Investing in Systems Changes to Transform Lives

Mar 10, 2015, 10:00 AM, Posted by Catherine Malone, Najaf Ahmad

We know that in order to address health disparities head on, we'll have to implement changes to the systems that influence where we live, learn, work, and play. Oscar and Jose's stories show us that it's possible.   

I was looking at somebody who could be a great person...who could do something great in his future. I also knew that if I sent him to prison, I’d knock him off of that road to success.

In the quote above, Steven Teske, a Juvenile Chief Judge in Clayton County, Georgia is describing the first time he encountered 15-year-old Oscar Mayes as he entered the courtroom in handcuffs. Judge Teske noticed that Oscar was an extremely bright young man and that he had no prior run-ins with the law. Yet Oscar was facing five years in the state’s long term lock up—five years that could have ruined his future.

Fortunately, Oscar literally got a Second Chance. This Clayton County initiative gives youth facing prison an opportunity to redeem themselves through intensive supervision, participation in evidence-based treatment programs, and weekly check-ins with the court. Judge Teske and others in his community had realized that too many of their students were falling out of school and heading into the criminal justice system. To address this, the Juvenile Court partnered with local schools and law enforcement to find ways of disciplining youth while keeping them “in school, out of court, and onto a positive, healthy future.”

Interventions like this have yielded impressive statistics in Clayton County: School arrests have gone down 83% and school attendance has gone up 86%. Clayton County’s approach to juvenile justice reflects the transformational impact that changing a system can have.

What are systems changes and how is the Robert Wood Johnson Foundation (RWJF) investing in them?

Systems are the practices, policies and procedures of institutions, corporations, agencies and other organizations that influence the determinants of health. Improving systems—and the way they work together—is our approach to eliminating health disparities.

It’s only when we critically examine these systems—be they access to quality health care, income, public safety, community environment, employment, housing, education—that we can find approaches to improve lives and reduce health disparities. We want everyone in our country to have an equal opportunity to live a healthier life which is vital to building a Culture of Health.

It’s frustrating to acknowledge that currently, this is not always the case. As RWJF’s own Dwayne Proctor noted, if you’re black you’re 21% more likely to die from heart disease than if you’re white. If you live in the “Deep South” your life is an average of three years shorter than if you live in other parts of the country. Health disparities like these affect individuals but they also threaten the prosperity of entire communities. We want to change this.

To do so, we are launching the RWJF Awards for Eliminating Health Disparities to recognize and celebrate those who have successfully implemented systems changes to eliminate health disparities. In doing so, we’re delving deeper into the determinants that impact health—the neighborhoods we live in, the schools our children attend, the jobs we work and the resources inside our communities. And we’re hoping to heighten awareness around the power of systems change.

Jose’s story: From school suspension to college

There’s one more powerful example that illustrates the impact that changing the system can have. Last year our colleague Maisha Simmons met Jose, a bright student from Chicago who used art as an outlet to express love, fear, joy and pain. He spread his art everywhere—on notebooks, text books and eventually the walls and fences of his community. Despite efforts of a relative to channel Jose’s passion into a community art program, one day Jose found himself in the principal’s office when teachers and staff wrongfully implicated him for vandalizing school property.

Unable to prove his innocence, Jose was suspended from school and found himself falling behind classwork—threatening his chance to graduate. Since art now reminded Jose of his struggles at school, he withdrew from his passion.

Fortunately for Jose, Chicago houses the Safe Schools Consortium, a coalition that offers less disruptive approaches to school discipline. A nonprofit partner of Safe Schools—VOYCE—offered him a chance to share his story and resume using art to positively impact his community. Thanks to this partnership, rather than dropping out of school, Jose is now in college.

Oscar and Jose are only two of a myriad of people who have benefitted immensely from systems changes. What we realize, and now want to promote, is how systems that may have previously tracked them into potentially less healthy lives may be reworked into systems that guide them and others towards a Culture of Health.