• Q&A
  • December 7, 2018
  • 18 minutes
  • 1

Medical care is not enough — here’s how to build a culture of health

Our health is connected to where we live, learn, work and play

Apolitical has partnered with the Robert Wood Johnson Foundation, on a soon-to-be-launched deep dive on health and wellbeing. We spoke with Sharon Z. Roerty, the foundation’s Senior Program Officer and Karabi Acharya, the foundation’s Director, Global Ideas for US Solutions about their work in the space and their hopes for the partnership.

RWJF is the largest foundation in the US dedicated solely to health and well-being. What are the major health challenges the Foundation is tackling? What are you optimistic about when it comes to solutions?

[Karabi]

We’re committed to working with others to build a Culture of Health in which everyone has a fair and just opportunity to be as healthy as possible. For some, that might mean access to high-quality health care, but for many others it’s quality schools, stable housing, good jobs with fair pay or healthy food and safe outdoor spaces for activity.

[Sharon]

We’re focused on solutions that break down traditional silos.

How do we engage teachers, parents and health providers to nurture the building blocks for lifelong health from a child’s earliest year?

How can developers, municipal leaders and public health advocates cultivate healthy and welcoming public spaces in cities and towns across the country?

How do we support current and future leaders looking beyond the walls of clinics, classrooms and narrow jurisdictions to challenge the current systems that create barriers to health equity?

Often, the major “health” challenge we face is fostering the will and the courage to do things differently. Inspiration from others can feed that will.

One of the things that makes me optimistic is increasing awareness around the need to create opportunities for all people to thrive and live their healthiest life possible. At RWJF we call it health equity; around the world it is called different things, but what’s clear is that there are large and small actions being taken to break down the institutional barriers to health and well-being for all.

[Karabi]

A big focus for us is changing systems. It may be a policy change like making improvements to the Supplemental Nutrition Assistance Program (SNAP) that serves as a lifeline for 40 million low-income people in the U.S.

It could also be moving industry norms and practices, such as requiring health impact assessments before large infrastructure projects or supporting disruptive new models like Project ECHO to move the knowledge of medical specialists to primary care providers on the frontlines in underserved communities.

More often than not, systems change means changing mindsets about how we understand both problems and solutions.

A key principle behind RWJF’s Global Ideas for US Solutions initiative is that those working on health and well-being in the US – from policymakers to advocates – have much to learn from looking at other countries, particularly less-developed ones. Why do you think that is?

[Karabi]

Good ideas have no borders. Whether you’re talking about democracy (Greece), yoga (India), bagels (Poland) or the toothbrush (China), we’ve embraced ideas from other countries and cultures and made them our own.

Health is no exception. Our job is to seek out global ideas that could become U.S. solutions. With our colleagues, we look to countries around the world — at all income levels — to learn about what they are doing to build their own Culture of Health.

We’re committed to working with the people often most marginalised in our society, and we know many lower-income countries have had great impact with similar populations. We want to explore how we can model their successes and learn from and adapt their good ideas.

And we look at initiatives that didn’t go well, too — so we can learn from them.

[Sharon]

But we can’t limit ourselves to countries of certain regions or GDP levels or cultural history. You may not be surprised to learn that the X-Ray was invented in Germany, but did you know that the practice of inoculation originated with mothers in Ghana?

We live in a highly connected global economy where the best ideas come from researchers and practitioners collaborating across countries and continents; and where some of the useful innovations are coming from remote villages.

Can you give an example of an interesting health innovation that the US has learned from another country? Including from the global south?

[Sharon]

Community health workers come immediately to mind. The Chinese “barefoot doctors” and health volunteers in villages in Thailand were some of the earliest examples. The model then spread to countries in Africa and Latin America. It only more recently has taken hold in the U.S.

There are lots of historical examples, but we’re excited about the ideas we continue to learn about through our exploration.
In Guadalajara, Mexico, 40 miles of city streets are blocked to car traffic each Sunday. The city comes alive with nearly half a million pedestrians, cyclists and young children and people of all abilities participating in public life. “Open Streets” promote more socially cohesive communities. Cities across the U.S. are learning from this approach.

[Karabi]

Two other quick examples.

Wales has pioneered a unique approach called the Cardiff Model of Violence Prevention. The model focuses on sharing data between police and emergency rooms to identify areas prone to violence and to develop more effective safety interventions. In partnership with the CDC Foundation, we’re exploring how the Cardiff Model might be adapted to big U.S. cities like Atlanta.

And we’re currently supporting a project by Slum Dwellers International to learn about innovative approaches being used to build vibrant healthy communities in overcrowded urban areas in Africa, Asia and Latin America — and how they can inform efforts in low-income communities in U.S.

We could go on…

Another fundamental principle of RWJF’s work is that good health is not simply a matter of improving medical care: it’s about a broad Culture of Health, touching on many issues traditionalists may not immediately connect with health. What major policy areas do you believe, in this interconnected age, need to be tackled in collaboration with health? Are you pessimistic or optimistic about the role of technology on this?

