RWJF - Culture of Health Blog Posts Our blog features perspectives from Robert Wood Johnson Foundation staff and guest authors about efforts to build a Culture of Health. Wed, 23 Feb 2022 10:45:00 -0500 en-us Copyright 2000- 2022 RWJF (RWJF) <![CDATA[Can We Redefine “Progress” to Center Well-Being?]]>

What can we learn from communities in the U.S. and around the world about changing the narrative on progress? What does it mean in practice to take a well-being approach?

A man rides his bike along a pedestrian only pathway.

For many months, our society has grappled with defining our “new normal.” The COVID-19 pandemic has exposed and deepened inequities that undermine well-being. Combined with a worldwide outcry for racial equity, we have been challenged to reconsider how the United States defines “progress.”

Our nation’s traditional story of progress has been limited to measures like economic growth and employment. When leaders tout our country’s successes, they cite GDP numbers, job growth, and unemployment rates.

On an individual level, a person’s bank account balance, the car they drive, and their generational wealth are heralded as markers of success. These benchmarks only tell a fraction of the human story. They also overlook how structural racism has undermined economic opportunity for communities of color among other outcomes.

What if we considered basic needs—like food, housing, education and employment—combined with needs like safety, dignity, and belonging? Together, they mean people are thriving and able to create meaningful futures. What if we made our collective well-being central to how we define and pursue progress? This means thinking of well-being holistically, encompassing everything people need to thrive and create meaningful futures, including physical and mental health, basic needs, social and emotional needs, and the well-being of our communities, our environment, and our planet.

At the Foundation, I’m part of a team that looks around the world for solutions to some of society’s biggest challenges. Last year, we partnered with RAND Corporation and Metropolitan Group to explore how communities are working to shift narratives around progress to center on a well-being approach. In this instance “narratives” refers to the collection of stories and experiences that shape our shared ideas about the world and why things are the way they are. (See the report for a full explanation.) Our hypothesis is that as long as the dominant narrative is “progress is economic growth,” it will be hard to take a different approach.

Through our work, we’ve learned how other countries are challenging the status quo by pursuing a well-being approach—that is, making decisions based on their impact on human and planetary well-being as well as economic growth, through policy, budget, and practice change, and by recalibrating narratives about what matters most. From New Zealand to the United Kingdom to Bhutan, countries are defining what well-being looks like, measuring how people are doing, and prioritizing well-being in budgets. They are demonstrating that it is possible to broaden narratives around progress to focus on well-being—which includes having a sustainable, just economy—along with a more robust and holistic set of other factors.

How are U.S. communities adopting lessons from abroad?

Last year, RAND Corporation and Metropolitan Group set out to understand how leaders across the United States could put some of these global lessons into practice. Here’s what they learned.

A food justice coalition is expanding the meaning of “economy”

HEAL Food Alliance, a national coalition of more than 2 million food justice practitioners, experts, and advocates, set out to reclaim the original meaning of the word “economy,” which stems from the Greek word meaning “management of home.”

They wanted to demonstrate that economic success should be measured by how resilient an economy is and how much it serves the well-being of its people. So, the team created a four-part video series that reimagined local economies as they relate to HEAL’s main work areas—health, environment, agriculture, and labor—lifting up their members’ voices, most of whom are excluded from mainstream narratives.

The City of Jackson, Mississippi, is framing broadband as a well-being issue

In 2017, Jackson’s city government developed a “dignity economy” model centered on well-being. The goal: to improve residents’ quality of life, ultimately laying the groundwork for new generations and businesses to thrive.

More recently, the city saw improving broadband access as a core strategy in its well-being approach. Using a well-being narrative, the team framed expanding broadband access as an investment with many economic and civic well-being benefits—from empowering residents to fully participate in democracy to offering better access to healthcare. Now, the challenge is to evaluate and discuss broadband outcomes across multiple dimensions of well-being (e.g., how it benefits social connection and mental health), not merely as an economic return on investment.

Cities across the country are applying data to bolster a well-being narrative

The National League of Cities convened leaders from across the country to help explore how the global research on well-being narratives resonates with efforts in the United States. Many cities are starting well-being work by creating an equity index to guide policy decisions. For example, the City of Charlotte’s Built City Equity Atlas helps the city set policies to prioritize investment in neighborhoods that have been under-resourced, and to identify policies that can mitigate unintended consequences such as gentrification and involuntary displacement.

For Charlotte and other cities, an equity index can be a precursor to establishing a well-being narrative because it defines and tracks all the elements of well-being, helping to make the case for a broader city goal. Municipal leaders in the United States also said they need evidence that a well-being approach will be effective and need help to counter current definitions of progress that are based on economic growth. “We have a bureau of labor,” said one participant, “but not a bureau of well-being,” pointing out current disconnects and the type of shifts needed to fully align with a well-being approach. In a separate but related project, National League of Cities also released a well-being message guide to support cities’ efforts.

Moving forward, we have the opportunity to establish a narrative about progress centered in well-being, in a way that is authentic, equity-based, and effective in shifting mindsets and actions. With this research and the work of our partners in mind, how can you advance well-being narratives in your work?

For more stories and insights, including the work of One Fair Wage and Peace First, read RAND Corporation and Metropolitan Group’s latest research, What if Progress Meant Well-Being for All? You can also explore the Foundation’s ongoing well-being learning journey.


About the Author

Karabi Achary

Karabi Acharya, who has drawn upon her expertise in anthropology, public health and systems thinking in working with the citizen sector in the United States, South Asia, and Africa, joined RWJF in 2015. She directs the Foundation's strategies for global learning as it identifies best practices in other countries and adapting them to improve the social determinants of health in communities in the U.S.

Wed, 23 Feb 2022 10:45:00 -0500 Karabi Acharya Child and Family Well-Being International <![CDATA[What Research Tells Us About Effective Advocacy Might Surprise You]]>

Storytelling can be a powerful tool to increase support for policies; but, depending on the audience, it can also have the opposite effect.

Megaphone illustration.

As the pandemic continues, our early child care and education systems have become increasingly fragile. Decades of divestment in school buildings means that many schools are ill-equipped to confront an airborne virus. Educators and others in the workforce are calling in sick or quitting at such high numbers that some areas have called in the National Guard to help schools stay open. The strain when children are sick or when schools close is impossibly hard on working families foremost, but it also disrupts society writ large.

Parents and other advocates are speaking up to demand better solutions. They share personal stories to illustrate both where systems have failed them, and also what is desperately needed. But when is storytelling effective and when does it backfire?

We recently conducted two studies: the first looked at communication to the general public, and the second to state legislators, both designed to generate support for public investments in affordable, accessible, high-quality childcare for all. What we found might surprise you (it definitely surprised us!)

We found evidence that policy narratives (short stories that paint a mental picture of what a problem is, who is affected, and how it came to be) were particularly effective at increasing support among the general public—notably, those who were initially most opposed. However, with state legislators, we found the opposite was true: the same narratives were not effective at increasing support and, in fact, appeared to deepen existing political divides.

Why Focus on Early Childcare and Education and How We Came to These Conclusions

Narratives are a frequently used form of persuasion in policy making and are commonly recommended in advocacy strategy. However, previous research has not tested the effectiveness of narrative strategies in the context of recent debates about early childcare and education policies and programs.

To explore the effectiveness of storytelling among the general public and state legislators we crafted a narrative about the impact of accessible, affordable, and high-quality early childcare and education in the context of advancing equity. The story was highly contextual and explained the circumstances of families who didn’t have access to affordable, high-quality child care. Like many other issues, lack of access is often framed as a failing of the individual parents or caregivers rather than shortcomings in the systems and structures that benefit some communities and impede others. Informed by previous work we have done related to messaging on equity, we knew that we needed to share a story that illustrated equity by painting a picture of the inequitable experience and then what equity would look like in the solution: in this case, increased investments in high-quality and accessible early childcare and education. Our story was about society changing the odds, rather than the story we often hear about individuals beating the odds.

Increasing Policy Support Among the General Public

Our findings offer tips for engaging members of the general public, particularly those who are ambivalent or inclined to oppose childcare policies:

●      Tell stories that paint a picture about what the problem is, who is affected, and how the problem started; avoid jargon in favor of clear descriptive language.

●      Repeat simple advocacy messages that emphasize the need for affordable, accessible, high-quality childcare for all.

●      Describe structural barriers to childcare (like cost, availability, and access) and describe clear policy solutions.

●      To preserve favorable childcare policy attitudes in the face of opposition, alert audiences to the likelihood that they will hear opposition arguments and build their resistance to the opposition arguments.

●      Use highly descriptive messages structured around fundamental principles of equity (like investing more in communities that are starting with the least) and which create clear mental images about what is involved in equitable solutions to the problem, as opposed to merely naming "equity" and hoping the term will connect those dots in audience members’ minds.  These messages can resonate across the political spectrum.

Considerations for Communicating With State Legislators to Increase Policy Support

The same stories that moved public opinion undermined some state legislator support for early childhood investments. This may be a recipe for increased partisan entrenchment or skepticism about stories, since stories are commonly used by legislators themselves to persuade fellow lawmakers to support policy priorities.

So what should you do to move legislators?

●      Know your audience, their contexts and histories on the issue, and find your allies—reinforce preexisting support from those already inclined toward the policy

●      In very polarized issues, consider focusing on delivering effective messaging to the public, who can help to shape policies indirectly by influencing decision-makers.

●      Recognize that the communication and persuasive task differs for those in decision making roles as compared with those in the general public: what they need to consider differs. You will want to sculpt your overall strategy, and subsequent messages, to suit these differing needs, considerations, and contexts.

More Resources to Help Shape Communication

If you’re interested in learning more about how media and messaging help form narratives and shape mindsets in a complex, polarized and changing information environment, check out the Collaborative on Media & Messaging for Health and Social Policy. This site synthesizes research—including research that we have led—from a broad set of studies on how to shift opinions to advance health equity, while identifying potential obstacles and pitfalls to avoid along the way.

There are subtleties to advocacy messaging—there’s no one size fits all approach. But evidence demonstrates that what advocates say, and to whom, can help or hinder efforts to build a Culture of Health.

Use our Storytelling for Social Change Messaging Guide to help shape your strategy.


About the Authors

Jeff Niederdeppe is a Professor and Director of Graduate Studies in the Department of Communication at Cornell University. He is Director of Cornell's Health Communication Research Initiative (HCRI) and Co-Directs the Cornell Center for Health Equity (CCHEq).

Liana Winett is an Associate Professor and Associate Dean for Student Affairs & Community Engagement at the OHSU-PSU School of Public Health, where she teaches graduate level courses in media advocacy and mass communication for public health.


Thu, 17 Feb 2022 11:00:00 -0500 Jeff Niederdeppe <![CDATA[Black Men Who Care Are the Role Models We Need]]>

How can encouraging men to share the joy and challenges of caregiving help erase stereotypes and transform the nation’s culture of care?

Men caring for family.

The acclaimed Carter Woodson, who is often called the father of Black history, said: You must give your own story to the world.

Those have been guiding words for me these past few years as I’ve shared my deeply personal journey as a Black father and family caregiver. My goal in doing so is to help break stereotypes, create a new narrative, and offer solutions to the caregiving crisis that is holding our country back.

I’m proud to be a caregiver to my family, which includes my wife, her 9-year-old daughter and 8-year-old son, my 9-year-old son, and the 2-year-old son we have together. Caring for four children, including one with special needs and another who is an active, curious toddler, is not easy. Doing it during a pandemic that has made life much more difficult for both kids and adults has been especially challenging.

As I write this, I am tending to my wife who is sick with COVID and my four children who are quarantined at home because they’ve been exposed to the virus. It’s not easy, but I wouldn’t trade the time I spend caring for my family for anything, despite the demands that come with providing family care while juggling a job.

I had no role model for this. My own father left when I was three years old, and I barely had male caregivers to learn from. Then and now, popular culture provided few examples of Black fathers caring for their families. So I hope that, by sharing my story and encouraging and supporting other men to do the same, I can help change that.

Man Enough to Care

In fact, I am far from alone in providing care. More men are engaged caregivers to their children now than in the past, and 40 percent of caregivers of adults in this country are men. A moving, inspiring, informative video series from Caring Across Generations shines a spotlight on some of them.

Retired NFL player Devon Still was just 25 when his young daughter was diagnosed with stage 4 neuroblastoma.

Man Enough to Care features four diverse male caregivers—comedian and writer Zach Anner, caregiving advocate Robert Espinoza of the Paraprofessional Healthcare Institute, actor Nathan Kress, and former NFL player Devon Still—along with Caring Across Generations Director Ai-jen Poo—in open conversations about providing care and needing care from a male perspective. The participants are brave and honest, and we can all learn a lot from what they share.

