A few months ago, I watched a documentary that presented a unique perspective on the world by attaching high-definition cameras onto the bodies of birds. As they swept across the sky, the familiar trappings of ground-level life—highways, neighborhoods, buildings, streams, mountains and oceans—looked completely different. Soil was bridged to sky. Near was bridged to far. From a bird’s-eye view, it was all part of a grander, connected whole.

This made me think about the new vision that we at the Robert Wood Johnson Foundation (RWJF) have been working over the past year to refine. It calls for us, as a nation, to strive together to build a Culture of Health enabling all in our diverse society to lead healthier lives, now and for generations to come. What, I thought, is the bird’s-eye view of this? What does a Culture of Health look like on a grand scale? What new bridges must our Foundation help build to make a Culture of Health part of the grander whole of what it means to be an American? 

This year’s President’s Message takes a closer look at our new vision—how we intend to help build a national movement to achieve it, and how building a Culture of Health will require us to think and work differently.

If those birds with cameras flew over America today, they would not see a flourishing Culture of Health. Instead, they would see a nation that has for too long mistakenly defined being healthy as simply not needing to seek health care. They would see a population whose health can be unduly and unequally influenced by income, education, ethnicity, and where a person lives. They would see a disjointed system of health care that does not systematically extend beyond the walls of medical offices to the places where people live, learn, work, and play.

Yet the birds would also see a nation dotted with points of promise. They’d see the growing number of communities planting the seeds of a Culture of Health, leading the way in demonstrating what is possible. They’d see bright spots such as post-Katrina New Orleans, where public officials, schools, businesses, and community members joined forces to create a recovery plan that included a focus on nutrition, physical fitness, and equal access to quality health care for everyone. The state of Pennsylvania, where Gov. Tom Corbett signed a transportation bill that dedicates millions of dollars to bicycle and pedestrian projects, with an eye toward addressing obesity by making it easier to remain active. And Canton, Ohio, where community leaders, faith-based organizations, businesses, social workers, health care leaders, and residents of a struggling neighborhood called the “northeast quadrant” have worked together to revitalize the area with housing, health, employment, education, and security at top of mind.

Today most people consider good health and healthy living as activities that are consciously chosen, or something that only those who are already fit can fully achieve. But imagine a culture that empowers everyone to live the healthiest lives that they can, even when they are dealing with chronic illness or other constraints. Imagine a health care system that couples treatment with care, and considers the life needs of patients, families, and caregivers, inside and outside the clinic. 

Seeing a Culture of Health from a bird’s-eye view means taking in the bigger picture of what defines health in America—how health will always be linked to health care, but also extends to work, family, and community life; how health equity is connected to opportunity; and how we, as a nation, must balance the costs, benefits, and effectiveness of treatment and prevention to provide our people with care of the highest possible value. It means focusing on the grander whole of what being healthy and staying healthy means. And it requires an understanding of a dynamic new world of Big Data, social networking, and creative innovation that is both cross-disciplinary and interprofessional.

We believe that striving toward a Culture of Health will help us realize our mission to improve health and health care for all Americans. Still, we know that building this vision of a Culture of Health will take time. It will take fortitude. It will take collaboration. And we certainly cannot do it alone. Nonetheless, we firmly believe the vision is within America’s reach, and we intend to use our Foundation’s influence and reputation to help our nation get there. To do that we must disrupt the status quo and catalyze a national movement that will:

• Cultivate a shared vision of a Culture of Health;
• Build demand for it among all Americans; and
• Discover and invest in solutions.

We see these actions as interdependent, each reinforcing and building upon the other to transform how our nation views and values health. As always, RWJF is committed to realizing this bold transformation through the pursuit of solutions that are evidence-based, measurable, and equitable. And we will keep pursuing the vision of a healthier America until it is achieved. 

It may mean having easy and affordable access to health care. It may mean creating neighborhoods where moms can feel comfortable letting their kids walk to school, play outside, and go to a nearby grocery store stocked with fresh and healthy choices. It may mean providing an elder with the helping hands she needs to remain in her home. Or it may mean living in a community where policy-makers, civic leaders, educators, employers, and residents work together to make the health of their entire community a priority.

There is no single definition, which means when America ultimately achieves a Culture of Health it will be as multifaceted as the population it serves.

It is rare to recognize the beginning of great change while you are living it because it does not present itself as spectacular. It trickles in. Carried and cultivated by everyday people. Our job is to find the earliest and strongest examples of a Culture of Health, share the lessons they have to offer, and serve to link together the leaders of change so they can join forces and build small victories into a national movement.

