providing 37 measures that address health, such as obesity rates and life expectancy, and conditions that shape health, such as child poverty, unemployment, and residential segregation. The country’s 500 largest cities—those with populations of approximately 66,000 or more—are all represented in the Dashboard, which also includes a rich set of resources to help cities take action to improve health.

For the City Health Dashboard team, our first year exploring the power of local data to understand and improve health was an exciting one, with many lessons learned. We delved into data on the availability of parks and affordable housing, rates of children in poverty and obesity, and other factors that affect health in the nation’s largest cities and towns. Out of this data exploration, we continued to address gaps in data needs, adding new features that make the Dashboard an even more powerful tool for cities and communities working to build a Culture of Health. We are excited to share three things we’ve learned from our first year, and we invite you to explore the Dashboard for yourself.

First, local data is so powerful because it allows cities to dig deeper into the factors that drive health. It’s hard to be healthy when you live in places where you can’t buy healthy food, find housing that is safe and affordable, or secure good-paying jobs. Local data illuminate these gaps, pointing to opportunities to take action and improve health. Neighborhood data is particularly helpful for small and mid-size cities that may lack the resources and capacity to conduct more comprehensive data collection and analysis.

With the Dashboard’s data and easy-to-use visualizations, community leaders in cities like Grand Rapids, Mich., population 195,355, can see how opportunities for health and well-being in neighborhoods right next to each other may differ drastically.

To ensure economic growth is equally distributed across communities in Grand Rapids, local officials used the Dashboard’s data on unemployment, income inequality, child poverty, and life expectancy to identify what they call “Neighborhoods of Focus” where residents are struggling the most. With partners like Invest Health, the city decided to focus on these 17 identified neighborhoods to make improvements and close opportunity gaps. For example, when the city received over $50 million in Low-Income Housing Tax Credits to provide more affordable housing, it targeted these resources to these Neighborhoods of Focus, ensuring the funds reached those who needed them most. Dashboard data provides the level of granularity city leaders need to identify patterns, connect the dots, and convene diverse community members to address issues for improving health.

Second, the Dashboard has revealed remarkable patterns regarding residential segregation and life expectancy. The Dashboard shows large gaps in life expectancy, some as large as 20 to 30 years, between neighborhoods within many cities. While the average gap across the Dashboard’s 500 cities between the neighborhoods with the shortest and longest life expectancies is 12.4 years, cities that have higher rates of neighborhood racial/ethnic segregation also tend to have greater life expectancy gaps between neighborhoods. Chicago has the largest gap in life expectancy at 30.1 years. Washington, D.C., has a life expectancy gap of 27.5 years, followed by New York City (27.4 years).

Dashboard data show that residential segregation is associated with shorter lives. This can be caused by a number of factors. Children who grow up in segregated neighborhoods tend to have less access to good schools and green spaces in which to play and exercise, as well as higher exposure to crime and environmental toxins. When these factors are combined, their influence on health can be especially damaging.

The good news is that we have tools and policies to help cities and communities improve their residents’ health. Research shows that universal pre-K programs, safe and affordable housing, higher minimum wage, and increased access to primary care all work to improve health. The challenges and the solutions will be different for every community. The Dashboard data equips cities to dig deeper and start conversations about how to build thriving and more equitable communities by improving education, housing, economic opportunity, and other factors.

Lastly, we’ve identified Dashboard features that are particularly valuable and strengthened them. We updated our Take Action section, offering city and community leaders additional strategies to drive change. For example, in addition to identifying resources for designing a “complete streets” policy to make roads safe and accessible to pedestrians and vehicles, you can now explore funding opportunities and partnership strategies that can help make these initiatives a reality in your community.

New interactive maps let you see where and how measures overlap, neighborhood by neighborhood. For example, in Buffalo, N.Y., neighborhoods with higher rates of children in poverty also tend to have higher rates of mental health issues. While this might seem intuitive, backing up intuition with data is how resources get allocated, programs enacted, and change initiated at the local level.


With 37 measures of health and well-being for 500 cities, you can use the Dashboard to compare across and within cities. With the addition of multi-year data for 29 metrics, you can now also track changes in your community year by year. These new Dashboard features help communities better understand their greatest challenges and, more importantly, to take action where it matters most.

Visit to explore the data, subscribe to our email list, and follow us on Twitter @cityhealthdata for the latest updates.

About the author

Marc N. Gourevitch, MD, MPH, is the Muriel and George Singer Professor and founding Chair of the Department of Population Health at NYU Langone Health. The focus of Dr. Gourevitch's work is on developing approaches that leverage both healthcare delivery and policy- and community-level interventions to advance the health of populations. Dr. Gourevitch leads the City Health Dashboard. Read his full bio.


About City Health Dashboard

City Health Dashboard was created by NYU Langone Health, Department of Population Health, in partnership with NYU Wagner Graduate School of Public Service, the National Resource Network, the International City/County Management Association, and the National League of Cities, with support from the Robert Wood Johnson Foundation.


Thu, 22 Aug 2019 12:00:00 -0400 Marc N. Gourevitch National <![CDATA[Walk With Us: Building Community Power and Connection for Health Equity]]>

What does it take to build community power? A community organizer-turned-funder shares first-hand insights, as well as a new RWJF funding opportunity to advance this learning journey.

A truck driver at a recycling facility.

While many think of the Bay Area of California as the center of big tech and wealth, my memories of Oakland take me back to its Port truck drivers. Working an average of 11 hours a day, waiting in long lines at the Port of Oakland to pick up their loads, truck drivers in the Bay Area were isolated—living in the rigs they decorated with photos of their children and families. You can guess all of the reasons this is unhealthy—stale air, diesel fumes, no bathrooms or opportunities for physical activity, just to name a few. Their days consisted of sitting...alone. And then driving cargo to a destination...alone.  