Devon Still says in one of the videos that he has found caregiving challenging and isolating. He was 25 when his young daughter was diagnosed with Stage 4 cancer. “I grew up really fast. I had no idea what the health care system was like... it was a lot of learning,” he says, adding that “when your daughter is battling cancer, there’s not much you can do. Sometimes I would just break down and cry.” He talks about being a Black man and a professional football player learning to provide care and that, at times, he felt he was failing as a father.

Actor Nathan Kress agrees that providing care “can be very overwhelming.” Kress’ wife has sometimes-debilitating endometriosis that “causes horrific pain.” He says it can be “really rough” to care for her and their baby and that, like too many others, he does not have male friends he can share with and talk to about being a caregiver.

Poo notes that traditional notions of masculinity can make it hard for men to ask for help. “But courage is this amazing thing, it’s contagious,” she says, reminding viewers that sharing personal stories makes care work visible and valued, thereby building support for policies that support caregiving and advance health equity. “That’s how culture change happens,” she says.

The mini-series calls on millennial men, in particular, to step up, identify themselves as caregivers, and join conversations that begin to define a new, healthy masculinity rooted in a culture of care.

I hope I am doing that, too, when I share my caregiving experience.

Caregivers Driving Change

For me, challenging the stereotype of the absent Black father is about more than setting the record straight. It’s about disrupting narratives that are terribly racist and deeply damaging. It’s about erasing stereotypes that dehumanize Black men and our families. It’s about encouraging men to embrace the joy and gratification that comes with family caregiving. It’s about helping men—and all of us—see the grace that comes with helping others live with dignity. It’s about making it possible for families to thrive no matter who they are, where they live, or how much money they make.

Caregiving is one of the greatest challenges facing our country, but the growing movement led by people of all genders and races who provide physical and emotional support gives me real hope. We’re taking this conversation to the media as we remind people how impossible it is to work without quality, affordable childcare, and to workplaces and the business community as we demand paid leave. And more and more, those of us who provide care are sharing our stories and leading the way.

So as we approach National Caregivers Day, I speak out with pride about the role Black men like me play in providing care to the people in our lives who need it most. Whether we are family or professional caregivers, we are making life better for children, seniors, people living with disabilities, and others who need us. We are the powerful role models the country needs.

If you are a caregiver, please take a moment to share what caregiving means to you on the Caring Across Generations Man Enough to Care webpage (scroll down to Share Your Story toward the bottom of the page).


About the Author

Dwayne Curry

Dwayne A. Curry is a program officer at the Robert Wood Johnson Foundation who strives to ensure that all families, no matter their background, have access to the resources they need to raise thriving children.

Thu, 10 Feb 2022 10:45:00 -0500 Dwayne Curry Child and Family Well-Being <![CDATA[Lessons from a Malawian Farmer on Climate Change, Food Justice and Gender Equity]]>

Can people in the United States heed the lessons offered by Malawian farmers and use them to build a healthier and more equitable future?

A large tree in a field. Photo Credit: Kartemquin Films

This is the question at the heart of the award-winning film by director Raj Patel, "The Ants and the Grasshopper." It follows farmer, mother, and teacher Anita Chitaya as she travels from her home in Malawi across the United States to engage farmers, food justice advocates, and climate skeptics in conversations about how we can build a healthy future.

Malawi is struggling with severe child malnutrition. Rising temperatures and extreme drought have made it tougher to grow nutritious food and pushed more families into hunger and poverty. In the film, we meet and travel with Anita, who mobilizes people in her village—encouraging farmers to try new agriculture methods and plant nutrient-rich food, and even getting men involved in cooking family meals to help children in Malawi grow up healthy. We learn that Anita and the people in her village have achieved the seemingly impossible—tackling the issues of patriarchy, child malnutrition, and climate change in interconnected and impactful ways.

The Ants and the Grasshopper movie trailer.

Anita travels from Malawi to California and then to the White House, meeting climate skeptics and struggling farmers. Her journey spans the rural-urban divide and schisms of race, class, and gender. It is a journey filled with moments of incredible hope as well as deep frustration. I walked away from the film more determined than ever to do my part in building a fairer, more just and sustainable world.

I recently sat down with James Beard Award winning activist and New York Times bestselling writer Raj Patel to discuss the film, and discussed how lessons from the film can inform the Robert Wood Johnson Foundation’s efforts to build a Culture of Health.

Here are some highlights from our conversation (edited for clarity and length):

So my first question to you, Raj, is how did “The Ants and the Grasshopper” come to be? What's the story behind the story?

Raj Patel headshot. Raj Patel, director of The Ants and the Grasshopper, is a James Beard Award winning activist and New York Times bestselling author. (Photo: Sheila Menezes)

My academic research has been filled with privilege. The greatest of these privileges was spending a great deal of time in the company of farmers’ movements and frontline communities around the world who have experienced, and innovated around, the big problems of the food system. Yet the media coverage I was seeing on the food system invariably painted those communities as victims, not as innovators. It was a story I very much wanted to tell, and I was lucky enough to start this project under the wing of Steve James, the director of the groundbreaking documentary Hoop Dreams.

Steve came with me to Malawi in 2011, when we started scouting out the community. I got up at the front of a big tent and announced to everyone, “We're here to tell your story.” Various village leaders replied, “We're very pleased that you're here from America to tell our story.” And then there were three women at the back of the room who were just sassing everybody. Steve's camera panned over to those women, and Steve said, “One of these three women is going to be the one who tells the story. They’re not true believers. They’re strong and skeptical and independent.” He was right. Anita was one of those three women, and her story became the heart of the film.

Anita shares so many poignant ideas. At one point in the movie she states that men everywhere are worried about women becoming as powerful as them, but the best men know that when women are powerful, everyone is better off. Another really powerful statement she shares is on the future of our children... “We all want a future for our children to stay well.” I found it so moving and so universal.

Me too! And she holds that view despite understanding the inequities facing children within the United States and around the world. Anita is a pessimist of the intellect and an optimist of the will. She's not unrealistic about her view of the United States and how irresponsibly we're tackling climate change. She isn’t filled with abundant optimism about the end of white supremacy. But she understands that we still need to fight for a world for all our children. That inclusive vision is accompanied by a deep insight: You can't fix these problems by taking small measures. Capitalism, patriarchy, white supremacy, and climate change are big problems, and they need big solutions.

The film eloquently depicts the connection between racial equity, gender equity, climate change, and patriarchy. Why was it important for you to show these connections?

Too often, we imagine change in the food system as merely a dietary shift, not as a shift in power. This kind of thinking, stuck in a silo away from discussions of power or of other social issues, profoundly limits action and success. Malawi’s great innovation was recognizing that ending child malnutrition involved ending patriarchy. That’s an insight that’s rare enough anywhere. That it comes from Malawi may be a particular surprise for those in the Global North who don’t understand how social innovation works, and who hold some preconceptions about who’s allowed to be a social innovator.

What impact have you seen from the film, both through the process of creating it and then sharing it with the world? Does the response help shape the discourse, both nationally and globally, around things like sustainable food systems and health and gender equity—all the issues that the film so deeply touches?

We always had two kinds of audiences here. One was the sort of dyed-in-the-wool food, or climate- or social justice advocates in the United States who are thinking about their issue in a silo. What we were excited about with this film is that it shows that you can't separate these things out into, ‘oh, this is a gender issue, this is a capitalism issue, this is a race issue, this is a climate change issue,’ because they're all smooshed together. A range of these organizations have found this film useful in explaining and sort of educating at the intersections of race and gender and climate and class and history.

Then there's another community that we're very excited about working with, and that's the faith-based community. For me, one of the big revelations in this film was the language of faith and how important it is. Anita speaks in the language of a prophet, and her words resonate with faith-based communities. So, we're working with an impact group called Peace is Loud to make this film available to a range of faith-based organizations, particularly Christian ones in the United States and around the world. And we're excited that there's already quite some buzz from evangelical communities in the United States about it.

Thank you Raj, I hope and believe we will continue to see the ripple effects of this film.

The lessons learned from Anita and the people in her village will remain with me. My hope is that by learning from one another, we can see a future where everyone can thrive. As Anita said in the film, “So much has been lost, but it’s never too late to change.”

Find out how you can host a screening of “The Ants and the Grasshopper” in your community.


About the Author

Jamie Bussell

Jamie Bussel, a senior program officer who joined RWJF in 2002, is an inspiring, hands-on leader with extensive experience in developing programs and policies that promote the health of children and families.

Thu, 3 Feb 2022 13:00:00 -0500 Jamie Bussel Child and Family Well-Being Health Disparities International <![CDATA[This Valuable Data Tool Informs Policies that Shape Child Opportunity]]>

Millions of children live in neighborhoods with limited access to safe housing, green space, or good schools. Data can inform efforts by local leaders to build a brighter, more equitable future for all children.

Child Opportunity Tool blog graphic.

The pandemic has underscored how profoundly factors like where we live, our income, the kind of job we have, and our race and ethnicity affect our health, well-being, and ability to prosper. Some families and children in the United States have had the resources to weather this storm. But far too many have struggled to meet their basic needs. A poll from late 2021 found that about half of households with children had no savings to fall back on. Significantly more Black and Latino households with children and households with incomes below $50,000 reported not having this buffer.

These are not individual failures. They are societal and systemic—stemming from the pervasive and persistent harm caused by long-standing racism, redlining, and segregation. They affect immigrant families, too, who have trouble accessing social safety net programs, even if they are U.S. citizens.

To advance equity for all, we must address child poverty, unequal access to education and healthcare, and environmental conditions for what they are—structural and systemic in nature. Change can start in your backyard.

Mapping Opportunity With the Child Opportunity Index

As a researcher who has studied the effects of residential segregation, redlining, and poverty for more than 20 years, I know that data is essential to helping us understand what we can do to build a better future for our youngest generation. In January 2020, my team and I updated the Child Opportunity Index (the Index) to help researchers, city planners, community leaders, and others identify and address inequities in their metros. It measures access to factors that affect children’s health and well-being, from safe housing to green spaces to good schools, at the census tract level.

The goals: to show how neighborhood conditions impact health and well-being, and to pinpoint exactly where we need to drive more resources to ensure all children have what they need to thrive.

Over the years, my team and I have worked with organizations and experts from across the country to help them use these data to shape policy changes on all scales, from the neighborhood to the federal levels. Here’s how some have used the tool to advance equity in their backyards:

Healthcare providers have used the data to understand what their communities need. The Children's Hospital Association, a national organization representing more than 220 hospitals, integrated the Child Opportunity Index into its data and research systems. This has allowed physicians and researchers to think about how addressing low neighborhood opportunity might reduce inequities in health outcomes for children they work with.

Some hospitals are using the Index in their community health needs assessments to identify and better serve lower opportunity neighborhoods, which often bear a disproportionate burden of children’s health problems. For example, Children's National Hospital in the Washington, D.C. area has prioritized serving neighborhoods with a very low opportunity score and a child population of at least 1,000.

Cities and towns have brought in the data to understand how built and natural environments affect quality of life. In Akron, Ohio, the Child Opportunity Index was used as part of the city’s State of Canopy report, which is laying the groundwork to increase equitable access to shade trees.

Massachusetts used the Index to figure out where low-income families receiving housing assistance can move to find better opportunities for their children. Their housing mobility program used the Index to help families use their housing vouchers in higher opportunity neighborhoods. It also works with landlords to make their participation in the program a success.

Inequities run deep—they are ingrained in our systems, structures and institutions. While we need to address the root causes of our biggest societal challenges—systemic racism, for one—to advance equity, we can also work with tools like the Child Opportunity Index to design, improve and implement more equitable policies from the neighborhood to the national level.

Explore the Child Opportunity Index mapping tool to understand what children and families are experiencing in your community. Share your findings and use them to drive equitable change.



Dolores Acevedo-Garcia is the Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy, as well as the Director of the Institute for Child, Youth, and Family Policy at Brandeis University.

Tue, 25 Jan 2022 11:00:00 -0500 Dolores Acevedo-Garcia Child and Family Well-Being <![CDATA[Protecting Employee Health in Tomorrow’s Workplace]]>

The pandemic, renewed attention to racial justice, climate threats, and evolving technology herald huge changes in the nature of work. To center equity in that shift, policies, practices, and culture need to change, too.

Future of Work illustration.

When the COVID-19 pandemic took hold in early 2020, the workplace almost instantly transformed. Many people began working remotely and long commutes vanished. Despite heightened anxiety and danger, the public health emergency ushered in unexpected benefits for some in the form of flexibility, accommodations to family life, and recognition of “whole person” needs.

In frontline settings, such as healthcare, grocery stores, public transit systems, and manufacturing sites, the situation was drastically different. While the workers who kept these essential services operating were rightly touted as heroes, many had little choice but to risk infection, hospitalization, and death to keep the lights on for the rest of us.