To best achieve this, we are making some adjustments in how we approach what we do. RWJF will continue to work on issues we believe are key to the well-being of all Americans. But within our organization we will no longer divide our efforts into the silos of health and health care. All that we do will serve one goal–building a Culture of Health.

We will work in tandem with others to transform what it means to be a healthy nation. We will amplify the voices calling for change. We will connect those who are willing to carry the banner and shine a spotlight of support on advancements that have already been made. We will build on many of our signature initiatives, focus our direct investments on a few new priorities, and update our approach to some of our best-known initiatives and leadership programs.

RWJF remains committed to reversing the childhood obesity epidemic in America. In 2007, the Foundation announced it would dedicate $500 million to this goal, and after years of disheartening news, we have started to see signs of progress. The relentless rise in childhood obesity rates has abated, and according to the Centers for Disease Control and Prevention, the rate among young children from low-income families has declined in 18 states and one U.S. territory. From Kearney, Neb., to the U.S. Virgin Islands, local efforts are making inroads. Effective strategies in these locations include offering healthier food in schools and child-care centers, posting nutrition information in chain restaurants, opening supermarkets in underserved neighborhoods, and designing safe and accessible streets, parks, walkways, and bike trails for children and adults to use.

Moving forward, the Foundation will shift its focus on the childhood obesity issue to stress the importance of achieving a healthy weight for all of our nation’s children, especially in poor communities and those of color, and we will strengthen the growing grassroots demand to make the healthy choice the easy choice for all Americans.

For decades, RWJF has worked to improve access to affordable, high-quality coverage for all Americans, and we will continue to do so. Despite the frustrating problems incurred during the launch of the federal health care exchange website, the implementation of the Affordable Care Act has created new opportunities for tens of millions to acquire health insurance. As Americans adjust to the new offerings, we will maintain our objective to ensure that all who are eligible for coverage know what benefits are available to them and how they can make the most of them.

RWJF will continue to seek the highest value for each dollar spent to keep Americans healthy both inside and outside of health care clinics and organizations. Getting the most for our dollar as a nation means building a better understanding of how the cost and price of care relates to health outcomes. It means carefully implementing strategies to reduce wasteful spending, while at the same time maintaining or increasing quality. It also means stressing both the economic and human value of other factors that influence our nation’s health—education, housing, transportation, clean air and water—as well as the built environment and public/business policies that encourage healthy living.

Going forward, RWJF will continue looking for innovative ways to improve the quality of the public health and health care systems. We will persist in supporting the creation of tools and strategies to achieve the highest quality care at the most affordable cost for both the practitioner and the patient. We will help build links between health care practices and community services through programs like Health Leads, which enables doctors and other health care providers to “prescribe” basic resources like food and heat just as they do medication to make sure patients can stay healthy between medical visits. And we will encourage approaches that make stronger connections between treatment and the factors outside of health care that influence how long and well Americans live. 

If being healthy and staying healthy is to become a core American value, we must foster individual and community actions that promote good health from the start of life until its end. We must support efforts that reinforce a Culture of Health, and we must spread the word about efforts that are succeeding.

Last year, we introduced the RWJF Roadmaps to Health Prize, honoring communities that have placed a priority on the health of their citizens. Some of the communities are urban. Others are rural. Some are affluent. Others are struggling. But they all have one thing in common: In each of these places community leaders, individuals, business, government and educators have forged powerful partnerships to inspire people to live healthier lives. This year there are 12 finalists for the 2014 award—which we now call the RWJF Culture of Health Prize. Stretching from Alaska to Georgia, with Texas, Iowa, and the Taos Pueblo Indian reservation in between, these communities are building a Culture of Health in their own backyards. Our goal is to use the visibility of this award to bring national attention to their strategies, and create enthusiasm for other communities to follow suit. 

The RWJF Culture of Health Prize grew out of the annual County Health Rankings (the Rankings) which measure 25 vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income, and teen births in every county in America. The annual Rankings provide a revealing snapshot of how health is influenced by everyday surroundings, behaviors and environmental circumstances. They should serve as a starting point for change. That is why RWJF provides tools to understand the data, and strategies that communities can use to move from education to action. Going forward, we intend to add to the Rankings by developing a health gap index that will highlight the often wide and disturbing gaps between positive and negative health factors in counties that are just miles apart.

Mahatma Gandhi once remarked that “the culture of a nation resides in the hearts and in the soul of its people.” In that spirit, RWJF will continue to bring together communities and networks of interested individuals through real and virtual meetings to share experiences and to learn from one another, encouraging the growth of micro-movements championing a Culture of Health.