Like poor air quality, poor ergonomics and lack of physical activity, social isolation is also linked to poor health. Alternatively, people with more social connections live longer and are more likely to say they are in good health.

Back then, I was a campaign director advocating for environmental and occupational health protections for communities and workers. Part of my job included “walking the line” with faith leaders, visiting these truck drivers as they sat in their cabs and waited in long lines outside the Port to pick up a load. Some of them were recent immigrants working to support families back home. Most of them made low incomes, barely living paycheck to paycheck after paying for the cost of their $250,000 (or more) rigs. All of them worked grueling hours. We asked about their families, brought them food and water, faith leaders provided blessings, and we all encouraged them to get out of their cabs to socialize with each other. We also helped them advocate for access to bathrooms, cleaner air, and the power to improve working conditions.


Although I’m no longer out “walking the line,” I’m still helping to support communities to build social connection and power, particularly for low income residents and residents of color who are especially affected by poverty, systemic racism, and other challenges.


Here’s what this looks like at the Robert Wood Johnson Foundation (RWJF). RWJF’s “north star” is building a Culture of Health so that everyone, no matter who they are, where they live, or how much money they make, has a fair and just opportunity to live the healthiest life possible. We aim to build capacity in communities to enable them to remove social and economic obstacles to health, including powerlessness.

Investing in Power

We have a long history of support for “community power building” in tobacco cessation, access to health care, childhood obesity, and, more recently, school discipline and worker rights. Just a few examples include:

  • In 2004, we funded Tobacco Policy Change, which worked intensively with low-income and Native American communities and with communities of color to build coalition campaigns for tobacco control policies. We sought out agencies that had credibility within their communities even if they lacked expertise in health, including groups that had worked on safety, Main Street redevelopment, and housing.

  • In 2011, we worked with the Funders' Collaborative on Youth Organizing to increase resources to the field of youth organizing and promote the leadership of low-income young people and young people of color in social justice organizing.

  • More recently, we’ve continued our focus on capacity building with national civic and faith organizations with chapters, members and volunteers around the country, including NAACP, UnidosUS (formerly National Council of La Raza), Faith in Action (formerly PICO National Network), and the YMCA

  • Our Voices for Healthy Kids initiative is making it easier for all children to eat healthy foods and be active and Forward Promise is strengthening communities that raise and empower boys and young men of color.

  • Last year, we completed a philanthropy scan to learn how funders view and apply community power to their work.

Support for community power building has always been a part of our work to improve health. That said, our more explicit focus on health equity is necessitating a new and more explicit focus on community power building.  

Walk With Us

A call for proposals (CFP) was released, deadline: September 24, 2019, to build an understanding of the range of methods applied in innovative and effective community base-building that result in changes to community-level social, economic, and physical conditions that we know influence health and equity. 

Base-building is a set of strategies and activities used by residents, workers, consumers, and other constituencies to build collective strength and power to address a variety of inequitable conditions in communities. Base-building has been utilized for generations by grassroots-led organizations and institutions to build power specifically in historically excluded or underrepresented populations. 

We are seeking research proposals whose project teams will participate alongside other field and research experts in RWJF’s Lead Local program, which is exploring the question: how does community power catalyze, create, and sustain conditions for healthy communities?

Lead Local: Exploring Community-Driven Change and the Power of Collective Action is seeking to: 

  • Deepen understanding of how power and power building operates in place;

  • Build greater understanding of how to measure and track the impacts of base building, as a core aspect of community power building;

  • Create shared understanding amongst collaborative members of how community power informs the conditions for health equity.

This CFP will support research projects led by a collaboration between a grassroots-led organization(s) and a researcher(s), with the anticipated grant recipient to be a grassroots-led organization(s).  

While it’s a far cry from my days of “walking the line” alongside neighbors and faith leaders, this opportunity to learn more about the strategies used by residents, workers, consumers, and other constituencies to build collective power and address inequitable conditions in communities serves as a reminder that we don’t have to walk alone.  



About the author

Aditi Vaidya

Aditi Vaidya joined RWJF in 2017 as a senior program officer working toward the goal of building community power to support a Culture of Health. With her far-reaching expertise in organizing, environmental health, economic justice, corporate accountability, and worker rights issues, she seeks to employ these skills to help communities promote health equity. Read her full bio.

Tue, 20 Aug 2019 12:00:00 -0400 Aditi Vaidya National <![CDATA[Lessons on Nurturing Homegrown Leaders]]>

This community development advocate has learned that great things happen when residents are invested in, and empowered to, change their world.

My hometown of Eatonville, Florida, is known as “the town that Freedom built,” and for good reason: It was founded in 1887 by black freedmen on land they bought from a rare white landowner willing to sell large tracts to black people. Today, it’s the oldest historically black incorporated town in America. 

This place exists and has survived because of citizen leadership, vision, and persistence. Many people here, like me, have multigenerational ties to the town, and all of us take deep pride in Eatonville’s role in history. Many people who live or work here, or attend one of our many churches, have contributed to building a Culture of Health in town and winning recognition for our efforts from the state of Florida and the Robert Wood Johnson Foundation. But the spirit of collaboration that made that possible didn’t happen by accident. Eatonville has proactively empowered citizens to become leaders. We value the voices and contributions of all of our citizens.

This is how real systemic change happens.

In recent years, the town has promoted leadership in a number of ways. These have included Healthy Eatonville Team, which I chair, a group of citizens working to improve health in the town; Leadership Eatonville, a 12-month training program; and efforts to launch neighborhood associations in the town’s four quadrants, starting with the neighborhood of Catalina. Before I took the helm, Healthy Eatonville Team already had a track record of success, helping to refurbish the gym of a former high school, install bike racks around town and add a free bike share at our library in the heart of our historic downtown. The group also was behind making sure the town included healthy community design in its community redevelopment master plan, which was updated in 2016 and governs the work we do at Eatonville’s Community Redevelopment Agency, where I am neighborhood coordinator.  