These very different experiences show the challenges we face as the structure and nature of work evolves. How the risks and opportunities are distributed in that emerging future will largely depend on the decisions we make as a society.

Drivers of Disruption

Well before the pandemic, technology was reshaping work. Some workers—those in knowledge and creative industries—saw benefits. Other workers—often those in frontline positions—found it was getting harder and harder to make ends meet, even with a full-time job.

Robotics, artificial intelligence, e-commerce, and data analytics have been potent disruptors. One MIT study found that each robot deployed in a manufacturing setting replaced an average of 3.3 workers. Another study, from the University of California Berkeley Labor Center, found that warehouse automation made jobs harder and more dangerous, putting Blacks and Latinos, who are disproportionately represented in these settings, at particular risk. At the same time, new business models are leading employers to shift to contractual or hourly wage arrangements, reducing worker benefits and introducing unstable schedules, which are associated with poor health.

Just as COVID-19 was making those different experiences with work evident to all, the murder of George Floyd sent shockwaves across the nation, generating widespread outrage and a long-overdue conversation about race in America. Under pressure to confront the starkest truths about racism, some business leaders began to examine their hiring and promotional practices and the culture of their workplaces.

Formal commitments to diversity, equity, and inclusion, difficult discussions about how to build an anti-racist workplace, and new training and capacity-building initiatives have followed. Two thousand CEOs have made specific commitments to pursue change through CEO Action for Diversity and Inclusion while major retailers have pledged to spend 15 percent of their total purchasing power on products from Black-owned businesses. Many Americans believe such steps are vital—more than half of adults surveyed in a Harris poll said they would consider leaving a company that did not speak out against racial injustice.

The worsening impacts of climate change, which does its greatest harm to vulnerable populations of color, are also reshaping work. Land degradation and reduced crop yields alter the demand for agricultural labor, supply chain disruptions force shifts in the industrial sector, and intensifying heat, air pollution, and biological hazards reduce productivity and harm worker health. Health equity needs to be a primary consideration in any search for solutions.

Toward a More Equitable Workplace

All of this matters because work consumes roughly half our waking hours—often more, especially for those struggling to pay rent or support their families. Workplace conditions, the stress engendered by bias and discrimination, compensation that determines whether housing, education, healthcare, and childcare are affordable, and accommodations for personal and family illness all have an outsized influence on health. A mix of public policies and private sector action is essential for the workplace of the future to contribute to a Culture of Health.

Basic safety net measures help shield workers from some of the most damaging consequences of the evolving workplace. People who work 40 hours or longer a week should not be too poor to afford housing, food, and healthcare. But many are, given the federal minimum wage of $7.25/hour, which is also the floor in 21 states.

Beyond a living wage, strategies are needed to support the care economy so that caregivers are protected and workers can stay on their jobs knowing that their children, elders, and ailing family members are safe. Many companies demonstrate that benefits such as paid sick days and family leave are compatible with the bottom line. A JUST capital study identified 100 companies within the Russell 1000 stock market index whose policies support healthy communities and families—and found that they generated a higher average return on equity. Health-focused workplace policies can also ease employer burdens by reducing absenteeism and turnover, increasing productivity, and lowering insurance costs.

The Work Design for Health toolkit, developed in partnership by Harvard and MIT, offers a path forward with evidence-based resources for redesigning workplace practices and relationships to support employee health and wellness. The toolkit is built around three core principles:

  • Give employees more control over their work, including greater autonomy over how they do their jobs, scheduling flexibility, and opportunities for influence.
  • Tame excessive work demands by providing more resources, including improved training, psychological support, and strategic staffing increases, and by identifying opportunities to streamline work processes.
  • Improve social relationships in the workplace. Strategies include fostering supportive relationships with supervisors and coworkers, promoting a sense of belonging, especially for historically marginalized and underrepresented individuals, and creating conditions for effective teamwork.

The center of these and any measure to support worker health must be equity. As we think about what work will look like in the future and how we should prepare—now, over the next few years, and in the decades to come—we need to act intentionally to ensure that the accompanying opportunities are shared fairly.

Learn more about how organizations can make sure work itself is promoting wellness. 


About the author

Paul Tarini

Paul Tarini, senior program officer, focuses on exploration, discovery, learning, and emerging trends that are important to building a Culture of Health, as well as fostering connections between health and healthcare.

Thu, 13 Jan 2022 11:00:00 -0500 Paul Tarini Child and Family Well-Being <![CDATA[Uprooting Racism to Advance Health Equity]]>

Can we break free from a history of racism that has taken a brutal toll on health? These trailblazers offer hope through their efforts to advance racial justice and health equity.

Race, Health and Equity

In 1966 our nation’s great civil rights leader, Dr. Martin Luther King Jr., proclaimed that of all the forms of inequality, injustice in health is the most shocking and inhuman. All these years later, this remains painfully true.

Study after study documents racism's brutal impact on health. Compared to White women, Black women are 3 to 4 times more likely to die in pregnancy, childbirth, or within a year after giving birth; Indigenous women face that prospect 2 to 3 times more often than Whites. Black and Latino adults disproportionately report being treated unfairly in healthcare settings because of their race or ethnicity and Blacks experience adverse patient safety events more frequently, even in the same hospital and with comparable insurance coverage. Even the consequences of climate change do their greatest damage to people of color, who are consistently exposed to higher levels of air pollution, live in hotter neighborhoods, and face greater food insecurity as agricultural patterns shift.

The impact of structural racism—the system in which our nation’s policies, institutional practices and cultural representation perpetuate racial inequity—became glaringly more visible during the COVID-19 pandemic and the racial reckoning that followed the anguishing murder of George Floyd. In an important step to advance racial equity and justice, many states and cities across the nation have declared racism a public health crisis.

As we enter a new year, we are highlighting past Culture of Health blog posts that offer solutions and hope for the future. Our contributors share many lessons from their work to dismantle structural racism and remove barriers to health. We celebrate their tireless commitment and determination to help build a more equitable nation.

Derek Hamilton It’s clear that the stigma and burden of overcoming racist structures leads to pernicious health consequences. —Darrick Hamilton

The wealth position that a child is born into will shape opportunity, outcomes and health throughout life.

These are the words of Darrick Hamilton, founding director of the Institute for the Study of Race, Stratification and Political Economy at The New School. Dr. Hamilton has gained national recognition for shaping policy solutions to close the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black families of resources that accumulate and transfer from one generation to the next. The typical White family has 10 times the wealth of the typical Black family and seven times the wealth of the typical Latinx family. This stark and persistent racial wealth gap has harmed generations, driven disparities and appears to be growing, even after controlling for household characteristics and long-term education and income gains by Black people. He shared powerful insights on how to shape policies and practices that empower Black people to ascend the ladder of economic prosperity.


The false, harmful stereotype of the "absent Black father" dishonors the powerful contributions Black men make to their families and society. 

Our colleague Dwayne Curry refuses to let structural barriers interfere with his role as an engaged, supportive father and the aspirations he is helping his family attain. He shares his experience growing up in Newark, New Jersey, "where norms for a Black child, a Black young adult, and a Black man could be stifling. The limits were very clear on what society deemed appropriate for a Black man, and how you were supposed to interact with others. I was never comfortable with those unwritten rules." He explains the importance of supporting Black fathers with changes in policy, culture, and leadership to help all families thrive.


Cindy Howe There are two million people without running water in this country, most of them in communities of color. —Cindy Howe

In the midst of a pandemic, more than 30% of Navajo Nation families in New Mexico have lacked running water

Many have driven hours along rutted roads to haul clean water back home. Broken promises and structural racism explain this glaring injustice, which has persisted for generations.

Cindy Howe grew up in the Navajo Nation and is helping to change that, one family at a time, through her work with DigDeep. She shares: "My own family had running water when I was growing up, but many of my friends did not. I want to see that change. My hope is that one day the homes of every Navajo person will be hooked up to a water system, with indoor plumbing, a really nice shower, a commode, and a sink. That is what I wish for my tribe and indeed for all in America."


One community is on a mission to ensure that race is no longer a predictor of success.

Kimm Campbell is assistant county administrator at Broward County Government in Florida. She describes how she is "a Black woman adopted from the child welfare system by White parents, and I’ve been aware of the fight for racial equality all my life. But it wasn’t until five years ago that, in the course of my work, I started focusing on equity. This is the idea that we must adjust resources, transform systems and remove obstacles to create fair and just opportunities and outcomes for Black, Indigenous and other people of color (BIPOC) so that they are supported toward success."

Campbell is leading efforts to address systemic racism through a multi-faceted strategy that includes comprehensive racial equity training, facilitated conversations designed to put antiracist ideas into practice, business engagement, and equity liaisons in schools. More than 3,000 community members have already received the training.


Maria Gomez Being transparent has been essential...I admitted when I didn’t have answers. I stressed that we were in this together. —Maria Gomez

How do you plan an equitable COVID-19 vaccine rollout?

This challenge intensifies when those who would benefit most have endured the health consequences of structural racism and discrimination for generations—including at the hands of our nation's medical and public health systems.

Trailblazing leader Maria Gomez is a public health nurse who founded Mary’s Center, an innovative community health center in the D.C. region that has been using an integrated model of health care, education, and social services for more than 30 years. She shared five important lessons she learned while vaccinating a diverse community.


Community health workers are becoming a powerful force for achieving health equity.

If you haven’t walked in the shoes of the person you are working with, you are more likely to be biased, says RWJF Award for Health Equity Winner Shreya Kangovi who is a primary care doctor in Philadelphia, a health policy researcher, and a professor working to advance health equity. Community health workers get to know their clients as human beings because they share many of the same life experiences and understand what it means to face injustice.


A shameful history of anti-Asian policies rooted in systemic and structural racism has created stark gaps in health, wealth, and well-being.

Our colleagues Mona Shah and Tina Kauh discuss the “model minority myth,” the importance of disaggregating data to understand differences within the Asian community, and the value of conversations across races to curb bias and violence against Asian American communities.


Sandro Galea, dean of Boston University School of Public Health, shares how his experience as an immigrant from Malta has shaped his perspective.

“Those of us who are not native born bring a distinctive lens to the legal, physical, and symbolic barriers that exclude some people from full participation in American society. Our personal awareness of how structures and systems are set up to sideline certain populations readily translates into an unyielding sympathy for those who cannot access power and privilege.”

He discussed how choosing love to advance health and racial equity begins with acknowledging the harms that have been inflicted upon some while celebrating what we have in common and how we are stronger together.


Learn more about racism's impact on health through these resources.


About the Author

Najaf Ahmad

Najaf Ahmad is managing editor of the Culture of Health Blog where she highlights perspectives about how the Foundation is advancing health equity in communities across the nation.

Tue, 4 Jan 2022 11:00:00 -0500 Najaf Ahmad Health Disparities National <![CDATA[In Mexico, Healthy Food Is a Child’s Right]]>

Last year, Mexico took a tremendous step toward prioritizing childrens’ health by banning junk foods and sugary drinks.

A young girl at a produce stand.

“Children have the right to be in environments that are health promoting and free of unhealthy foods and drinks.” —Ana Larrañaga works with Salud Crítica, a public health advocacy organization based in Mexico City

Editor’s note: This post originally appeared on the State of Childhood Obesity website.

Last year, in the midst of the pandemic, legislators in Mexico moved swiftly to ban the sale of unhealthy foods and beverages to children.

Oaxaca was the first state to approve junk food bans.

This started as a true grassroots movement, ignited by the strong community advocacy of 13 different Indigenous groups who were determined to protect people from diabetes and obesity—and prevent the displacement of traditional foods that are deeply rooted in their culture. They fought to prohibit distributors from delivering sugary drinks and junk food to their local stores.

This sparked a domino effect. The Mexican states Tabasco and Colima soon followed suit. Many others have introduced similar bills. The laws expressly prohibit donations, sales, or supplies of sugary drinks and high-calorie packaged foods such as soda, chips, and candy to children under 18.

These bans were initially part of a strategy to regulate the food and beverage companies’ advertising tactics. But the local congresses acted autonomously to enact a nationwide labeling law that introduced warning symbols for all packaged food and beverages that are high in sugars, calories, salt, and saturated or trans-fat.

The symbols—stark black stop signs with written warnings such as “excess sugar” and “excess sodium”—must be placed on the front of the package where it’s easy to see. These warning signs will make it easier to follow the new laws, helping people to identify what is junk food, and not sell or give it to children.

Momentum for these bans was triggered by the ministry of health’s communication around COVID-19 prevention—including the important role that food plays in promoting health and preventing disease. These messages about the importance of healthy eating and drinking also appeared in the media, which pointed out the health harms of consuming processed foods that are high in sugar, sodium, fat, and empty calories. The undersecretary of health even called soda “bottled poison.”

“With these bans, Mexico is taking a huge step forward in protecting and guaranteeing a child’s right to a healthy future and recovery from the pandemic.”

