News and analysis
July 23, 2014

Robert Wood Johnson Leader Details Plan to Shift Health-Care Strategy

Allan Shoemake

Risa Lavizzo-Mourey

The Robert Wood Johnson Foundation, America’s third-largest private grant maker, announced in June a major shift in its giving strategy: Rather than focusing on individual problems like cigarette smoking that land people in the doctor’s office, it would emphasize helping people sustain healthy habits in their daily lives.

The switch is part of an effort to take health care out of the clinic and promote a "culture of health" at home, in the workplace, in public spaces, and in schools, says Risa Lavizzo-Mourey, the foundation’s president. Building a culture of health, she says, will push the foundation to work with a broader set of collaborators, not only in health care but in finance, business, community development, and urban planning.

Starting out, the $10-billion foundation, which made $450-million in grants in 2013, will try to reduce disparities in health care based on wealth and race and to treat violence as a public-health problem. It will also push the food industry to reduce "empty" calories in its products.

In January, the foundation’s researchers found that leading food and beverage companies were able to cut 6.4 trillion calories from their products over the course of the year—400 percent more than the companies thought was possible -- by altering recipes, reducing serving sizes, and creating low-calorie options. The effort was the result of a partnership between food and beverage companies and Partnership for a Healthier America, a nonpartisan organization dedicated to advancing the goals of Michelle Obama’s "Let’s Move" effort.

The foundation, assisted by the RAND Corporation, is still working out how exactly it will measure progress as it implements the changes. But the result, Dr. Lavizzo-Mourey says, will mean people won’t have to go out of their way to make healthy decisions.

In an interview with The Chronicle, the foundation president discussed her organization’s shift in strategy.

What is a "culture of health"?

A culture of health is a situation in which everyone in our country has the opportunity to get and stay healthy by having the opportunity to chose healthy options and having those be the easiest options to choose. Making the choices to be healthy are hard, and we want those choices to be easy.

Let’s imagine I have diabetes and need to control my diet and get exercise on a regular basis, and I live in an environment where I have a long commute to work and my immediate environment doesn’t have a grocery store, doesn’t have restaurants that serve healthy food or have menu labels so I can understand what I’m eating. Let’s also consider that there’s not a lot of open space or parks. If I’m going to take care of my diabetes and eat a diet that allows my blood sugar to be controlled and get regular physical activity, it’s going to be hard for me to do that.

But if I work for an employer who makes healthy options available at the cafeteria as a default and gives me the option of doing a bike share for part of my commute, and I live in a community that builds open space in the environment because they have good partnerships between urban planners, architects, mayors, and community leaders, then I’m going to have more opportunities for physical activity.

If the banks and community-development organizations get together to finance a grocery store in my neighborhood, I’ll have the option to get healthy, affordable food more easily than I can now.

All of those changes make it easier for me to control my diabetes and reduce the burden of chronic illness on society.

Who will join this effort?

Right now we place a premium on getting people well. We’re focused on alleviating sickness. We’ve tended to take it problem by problem. We’ve really got to connect these individual silos of problem solving.

If you look at some of the places we’re looking for new partners, we’re working with mayors, we’re working with business. We know we’re going to have to develop relationships with organizations that finance much of this change. And voluntary organizations like the American Heart Association and The Y that are literally in every community.

Is working with business a challenge? How did you help food providers make such a drastic caloric reduction in their products?

We were able to work with them to validate their commitment and at the same time get them to understand what a reasonable magnitude would be to actually make an improvement in the population’s health.

We have to understand business is not a monolith. There are going to be some companies and segments of industry that are going to respond very positively and some that aren’t. What we want is to find those leaders that understand that it is in their own interest to invest in the health of their employees and the community.

Your new plan focuses on preventing violence and responding to health disparities, whether they are based on race or income. How big a change is this for groups that currently receive financial support from the foundation?

Our current grantees enter into a relationship knowing that no grant is forever. They have a beginning, middle, and an end. In talking to our grantees, what I’m saying to them is ask the question: How will your work be able to advance the larger goal?

We have had a number of programs focused on treating violence as a public-health problem. But we realized that there’s not as many programs focusing on the effects of trauma at an early age, addressing violence among children and families, teaching them alternative ways to deal with difficult disputes, and developing systems and approaches to mitigate the consequences of early stress and trauma.

When we ask ourselves what is it going to take to build a culture of health, it’s clear that we’ve got to do this together. It’s got to be inclusive. We can’t achieve a culture of health if some parts of our society, through no fault of their own, face tremendous barriers. We need people to understand across the many areas where we work that we can leverage one area to another. We haven’t articulated well with people we work with the importance of making those connections.

How will you measure success?

We are working with the RAND Corporation to develop a framework of measurement. We’re going to need to foster more civic engagement and we’re going to have to actually reduce disparities.

At this point, what we’re trying to do is engage people who are experts in measurement development so we have a broad level of input on what kind of metrics might actually be useful. The idea is to continue that process, refine it, and probably sometime in the second quarter of 2015 to begin rolling that out

What’s at stake?

Everything. We’re a country that spends $2.7-trillion on health care and yet we have the appalling fact that our young people aren’t eligible for military service because they aren’t meeting the standards for health. They’re too overweight. They don’t have the educational level they need, and they have far too much substance abuse. We cannot continue to spend on health care at the rate we do. It’s forcing us to make choices that we don’t want to make as a country. We have to choose between health care and education or health care and infrastructure. Those are choices we can’t make as a country and continue to grow and prosper as we need to.

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