If we are to achieve a Culture of Health that benefits our entire nation, we must ensure that all in our society—regardless of where they live, how much money they make, or where they come from—have the opportunity to make the most of their health. In the past, RWJF has endeavored to acknowledge the issue of equal opportunity in all the programs we have supported. But we have come to believe that we must make a more defined commitment, and take a more coordinated approach, to minimize the barriers that continue to compromise the health of so many in our society.

Personal responsibility plays an important role in getting and staying healthy. But too many Americans still do not have access to an equal measure of choices and opportunities to pursue healthy lifestyles. Research shows some will die 20 years earlier than others who live just a few miles away because of differences in education, employment, housing, safety, community development, and access to quality health care. RWJF will join with other foundations, organizations, and businesses that have long worked to increase opportunities in education, housing, and community development to make the fruits of good health available to all.

In 2013, we established Forward Promise, a $9.5 million initiative focused on promoting opportunities for the health and success of middle school and high school-aged boys and young men of color. And we have formed an alliance with 25 other philanthropies to expand the potential for boys and young men of color to grow up safe and healthy, obtain a good education, and find lasting and meaningful employment. Taking the long view, RWJF will continue to delve more deeply into the causes of the unacceptable gaps in opportunity for good health and identify additional areas that we believe call for immediate attention. 

We cannot call ourselves a healthy nation if we continue to be a violent one. RWJF is proud to have supported several initiatives dealing with domestic and community violence. But we must do more. 

Violence is a serious health issue that can alter and compromise the strength of a community and damage the lives of individuals forever. For those reasons, we have chosen to increase our work in violence prevention by determining how health is diminished by all forms of violence—child abuse, bullying, post-traumatic stress, domestic abuse, street violence—and how the cycle can be broken. This is an area where we will come together with organizations such as Blue Shield of California Foundation and others that are already established in the field. 

Building a Culture of Health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can. For the Foundation, it also means informing the dialogue and building demand for health by pursuing new partnerships, creating new networks to build momentum, and standing on the shoulders of others also striving to make America a healthier nation. Examples include:

• The Healthy Weight Commitment Foundation, an organization made up of 16 major food and beverage companies that pledged to remove 1.5 trillion calories from the marketplace by 2015. Acting together, the group not only met the challenge early but exceeded it, selling 6.4 trillion fewer calories in 2012 than they did in 2007.
• The state of Oklahoma, where policy-makers put partisan politics aside to create a statewide program providing pre-kindergarten classes to every 4-year-old for free.
• Habitat for Humanity, revitalizing neighborhoods across America with an eye toward providing shelter while also building community gardens, health support systems for older adults, and strong community coalitions.
• The California Endowment and its 10-year Building Healthy Communities program, promoting health across the state using innovative programs, including a unique museum exhibit targeted to children. 

Since the Foundation’s founding more than 40 years ago, the Foundation has placed a high premium on fostering great leadership and supporting strong professional development. We take great pride in our legacy of identifying leaders with the potential to transform our nation’s health, and providing them the support to realize their promise. We remain deeply committed to investing in the development of health innovators. And we intend to tailor our programs to better meet tomorrow’s demands for effective leadership. They must create strong connections between, and across, disciplines and professions. They must encourage networking. They must reflect the rich diversity of our nation. And they must be committed to a vision of building a Culture of Health. This year, we will start the process of restructuring and refocusing many of our human capital programs with these goals in mind, and we will introduce a new RWJF Leadership Network. 

Fueled by social media—the RWJF Leadership Network will create a dynamic professional space where practitioners, scholars, policy-makers, community activists and thousands of others connected to RWJF can exchange ideas, promote research, collaborate on initiatives, and learn. It will underscore the power of collaboration, and it will call for action. There is an African proverb that teaches “it takes many hands to cover the sky.” Building a national Culture of Health will, indeed, take many hands and the RWJF Leadership Network will encourage everyone involved to walk toward success together.

RWJF has a reputation for rigorous evaluation of our work.  So how will we measure our nation’s movement toward a Culture of Health?

Over the next few months, and with your help, we will translate the abstract concept of a Culture of Health into a set of tangible measurements that will help us all track our nation’s progress toward the goal. The measurements will focus on the key elements of a Culture of Health such as personal behavior, norms, values, institutions, and systems, and they will reflect where communities are performing well, and where they need more help. When this process is complete, we expect to have a useful tool that will not only help us assess our work, but also will serve to garner trust, galvanize support, and inspire others to help lift America to a level of health that a great nation deserves.

There is a Crow Indian proverb that declares you already possess everything necessary to succeed. We are optimistic that America can and will achieve a Culture of Health if, together, we make it a national priority. RWJF is committed to working with you to reach this goal, and we welcome you to the journey.

Risa Lavizzo-Mourey, MD, MBA

President and Chief Executive Officer