What is most striking about the junk food bans in these three states is that they were not conceived under the local health laws, but rather within a framework of children’s rights.

This tells us a lot about how the health of a child is viewed in Mexico, specifically related to the consumption of energy-dense, nutrient-poor foods. It’s not just a matter of health or disease prevention, but also about the right children have to be in environments that are health promoting and free of unhealthy foods and drinks.

In addition to prohibiting unhealthy products, these initiatives also aim to promote consumption of fresh, natural, traditional and seasonal foods as the first options for children. If implemented successfully, this could not only improve children’s nutrition, but also have a positive economic impact for local producers and traditional cooks.

Now, are these laws perfect? And are they applied perfectly? No.

The reality is that they have encountered quite a lot of push back from food and beverage industries. They also require a lot of political will to be carried out and monitored.

But across the country, there is general consensus that junk food and sugary drinks will not help us move forward from the pandemic.

Ana participated in the December 2019 Salzburg Global Seminar “Halting the Childhood Obesity Epidemic: Identifying Decisive Interventions in Complex Systems,” which was sponsored by the Robert Wood Johnson Foundation as part of its efforts to learn from abroad to improve health and well-being in the United States.


About the Author

Ana Larrañaga is an activist for the right to nutritious food who works with Salud Crítica, a public health advocacy organization based in Mexico City. She believes all children have the right to be in environments that are health promoting and free of unhealthy foods and drinks.

Tue, 7 Dec 2021 13:00:00 -0500 Ana Larrañaga Childhood Obesity Early Childhood International <![CDATA[Transforming Rural Health Through Economic Development]]>

The challenges and opportunities for rural America are complex. While rural economic development has come a long way in the last 40 years, we still have a lot to learn. 

Aerial image of a rural town.

RWJF’s Maryam Khojasteh sat down with Janet Topolsky, who served as the executive director of the Community Strategies Group at the Aspen Institute, to discuss rural economic development, the challenges and opportunities facing rural America, and what the future holds for improving rural economies. Topolsky, who stepped down after a 40-year career working on developing opportunities and capacity in rural America, oversaw the development of the Thrive Rural framework, an effort begun by the Aspen Institute Community Strategies Group (Aspen CSG) in partnership with the University of Wisconsin Population Health Institute with support from the Robert Wood Johnson Foundation. The Thrive Rural framework aims to organize learning, strengthen understanding, and catalyze and align action around what it will take for communities and Native nations across the rural United States to be healthy places where everyone belongs, lives with dignity, and thrives.

Over your career, what are some ways in which community and economic development has evolved to foster health and equity in rural America?

There is a larger understanding of the mix and strength of what truly constitutes the basis for development, essentially the multiple assets in any community, beyond just financial capital. The individual assets or skills and health of individuals who are making decisions, working and providing services; the intellectual assets of what a place knows how to do; the natural assets like air and water and the health of natural resources that rural economies depend on; the built assets, including infrastructure; the cultural assets; the political assets; and the social assets and how well people work together. Every rural place and economy and community has a different variety and volume of assets—but they all have assets to build on.

There's also a growing understanding that the disparity in wealth is even greater than the disparity of income, and that the ability of families as well as communities to get ahead, depends more on wealth and having stocks of wealth than on income.

Janet Topolsky In many ways, rural America is an “essential worker” for the nation. It stewards natural resources in ways that are not compensated fairly and provides all kinds of resources the nation needs... —Janet Topolsky

There’s a tendency to lump rural America together and assume there's a one size fits all solution. What do developers, funders, policymakers, and the public, get wrong about rural places?

An appreciation for the diversity of what comprises the economic base in different rural regions. I love popcorn but I’m tired of photos of cornfields representing rural America. A larger percentage of rural workers are engaged in manufacturing than in agriculture, but we continue to depict rural America as mostly farmland.

People also don’t understand who lives there. One in five people live in rural areas, and 20 percent are people of color; many immigrants who are new to the country are living in rural areas.

In almost every racial category, the percentage of the population in poverty is higher in rural than in urban places. You can't address economic or racial disparities without focusing on rural places.

People also don't understand the interdependence of rural and urban. In many ways, rural America is an “essential worker” for the nation. It stewards natural resources in ways that are not compensated fairly and provides all kinds of resources the nation needs, whether it's food or energy or water; and it provides a lot of productivity and skilled workers and leaders in many sectors.

Finally, people don’t value rural places as sources of innovation. Rural too often is an afterthought baked into elements of policy and program design.

You've noted that development fails if it doesn't include everybody. How important is local ownership to this work or making sure those who are most affected are at the table?

This is human-centered design. If I'm trying to make something better, I can choose to imagine in my mind what the problem is and then deliver the solution that I think will work. But it likely will not work because I didn't ask the people the solution is supposed to help about what their real barriers are, and what design elements are essential to catalyze a solution that works.

You’ve heard the phrase "Nothing about us, without us." Another rephrasing of this that I've heard from a community activist is: "If it's for us, without us, it's not about us." We need to take that to heart. Can we consult? Can we share the power for co-designing? Can we respect the wisdom of the people we're trying to help? And can we meet people where they are?

How has Thrive Rural approached inclusion when it comes to working with tribal lands and nations under the broader definition of rural? How did you come to see these differences in practice and what they mean for rural development?

The Thrive Rural framework is a tool to organize learning, strengthen understanding and catalyze and align action around what it will take for all communities and Native nations across rural America to be healthy places where everyone belongs, lives with dignity, and thrives. The tool includes a specific focus on dismantling practices and behaviors and policies that—intentionally or unintentionally—discriminate against rural based on geography/size or race or class.

We've just released Thrive Rural Field Perspectives briefs—ideas and experience from practitioners and experts that offer new ideas for rural progress. One focuses on Native nation-building as a critical early–action element in improving tribal area economies, and why honoring and supporting nation-building, recognizing, and valuing tribal sovereignty and each tribe’s unique governance structure, and embracing their culture, traditions and practices is vital to rural development.

In a chapter in a book from the Federal Reserve Board and Federal Reserve Bank of St. Louis you discuss your turning points for doing rural development differently. What were they?

Every community has a different starting point. And you must learn how to connect and leverage their assets at that starting point. Start with local analysis and know-how in the room to identify the starting point of the assets in a place. How do people in the area interpret what's true about the community and what will unleash more action? And, bring more voices into the room who can share experiences and expand opportunities.

Then assess what do people and key actors in the region already know how to do or make—or what could they most likely adapt and what is the demand. Identify the action or resource gaps that can meet that demand, and fill in those gaps with local enterprise, build local capacity with new learning, and use local assets and energy to leverage in essential partners to help.

Finally, intentionally design with equity at the front end and measure for outcomes that strengthen, not significantly deplete (or destroy) local assets; increase equality; and build local ownership and control.

Can you discuss the role that Rural Development Hubs or intermediaries play in building wealth, increasing capacity and creating opportunities?

In rural places you've got dots of small communities that may be miles and miles apart, but they all think they're part of the same region. And that region is one they self-identify with, whether it's because of geographic similarities, a similar history, commuting patterns, industries, media markets or economic base. All kinds of things may make you feel like, “I live in The Thumb” in Michigan but there is no “government of The Thumb.” There's no one who develops or improves the region of The Thumb unless they create it themselves. There's logic to work regionally but no formal institution to do it.

Through an RWJF grant we talked to 45 of what Aspen CSG calls Rural Development Hubs to understand how they do this work and what are the challenges. We learned that there are various organizations that have, in some rural regions, taken up the mantle of working across a region on critical issues and bringing a region together to address them together. We've got to strengthen these hubs absent any other structure and create or catalyze them when they don't exist.

Looking down the road what are the key things you’d like to see for the rural development field going forward?

  • Coalescing in all fields around what the true outcomes of development should be, including how and what we measure for success. This is especially important for reducing health, wealth, social and racial inequity.
  • Organizing and leveraging a collective rural voice in the design of programs that affect people in rural places, at the local, state and national levels. People have started collaborating to benefit rural. That should be formalized.
  • Addressing climate and related natural disasters as an opportunity so local people can understand and act on. This is an opportunity for the future for improving health, future livelihoods and the economy, and all built and natural capital.

Learn more about Thrive Rural which aims to build stronger rural and regional economies, more inclusive rural communities and healthier rural people.


About the Author

Maryam Khojasteh focuses on developing, managing, and implementing rigorous and evidence-based research to advance health equity and promote a Culture of Health.  

Wed, 17 Nov 2021 11:00:00 -0500 Maryam Khojasteh Public and Community Health <![CDATA[Four Ways to Support Men in Solving America’s Caregiving Crisis]]>

Caregiving is one of the greatest challenges of our time, with significant implications for families and our economy. 

Men and children illustration.

The pandemic has exacerbated the struggles facing many who care for children, aging relatives, loved ones with disabilities, and family members who are sick with COVID-19 or other illnesses. With long-stalled federal investments in a care economy, paid family and medical leave, and other policy and workplace reforms under consideration, my colleagues and I weighed in on the role men can play in providing unpaid and paid care in a series of posts this year.

They are based on reports from New America that explore the cultural, legal, and other changes that would enable more men to do this essential work.

But as I wrote in April, it is also true that before and during COVID-19, men have been significant providers of care work, both within their families and in their careers.

With gender roles and intergenerational dynamics shifting, more men will be caregivers in the future, which is good not only for men but also for women and society. A series of reports produced by the New America Foundation and funded by RWJF sheds light on the caregiving experiences of nearly 3,000 men as fathers, as caregivers to relatives, and in their professional careers. Many find it immensely rewarding.

For men to succeed in caregiving professions, the culture must change. Caring professions include some of the fastest-growing jobs and it’s time to end the stigma and pressures that discourage men from entering those fields. Caregiving careers should be recognized as respectable for people of all genders.

Media, television, and popular music perpetuate this idea that Black dads aren’t in their children’s lives, and that’s simply not true. Good Black fathers do exist, but it’s taken more time for our experience and contributions to be recognized. It is so important and powerful for a child to have a father figure. I see that my kids’ view of fatherhood is being shaped by what they see in me... Many obstacles prevent fathers from being fully present in their family's day. Because of the environment I grew up in, I intimately understand the forces holding people back. I’m referring not just to a culture that only encourages men to pursue a very narrow set of traditionally masculine career paths, but also systems that make it difficult for men to take time off when they have a new baby or a sick parent. There is no question that policymakers can do more to break down those barriers with reforms like paid family leave. There’s a role for employers here, too...

I’ve also seen what male caregiving can do to help a family grow and thrive... As someone who has been impacted by false narratives, and is working to bring about a new one, I’m grateful to be involved in this work. In my life at home, I know that I may not always have the perfect words to express how I feel on command, but my children know that I love them, and my wife does too, because I show them every day. There is nothing more important to me than that.

The pandemic has caused a reckoning in our country regarding caregiving. RWJF managing director,  Program, Jennifer Ng'andu interviewed Brigid Schulte, who directs the Better Life Lab at the New America Foundation, about reports on men and care work. They discussed how men overwhelmingly value care work but lack supportive workplace cultures and public policies. The reports underscore the need to counter the cultural narrative that caregiving is exclusively women’s work and to advance equitable policy solutions.

We spoke to men who are nurses, childcare workers, and home health aides. They are proud of their care work and find it challenging and fulfilling. Yet one in five reported feeling stigmatized as caregivers just because they’re men... Women are still expected to serve as primary caregivers for family members—from infants to elderly family members. These outdated views... prevent women from advancing professionally... [and] prevent men from being the active and engaged caregivers that our research affirmed they want to be.

Having an accurate picture of how gender shapes care and caregiving at home and in the care economy, and understanding the motivations, goals, and barriers experienced by those who are engaged in these roles, are essential building blocks to creating the necessary new policies, workplace practices and cultural norms that will lead to a stronger, healthier and more equitable future.

4.    Adopt innovations tested in other countries.

Another study by Better Life Lab and RWJF reconfirms that the U.S. status quo of gender roles, both at work and home, is not working for many families. Men are missing out on caretaking roles that enrich their lives and enhance bonds with loved ones, while women are struggling with role overload, feeling unsupported, and missing out on income and economic mobility. The U.S. can learn from the many other nations that are advancing gender equity through solutions like paid leave that benefit health, child development and family well-being, and advance racial equity.

In Sweden, lawmakers redesigned paid leave policies with individual entitlements. Rather than a gender-neutral default, each parent received a specific amount of leave. That meant that if fathers did not take their portion of leave, the balance could not be transferred to the mother, and the family would lose out... This “use it or lose it” policy change resulted in Swedish paternity leave acceptance rates skyrocketing from 5 to 90 percent within a few short years...

When policies are carefully designed to account for the cultural resistance and stigma associated with men investing their attention and energy into their children, they are especially effective. When cultural stigma and financial punishments are removed, men can and do engage in care work...