[Karabi]

It’s a tough question. The truth is that we can’t tackle one or two in isolation. It’s all interconnected. Our health is connected to where we live, learn, work and play — it’s housing, jobs, food, transportation… even weather.

It’s about multi-solving. We funded a report by Climate Interactive to identify communities across the globe taking steps to both improve health and address climate change with a single budget and aligned partners who might not otherwise see their common interests.

Climate change is a challenge that connects all of us. We recently supported the World Health Organisation and UN Framework Convention on Climate Change to develop two country profiles for the U.S. to provide policymakers and advocates with both information on future projections around extreme risks, as well as health gains that could be reached through efforts like emissions reduction policies.

We’re also working with the WHO to explore how we can track our country’s progress in health and climate.

Another major issue that stands out for me is residential segregation. It’s an area where researchers like Raj Chetty are doing really important work. We’re just embarking on an effort to explore how we can learn from Singapore’s approach to this challenge.

[Sharon]

As an urban planner, one area that concerns me relating to technology and health that’s not being actively addressed in the U.S. is the future of publicly owned street space in the advent of autonomous vehicles.

In the U.S., this is both a transportation and a land use policy area with the potential to pit public ownership against private interests. Municipalities looking to solve budget crisis may be tempted to plug gaps by selling off rights to public lands.

Why is this a health issue? Think walking, biking, transit to your job or neighbor’s house. The opportunity cost of the loss of free public space — once it’s gone it’s gone. AI and autonomous vehicles are a global issue that we will all struggle with — and we need to learn from each other.

What role do economic and social inequalities, including gender and racial inequalities, play in determining health outcomes in the US? Can you point to particular policy solutions in this space?

[Karabi]

Health equity is a central pillar to building a Culture of Health. It means EVERYONE has the opportunity to live a healthier life, no matter who they are, where they live or how much money they make. For generations, too many people have been isolated from opportunity based on policies and practices at every level that have created deep-rooted barriers to good health. This happens in the U.S. and around the world.

But we also believe that more and more communities are recognising that we’re all better off when everyone has the opportunity to live their healthiest lives. We’re looking to learn from the communities that are making real progress.

Last year, we supported a summit connected to PAHO’s Commission on Equity and Health Inequalities in the Americas. We wanted to learn from their effort to identify strategies to bring health equity solutions forward in communities across the two continents. We’re now supporting an ongoing cross-border network of health equity experts to spur learning exchanges and spread best-practices. The effort has a specific focus on gender, race and ethnicity.

One area RWJF works on is building healthy communities, including the use of public spaces. Can you explain this connection? Do you have any examples of how this works?

[Sharon]

This is a topic close to both our hearts. Did I mention I’m an urban planner?

At first glance, you might wonder what public spaces have to do with health. And then you might think mostly about physical activity or even violence prevention. Those are areas of interest and exploration for us; as is how public spaces can bring people together and foster inclusion and connection.

Most recently we embarked on a learning journey that took us from Philadelphia to Copenhagen to Lisbon to understand how communities around the globe are cultivating welcoming public spaces that promote health and equity. As we seek to build a Culture of Health, we believe public spaces are critical to building connection and reducing isolation — and how connected we feel is a major driver of our health.

Working with Gehl Institute, we supported the development of a framework and principles for building inclusive healthy places, which we’re now focused on getting out broadly to developers, planners and policy makers to inform practice across the U.S.
When I was young I saw the sci-fi movie Logan’s Run. It had an over-sized impact on me and has influenced how I think about both the natural and built environment — what it means to our physical, social and emotional health. There are some people that may never see the inside of a hospital but everyone gets outside at some point if not everyday. Health is where we live.

What do you see as the respective roles of government and philanthropy in promoting public health and well-being? How do you currently work with public servants and policymakers?

[Karabi]

I think there’s a common narrative between philanthropy and government that’s useful framing but also more and more being blurred. Done well, philanthropy should move more quickly to test and evaluate new approaches, be comfortable with taking more risks and learning from failure, and own a responsibility for sharing that learning with government.

Philanthropy also has a strong convening role to play. Government brings resources at a level that philanthropy can never match. It can truly take ideas to scale in a way philanthropy just can’t.

But it’s generally slower moving, and it’s ability to experiment and take on risk is more limited. Again, these lines are blurring, and government’s role in spurring innovation — while not new — is growing.

We regularly work with officials at all levels of government in the U.S. In some cases, we collaborate on projects with key agencies or leaders, such as the CDC with the Cardiff project or city mayors with the Open Streets initiatives. We share research, support demonstrations and fund evaluations of government efforts; and we listen.

As the largest foundation focused on improving the health and well-being of all in America, we can’t achieve the impact we want without engaging with policy makers and practitioners. That means sharing our learning and learning from the many efforts underway in the public sector both in the U.S. and around the globe.

(Picture credit: Unsplash)

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