Tackling Life Expectancy Gaps in New Jersey

Nov 9, 2016, 9:00 AM, Posted by Bob Atkins

New Jersey Health Initiatives is driven by five key principles for building empowered, equitable and healthier communities and narrowing the gaps in life expectancy across the state.

It’s a dismaying fact that we’re all familiar with: where you live has an enormous impact on your life expectancy. Indeed, some researchers now quip that your ZIP code may matter just as much, if not more, than your genetic code when it comes to your health. As one journalistic account put it, it’s “Death by Zip Code.”

New Jersey is no different. This summer, the Robert Wood Johnson Foundation (RWJF), together with Virginia Commonwealth University, published analyses of Mercer County, a prime place to showcase the impact of geography on health. It’s home to both affluent Princeton and economically strapped Trenton. And perhaps not surprisingly, life expectancy reflects the gulf in resources between the two towns. While a person born in Princeton can expect to live 87 years, his or her neighbor in Trenton has a life expectancy of 73 years—a staggering 14 year age gap across only a dozen miles.

These results are sobering. It’s easy to get despondent over them and locked into a narrative of failure and decline. But RWJF’s Culture of Health efforts involve cultivating potential, even in places where we wouldn’t normally think to find it. That’s where New Jersey Health Initiatives’ (NJHI) work comes in.

I lead the work of NJHI which is dedicated to supporting innovations and driving conversation to build healthier, thriving communities within the state. Since 2015, we’ve funded 20 grantees, representing community-focused coalitions, to do just that. They include organizations as diverse as Irvington Township, Orange Public Schools, and the United Way of Greater Union County. They’re aligned, though, in their emphasis: tackling major population health issues—from food insecurity to sedentary behavior—by engaging people at the most local level.

My approach toward working with these communities unfolded and evolved over time. Years ago, after graduating from nursing school and starting my first job in Camden, I realized that neighborhood institutions—the very places where people played, lived and learned—were where the action was. The most successful intervention, then, had to meet people where they were.

My early days in Camden continue to shape NJHI’s vision. We use five interrelated principles to shape our programming. Some of these break from common approaches in the philanthropic and non-profit world. But ultimately we believe that our commitment to these principles will eventually narrow the gaps we see in life expectancy and create healthier, more equitable communities within our state.

1.     Going upstream requires working from the bottom up, not just the top down.

My days in Camden taught me that there’s limited value when an organization parachutes from on high and imposes a program from the top-down, assuming a one size fits all approach. While wisdom from wonks may be important, potentially more important is input from community members who stand to be impacted by any new programs or policies: youth, older adults, people with special needs, and moms and dads.

That means our grantees need to adjust to the real-world circumstances of those they serve. For example, our coalition in Irvington recently held a packed community forum on a Friday evening to get community input on health concerns, demonstrating how a simple change in meeting hours can increase engagement of community members.

2.     Focus on identifying a community's assets, not just it's deficits.  

After looking at the life expectancy differences in Mercer County—and across New Jersey more broadly—the immediate impulse is to name all the problems with the places at the distressed end of the spectrum. But this can quickly morph into listing problems and fixating on deficits without identifying assets and sustainable solutions. Sustaining community change around policies, systems, and environments begins with identifying valuable assets that all communities do have, no matter how resource-depleted they appear to be at first glance.

Part of identifying those assets is to widen the definition of what a valuable asset is. Community stakeholders should instead ask: “What resources do we have? What resources can we leverage?” Some of these might be right under our noses. For example, our grantee working in Asbury Park identified the city’s location right next to the ocean as an asset that could be leveraged for all sorts of future health-enhancing activities around it.

Another asset—so obvious that you might miss itis population size. A major upside of a smaller population—Camden’s 77,000, for example—is a shorter path to cultivating social networks and trust. The local organizations already know each other and a primary aim of our grantmaking initiative is to assist them in building trust. We know trust serves as a accelerant to drive the conversations that connect and leverage community assets.