Real solutions to support men, women and people of all genders who care are not out of reach here. We—as a nation—just have to be willing to find them and make them a reality.


About the Author

Gina Hijjawi, PhD, senior program officer, Research-Evaluation-Learning, joined RWJF in 2018. With her deep commitment to bridging systemic gaps in children’s health and social services, she values “the opportunity to advance understanding of how child and family serving systems, environments, and policies can support the healthy development and well-being of all children.

Tue, 9 Nov 2021 11:00:00 -0500 Gina Hijjawi Child and Family Well-Being <![CDATA[How Local Leaders Can Create Socially Connected Communities]]>

Simple steps, guided by input from community members, can help reduce social isolation and improve health, well-being, and civic engagement.

Social Connection infographic.

What happens when young men and boys of color aren’t able to be themselves in any setting? 

In San Diego, refugees from East Africa commonly experience discrimination, racism, and Islamophobia. Young men and boys, in particular, describe how they have to act one way in school, another way with friends outside of school, and another at home. It is important for the community to find ways to improve social connections, increase opportunities, and build resilience, since their social isolation can lead to unhealthy behaviors that put their health and futures at risk.

Social isolation—the lack of significant social connections interpersonally and within a community—is a “deeply consequential” public health crisis, according to U.S. Surgeon General Vivek Murthy. He noted how “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness.”

Indeed, the health risks of social isolation have been compared to those of smoking and obesity, and it is linked to depression, impaired immunity, increased suicidal tendencies, and increased risk of death. 

Like San Diego’s East African refugees, people who feel that they do not belong to majority social groups because of their race, ethnicity, religion, immigration status, gender identity or sexual orientation, for example, are most susceptible to social isolation. However, people of all ages, demographics, and identities experience isolation. In a 2018 study, more than half of adults had one or fewer confidants. And this was before the COVID-19 pandemic shuttered many of the gathering places that had served as antidotes to isolation.

Social Connection Improves Health

Leaders who strive to create resilient, equitable, and healthy communities often do not recognize the importance of social well-being, which refers to the strength of a person’s relationships and social networks. People living in socially connected communities are more likely to thrive because they feel safe and welcome and trust each other. Trusting, meaningful relationships enhance our mental, physical, and emotional health and well-being. 

In fact, strong social connections and networks can boost a person’s lifespan by 50 percent

To address the social isolation among San Diego’s East African refugee population, Prevention Institute and United Women of East Africa Support Team launched the Making Connections initiative. Participants co-developed a culturally- and community-rooted space in which to gather, connect, and support each other. Having this safe space helped them to experience a sense of belonging, and to grow their collective capacity to identify and advocate for solutions to other challenges—like a lack of affordable housing and educational and employment opportunities. They advocated for more diversity training for law enforcement and increased funding for community services, demonstrating how social connection can improve health and well-being.

Taking Action in Your Community

Communities can support meaningful social connection among residents, improve trust between neighbors, and strengthen an overall sense of belonging. 

This doesn’t require a brand new, city-wide program. Instead, you can weave opportunities for social connection into the fabric of society. After all, social isolation is not a personal choice or individual problem, but one that is rooted in community design, social norms, and systemic injustices—and must be addressed as such.

From architects to educators, faith leaders to health providers, local governments to grantmakers—everyone can help stop social isolation. 

Here are five ways to get started:

1.    Design, Maintain, and Activate Inclusive Public Spaces 

Opportunities to promote health and strengthen social connection are endless in parks, community gardens, greenways, streets, sidewalks, libraries, community centers, waterfronts, shared-use schoolyards, and the interstitial spaces around public buildings. Urban, suburban, and rural settings provide equally powerful opportunities to offer places where residents can interact, experience culture, access nature, and gain a sense of belonging.

2.    Prioritize Connection in Transportation Systems 

Safe, accessible, affordable transportation connects people to jobs, education, healthcare, child care, social services, and other resources that foster social connection and advance health. However, the United States’ transportation system prioritizes personal vehicles, which creates barriers for those who are unable to drive, cannot obtain a driver’s license or afford a car, or fear discrimination during traffic stops. A re-imagined transportation sector can spark conversation, increase engagement, and improve health and well-being. 

3.    Construct Housing Environments that Build Community

Millions of people do not have safe, affordable, stable, and healthy housing. Historically oppressive policies and practices have made homeownership disproportionately difficult for Black, Indigenous, and other people of color. Absentee landlords and discrimination exacerbate negative conditions. Unstable housing conditions weaken social networks. We must design communities with housing options that provide access to jobs and healthy food, create opportunities to build relationships with neighbors, and strengthen the sense of community.

4.    Invest in Inclusive Practices and Community-Led Solutions 

We need community-led solutions that are driven by a belief in the power of people to reshape their communities. That means local leaders who learn from and with residents, and welcome ideas from those most impacted by social systems. The engagement process itself can bring together community members who wouldn’t otherwise interact and forge stronger social connections and civic engagement.

5.    Make Social Connectedness a Community Norm

Every aspect of community life can either enhance or suppress social well-being. All sectors have a role to play, and social connectedness should be a community-wide priority and norm. When community leaders pair a Social in All Policies framework with approaches that are trauma- and resilience-informed, they improve trust between residents and leaders and open the door to a future where everyone experiences absolute belonging and social well-being. 

Building Socially Connected Communities

Imagine a socially connected community where people know and trust their neighbors and people from different neighborhoods. Where they are motivated and supported to be civically engaged. Where structures, policies, and relationships connect residents to services, resources, and inclusive spaces. And where, through signals (such as public art and signage), people see themselves represented and feel welcomed. 

The Making Connections participants share this vision. They recently organized hiking groups to change the perception of who belongs in parks and other recreational spaces. In addition to expanding health-enhancing opportunities, they are now collectively raising their voices to create a culture of dignity and respect for all, so that everyone experiences absolute belonging.  

At this pivotal moment, it is especially important to create socially connected communities. Together, we can address traumas caused by structural and systemic oppression and build more cohesive, resilient, and equitable communities where everyone is able to thrive. 

Read Socially Connected Communities: Solutions to Social Isolation which describes these five recommendations in more detail. 


About the Author

Risa Wilkerson is executive director of Healthy Places by Design, a nonprofit consulting group serving philanthropy, nonprofit, and community-based organizations across the United States. Risa provides overarching guidance and strategic vision to fulfill the organization’s mission of advancing community-led action and proven, place-based strategies to ensure health and well-being for all.

Mon, 1 Nov 2021 13:00:00 -0400 Risa Wilkerson Public and Community Health Social Determinants of Health National Community Health <![CDATA[How Love and Hate Influence Health and Racial Equity]]>

To provide color and context for RWJF’s call for racial equity research, physician and epidemiologist Sandro Galea shares personal and professional insights on why we must turn to compassion and evidence-based action to heal the nation.

Girl with umbrella. Photo Credit: Pixabay, Yumu Hunzhu CDD20

Love and hate are not always words that come first to mind when we consider strategies to advance health and racial equity. But as I watch the divisions that continue to tear people in America apart—and bear witness, too, to the compassionate love that creates space for community—I have become convinced that these are foundational influences.

I have quoted the poet W.H. Auden on the brink of World War II to highlight the stakes. “We must love one another or die,” he wrote. Seven simple words that should guide us, both as individuals and as a collective force, in deciding what to say and how to act.

If talk of the redemptive power of love sounds abstract, let me explain just how directly it influences the Culture of Health at the core of the Robert Wood Johnson Foundation’s mission.

Overcoming “Othering”

Choosing love to advance health and racial equity starts with acknowledging both the harms that have been inflicted upon some populations and a celebration of all that we have in common and how we are stronger together. Then we must move from acknowledgement to action, confronting the structures that have undermined equity and removing barriers to opportunity. The starting place is respect and acceptance, and only then can we journey on toward equitable access to opportunities for health and well-being.

The polar opposite of love is hate. Sometimes, that is expressed overtly, through violence and cruel rhetoric, but often, it lodges in the more subtle forms of discrimination embedded in our systems, policies, and practices. Racism, an antithesis of compassion, has been a dominant form of hate in this country for centuries, marginalizing people on the basis of a single characteristic, the color of their skin. Hate is expressed in other ways, too, as when individuals elevate a single identity, value, or point of view above all others or when institutions discriminate on the basis of gender, religion, immigration status, or sexual orientation. All of that allows us to “other” people, a mindset that makes it easy to see them as less deserving and thus justifying disparities in access to healthcare, education, housing, and so much else.

The counterweight to the forces of hate must be love. By fostering compassion and reminding us of our shared humanity, love can clear a path through social, economic, and environmental inequities. Turning to love means refusing to tolerate injustice anywhere, to anyone, and instead embracing diversity and inclusion. When a broad mix of people with differing perspectives and lived experiences participate fully in the process of analyzing challenges, generating ideas, and making decisions, the conditions to pursue equity are ripe. But frustration, rage, and the spread of misinformation too often blinds us to our common cause. A reluctance to hear opinions across the political spectrum can close doors. If we are unwilling to listen to those with whom we vehemently disagree, we not only minimize their concerns, but also lose the opportunity to sharpen our own thinking.

My Story

My own life, blessed by privileges that so many others have been denied, has taught me much about the forces of love and power. I am profoundly grateful for the opportunities I have had in this country, but as an immigrant who came to Canada from Malta at the age of 14 and then moved to the United States in my late 20s, it would be naïve to pretend my path was burden free. I do not talk readily about some of the slights I encountered on that journey, and that I continue to encounter, in part because I know that others have endured so much worse. But let me share one story that speaks to the careless treatment of those who are perceived as different.

In high school, my English teacher kept grading my essays with a C-minus. I could not understand why—until I realized he was not actually reading them, but rather assumed they could not be well written because I spoke with an accent—as I do to this day.

My experience as an immigrant has allowed me to see the world through the eyes of an outsider. Those of us who are not native born bring a distinctive lens to the legal, physical, and symbolic barriers that exclude some people from full participation in American society. Our personal awareness of how structures and systems are set up to sideline certain populations readily translates into an unyielding sympathy for those who cannot access power and privilege.

An Imperative to Advance Collective Healing

The COVID-19 pandemic is a perfect example of the health-damaging consequences of being so locked into our mindsets that we are unable to talk to one another. It is hard not to wince at the schisms that have allowed so clear a societal benefit as vaccines to become a divisive tool. But if their safety and effectiveness is clear to most of us in public health, the intensity of the resistance in some quarters tells us not only that we are deeply fractured, but also that we have enormous incentives to come together. Dismissing people who are mistrustful of vaccines undermines our ability to articulate counterarguments and change minds.

And here I think we have to consider the nature of power and its role in shaping our thoughts, desires, and beliefs. Too often used to amplify and reinforce the societal inequities that generate a wellspring of anger and suspicion, power can also be applied to advance the collective good—to spread love, not hate, in our communities. Wielded properly, power can be a tool to alter the structures that have preserved racism, intensified economic disparities, and harmed so many. For example, researchers have identified ways to identify policy interventions that minimize economic and health disparities. Another study finds early evidence that guaranteed income improves health and well-being in a medium-sized city. We need to seek innovative opportunities to inform decision making and catalyze the structural changes that enable racial and health equity.

A Funding Opportunity: Innovative Research to Advance Racial Equity

“Othering” mindsets, my experience as an immigrant, power dynamics: All of these have very much informed the ways in which I think about health, and how I perceive the impact of marginalization and hate-fueled racism. RWJF’s Evidence for Action (E4A) program encourages and supports innovative, rigorous research on the impact of programs, policies, and practices on health and well-being, focusing on research that will help advance health and racial equity. We already know that racism is detrimental to health and are not looking for science to re-establish that unassailable fact. Rather, we want to know exactly how structural racism expresses itself and what we can do to confront it. 

That is the focus of Evidence for Action’s new funding opportunity. We seek proposals on a rolling basis that studies how we can dismantle unjust systems and practices. We want to hear ideas from a wide range of people—researchers, practitioners, community leaders, advocates, policymakers—and we welcome multidisciplinary teams. 

Together, we can move toward health and racial equity by focusing on the foundational and structural drivers of health. Learn more and apply today



Dr. Sandro Galea is the dean of the Boston University School of Public Health. He is the former Chair of Epidemiology at the Columbia University Mailman School of Public Health, among other leadership positions, and author of the forthcoming book, The Contagion Next Time.

Wed, 27 Oct 2021 13:00:00 -0400 Sandro Galea Health Disparities National <![CDATA[Parks and Green Spaces, For the People and By the People]]>

Communities should be empowered to create safe, green, vibrant spaces and parks that everyone can access. Read how a group of citizens worked to support park equity, and how you can play a role, too.

A boy plays on a seesaw in a park.

The first time I visited Elm Playlot was on a bright, sunny afternoon in May 2007.

