Culture of Health Blog

New York City’s new deputy mayor for health and human services shares how inspirational mentors and rich experiences have cultivated her career.

Change leadership means thinking big about impact, responding to urgent needs, and actively tolerating risk. This is the kind of big, bold way of working—together—that will get us to a Culture of Health.

The beginning of a new year is a great time to reflect on progress toward longstanding goals. At RWJF, we’ve spent the better part of four decades advancing solutions to help everyone in our nation gain access to affordable, high quality health care—a goal we reaffirmed in 2014 when we announced our vision for a Culture of Health in America.

Happily, our country has made enormous progress toward this goal in 2014. Health coverage rates improved dramatically last year because of robust enrollment through the health insurance marketplaces, Medicaid, and CHIP. As we enter 2015, we continue to see strong coverage gains, with nearly 6.6 million consumers newly enrolled or renewing through HealthCare.gov.

But let’s not forget that more than 40 million people remain uninsured. There is still more work to be done to make sure all those who are eligible can get the coverage they need and deserve.

I am thrilled to begin my job as the entrepreneur in residence (EIR) at the Robert Wood Johnson Foundation.

You might think that the EIR role is traditionally associated with venture capital firms, not foundations. But scratch the surface and you’ll find commonalities between the two industries. Both VCs and philanthropists have daring ambitions, place lots of bets, and hope for a big pay-off every once in a while. The difference is that a philanthropy like the Robert Wood Johnson Foundation places a priority on societal dividends, such as greater access to health care or a reduction in childhood obesity.

I also like this definition of entrepreneurship: “The pursuit of opportunity without regard to resources currently controlled.” That fits the Foundation to a T as we pursue the audacious goal of building a Culture of Health in the United States.

But how will we measure success? How will we know if our bets ever pay off, especially when we are talking about culture change? I have a story to tell that I think illustrates how a small grant can make a big difference in the world.

“I want you to join together with the band.”
—Join Together, The Who

I’ve been thinking about this lyric after attending an important health conference in Washington, D.C., earlier this month, focused on strategies and collaborations that can reverse the childhood obesity epidemic in the U.S. The attendees weren’t just your usual health conference suspects—researchers, medical professionals, public health officers, etc. The Building a Healthier Future summit, convened by the Partnership for a Healthier America (PHA), also offered leaders from the nonprofit, academic, and public sectors the all-too-rare opportunity to swap ideas and strategies with corporate executives.

Now that’s a band.

If you’re thinking that a healthier future and the likes of Pepsico and Del Monte Foods have nothing in common, it is time to revise your thinking. PHA was formed in 2010, at the same time as Michelle Obama’s Let’s Move initiative, to work with the private sector to develop strategies for addressing childhood obesity (RWJF was one of the founding partners).

With the opening of health marketplaces and the Affordable Care Act’s partial expansion of Medicaid, our nation has an opportunity to substantially expand health insurance coverage for all Americans, and ultimately, to significantly reduce racial disparities in access to affordable coverage.

But to achieve that goal, communities of color must attain robust enrollment gains. That’s why RWJF is working with religious leaders and their congregations to help make sure that all who are eligible enroll.

The Problem

According to United States Census data for 2012, approximately 48 million Americans are uninsured. It is a problem that cuts across all racial and ethnic groups, but is most acute in two, resulting in 19 percent of African Americans and more than 29 percent of Hispanics living without health insurance.

In 2009, the Institute of Medicine documented what many suspected: The uninsured are much less likely to obtain preventive care; get timely diagnoses for illnesses, including cancer; receive treatments for chronic illnesses such as diabetes and asthma; and take prescription medications as recommended by physicians.

Beyond the health consequences of uninsurance, there are steep costs for our economy. We all pay the bill for indirect fiscal burdens associated with the uninsured—including illness and injury, decreased workforce productivity, developmental and educational losses among children, and shorter life spans, costing the U.S. economy between $100 and $200 billion each year.

Today, the Centers for Disease Control and Prevention reported that obesity rates among young children from low-income families are falling in 18 states and one U.S. territory—and rising in only three states. 

What an important sign of progress for all of us working to reverse the childhood obesity epidemic! It’s especially terrific because it builds on recent positive news coming from all across the nation.

Childhood obesity rates are falling in states like West Virginia, Mississippi, New Mexico and California. They’re dropping in big cities like New York and rural areas like Vance and Granville Counties, North Carolina.

Today’s news is of falling obesity rates among children participating in federal health and nutrition programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children program, better known as WIC. These are young children in low-income families. Children who have been at the highest risk for obesity and whose families have had the most limited chances to make healthy choices. So this is huge.

Does anybody commute to work anymore without passing by a huge billboard promoting world-class health care at a nearby hospital or surgicenter?  I know I see enough of them to have become pretty calloused to their messages.  But then, I don’t need health care right now.

What if I did?  Could I count on these extravagant advertisements to give me good guidance about where to seek care?

Unfortunately, the answer is probably not.

As a parent, I want my daughter to have every opportunity to succeed in life. Some would say I obsess about it, making sure she’s exposed to all kinds of music, sports, languages, people, places, and families. My spouse and I give her a stable home filled with love and structure, and we teach her how to face challenges and learn from them, believing this will help her make good choices and have every opportunity to be healthy and happy in her life.

You might be asking, “what in the world does this have to do with the work of the Foundation?” Well, last month the Foundation convened the 2013 Commission to Build a Healthier America to discuss the importance of early childhood development (pre-K education that help kids learn the skills they need to succeed in school and life) and community development (not just economic development, but using resources to create communities with safe housing, quality education, parks, and a thriving economy).

Almost 48 million Americans receive benefits from the Supplemental Nutrition Assistance Program—SNAP, for short. This federal entitlement program helps low-income Americans purchase food for their families, and it encourages healthy eating habits.

Writing in the Huffington Post, RWJF Senior Vice President James S. Marks, MD, MPH, says SNAP's benefits to society are clear, in spite of arguments to the contrary. For every dollar spent on federal food aid, he says, benefits generate $1.72 in economic activity. Of course, SNAP principally helps families alleviate hunger, reap critical nutritional benefits, and combat the nationwide obesity epidemic.

Unfortunately, federal lawmakers are considering ways to take a bite out of SNAP. Two million people would lose food assistance, and more than 200,000 children would stop receiving free school meals under a version of the Farm Bill recently passed by the House Agriculture Committee, Marks asserts. A Senate bill would cut less, he adds, but the reduction in benefits and more stringent eligibility requirements would still be substantial, and damaging to the public's health.

"Fortunately, there is still an opportunity for Congress to chart a different course," Marks suggests. "As we strive for a full economic recovery and a healthier nation, supporting SNAP is both the right thing to do and the smart thing to do."

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