We’re working on building on that list of accomplishments. It’s not always easy, but every step we take is worthwhile because of our commitment to the people of this town. Here are three things I’ve learned about nurturing homegrown leaders during my year of leading Healthy Eatonville Team.


We have a long and ambitious list of things we’d like to do to promote health and well-being in Eatonville. We can do them all—just not at the same time. And it’s important to remember that sometimes doing “small” things—like fixing sidewalks—can have a big impact in a town our size. I learned that people see sidewalks as a path to better health. So, Healthy Eatonville Team has gotten serious about sidewalks, and at the moment, we’re focusing most of our efforts there. 

Better sidewalks that connect throughout the town will improve residents’ ability to get around by foot and stay active. This is intuitive, but not the kind of thing that planners would necessarily focus on first if not for hearing the voices of the people who walk those paths. Though sidewalk improvements and repairs are already included in Eatonville’s comprehensive plan, taking the project on requires money and proper planning. So members of Healthy Eatonville Team have taken the initiative to look for state and federal grants to help fund the effort.

But even as we prioritize those sidewalks, Eatonville’s other ambitions on that list to improve health and well-being will get some love. This is where leadership across the work in our community is integral to our success. Communication and connection on the issues that unite us is essential. And it’s because of our approach that our town’s economic development projects, diabetes management and prevention efforts at the health and wellness center Healthy Eatonville Place, and our work to empower young people continue. Healthy Eatonville Team doesn’t have to focus on everything, but the group is an important mechanism for reaching consensus on issues that are important to people in town. To that end, we’re also getting more organized in how we educate other residents and communicate with town government about the changes citizens would like to see so we can coordinate our work and priorities.  

Eatonville, Florida

Lead, But Listen

Healthy Eatonville Team has been fortunate to have many “stakeholders”—like the principal of our elementary school, members of local health systems and foundations, business owners or representatives from nonprofit service providers—coming to meetings and joining the work of our group. These leaders’ involvement is important and aids coordination across sectors. But to truly represent citizen concerns, I want to ensure people who live in town—or work or go to church here—and aren’t normally viewed as leaders make up the bulk of our group’s participants. These often-undervalued members of our community must understand that the town needs them and their energy and activity. I want them to see, through their participation in our planning and activities, that their contributions are valuable to our collective progress. Once they recognize how important they are, they’ll be encouraged to do more and invite more people to do what they can. That’s how a movement toward better health grows.

Find Champions for Citizens’ Work

In Eatonville’s efforts to launch a neighborhood association in Catalina, one of Eatonville’s four quadrants, we’ve identified two residents as leaders. And to encourage and motivate them and get others in the neighborhood involved, we’re coordinating with Tarus Mack, one of our city council members who lives there. He sees the value of deep citizen involvement and plans to be a champion for the neighborhood association. Mack is going to speak with residents and actively participate in the group, modeling the type of engagement that will help Eatonville thrive and continue to feed our Culture of Health. Such on-the-ground engagement is also how today’s leaders inspire tomorrow’s.

People are often so busy with the many commitments in our lives, but seeing a member of our city government prioritize and engage at the neighborhood level will, we hope, inspire others to make a difference right where they live. Leadership comes in all shapes and sizes—something our small town knows about given our oversized historical footprint.

I’m excited about getting more people involved in improving health and well-being in Eatonville, and I’m confident we can keep building momentum. We cultivate the type of leadership that can spring forth from unexpected places. And once you get citizens engaged and invested in change, nothing will stand in their way. 

Read more about Eatonville, a 2018 RWJF Culture of Health Prize winner, and apply by November 4 to be a 2020 Prize-winning community.


About the Author

Jasmyne Reese is neighborhood coordinator for Eatonville, Florida’s Community Redevelopment Agency and a public policy intern at IMPACT Strategies, a political advocacy firm. She spent part of her childhood in Eatonville and now lives five miles away, in Altamonte Springs, Florida.

Thu, 15 Aug 2019 10:15:00 -0400 Jasmyne Reese Public and Community Health National <![CDATA[Global Approaches to Well-Being: What We Are Learning]]>

What can we learn from other countries about advancing well-being—a notion of health that extends beyond the absence of disease?

A father and mother hold their baby.

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

We were missing out on insights, for example, from years of research and community engagement underpinning New Zealand’s well-being indicators and recently announced national well-being budget. Officially introduced in 2018, the country’s Living Standards Framework redefines the national government’s priorities and measures of progress. It expands beyond economics to also consider policy impacts on human and environmental well-being.

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

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

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

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

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

Here are some early considerations to share.

A Holistic Vision

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

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

Tailored Approaches

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

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

Subjective Experience

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

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

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


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

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

What RWJF is Doing

In 2018, one of RWJF’s first steps on our learning journey was to convene thought leaders from five continents and 19 countries at the Rockefeller Foundation’s Bellagio Conference Center. The examples I cited above are all based on the work of people we met there. Since then, the participants—many of whom hadn’t met each other or RWJF before—have continued to collaborate, including on a recent Academy Health webinar on leveraging well-being measurement to shift narratives about what matters. We recently published a report based on those global insights and, as part of our Culture of Health series with Oxford University Press, will release a related book in 2020.

We are continuing to observe, test ideas, and explore how to integrate these insights from around the world into how we build and measure a Culture of Health across the United States, from our most rural communities to our largest cities.

Questions to Expand Well-Being Thinking

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

Learn more and sign up to be alerted when free copies of our Oxford University Press volume on well-being become available next year.


