Culture of Health Progress Report: Phase Two Findings and Conclusions

The Robert Wood Johnson Foundation’s (RWJF) vision of a Culture of Health is for health to be a national priority—valued and advanced by collaborators from all sectors.

The Culture of Health Progress Report, led by an evaluation team at Westat, assesses RWJF’s contributions toward improved population health, well-being, and health equity through a Culture of Health lens. The Progress Report covers the period from July 2017 to January 2020, also referred to as “phase two,” the developmental phase. (See the Phase One Progress Report).

About the Assessment

The report sheds light on what it means to advance a Culture of Health. It offers examples of what the work looks like in practice. It also offers a long-term evaluation plan to understand the spread and uptake of the shared Culture of Health vision, as well as the effects of improving population health, well-being, and health equity. The report looks at both RWJF’s contributions as well as external drivers to progress in these areas.

The activities that Westat conducted included:

• Ten case studies of organizations identified by RWJF staff as having adopted or aligned with Culture of Health principles; 
  
• A review of 10 RWJF initiatives identified by RWJF staff as being illustrative of the Culture of Health; 
  
• A survey of housing agencies across the United States; a survey of county health officials in 16 counties across the U.S focused on their use of Culture of Health principles, with a particular focus on health equity; and
  
• The development of RWJF’s Theory of Change and a long-term evaluation plan.

Key Findings

• Health equity was viewed as pivotal to advancing a Culture of Health, but integrating health equity can and should occur at different levels. For example, efforts to integrate health equity into policies focused on policies at federal, state, and local levels.
• Making Health a Shared Value (Action Area 1) emerged as a necessary element to advancing a Culture of Health vision. Authentic community engagement is crucial to fostering a Culture of Health vision. Success depends on gaining the trust from the community so members will participate fully and own the work. 
• Cross-Sector Collaborations (Action Area 2) were found to foster the development of all the other Action Areas. Identifying leverage points can help shift practice and policy. Building a Culture of Health requires collaborating with partners often in other fields, and finding points of leverage to achieve shared goals. Early and structured collaboration, support, peer learning, and evaluation will build overall capacity for systems change. 
• Initiatives focused on Creating Healthier, More Equitable Communities (Action Area 3) to improve health and health equity were often motivated by an acknowledgement of residents’ health and social needs.
• Disseminating findings in a timely manner may result in efficient systems change, but timeliness is often challenged by standard research practice. 
• Advancing a Culture of Health has to be local and tailored to context and requires agility, flexibility, and creativity.

Next Steps

Progress is now being guided by the long-term evaluation plan and its four guiding questions:

• What is RWJF doing to build a Culture of Health?
  
• How is a Culture of Health and health equity operationalized within key areas of RWJF programmatic strategies?
  
• How is a Culture of Health and health equity spreading more broadly?
  
• What is the influence of a Culture of Health on population health, well-being, and health equity?
  

Future progress reports will examine the direct impact of efforts to build a Culture of Health. Assessment of community-level impacts is critical to determining how effective these efforts are in advancing a Culture of Health and what changes are needed to improve them.

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