Elm Playlot is a small, one-half acre pocket park in the heart of Richmond, California’s “Iron Triangle” neighborhood. It is one of the few city parks and playgrounds in the Iron Triangle. The park serves a densely populated, diverse neighborhood that I knew was chock-full of children. However, when I visited Elm Playlot that afternoon in May, I didn’t see a single child playing there.

It wasn’t hard to figure out why.

A group of men sat on Elm Playlot’s benches drinking alcohol. The play structure and swings were tagged top-to-bottom with graffiti and menacing gang slogans. Litter was piled up around the picnic tables, the slide, and the swings: broken glass, hypodermic needles, cigarette butts, used condoms, empty liquor bottles.

Later, in conversations with community residents, I would learn that parents had regularly told their children not to play at Elm Playlot; it was too dangerous.

In 2009, the city of Richmond raised $300,000 in grant funding to renovate the park. Then, the city followed the same established “Design-Bid-Build” process used by virtually every city in America to build or rebuild parks. In this process, all key design decisions come from city officials outside the community, and contractors from outside the community bid on the construction.

The community’s role? Except for a handful of community meetings, which are organized and run by city staff and design professionals, local residents—experts in their own neighborhood—are expected to enthusiastically and gratefully participate in the park’s design phase as unpaid volunteers.

This well-oiled process rarely results in the creation of parks as vibrant community hubs or safe, green places for children to play.

One week after the city completed its Design-Bid-Build project and Elm Playlot reopened for public use, the new play structure was covered with spray-painted graffiti. A few days later, someone tried to light the entire play structure on fire. And within weeks, the men were back, sitting together on the sparkling new park benches, drinking.

This is not an atypical result, and it has pernicious reverberations: a sense of hopelessness deepens in the community, and cynicism grows among design professionals and city staff that anything will ever change.

A New Approach to Community Engagement

I started Pogo Park, a 501(c)(3) nonprofit organization in Richmond, to try a different approach.

The first thing I did was to go door to door to hire a core team of people from the community—those who know their neighborhood best—as paid staff to design, build, and eventually operate our new park at Elm Playlot. Diverse in age, gender, and race, the Elm Playlot Action Committee (EPAC) attacked its core job with vigor: to bring Elm Playlot to life.

These residents cared what their neighborhood looked like and what went on there. They knew their neighborhood better than anyone, and they knew what it needed to thrive.

We partnered with Scientific Art Studio (SAS), a local Iron Triangle custom design and fabrication business. SAS is renowned for designing and building cutting-edge, thrilling, and dynamic play environments for multiple clients, including children’s museums and zoos.

SAS opened its two-acre Iron Triangle studio as a sheltered and supportive place where Pogo Park’s EPAC team could gain real-life, hands-on experience planning, designing, and eventually re-building Elm Playlot slowly, over time, with their own hands.

A Hub of Community Life and Health

After a decade of work reimagining, rebuilding, and running Elm Playlot, the park is now a safe and beloved public green space that the whole neighborhood is proud of. Families and children visit every day to play, exercise, and simply gather. Pogo Park staffs the park with community residents who clean and maintain it with care and love. They offer free enrichment programs to children that include art, chess, nature education, petting zoos, gardening, and hip hop dance.

Additionally, Elm Playlot is a trusted public space to provide urgently-needed services to the community. It is one of Richmond’s largest distribution points for the local school’s free meal program, serving thousands of meals annually to children and youth from families with low incomes. Vision to Learn provides free eye exams and glasses to hundreds of children each year through a mobile clinic at the playlot.

The park and its programming isn’t just a place for children. Parents walk the park’s trike path for exercise and participate in daily Zumba classes. Elm Playlot has transformed from dirty, dull, and dangerous into a vibrant hub of community life and health.

The Domino Effect

We’ve since replicated this approach to bring a second park to life in Richmond, called Harbour 8, and build the “Yellow Brick Road,” a walk-bike street through the center of the neighborhood that safely connects children and families to the parks and other community amenities including churches, public transportation, and schools.

And our approach is gaining traction throughout the city and the state—urging local governments to re-examine the power dynamics at play and rethink their approach to decision-making around parks in ways that put the community at the center.

Increasing Park Equity

There are parks like the old Elm Playlot all over the country—parks and recreation areas that are poorly maintained, understaffed, unwelcoming, and unsafe. And it’s no coincidence that they tend to be in neighborhoods where people with low incomes and people of color more often live.

As in the Iron Triangle, the challenges these communities face didn’t happen overnight; they are the product of decades of disinvestment, racism, and harm.

It’s clear that our nation needs greater park equity—a more fair and just distribution of parks and green spaces. But park equity means more than simply having a park. It’s about more than a prescribed quota of 3.0 acres of parkland per 1,000 residents. What we have discovered is this: park equity means that everyone must have access to a safe, green, vibrant park that is truly alive. The way for that to happen is to set in place a system that empowers local people to develop a vision, slowly over time, and enact it.

Learn more about the relationship between our environment and health, and how you can get involved in supporting equitable built spaces.


About the Author

Toody Maher recognized that city parks—if brought to life—were a powerful vehicle to transform the health and well-being of entire communities. This realization led her to found Pogo Park in 2007.

Mon, 25 Oct 2021 13:00:00 -0400 Toody Maher Health Disparities Built Environment and Health National <![CDATA[What the United States Can Learn From Other Nations on Paid Leave Policy]]>

Policies like paid leave are working to advance gender equity at work and at home in other nations. We just need to expand them here in the United States.

Parents hold their infant child.

"We are one of the only countries in the world that doesn't offer paid family and medical leave to those who need it."  —Robert Espinoza, Vice President of the Paraprofessional Healthcare Institute

A study by Better Life Lab and the Robert Wood Johnson Foundation reconfirms that the U.S. status quo of gender roles, both at work and home, is not working for many families. Men are missing out on caretaking roles that enrich their lives and enhance the bonds with loved ones, while women are struggling with role overload, feeling unsupported and missing out on income and economic mobility.

In contrast to the U.S., many nations are advancing gender equity through solutions that benefit health, child development, family well-being, and advance racial equity, like paid leave. The United States can learn from the experiences of other nations that are implementing paid leave policies and find approaches that encourage fathers to take advantage of these policies.

A Vicious Cycle: Lack of Gender Equity at Both Home and at Work

Many gender inequities are rooted in deeply held cultural norms that also influence how men and women are treated differently in the workplace and in the expectation of who should be primary caregivers. In the United States, the gender pay gap starts early. Male-dominated fields, like computer engineering, pay far more than female-dominated professions, like care work. In addition, research continues to find pay gaps between men and women in the same role with the same education and experience levels. One study found that 38 percent of the pay gap is unexplainable, and could likely be the result of gender bias. On top of it all, the United States has a “motherhood penalty” and a “fatherhood bonus,” where men start making far more money and women start earning sharply less when they become parents.

Studies show that employers often perceive mothers as less committed, competent or available, and by extension, less financially valuable. Alternatively, men typically see a 12 percent increase in pay after they become fathers. In the end, married mothers with at least one child under age 18, earn 76 cents to a married father’s dollar. If a woman is unmarried, has more children, or is a woman of color, the gap only widens.

As a result, at home, women spend about twice the amount of time providing care and doing housework as men, while men spend more time at work. This “double shift,” where women work a full day at the office before returning home to hours of domestic labor, hasn’t budged in decades. Additionally, unlike every other advanced competitive economy, the United States does not have a paid maternity leave policy, and is one of only seven wealthy nations with no paid paternity leave policy. Private companies are not filling much of this gap. Eight in ten workers in the civilian workforce in the United States have no paid family leave benefits through their employers at all, with low-wage workers least likely to have access to any benefit.

Shifting Gender Norms Through Policy

In contrast, countries around the world are carefully designing public policy to shift antiquated gender norms, and the financial disincentives that reinforce them. For instance, when paid parental leave was introduced in Sweden, the first iteration of the policy was gender neutral, meaning that either parent could accept any portion of the leave. Yet, because of social norms around care, mothers wound up taking the bulk of the leave, which disadvantaged them at work. Some employers were reluctant to hire young women, and many women wound up working either part-time or in the public sector.

With an eye toward fostering true gender equity, lawmakers redesigned paid leave policies with individual entitlements. Rather than a gender-neutral default, each parent received a specific amount of leave. That meant that if fathers did not take their portion of leave, the balance could not be transferred to the mother, and the family would lose out on maximizing the overall amount of time a baby spent with their parents at home.

This “use it or lose it” policy change resulted in Swedish paternity leave acceptance rates skyrocketing from 5 to 90 percent within a few short years. Cultural norms began shifting as well. Being a good father came to mean spending time with family and using the paid leave allotment, rather than doubling down at work. Global gender equity rankings show that these and other reforms have narrowed the gender pay gap in Sweden, while the time men and women spend at work and giving care is becoming more equal.

Meanwhile, in Japan, good policy is only one piece of the gender equity puzzle. To affect change, cultural narratives, mindsets and workplace norms also must shift. Japan has one of the most generous paid leave policies for men, yet even after concerted efforts to get men to take it, only about 7 percent actually do. Even those who accept the benefit usually take it only for a few weeks, not the full year that’s guaranteed. According to some studies, these men are afraid that taking time to care for their families would damage their careers. This is where fielding surveys, discussing barriers, and sharing stories of pioneering men who normalize male caregiving can help. Research has found that, because gender equity is not openly addressed, men in Japan want to be more active caregivers, but are worried that they will be ostracized for doing so.

Other nations may want to take notice of Sweden’s nuanced approach, and design incentives that specifically account for the gender bias that makes so many men hesitant to be active caregivers. When the policies are carefully designed to account for the cultural resistance and stigma associated with men investing their attention and energy into their children, they are especially effective.

When cultural stigma and financial punishments are removed, men can and do engage in care work. For instance, our research found that men anticipate needing time off of work to care for a loved one at the same rate that women do. The difference, however, is that many men don’t feel they can follow through on fulfilling those caregiving needs, and women feel they have no choice, taking time off even when it’s unpaid because someone must give care.

As the world has already shown us, real solutions to support men, women, and people of all genders who care are not out of reach here. We—as a nation—just have to be willing to find them and make them a reality.

Explore four additional ways of supporting men in solving America’s caregiving crisis.


About the Authors

Brigid Schulte is the director of the Better Life Lab, the work-family justice and gender equity program at New America, a nonpartisan think tank, that uses narrative to move public policy, workplace practice and culture so that people of all genders and racial and ethnic identities can thrive, with decent, dignified work and time for care and connection across the arc of their lives.

Jennifer Ng’andu, managing director–Program, at RWJF, helps lead grantmaking activities to advance social and environmental changes that help ensure that all children and their families have the full range of opportunities and resources to lead healthy lives, starting from a child’s earliest years.

Wed, 13 Oct 2021 13:00:00 -0400 Brigid Schulte Child and Family Well-Being Health Disparities International <![CDATA[Grandfamilies and COVID-19: Families of Unique Origins Face Unique Challenges]]>

Raising a child can be hard at any age. Doing so in one’s golden years during a global pandemic introduces an array of unique challenges.

Grandfather carries grandson on his shoulders.

EDITOR’S NOTE: A shocking 140,000 U.S. children lost a parent or grandparent caregiver to COVID-19 in just 15 months, according to a study in Pediatrics, with children of color much more likely to lose a caregiver than White children.

The harm can be long-lasting. These losses also dramatically increase responsibilities for the grandparents and other relatives who step in to provide care. In a powerful post last year, RWJF’s Jennie Day-Burget looked at what Generations United has learned about the challenges facing grandparent caregivers and the policies that would support them. As Congress debates budget reconciliation, we re-share her piece.

Mel Hannah spent most of his life in service to others. He was the first African American member of the Flagstaff City Council and vice chairman of the NAACP Arizona State Conference. And, in service to his beloved family, Mel and his wife Shirley, now in their 80s, have been helping their daughter Ashley raise her three children these past years. Sadly, however, Ashley contracted and tragically died from COVID-19 in May. Ashley’s untimely death left the Hannahs as the sole caretakers for her young boys, ages 5, 4, and 1.

The Hannahs’ story exemplifies the heavy toll of the pandemic, and especially the unique and often overlooked impact it is having on “grandfamilies” or kinship families. These are families in which children live with and are being raised by grandparents, other extended family members, and adults with whom they have a close family-like relationship, such as godparents and close family friends. Astonishingly, about 7.8 million children across the country live in households headed by grandparents or other relatives. Of that number, 2.7 million do not have a parent living in the household.

Often these families come together because of serious circumstances—including death, trauma, deployment, incarceration or substance abuse, and since March, the death of parents due to COVID-19. Raising kids is hard at any age, but doing so in one's “golden years” like the Hannahs’—particularly during a global pandemic—comes with its own unique challenges.