About the Author

Headshot of Alonzo Plough

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

Mon, 29 Jul 2019 11:45:00 -0400 Alonzo L. Plough International <![CDATA[Home Is Where Our Health Is]]>

Where we live affects how long and how well we live. Yet, affordable housing is out of reach for too many. RWJF is addressing housing stability, equity, and health through data and research. Read on to see best practices you can use in your community.

Everyone should have the opportunity to live in a safe community.

There is growing evidence that safe and secure housing is a critical factor in achieving good health. Where we live can determine whether we’re connected to: safe places to play and be active; quality jobs and schools; and transportation to get us where we need to go. Yet millions of people in America live in substandard or overcrowded housing, temporary shelters, in cars, and on streets. Disadvantages also exist for the many living in residentially segregated neighborhoods isolated from opportunity. For them and others, the inability to access quality housing and neighborhoods deepens challenges and makes it much more difficult to be healthy and break out of poverty. 

Housing’s profound effect on health is often overlooked and misunderstood. This year, the Robert Wood Johnson Foundation (RWJF), led by President and CEO Richard Besser, MD, is shining a light on the link between housing and health. In his Annual Message, Besser discusses how safe and affordable housing supports positive outcomes across the lifespan—and how unsafe and insecure housing can deepen inequity and undermine a Culture of Health. 

He shares stories from housing initiatives across the country—from Boligee, Ala., to Chelsea, Mass., to San Antonio. These examples show that when we improve the quality and affordability of housing—health and lives also improve. Creating safe and affordable housing—as an essential part of comprehensive efforts to transform impoverished neighborhoods into places of opportunity—becomes a pathway to helping communities thrive.

In this post, we share illustrations that reflect lessons learned from this important work. We also revisit past Culture of Health Blog posts in which experts have explored the role of housing as a determinant of health. With a focus on housing as a key to health, we hope to unlock better health for all.


Safe, Affordable Housing

The quality and stability of our homes shape our health.

Home is where the heart is, but it’s also where our health is. The quality and stability of our homes shape our health, our communities, and our society. When we live in safe, quality homes that are: free of physical, chemical, and environmental hazards; are near decent jobs, good schools, reliable transportation, and safe play spaces, we can flourish. When we don’t have these opportunities, we can suffer—and so do our communities. 

As Amy Gillman, a senior program officer at RWJF writes, “There is a strong and growing evidence base linking our homes to our health.”

But safe, stable, and quality housing is out of reach for millions of people in America—and that has profound implications for health. “Where we can afford to live impacts where we live,” Gillman writes, “and our neighborhood’s location can make it easier or harder: to get a quality education; to earn living wages; to afford and have access to nutritious food; and to enjoy active lifestyles.”


Housing Costs Can Undermine Health

High rent forces some to live in unsafe places.

The cost of housing in America is high—and getting higher in many places. Over the last two decades, rents have increased, while incomes have stayed flat. This takes an especially heavy toll on the 38 million “cost-burdened” families in America—more than half of whom spend over 50 percent of their incomes for the roofs over their heads.

To make ends meet, many families must live in unsafe or overcrowded housing. And many others—especially low-income families—after paying for housing, don’t have enough left over to cover necessities like nutritious food, health care, and transportation. As Gillman writes, “When we’re spending too much of our income on rent or a mortgage, that leaves little to pay for transportation to work or the doctor or to put healthy food on the table for our kids.”


Housing Discrimination

Poor health is more common in places that are segregated.

In America, not everyone has the opportunity to live in an affordable, stable, safe home in a neighborhood that fosters well-being.

Unequal access to affordable housing contributes to other inequities, according to Kerry Anne McGeary, a senior program officer at RWJF. “We know there is a direct line from opportunity to equity to health—with access to good schools; affordable housing; safe neighborhoods; and quality health care as some of the key stepping stones,” she writes. “When those resources are unevenly distributed across neighborhoods—and sometimes within the same few outcomes are certain to be inequitable as well.”




End Discriminatory Housing Policies

Housing and health inequities stem largely from decade-old discriminatory practices.

Not all discrimination is conscious,” writes David R. Williams, a professor of public health at Harvard University. It’s often built into policies and practices that affect where we live, learn, work, and play—all of which shape our health. 

Over the last four centuries, the “land of the free” institutionalized slavery, forcibly removed Native Americans from their lands, implemented a system of legalized racial segregation, denied housing loans, and more. 

The country has made progress, but racism and discrimination persist. Nearly half of black people, for example, say they have experienced discrimination when trying to rent or buy a house, limiting access to one of the most foundational needs for good health.

The result, says Sheri Johnson, director of the University of Wisconsin Population Health Institute, “has been an accumulation of disadvantage through decades and generations.”


Working Toward Solutions

The Robert Wood Johnson Foundation is working to build a national Culture of Health where everyone has the opportunity to live a healthier life. The evidence is clear that “where we live affects how long and how well we live”—including our home and all the essential resources to which our home connects us.

Read Rich Besser’s Annual Message to learn more about how our homes are key to our health.


About the Authors

Najaf Ahmad

Najaf Ahmad spreads vibrant stories about the Foundation’s work as content management editor of the Culture of Health Blog. Read her full bio.

Headshot of Jessica Mark

Jessica Mark brings extensive experience to her work as a communications officer for RWJF’s Healthy Communities theme.

Mon, 22 Jul 2019 12:00:00 -0400 Najaf Ahmad National <![CDATA[How San Antonio, Texas, Fixed Its Broken Truancy System]]>

Bexar County once handled 36,000 truancy cases a year. Now students get one-on-one help to boost their attendance, and truancy cases have dwindled.

Texas was the last of two states—Wyoming being the other—that treated truancy as a crime. Students and their parents faced court fines, and if penalties went unpaid, teen truants could be cuffed by constables and sent to jail.

