Sixteen years ago, I embarked on what I thought would be a year-long project to help the residents of West Oakland gain reliable access to affordable, nutritious food.

More than 23.5 million people live in low-income areas that are more than a mile from a supermarket, according to the USDA. That includes West Oakland, one of the city’s poorest areas. The community has a high rate of crime, pollution and unemployment—along with dozens of liquor stores and fast food outlets. Health outcomes are dismal; residents are two times more likely to be born at a low birth weight and 2.5 times more likely to die of stroke than residents in the nearby affluent area of Oakland Hills.

Teaming up to reverse childhood obesity has yielded promising results—including new data that shows rates among 2-4 year olds enrolled in the federal WIC program have declined in 31 states. But the work is far from over. 

Some of the most fulfilling and valuable experiences of my early career involved working as a home visitor about twenty years ago. I traveled through Philadelphia’s most underserved neighborhoods with a team from the MomMobile, a community-based organization that provides free support and education to families facing the challenges that pregnancy and parenting bring. I’ve personally witnessed the powerful impact home visits have on families, and that’s why I’m so passionate about the role they can play in building a Culture of Health.

The Affordable Care Act (ACA) has drastically accelerated change within the nation’s health care system. While the law is known for ushering in national reforms—policies that aim to better health, improve care, and lower costs across the United States—it has also fostered new opportunities for states to serve as incubators for health care transformation. Valuable lessons can be drawn from these early-innovator states and their commitment to payment innovation, restructuring care delivery systems, and efforts to build healthy communities that extend beyond traditional medical providers. Multi-state health systems are uniquely positioned to facilitate this innovation.

The Centers for Medicare and Medicaid Innovation (CMMI), an office created by the Affordable Care Act to drive change in the health care system, has awarded about $960 million to 34 states, three territories, and the District of Columbia to test comprehensive transformation plans through its State Innovation Model (SIM) initiative. At Trinity Health, we're supporting and studying nine SIM awardees: Connecticut, Delaware, Idaho, Iowa, Massachusetts, Michigan, New York, Ohio, and Oregon. We're committed to sharing early lessons and best practices in addition to obstacles identified within our own health system. This information can help states, CMS, and other stakeholders expedite their own innovation.

It’s a dismaying fact that we’re all familiar with: where you live has an enormous impact on your life expectancy. Indeed, some researchers now quip that your ZIP code may matter just as much, if not more, than your genetic code when it comes to your health. As one journalistic account put it, it’s “Death by Zip Code.”

New Jersey is no different. This summer, the Robert Wood Johnson Foundation (RWJF), together with Virginia Commonwealth University, published analyses of Mercer County, a prime place to showcase the impact of geography on health. It’s home to both affluent Princeton and economically strapped Trenton. And perhaps not surprisingly, life expectancy reflects the gulf in resources between the two towns. While a person born in Princeton can expect to live 87 years, his or her neighbor in Trenton has a life expectancy of 73 years—a staggering 14 year age gap across only a dozen miles.

These results are sobering. It’s easy to get despondent over them and locked into a narrative of failure and decline. But RWJF’s Culture of Health efforts involve cultivating potential, even in places where we wouldn’t normally think to find it. That’s where New Jersey Health Initiatives’ (NJHI) work comes in.

Providers need to be equipped with the tools to help patients make healthy choices. That’s why the Alliance for Healthier Generation is recognizing innovative training programs providing nutrition, physical activity and obesity counseling education to their students.

Even at the young age of four, Luke was overweight. In fifth grade, he tried out for the baseball team, and although he made it, he struggled that season. He was slower than the other kids as he rounded the bases, and he started having knee pain from the extra weight on his joints. Luke and his family knew they had to do something. But they dreaded going to the doctor, knowing he’d get weighed and then have to confront the escalating numbers on the scale. Year after year, the same thing would happen, and they’d have the same discussion with his doctor when they finally worked up the nerve to go. But the weight never came off.

Apprehension about a visit to the doctor is something we all face, no matter our age or health. Who among us doesn’t get a little nervous before our annual visit, knowing we might face a difficult conversation about losing weight, or flossing more, or stopping smoking? These are things we all know, but have a hard time talking about.

And even worse, if we do have these important conversations, they can lead to feelings of shame and disappointment.

But the reality is that it’s not necessarily your doctor’s fault. Even with the hundreds of thousands of hours of education your doctor gets in classrooms and hospitals, most receive little to no training in how to talk to patients about making healthy choices. In fact, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise recommended by the National Academy of Sciences, Engineering and Medicine.