A report from RWJF grantee Generations United sheds light on families like the Hannahs, including the particular challenges they are facing as the world grapples with the coronavirus. The report found:

  • Almost half of grandparent caregivers are age 60 and older and at heightened risk for COVID-19.
  • More grandparent caregivers have disabilities than parents and also are likely at heightened risk for COVID-19.
  • Children being raised in grandfamilies are more likely to be Black or Native American than White. These are the same populations that are much more likely to be impacted by the pandemic and die as a result.
Racial Overrepresentation in Grandfamilies Caregivers in grandfamilies are disproportionally Black or Native American. These are the same populations that are more likely to be impacted by COVID-19 and die as a result. Source: Facing a Pandemic: Families Living Together During COVID-19 and Thriving Beyond, Generations United 2020 State of Grandfamilies in America Annual Report, September 2020

Kin Caregiving Poses Unique Challenges

The report also features the first nationwide survey of grandfamilies during COVID-19, conducted in partnership with GrOW (Grandfamilies Outcome Workgroup) and Collaborative Solutions, which revealed heightened needs related to housing, food insecurity, and alternative care plans:

  • 38% are unable to pay or are worried about paying mortgage or rent
  • 43% fear leaving their home for food
  • 32% arrive at food pick up sites after they have run out of food
  • 30% have no caregiving plan for the children if the caregivers die or become disabled
COVID-19 Challenges Facing Grandfamilies Grandfamilies are being forced to reckon with unprecedented challenges and tough realities and oftentimes with limited support systems in place. Source: Facing a Pandemic: Families Living Together During COVID-19 and Thriving Beyond, Generations United 2020 State of Grandfamilies in America Annual Report, September 2020

We all have heard that older adults should keep their distance from children because of the heightened risk of infection from COVID-19. For grandfamilies, that distance is impossible.

Also, kin caregivers do not always have automatic legal authority to access support and services for the children in their care. That becomes especially problematic when it is time to enroll in school, access health care, or find another adult to care for the child if the caregiver dies. Obtaining legal authority has been complicated by the pandemic for many families as courthouses are often closed, lawyers are in high demand, and the need to establish alternative care plans is urgent because of unexpected deaths from COVID-19.

Finally, most kin caregivers did not plan to be raising children at this point in their lives. Often, their homes do not have extra room to accommodate children, and they live on fixed incomes so supporting children can be difficult.

Benefits of Kin Caregiving

Decades of research show that children raised by loving family members have much better outcomes than children raised by unrelated parents in foster care. Children living with relatives have more stable and safe childhoods with a greater likelihood of having a permanent home. These children have fewer school changes, experience better behavioral and mental health outcomes, and, perhaps most importantly, are more likely to report that they “always feel loved.” They keep better connections to their brothers and sisters, extended family, and cultural identity.

There are also significant savings to taxpayers—estimated to be $4 billion a year because grandfamilies are caring for children who would otherwise go into foster care.*

*Generations United calculated this figure based on the federal share of the 2011 national average minimum monthly foster care maintenance payment ($511) for 1.1 million children. The number of children is less than one-half of the children being raised in grandfamilies outside of the formal foster care system. We use this number in the calculation due to a conservative estimate that the others may already receive some type of governmental financial assistance, such as a Temporary Assistance for Needy Families (TANF) child-only grant. Generations United also knows that a number of children in grandfamilies have special needs that would warrant higher monthly foster care maintenance payments. The cost of 1.1 million children entering the system would represent all new financial outlays for taxpayers.

Policy and Practice Recommendations to Support Grandfamilies and Kin Caregiving

The report contains robust policy and practice recommendations that would provide better support to these families. A few that are especially important are to:

  • Increase funding for Temporary Assistance for Needy Families (TANF) and encourage states, tribes, and localities to increase the monthly child-only grant amount to mirror foster care maintenance payments in each jurisdiction.
  • Coordinate COVID-19 response efforts across systems—including aging, education, housing, and child welfare—to ensure that grandfamilies can obtain services and support such as legal assistance to make alternative care plans; child care and respite; hardware and technology support; financial and housing assistance; help with court orders and child welfare case plans mandating visitation with birth parents; and caregiver training and other support.
  • Improve access to TANF child-only grants through simplified applications and more community outreach so kin caregivers can meet the needs of the children they did not plan or expect to raise.
  • License more relatives as foster parents by responding to delays caused by the pandemic with innovative virtual and other known solutions.
  • Use inclusive language and images in outreach materials, such as “caregiver” or “family member.”

Grandfamilies Must be Included in an Equitable, COVID-19 Recovery   

The health of our nation depends upon the health and well-being of our children and families—all our families. All parents and caregivers strive to provide what’s best for their kids. But in today’s America, families do not have the same access to opportunity—and the COVID-19 pandemic is making those gaps even wider. Families are making impossible choices between putting food on the table, providing shelter, and getting quality healthcare when a child gets sick. A recent poll released by RWJF, NPR and the Harvard T.H. Chan School of Public Health reveals how households with children experienced widespread, serious financial and health problems since the start of the COVID-19 pandemic, including problems caring for children and paying bills.

These challenges are often exacerbated for grandfamilies. For example, when Mel and Shirely Hannah’s daughter Ashley was living with them, she worked and was able to help with household expenses. They have struggled financially since her death. They have a hard time covering their $400 a month energy bill and had to give up their internet connection, making it difficult for their five-year-old to participate in online classes.

It is important to understand stories like the Hannahs’ and others like them, which you can listen to on Every Family Forward, so we can better consider, discuss, and design equitable policies and systems that support all families, including grandfamilies, who have lived unnoticed and under-resourced for far too long.

Learn more about the unique challenges that grandfamilies like the Hannahs' are facing by reading Generations United’s 2020 State of Grandfamilies in America Annual Report, Facing a Pandemic: Families Living Together During COVID-19 and Thriving Beyond.


About the Author

Jennie Day-Burget

Jennie Day-Burget, an award-wining public relations and communications professional, joined RWJF in 2015. She provides communications support to RWJF initiatives aimed at strengthening vulnerable children and families and programs that help all children achieve a healthy weight.

Tue, 12 Oct 2021 09:00:00 -0400 Jennie Day-Burget Child and Family Well-Being <![CDATA[Learning with Indigenous Communities to Advance Health Equity]]>

Tribal Nations, resilient stewards of the natural resources that give us life, can lead the way to a more sustainable and healthy future. Indigenous Peoples' Day marks the urgent need to embrace the expertise they’ve held since time immemorial.  

A woman speaks into a microphone at a dance show. A Tlingit Native welcomes an audience to a community house. The traditions and leadership of the Tlingit, the people indigenous to Sitka, are infused throughout the community, including through educational and environmental programs.

For generations, Indigenous Peoples have known that our health is intertwined with the health of our earth. Their worldview recognizes that being healthy means ensuring the natural resources that give us life are well cared for.

In contrast, Western mindsets tend to view the natural world as an inventory of useful commodities—separate from, and existing only in service to, humanity. Overusing, polluting, and extracting without considering the long-term impacts has created conditions that fuel health inequities in our country: contaminated drinking water, food scarcity, air pollution, and extreme heat are contributing to poor health and driving up disease, particularly in low-income neighborhoods and communities of color.

Transforming our relationship with nature is key to building a sustainable, equitable, and healthy future for all. Through the forcible removal, violence, oppression, and other injustices Indigenous Peoples have experienced, they have remained powerful stewards for many of our natural resources. Their values, practices, and policies can show us the way to heal and reclaim the health of our earth and humanity.

Here are just some examples of Indigenous leadership in practice:


Tó éí  ííńá át’é. In the Navajo language, that means water is life. As sacred as Earth, fire, and air, the element cannot be taken for granted on the Navajo Nation lands in northwest New Mexico, where one-third of the tribe lacks running water at home.

A severe underinvestment in infrastructure in the Navajo nation—driven by structural racism—and mismanagement of the Colorado river by government agencies has left the Navajo Nation confronting major water resource problems. Cindy Howe, project manager at the Navajo Water Project, is helping to catalyze healing by addressing the immediate need to increase access to water with the DIGDEEP water system—plumbing that draws on a buried 1,200-gallon tank powered by solar panels to provide for a family’s basic needs.

“My hope is that one day the homes of every Navajo person will be hooked up to a water system, with indoor plumbing, a really nice shower, a commode, and a sink,” says Howe. “That is what I wish for my tribe and indeed for all in America.”


Shortly after this video was published five years ago, Charlie Four Bear—the Native elder featured—passed away. His teachings about how to build resilience, however, continue to endure.

Horses have long been integral to Native cultures, a source of both abundance and spiritual connection. Indigenous Peoples have many stories to tell about how horses entered their lives and a rich tradition of art that honors the animal as a fellow creature of the Earth. For Charlie Four Bear, an elder on the Fort Peck Indian reservation in Montana, horses also became a way to reach young people who felt disconnected from their roots: a feeling many Native young people share as a result of our country’s colonial history and assimilation policies that have led to the erasure of Indigenous culture. 

His Youth Mentor Equine Program helped to rekindle a sense of identity as it taught boys and girls how to forge a relationship with horses. Sadly, Charlie Four Bear passed away in 2017, at the age of 59, but his efforts remain an inspiration. A story in Take Us to a Better Placean RWJF-developed collection of fiction that encourages dialogue about a Culture of Health, draws on his work. 


Dams, diversion techniques, and allotments for crops and electricity that treat water as a commodity rather than an ancestral gift are doing great damage to the nation’s rivers. Coupled with rising temperatures and drought, tributaries in Arizona that were once perennial sources of a life-sustaining elixir now flow intermittently and headwaters are running dry.

New Zealand is showing how things can be done differently, thanks to legislation championed by the Māori peoples and passed by parliament. Through those efforts, the Whanganui River was granted “personhood,” recognizing its right to be healthy and protected from harm. In 2020, tribal leaders from Arizona travelled to New Zealand to immerse themselves in the culture and customs of their Indigenous relatives and draw blessings from the Whanganui. In connecting with the spiritual authority of the waters, the visitors deepened their understanding that rivers can only be reinvigorated by changing the ways in which we relate to them.

LISTEN TO Aleena Kawe of Red Star International and Herminia Frias of the Pascua Yaqui Tribal Council share practical lessons for cultivating a reciprocal relationship with nature to advance health equity.



Karabi Achary

Karabi Acharya, who has drawn upon her expertise in anthropology, public health and systems thinking in working with the citizen sector in the United States, South Asia, and Africa, joined RWJF in 2015. She directs the Foundation's strategies for global learning as it identifies best practices in other countries and adapting them to improve the social determinants of health in communities in the U.S.

Thu, 7 Oct 2021 11:00:00 -0400 Karabi Acharya Health Disparities Public and Community Health International <![CDATA[How a Native American Tribe Found Healing Through Horses]]>

Bring horses and Native youth together, and connections are built that can change lives. 

Editor’s note: Shortly after this video was published five years ago, Charlie Four Bear—the Native elder featured—passed away. His teachings about how to build resilience, however, continue to endure.

Deep ties to the land and close connections with animals have long helped to define Native American culture and make their way of life possible. In Fort Peck, Montana, Charlie Four Bear reclaimed that legacy by helping young people develop enduring relationships with horses. Four Bear (Dakota and Lakota) was an elder on the Fort Peck Indian reservation and a former police officer.

 “First they took away our land,” he said, describing the destruction that occurred as White settlers pushed West. “And then they took away our buffalo. And then they took our horses away.” The theft of so much Native culture, and the inequitable distribution of resources and opportunity that continues to this day, have damaged lives and undermined communities. The scars are apparent in the substance use and loss of hope revealed in one horrifying statistic: in a single year, 28 of 223 students at the local high school attempted suicide.  

The Youth Mentor Equine Program that Four Bear ran at the time was one way that tribal leaders honored Native traditions while rekindling a sense of identity. It was one example of how community-power building can overcome the systemic harms that undermine health.  

Horses had always been in Four Bear’s life—“part of our family in every aspect of the word,” he said in a video describing his work, and it is that connection that has been shared with young people. Climbing on a horse for the first time is frightening, he acknowledged. “There is a thousand pounds of bone and hoof ready to step on you.” 

But that fear quickly gives way to a sense of belonging, recalls a young Native boy named Jay, who came to feel very much at ease with the animal. “It felt pretty cool. It felt cool to connect to the horse in every single way you possibly can.” When circumstances separated Jay from his horse for a few months, he recalled that “everything started going back to the way it was,” a downward spiral that landed him in juvenile detention. He jumped at the offer to get back to the horses.

The sense of hope Jay found among the animals is perhaps a harbinger of things to come. “It is foretold by ancestors that the seventh generation is one that is going to come and be in that time period where things are going to change to benefit the Native American getting back to who we say we are as Natives,” says Kenny Smoker, Jr. (Assiniboine & Sioux), who coordinates the Fort Peck Tribe’s wellness program. He believes that the tribal elders will point the way. “They provide wisdom for our tribe. We really need to tap into that to help address the suicide and the other health disparities that exist.”