None of this made any sense to me when 10 years ago, as San Antonio’s presiding municipal judge, I inadvertently began the process of changing the system across the state.

I had heard from a friend who handled attendance in one of the largest of San Antonio’s 16 school districts. This assistant principal was concerned because truancy cases filed in January could not be heard by justices of the peace until October. At the time, Bexar County, which includes the city of San Antonio, handled about 36,000 truancy cases a year.

I wondered why we weren’t figuring out why students were not going to school—as opposed to just jamming them into the school-to-prison pipeline. Troubled by that question and knowing there was nothing to preclude a municipal judge from hearing truancy cases, I stepped in to work through the backlog with another judge. We processed 1,200 cases over three weeks.

I could immediately tell the system was definitely broken.

Some students had special needs that weren’t being addressed. Others may have missed school because their families were homeless, or they had to work to support siblings and parents. 

In San Antonio and Bexar County, the municipal court took over the handling of all truancy cases, and immediately the number of criminal actions halved to about 16,000. We also established a system to use juvenile case managers to intervene with students and prevent truancy cases from escalating into criminal action.

Certainly, you had some kids who were just hard to reach. But a lot of the time we were able to identify clear issues that we could at least try to help them get addressed.

Meanwhile, a panel of lawmakers, judges, prosecutors, and educators was convened in 2013 to create a uniform approach to truancy prevention for the city and county that persists to this day. Juvenile case managers get involved as soon as a problem becomes apparent and work one-on-one with students and parents to come up with a “contract” for improving attendance. This could involve counseling, tutoring, mentoring, community service, or other types of services for the student or parent.

I went to Austin next and testified before state legislators for the need to remove truancy as a criminal offense. Some justices of the peace argued that without fines, the court had no teeth. They kept talking about teeth, and we were talking about heart. The measure to remove the criminal treatment of truancy became Texas law in 2015.

Today, San Antonio has more than 30 case managers at schools around the city and county who deal with truancy issues. The only way a formal case can be brought is through a civil process. Only about 16 truancy cases are filed a year. We were the first large court in Texas to receive a grant from the governor’s office to fund additional juvenile case managers with the express intent of intervening early on, preventing truancy and reducing the number of juvenile court referrals.

One of the early observations that we made, which kind of became the mantra of our court, is, “Kids don’t have truancy problems. They have problems that are causing them to be truant.” It’s one of the greatest achievements of my career that the entire state took up my mantra. Now, in San Antonio, we can really help students overcome their problems, instead of compounding them.

Learn more about San Antonio’s efforts to build a Culture of Health.



A judge sitting at the bench of a courtroom.

John W. Bull began his legal career as a small-town lawyer. He was elected to the municipal court in San Antonio in 1999 and became the presiding judge in 2004.

Wed, 17 Jul 2019 11:45:00 -0400 John W. Bull Child and Family Well-Being <![CDATA[Helping Dads Support Their Kids’ Health and Development]]>

Research shows that children and moms benefit when dads are actively engaged in their kids’ health and development. A new study examines barriers that make it difficult for some fathers to be involved and how to overcome them.

Dad holding his smiling daughter.

This Sunday, families around the country will celebrate Father’s Day and pay tribute to the special caregivers in their lives. It’s a time when I find myself feeling especially grateful for all the positive ways my own father has influenced my life and the crucial role my husband plays in raising our daughters.

I also think about the many dads I have been lucky enough to meet throughout my life. These are the special dads who are determined to make sure that all kids--both their own and others--have every opportunity to grow up healthy and happy.

One such father who stands out for me is Steve Spencer. I learned of Steve a couple of years ago when he represented his home state of Oregon at Zero to Three’s Strolling Thunder event. The event brings together parents from across the country to meet their Members of Congress and share what babies and families need to thrive. As a single dad raising two boys, Steve is a knowledgeable and passionate advocate for the kind of supportive services parents rely on to give their kids the healthiest start.

Steve put it best when he outlined the day-to-day realities of parenting, "It's really hard to put focus in trying to figure out a way to keep the apartment and get food in these kids' bellies and so on and so forth on top of taking care of him [his four-month-old son] and not sleeping."

Despite the constant juggling that comes with parenting, Steve is just one of many fathers who takes an active role in in his children’s health and development. And, according to a recent study in the journal Obesity, if the barriers that make participation difficult were removed, more fathers (and likely more mothers and caregivers in general!) could attend the many appointments and meetings that are essential to raising healthy kids. These include prenatal and pediatric care appointments, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) visits, home visits for pregnant women and families with young children, and Early Head Start activities, all of which help form the “circle of care” of a young child’s first few years.

The study, Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies funded by RWJF’s national nutrition research program, Healthy Eating Research (HER), looked at ways to engage more fathers in programs and practices that could help prevent childhood obesity during a child’s earliest years. The study highlighted emerging evidence about the “unique role” fathers play in childhood obesity prevention.

One of the pieces of research it references to support this found that “increases in fathers’ participation in physical child care (e.g., giving the kids a bath and getting them dressed) and the frequency of taking children outside to walk/play (which dads tend to do more of than bathing/dressing activities) were associated with decreases in the odds of childhood obesity from age 2 to age 4.”

And, the benefits extend beyond physical health. According to a study highlighted by the National Institute for Children’s Health Quality, “when fathers are more engaged with their children, their children have better developmental outcomes ... including fewer behavioral problems and improved cognitive and mental health outcomes.”

Most families divvy up routine child-care tasks like bathing, dressing and playing, among multiple caregivers in the way that works best for them. But it’s harder to do this with the programs and appointments examined in the HER-funded study, all of which specifically integrate obesity prevention services. This is because providers manage factors such as patient access and scheduling, so parents have less control.

