Building a Culture of Health through Policies for Action

As part of its broad vision to build a Culture of Health in the U.S., the Robert Wood Johnson Foundation (RWJF) created the Policies for Action (P4A) research program. P4A’s goal is to develop the evidence base on policies, laws, system interventions, and community dynamics that improve population health, well-being, and potentially achieve health equity. This September, the Urban Institute partnered with RWJF in assuming the role of the P4A national coordinating center (NCC). Together, RWJF, P4A, Urban Institute, and our grantees are working to build a Culture of Health where everyone has the opportunity to live as healthy a life as possible, no matter who we are, where we live, or how much money we make.

P4A is designed to examine how polices relating to sectors such as housing, education, or employment – ones not traditionally thought to be connected to health – influence health and well-being. It also supports policy-oriented research projects relating to behavioral health, public health, and healthcare systems integration. As Alonzo Plough, RWJF’s vice president of Research-Evaluation-Learning and Chief Science Officer, recently explained to Health Affairs, the P4A research program seeks “to understand and actually show some evidence around the pathway for policy change and what kinds of policies seem to have the most impact on improving the kinds of population health outcomes we are interested in.”

P4A is just starting its second year, and there are already five research “hubs” and six individual grantees conducting 22 research projects. Justine Hastings and Jesse Shapiro at Brown University, for example, are investigating whether enrollment in the Supplemental Nutrition Assistance Program (SNAP) encourages families to buy healthier foods and thus improve their nutrition, while Sherry Glied and her team at New York University are linking Medicaid data to other data to research the connections between health and social programs including housing, transportation, and early childhood education. 

This inaugural blog will be followed by future posts featuring P4A research and the findings that emerge, as well as posts on other related research and news. The program’s core focus on both policies and action make it especially exciting – one with great potential to improve health for all Americans.

With Urban assuming the leadership role as the NCC for P4A, it is worth reflecting on the Foundation’s Culture of Health Framework and the four action areas that underpin it: making health a shared value; fostering cross-sector collaboration to improve well-being; creating healthier, more equitable communities; and strengthening integration of health services and systems – all with the common goal of improving population health, well-being, and equity.

The themes of inclusiveness, well-being, and community all shine through. And while no one sector (e.g., education, housing, or health care) or institution (e.g., government, business, or family) can alone solve our nation's health challenges, it is also true that all of them have an important role to play. And there is no time to lose: compared to people living in other advanced democracies around the world, Americans spend more on health care, but experience poorer health and shorter lives. 

As the P4A program matures, it is also interesting to reflect on the parallels between the Culture of Health Action Framework and the foundations of RWJF. As adapted from materials sharing RWJF’s internal history:

Robert Wood Johnson was is perhaps best well known as a business leader and industrialist who grew Johnson & Johnson into the world’s largest medical supply company. What is less well known is that he had a deep concern for the wellbeing, equity, and health of the population that worked with him. He championed and paid a minimum wage, supported the role of women in public life, and spoke out about environmental concerns decades before those positions were widely accepted.  And through his work, he developed a concern for hospital patients whom he saw as being lost in the complex world of medical care. This drove him to improve the delivery of health care by creating the world’s first school of hospital administration at Northwestern University.

During his lifetime, Johnson personally helped many individuals in need without fanfare. To further his philanthropic convictions, he created the Robert Wood Johnson Foundation in 1936 to improve conditions for the community he called home. When Johnson died in 1968 his fortune was bequeathed to the Foundation and in 1972 the Robert Wood Johnson Foundation “went national,” becoming the nation’s largest health care philanthropy, and one of the largest philanthropies in the world.

We are struck by how many of the issues that Johnson championed are still being debated today: the minimum wage, the role of women, and environmental concerns to name just a few. And we suspect the world of medical care is even more “bewildering” today than it was in Johnson's lifetime. In addition to the P4A research highlighted above, other current projects on paid family leave, family income supplements, “super utilizer” patients, and similar topics will help us understand what policies can best drive needed improvements in population health, well-being, and equity.

That Johnson was a visionary business leader who prioritized the needs and interest of customers over stockholders is also noteworthy. The critical role of business leaders, and the private sector more generally, in shaping our nation's Culture of Health should not be underestimated. Without the strong involvement of the business and civic community, from small businesses to large multi-national corporations, it is not clear how the country will succeed in making fundamental improvements in health and well-being for all. Employers, business leaders, and indeed the nation's future economic competitiveness, depend on a strong and healthy population.

The Robert Wood Johnson Foundation began its work in 1936 to relieve Depression-era conditions in New Brunswick, New Jersey. Today there are still many communities across the country where the conditions of life are leading to unnecessary illness and disability, and premature death. The cross-disciplinary and cross-sector research the Foundation and Urban are supporting through the P4A program aims to understand and address these conditions and advance a Culture of Health all across the country, and especially for the people and places that need it most.