3.     Youth are the future of their communities.

The youth presence is perhaps the most important asset hidden in plain sight. Many of NJHI’s grantees are in places that skew young, with those under 18 making up as much as 40 percent of the community’s population. Cultivating the talent of youth—and increasing their civic engagement—is a cornerstone of the Culture of Health and NJHI’s work.  One example occurred right in Bridgeton, where the Gateway Community Action Partnership received an NJHI grant. This past summer, Bridgeton Mayor Albert Kelly selected 15 youth to play a critical role in the federal Summer Food Service Program, which ensures healthy meals for children even when they’re out of school. The young people went door to door, got more families enrolled, and taught them about the locations and services of feeding centers.

The Bridgeton experience isn’t just about the immediate goal of food provision during summer, the “hungriest time of the year” for school-age youth. It’s about giving youth the opportunity to make meaningful change in their communities and the skills and confidence they will need to become engaged civic actors. “Youth are our future” is not just a slogan! Some of the youth in Bridgeton will likely run for school board or even city council in the not too distant future. Our goal is that in 2017, our communities start thinking of youth as a resource and as our future civic leaders.

4.     Build the capacity of communities to trust—not compete with—each other.

Few concepts have had more traction in recent years than Health in All Policies (HiAP). It’s the idea that those working in health need to build bridges into sectors and with organizations that do not think of themselves as traditionally working in “health.” The reason? Whether they label themselves as health or not, their activities often carry huge health ramifications. Think of your typical transportation or housing department, for example. Finding shared value between people who might otherwise not talk to one another—a core goal of the Culture of Health—drives NJHI grantmaking. We’re encouraging the breaking down of silos, where each potential grantee only fends for itself. It’s a change from the norm.

Historically NJHI’s grantmaking set the stage for different organizations within a community to compete for a grant. It was a zero-sum game with one winner. By contrast, our Moving to Action grantmaking required organizations to apply for funds on behalf of a multi-sector coalition. The more sectors and organizations from the community represented in the coalition, the stronger the application. Moreover, only one application was funded from any given community, promoting cooperation for the good of the community from the outset. This early cooperation provides the basis for future collaboration as community stakeholders and organizations develop a plan for action in their community. The plans for action are “bottom up” because NJHI believes that our grantees know better than we ever could what their communities need and the best ways to build trust in their communities. For example, our coalitions in Atlantic City and Jersey City engaged more community stakeholders and built social capital by re-granting their funds. This innovative thinking and action—using financial capital to build social capital—is a just one example of how our communities in New Jersey are taking the lead in building a Culture of Health.

5.     Communicate about what grantees are doing and ask about challenges they face.

The approach of many grantmakers has been to award a grant, allow the grantee to implement their project, and then conduct some form of evaluation. For NJHI, evaluation is important, but so is what goes on long before a project is over. Ideally, NJHI serves as a learning hub disseminating what we are learning with our grantees and other stakeholders.

One way NJHI facilitates the sharing of learning is by promoting the work of its grantees prominently and widely, particularly through the use of social media. We encourage grantees to use a series of hashtags—#NJHICollectivePower, #NJHIAddressingBarriers, #NJHILeverageResources, among them—when posting about their work.

Social media helps grantees keep track of what they’re doing and where they’re going. And it’s a window for us to continually stay engaged with activities we’re funding. It also allows NJHI to provide timely support if grantees express any difficulties with their work.

Academic journals are running over with bleak diagnoses of America’s population health problems. They tell the story of gaps and deficits, falls and declines. For NJHI, that view of things has its limits and exemplifies the age-old dilemma of naming problems without providing solutions. Worse, it doesn’t identify existing tools that are there for the taking and repurposing—if only people would notice them: trust networks, youth capacity, and natural landscapes, among others.

For me, New Jersey and the work of NJHI are at the center of the Foundation’s work to build a Culture of Health. And it’s our hope—and that of RWJF—that the 20 NJHI grantees, whose ideas and actions are actively being communicated in real-time, serve as a model for a new kind of health philanthropy and program building across the country.