We know that the earlier dads are involved, the better it is for moms and babies. But we lack robust evidence and a good understanding of participation rates and levels of engagement in the programs that serve kids and families during those first few years of childhood. As the study outlines, we are more informed about barriers to involvement and potential ways to address them. Some of these barriers include:

  • Inability to schedule appointments outside of regular (9-5) working hours and long wait times in clinics. Evening and weekend availability would help all dads and moms accompany their babies to appointments whether they’re at the local WIC office or with their pediatrician.
  • Lack of materials and information with images and messages that resonate with dads. Health care provider offices, WIC clinics, and home visiting and early Head Start programs are great resources to gather information about how to care for babies. But, handouts and booklets are dominated by pictures of moms and portray mom-centric activities such as breastfeeding. This can inadvertently leave dads feeling that their participation is not important, which is clearly not the case. Developing materials that are better tailored to fathers by sharing guidance on their specific roles could help create more inclusive experiences.
  • Programs like home visiting and Early Head Start have few male providers on staff who might be more comfortable/effective working with and engaging dads. More broadly, many program and clinic staff do not have much experience or formal training on how to effectively engage fathers. Hiring more male staff and implementing a robust program-wide “father-engagement training curriculum” may improve interactions with dads during appointments.  

And, the most significant challenge, which creates and/or contributes to the smaller-scale barriers listed above is the “lack of long-term, stable funding specifically earmarked for father-engagement activities.” Funding specifically designated to engage fathers would certainly make “father-focused programming, hiring of male providers, and the ability to offer extended-hour appointments” more feasible.

In the spirit of the holiday, let’s acknowledge the many wonderful ways dads show up for their kids. Then, when Sunday comes to a close, let’s commit together to continue addressing the challenges that so many dads (and moms!) face when it comes to giving their kids the best start from their very first days.

What other steps can support fathers in playing a more active role in their children’s health? Share your ideas in the comments below!


About the author

Jamie Bussell

Jamie Bussel, MPH, a senior program officer who joined RWJF in 2002, is an inspiring, hands-on leader with extensive experience in developing programs and policies that promote the health of children and families. Read her bio.

Thu, 13 Jun 2019 13:00:00 -0400 Jamie Bussel Child and Family Well-Being National <![CDATA[Training Police to Handle Trauma]]>

This 2018 Culture of Health Prize winner helps officers and the people they serve deal with the ‘bad things’ they witness and experience every day.

A veteran police officer in Cicero, Illinois, is quick with an answer when the therapist asks him: “What’s the worst thing you’ve witnessed on the job?”

Instantly, it’s 2010, an icy Valentine’s Day, and Officer Joseph Melone is staring in horror as flames engulf a three-story house. Melone is an arson specialist, and when the fire subsides, it’s his job to pick through the rubble. Seven people are missing. The oldest is 20; the youngest is that man’s newborn.

Melone finds the remains of the three-day-old baby.

“The 911 call from inside that place will haunt me until the day I die,” the 47-year-old Melone, now a sergeant, recalls. “You can hear the fire crackling around the caller and nobody could get in there.”

The story spills out from Melone as part of a training to give officers with the Cicero Police Department better tools for dealing with trauma in the lives of crime victims, as well as their own. The 8-hour course was built from scratch and tailored to the needs of the Cicero Police Department by local nonprofit staff from Youth Crossroads and the domestic violence agency Sarah’s Inn, as well as a psychologist from the local school district.

The idea for the course arose from a conversation the two of us had in early 2017 about the high suicide rate for members of the Chicago Police Department, which was 60 percent more than the national average, according to the Chicago Sun-Times. While the police department in Cicero is a tiny fraction of neighboring Chicago’s—160 versus 12,000—the pressure bearing down on officers is the same.

We recognized that in a community like Cicero, which is recovering from a history of gang violence, police need the tools for dealing not only with their own exposure to trauma, but also for helping community members overcome the effects of adverse experiences. It’s a way of shifting how law enforcement approaches and interacts with the citizens they are sworn to protect.

From those conversations, we worked together to put in place a trauma training course for every officer. And officers appreciate what they have learned.

Police officers are exposed to bad things every single day. They get used to it and don’t realize it, but over time the effects accumulate.

Learn how Cicero, Illinois—a Latino-majority town—is empowering residents of all ages to improve community health.

“It’s very important for police to understand the community,” says Cicero Police Superintendent Jerry Chlada, Jr. “If we’re going to be a partner, we have to understand everything.”

In one-on-one sessions, police officers gave direct input on what the course should cover. They talked about the types of situations that had the deepest impact on them, the supports they had, and the people they felt they could talk to.

The course focuses on three areas: what is trauma; how can an understanding of it shape how police do their jobs; and how police can manage trauma in their own lives.

In the first part, the trainers give words to situations the officers have observed in the line of duty—like adverse childhood experiences (ACEs). They explain how repeated exposure to stressful or violent events can affect someone emotionally, developmentally, and physically. They walk through particular situations, like dealing with victims of domestic violence who may not want to cooperate. 

In the second part, officers are guided through how to better interact with crime victims, using a technique developed by the military known as the forensic experiential trauma interview (FETI), which aims to calm a victim or crime witness in order to draw better information about an experience.

The last part of the course turns the table and looks at how trauma affects police. When they witness violence, trauma, and death, they can develop PTSD of their own. They often think, “I shouldn’t feel like this” and brush their feelings off. To give officers somewhere to turn for help, the training ends with information on resources, including counseling services and a 24-hour crisis hotline (Serve and Protect, 615-373-8000).

The positive feedback we’ve gotten from officers after trainings is overwhelming. Now, we have a therapist on call to help officers after intense, stressful incidents, and the department has created a wellness committee and peer support program to address stress and ways to improve the health of its officers. The group would like to train officers to help each other after traumatic events, so they’ll always have someone to tell their stories to. Someone who’ll understand when they say, “I’m not feeling right.”  

