A Culture of Health exists when “individuals, communities, and organizations prioritize and promote enhanced well-being for all and value health as being fundamental to the nation’s future.”

This vision has gained traction with some leaders and stakeholders, while opportunities await for reaching other groups.

Building a Culture of Health

In 2014, the Robert Wood Johnson Foundation (RWJF) announced its deep commitment to improving health, well-being, and equity in America; to build a Culture of Health where everyone in every community has a fair and just opportunity for health and well-being. A Culture of Health is not an RWJF funding initiative or a program, but an organizing principle that uses an Action Framework to guide the Foundation’s work, and to catalyze, chart and measure the nation’s progress in achieving improved health, well-being, and equity.

This assessment focuses on the broader concepts of a Culture of Health—the principle, Action Areas, and health equity—and whether the Framework is understood by and incorporated into the work of staff, grantees, partners, and other stakeholders.

About the Assessment

In 2016, the Foundation commissioned the Center for Public Program Evaluation to assess the progress and challenges in achieving a Culture of Health during its first year (June 1, 2015, to September 30, 2016). The assessment team was overseen by Tracy Costigan, senior learning officer at RWJF; and included George Grob, president, Center for Public Program Evaluation; and a diverse, 19-member advisory committee.

Summary of Methods

The assessment team selected a sample of groups who they felt would be most affected by a Culture of Health; best positioned to contribute to it; and be essential to its success. These included groups within and close to RWJF, as well as others further afield, but who would be likely to both contribute to and be influenced by the Culture of Health.

The assessment included observations in the following eight areas:

1)      Implementation and Outreach

2)      Uptake of and Conceptual Agreement with Culture of Health

3)      Equity

4)      Influence of the Culture of Health Vision and Action Framework

5)      Spreading the Message

6)      Practical Guidance

7)      New Ideas to Build a Culture of Health

8)      Tracking Progress

Key Findings

The author, guided by a diverse, 19-member advisory committee assessed the progress and challenges in achieving a Culture of Health during its first year. Among the observations:

• Grantees and health and partner organizations, as well as city health commissioners and some mayors, said they are familiar with the concepts of a Culture of Health and some are taking action in areas outlined in the Framework.
  
• Equity is an underlying principle across the Action Framework. Most mayors (70%) and almost all health commissioners (96%) have heard of the term health equity. Commissioners more than mayors, though, think public policies could help improve equity (92% versus 70%).
  
• For RWJF partners, grantees, and close associates, the Culture of Health vision influences their thinking, and to some degree their activities to advance health equity, including in the areas of strategic planning and developing new partnerships.
  
• Health and other sector leaders are familiar with RWJF’s vision. The Foundation has an opportunity to use its prominence to promote the broad social movement of a Culture of Health by engaging potential adopters through their various professional organizations.
• Partners and grantees requested more guidance about the Foundation’s priorities, and how to make health a shared value and achieve health equity.
• RWJF has taken actions to promote a Culture of Health by restructuring its operations and conducting extensive outreach through meetings and communications activities.

Conclusion

The assessment team reviewed documents; conducted interviews, focus groups, and surveys; performed data analysis; and produced thought papers on emerging issues, and as a result recommended the Foundation focus on the following:

• Expand public awareness through media and professional outlets;
• Reach out to communities with the greatest needs;
• Cultivate nonhealth partnerships; and
• Systematically track uptake of a Culture of Health in the media and in state legislative activities.

Next Steps

In addition to producing a series of brief reports over the course of 2018, the Foundation will continue to assess national progress in Building a Culture of Health and will develop a long-term evaluation plan for Years 5 and 10.