Training police is just one way we’re dealing with community trauma and building resilence in Cicero. We’re also engaging parents and school personnel to help transform Cicero public schools into welcoming, safe environments for their children. In the years-long effort to build a healthier community, everyone—including police—has a role to play.

Learn more about Cicero’s efforts to build a Culture of Health.

County Health Rankings and Roadmaps, an RWJF project, hosted a webinar on June 18 about how Cicero is addressing community trauma. Learn more.



Vincent Acevez is a 20-year veteran of Cicero, Illinois’ police department, where he is deputy superintendent of the Patrol Division. He is a member of the department’s wellness committee.

Jaclyn Wallen is a licensed clinical professional counselor at Youth Crossroads, a nonprofit that works with young people in Cicero, Illinois. She helped design Cicero Police Department’s trauma training for officers.


Thu, 6 Jun 2019 13:00:00 -0400 Jaclyn Wallen Public and Community Health <![CDATA[To Improve Health Equity, Rural America Must Be Part of the Frame]]>

What does it take to build fair opportunities for health in rural communities? A passionate advocate shares firsthand insights, as well as a new funding opportunity aimed to help build on existing lessons.

Fostering Health Equity in Rural Communities image.

My family lives in Athens, Tenn., population 13,000, and we are familiar with the truths of an economy that has changed. We shake our fists at spotty broadband and crumbling roads. And we know what it’s like to watch main street awnings turn yellow and old factory stacks rust and crack in the sun, to lose family farms to corporate agribusiness, and see health care specialists move to medical centers 70 miles up the road.

But these challenges obscure a much deeper truth about my hometown and other places in the countryside: we keep showing up in many ways and in many roles as public servants, entrepreneurs, social change agents, and keepers of community memory.

For us, the key is to acknowledge that change is inevitable, that growth is necessary, and that communities should be the drivers of their own destinies.

My hometown is a proving ground for leadership and imagination. We may not have a gig of broadband, but we know how to assemble a community potluck on the fly. We know the ins and outs of local systems and relationships, and we’re pretty good at negotiating them. We’re used to living, working, and worshipping alongside folks with whom we agree and disagree, and this gives us a head start when it comes to bridging divides and joining forces in ways that improve health, equity and opportunity.  

For example, recently our YMCA partnered with The Arts Center to provide programming to at-risk youth in after-school care. And our public library regularly links up with our local public schools to provide STEM programming and coding classes to elementary school kids.

Our extension office partners with local health care providers to offer workshops on healthy living and facilitates Tai-chi classes for all ages in public spaces across town.

And we’re seeing steady progress—through the combined efforts of small business owners, city officials, local industry, and nonprofits—to revitalize our downtown. We recently achieved accreditation as a Main Street community.

So while many rural places lack more recognizable financial and civic resources, those assets take alternative forms: personal and family relationships; cultural cohesion; connection to place; or civic and religious infrastructure. Our devotion to social and civic rituals affect our mental and physical well-being, and can even extend how long we live. And a growing body of research shows that social connection is at the heart of good health.

Make no mistake, these collaborations are driven by relationships. A wise Athenian once told me that “real change moves at the pace of relationships.”

Lessons Learned Along the Way

At a time when we are trying to understand how ZIP codes influence our health and quality of life, rural people have lessons to share about what it takes to build equity and opportunity in their communities.

Here are lessons I’ve learned in my work with the Robert Wood Johnson Foundation:

  • Work with and through local and regional intermediaries. When it comes to making change in rural communities, you have to start with the schools; community-based organizations; regional health centers; faith-based institutions; and small businesses. Small businesses, for example, play a vital role in rural America, creating roughly two-thirds of new jobs and supporting the economic and social well-being of their communities.
  • Grow and engage leaders of different kinds and at different levels to get the work done together. This isn’t about another leadership training, but about finding champions in each community and helping them develop the skills they need to facilitate change. In Well-Connected Communities, volunteer leaders are helping their neighbors be healthier at every stage of life by coming together. In Athens, we are learning how to engage new messengers in small and big ways. At our quarterly Civic Saturdays, readers and speakers are strategically selected to bring new voice and experience to our civic rituals.
  • Connect people within and across sectors and geographies for peer learning and collective action. When you bring a diversity of perspectives to the table, you are more likely to generate the right energy and strategy around the solutions rural communities need most. Within our own Rural Assembly, we represent a diversity of cultures, geographies, and ethnicities, as well as a diversity in interests and expertise for our hometowns and communities. These range from climate and energy solutions to creative placemaking initiatives, from economic transitions to restoring our democracy.
  • Develop and strengthen the infrastructure for local, state, regional and national resource and information-sharing. Urban and rural boundaries are porous and our residents are itinerant; the roads leading in and out carry people, goods, and ideas without regard to ZIP code, making the futures of rural and urban places intertwined.

How You Can Be a Part of This Journey

RWJF released a call for proposals (deadline: May 22, 2019) to identify a Rural Learning and Coordinating Center that will build on these lessons. The aim is to better connect the work happening to improve community conditions for better health in rural America; advance the research and evidence that can support this work; and identify policy and systems solutions that support change in rural places because—despite talk of divides, we belong to each other. And to advance equity where we all live, rural must be part of the frame.

Hear more from Whitney Kimball Coe at the May 2019 Life in Rural America Symposium:


Whitney Kimball Coe serves as coordinator of the National Rural Assembly, a rural movement made up of activities and partnerships geared toward building better policy and more opportunity across the country. Her focus on building civic courage in communities is directly tied to a practice of participation in her hometown of Athens, Tenn., where she lives with her husband Matt and daughters, Lucy and Susannah.

Thu, 2 May 2019 13:00:00 -0400 Whitney Kimball Coe National Rural <![CDATA[Power and Opportunity in the States]]>

State policymakers have more flexibility than ever to advance health-promoting policies and programs, and to showcase effective strategies from which other states—and the nation as a whole—might learn. RWJF helps inform their efforts through research and analysis, technical assistance and training, and advocacy.

Map of United States.

Why States Matter

States have long been laboratories for innovations that influence the health and well-being of their residents. This role has only expanded with the greater flexibility being given to the states, especially as gridlock in Washington, D.C. inspires more local action. The bevvy of new governors and state legislators who took office early this year also widens the door to creativity.

Medicaid is perhaps the most familiar example of state leadership on health. With costs and decisions shared by state and federal governments, the program allows state policymakers to tailor strategies that meet the unique needs of their residents. Among other examples, efforts are underway in California to expand Medicaid access to undocumented adults, and in Montana to connect unemployed Medicaid beneficiaries to employment training and supports.

In Washington state and elsewhere, Medicaid dollars can now cover supportive housing services, while Michigan is among the states requiring Medicaid managed care organizations to submit detailed plans explaining how they address social determinants of health for their enrollees. All of this experimentation is happening as states struggle to control the growth of their health care spending—a balancing act of immense proportions.

States are taking action on early childhood health as well. For example, while subsidized child care for low-income families is funded primarily by the federal government through the Child Care and Development Block Grant (which got a record-breaking $5.8 billion boost from Congress in 2018), states have a big say in who qualifies for subsidies and whether to offer additional supports. This can lead to substantial variation across the country. Wyoming and Minnesota, for example, maintain child care copayments of $100/month or less from a family of three earning $30,000/year,­ while 14 states offer no subsidy at all for families at that income level, meaning they must pay fully out of pocket for child care. One in four states provide additional assistance, supplementing childcare subsidies with refundable tax credits to help families cover the costs of child and dependent care.

Not all state policies have a positive influence on health. Decisions about who qualifies for public benefits, ways to generate new state revenue, and how to implement and enforce laws related to housing, education, and civil rights can put well-being at risk, particularly for marginalized populations, if they are not carefully considered. States must be vigilant about their choices and pay attention to intended and unintended consequences.

To meet that responsibility, policymakers need access to the best available evidence, lessons from other states, and data and stories that can make the case for new investments and health-promoting policies. When policymaking is fully informed, it can help close persistent gaps in well-being and lead to breakthroughs that spread to other states and even to the nation as a whole.

How RWJF Supports the States

At the Robert Wood Johnson Foundation (RWJF), we keep a close eye on what is happening in state capitols because of their crucial role in building a Culture of Health. Look no further than state budgets: health care and education typically account for the largest outlays and both, of course, are core building blocks of individual and community well-being.

To have a voice in all this, our state-level work falls into three categories:

Research and Analysis: We fund assessments of the potential impacts of policy proposals, offer guidance to help states monitor and evaluate new programs, and study the results of policies once adopted. Without such analysis, experimentation can’t lead to new knowledge.

An example is From Safety Net to Solid Ground, an Urban Institute initiative that looks at how states are responding to federal safety net reforms in the context of nutrition assistance, housing supports, and Medicaid. Part of that work tracks the effects of adding or tightening work requirements in public benefit programs. We are also exploring how state fiscal decisions affect the public’s health, essentially showing that A Good State Budget is the Best Medicine.

Technical Assistance and Training: We provide non-partisan technical support to policymakers facing tricky policy design and implementation challenges. These stages in the policy cycle are crucial but underappreciated opportunities for promoting health equity.

One of our longest running and most successful technical assistance programs is State Health & Value Strategies, which helps states transform their health and health care systems. We also support longitudinal training and peer learning opportunities for state leaders, including health agency heads, Medicaid directors, and officials involved with children’s issues.

Advocacy: We invest in coalition building, storytelling, and policymaker education (without supporting lobbying). These activities raise public and decision-maker awareness of pressing issues, explain the implications of various policy approaches, and mobilize state residents, researchers, and private sector groups to support appropriate solutions.

One of our largest state-focused advocacy efforts—Voices for Healthy Kids—has  worked to build the capacity of advocacy organizations addressing childhood obesity and has ultimately contributed to the adoption of more than 120 childhood obesity prevention policies in 46 states. We also work to advance health-promoting policies related to early education, family social and economic supports, and health care coverage.

The November 2018 elections brought 20 new governors and thousands of new and exceptionally diverse state legislators into office, making this a timely moment for outreach. While some officials have strong governing and legislative records, many are new to the policy arena. And most state legislatures operate part time, with little staff to do any legwork. All of that makes state policymakers hungry for evidence and practical lessons to inform their decisions.

At RWJF, we have just publicly released a series of information-packed issue briefs—seven on Medicaid and six on early childhood development, all written with a state policy and decision-maker audience in mind. They address the basics of program structure, financing, and operations; summarize the available research on health impacts; forecast the most pressing challenges state leaders will face; and point toward best practices from around the country. These briefs provide another set of tools to support states in implementing policies that will improve health and well-being within their own borders, and across the country, in the most equitable manner possible.  

Learn more about the role states can play in promoting health from RWJF’s new briefing series: Key Medicaid Issues for New State Policy Makers and Giving Kids a Healthy Start to Life.


About the Authors

Headshot of Giridhar Mallya

Giridhar Mallya, MD, MSHP, is a public health physician and health policy expert. Working to advance the role of policy in building 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.” Read his full bio.

Tara Oakman

Tara Oakman, PhD, is a senior program officer working to improve the value of our investments in health and health care and also to help ensure that all young children—supported by their families and communities—have the building blocks for lifelong health and well-being. Read her full bio.

Thu, 18 Apr 2019 14:00:00 -0400 Giridhar Mallya Health Care Coverage and Access Health & Health Care Policy