Four Bear, too, saw the possibility. “We can help each other and become a healthy tribe again,” he declared in his soft-spoken, determined manner.

Four Bear’s story inspired a powerful work of fiction by author David A. Robertson. Read “Reclamation” in RWJF’s short-story collection, Take Us to a Better Place.

Wed, 6 Oct 2021 10:00:00 -0400 Culture of Health Blog Health Disparities Public and Community Health National <![CDATA[A Historic Day for SNAP]]>

October 1 ushered in the largest permanent benefits increase in the nearly 60-year history of what is known today as the Supplemental Nutrition Assistance Program (SNAP). 

SNAP benefits for health care.

A recent report from the U.S. Department of Agriculture (USDA) finds that approximately 10.5% of families experienced food insecurity in 2020—the same percentage as 2019.

That finding may not seem groundbreaking. But it is truly stunning.

How is it possible that rates of food insecurity did not increase during the worst pandemic in a century? After all, the economic upheaval caused by COVID-19 was swift and severe, with a perfect storm of factors—including massive job loss, significant wage reductions, widespread school closures, and marked increases in food prices—that one would naturally assume a sizable increase in rates of food insecurity across the board would occur.

It didn’t happen.

To be clear, a food insecurity rate of 10.5% is far too high. Rates are even higher among people of color and those with low incomes; we cannot accept that status quo. But major increases in economic and nutrition assistance, approved by Congress during the pandemic, prevented a dire economic situation from turning catastrophic. These types of strategic policy decisions offer a roadmap to not only navigate a public health emergency, but also to accomplish big goals—like ending hunger and poverty in this country for good.

October 1 marked a significant turning point in our efforts to achieve the healthier and more equitable future that is in our grasp. It ushered in the largest permanent benefits increase in the nearly 60-year history of what is known today as the Supplemental Nutrition Assistance Program (SNAP), the largest nutrition assistance program in the United States.

To explain the significance of this moment—both how we got here and where this road could take us—I had the privilege of talking to a wonderful colleague and terrific friend: Jamie Bussel, a senior program officer at RWJF who oversees our childhood nutrition work.

What has SNAP’s role been during the COVID-19 pandemic?

SNAP is extremely effective at increasing food security, improving children’s health and academic performance, supporting economic growth, and lifting people out of poverty. Because of that record, SNAP has been a key component of our economic response to COVID-19.

Jamie Bussell SNAP is extremely effective at increasing food security, improving children’s health and academic performance, supporting economic growth, and lifting people out of poverty. —Jaimie Bussel

When the economy went into a recession after COVID-19 hit, several million people turned to the program to help. Congress responded by increasing funding for SNAP to cover the additional participants and also providing a temporary 15% increase in monthly benefits. A new Pandemic-Electronic Benefit Transfer program was created to provide additional support to families that participate in SNAP who lost access to healthy meals when their schools or child care facilities closed. And regulatory changes eased eligibility requirements and made it easier for participants to use their benefits online. Combined with additional economic assistance like the expansion of the Child Tax Credit, this strategy reflects the connections between financial security and food security, and has already had a positive impact.

Looking forward, the Urban Institute estimates that the temporary increase in SNAP benefits—along with direct cash payments, enhanced federal unemployment insurance benefits, and the expanded Child Tax Credit—will contribute to an astonishing decline in poverty in 2021. But what about 2022 and beyond? How can we better utilize SNAP over the long-term? Because even with these short-term supports, we still haven’t been maximizing the full potential of the program to help those in need.

That’s an interesting point. What have we been ‘leaving on the table,’ so to speak, when it comes to SNAP?

SNAP benefits are a lifeline to program participants. But prior to the temporary 15% increase in benefits, in 96% of counties in the U.S., the average SNAP benefit wasn’t enough to cover the cost of an average meal, with the highest gaps seen in both higher-cost urban and smaller rural counties. And even with that bump, which expires at the end of September, the average SNAP benefit still isn’t enough to cover the average meal cost in more than 40% of U.S. counties, with dramatic differences in food prices still playing a significant role in how far a family’s benefits can go. No matter where participants live, SNAP benefits must be enough to cover food costs and ensure families can afford to make healthy purchases. And that’s a big reason why USDA seized this moment to take a truly game-changing step: updating the Thrifty Food Plan.

Tell us about the Thrifty Food Plan. I imagine a lot of people may not even know what it is.

I think you’re right: the Thrifty Food Plan is pretty obscure. But it’s actually incredibly important because this is the mechanism USDA uses to calculate SNAP benefits for participants. The Thrifty Food Plan takes into account a variety of metrics to make those calculations, from food costs to dietary guidance to the nutrition content of certain foods. It has been in existence since 1975, but as USDA notes, the purchasing power of the plan has never changed since its creation.

So USDA used the authority it had been given in the most recent Farm Bill to update and modernize the Thrifty Food Plan, and the results are transformative. Thanks to these updates, the average SNAP benefit will increase by about 25% compared to pre-pandemic averages, increasing the average benefit per participant from $121 to $157.

An extra $36 a month may not seem like much at first glance, and it’s by no means a panacea, but it will make a tremendous difference. The vast majority of SNAP benefits go to households with incomes at or below the poverty line. Many families run out of SNAP benefits before the end of a given month; more than 80 percent of SNAP benefits are spent within the first two weeks of receipt. That makes it exceptionally difficult to buy food in the latter half of a month before the next month’s allotment is distributed. These extra dollars will go a long way toward filling that gap, and keep families from being forced to make impossible choices between buying food, paying the rent, and purchasing medications.  

What does the future of SNAP look like? Where does the program go from here?

One of the lessons of the pandemic is that we can’t be satisfied with simply reducing poverty or hunger; our goal must be to eliminate these conditions for good. So while the impact of the permanent benefit increases that took effect on October 1 can’t be overstated, there’s still more we can do. The Robert Wood Johnson Foundation supports a series of additional steps to further strengthen SNAP, including ensuring that all eligible people—particularly immigrants, people of color, and rural residents—are able to easily access the program; broaden eligibility to cover more people; expand nutrition incentive programs that help participants make healthy food purchases; and eliminate the lifetime ban on SNAP participation for convicted drug felons.

I’m proud of the work RWJF has been part of over the past several years to advocate for SNAP participants and add to the research base showing how effective the program is. This week will mark a huge milestone for the program, and it should be rightly celebrated. But there is so much more to do to strengthen and modernize our nutrition assistance programs and policies.  And that’s why we’re just getting started.

Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, is funding research focused on how COVID-19-related relief and recovery policies and programs impact child obesity, diet quality, food security, and other relevant child and family health outcomes. APPLY FOR FUNDING  


About the Author

Jennie Day-Burget

Jennie Day-Burget, senior communications officer, provides communications support to RWJF initiatives aimed at ensuring children and families have the resources they need to thrive, including those that help improve policies, systems and environments to reduce rates of childhood obesity and improve health outcomes for those most impacted by climate change. 

Thu, 30 Sep 2021 13:00:00 -0400 Jennie Day-Burget Child and Family Well-Being Childhood Obesity <![CDATA[Healing Our Rivers and Ourselves: Learning with Indigenous Peoples of New Zealand]]>

Our health is inextricably connected to the health of land, water, and all living things. The ways in which Indigenous peoples live that connection offer lessons that could benefit all of humanity. 

A woman stands on a walking trail bridge over a river.

Our nation’s health is intertwined with the health of our rivers. And our rivers are unwell.

Drinking water, food, sanitation, clothing, transportation: almost everything we do involves an interaction with water. Yet many people in America take water for granted, not realizing that pollution, overuse, and climate change are putting a chokehold on the country’s natural water reserves—posing a direct threat to health, equity, and our way of life.

While many may think that new technology and innovation can resolve our water crisis, I believe that the solution lies with Indigenous practices that have fostered a holistic approach to living in relationship with the natural environment for millennia. Let me explain.

Our Relationship with Nature

Indigenous peoples share a common worldview of our relationship with the natural world. One that is guided by Indigenous values and principles of respect, cooperation and responsibility. These principles govern our individual and collective beliefs, behaviors and relationships—as given to us from our ancestors. While our customs may differ, our lived connection with our environment is universal. In sharp contrast, Western mindsets tend to view nature as a commodity, maintaining a relationship that is centered on resource-taking.

Rivers are an excellent example. The Māori peoples of the Whanganui River in New Zealand view their ancestral river, Te Awa Tupua, as an indivisible whole, incorporating its tributaries and all its physical and metaphysical elements from the mountains to the sea. This catchment-wide approach ensures that all of the waterways that form the Whanganui River are viewed and managed, not in isolation, but with reference to the whole river as an interconnected ecosystem.

In the United States, and in particular the Colorado River Basin where I grew up, we create laws that slice up our rivers with little regard for their health. These laws divide our rivers in half between the upper and lower basins, separate out the groundwater from the surface water, and apportion the tributaries—cutting them up into allotments measured in cubic meters for the taking. We wield control over our rivers, damming and diverting their flow to water our crops and power our electricity. This approach leads to over-allocation, poor water quality, and rivers that are sucked dry.

Historic Roots

American’s view of nature as “property” run long and deep—and can be traced all the way back to the colonial settler attitudes. For the last 175 years, federal policies have systematically disrupted traditional life ways among the 30 tribes with historic ties to the Colorado River Basin. In the mid- to late 1800s, many river tribes were confined to small reservations, and in some cases, forcibly removed from their ancestral homes, dismantling their relationship with the rivers as their original custodians.

A similar colonial history is shared with Māori. In New Zealand, more than a century of laws, regulations, and actions of the government also fragmented the Whanganui River, diverting its headwaters, building hydroelectric dams that stem its flow and threaten its health. Since 1873, local Māori had sought to obtain legal protections for the Whanganui River, catalyzing “one of New Zealand’s longest running court cases.”

Five years ago, all of that changed when the New Zealand parliament passed unprecedented legislation granting ‘personhood’ to the country’s Whanganui River. Contrary to American law which defines nature as property, legal personhood recognizes the rights of the river to be healthy and to be protected from harm. It is also the framework by which the innate relationship of the River to the People and the People to the River is upheld.  

The Te Awa Tupua (Whanganui River Claims Settlement) Act 2017 also created the office of Te Pou Tupua, which comprises two people—one of which is Matua Turama Hawira—to act as the face and voice of the river.

Learning From the World

The victory achieved by Māori iwi (tribes) for their Te Awa Tupua (ancestral river) inspired me to bring tribal leaders representing four tribes from my home state of Arizona, to Aotearoa (New Zealand) in 2020 to meet with Whanganui River iwi for a cross-cultural exchange.

The road to the Whanganui River wove through verdant forests that framed the river’s glistening waters, a sharp contrast to the red earth and towering rock formations of our desert home. We arrived at Hiruhārama Marae, a traditional meeting grounds nestled in a bend of the river, where, meeting us for the first time, Turama along with the local Māori community welcomed us as relatives.

We spent the next three days on the river, fully immersed in the culture and customs of our new relations. We stood before Te Awa Tupua and bowed our heads in reverence as our Māori guides acknowledged the river’s spiritual authority with prayer and invocation. We cupped our hands in the river’s flow and blessed ourselves with it. It was a sensory experience; one of love, connection and awe. Our relationship as one with the river had begun.

As desert people, it was the most time many of us had ever spent in and around so much water. For centuries, our rivers in Arizona were perennial. Today, their flow is now intermittent at best. For the past hundred years, legislation and water policy have allowed seven states to legally use more water from the Colorado River Basin. To make matters more dire, rising temperatures and drought have exacerbated the problem, drying out the headwaters and eroding tributary flows. The last time the Colorado River reached the sea unencumbered was 1963. The shortage has forced the federal government to take the unprecedented step of introducing water cuts. More than 40 million people and nearly 4 million acres of American and Mexican crops now depend on a water supply that is quickly dwindling.

Healing our Rivers and Safeguarding our Health

We are at a critical juncture where an innovative approach is needed to guide water resource management; one that reinvigorates our rivers from the mountains to the sea and guarantees a future where our rivers are healthy and access to clean water is certain for the coming generations.

It starts with changing the way we relate and think about our rivers.

We must begin by seeing our rivers as interconnected, living systems that incorporate not just physical but also metaphysical elements. We must approach our rivers with respect and care for them the same way we protect and care for our families. Only then will our decisions about water use be responsible and contribute to the vitality and longevity of our rivers.

In essence, we must prioritize the river’s health in our decision-making at the national, state, and local level. If we change now, we can heal our rivers—and safeguard our own health. Tribal Nations, the original stewards for many of our natural resources, can show us how and lead the way to a more sustainable future.

JOIN ME in conversation to learn more about how Indigenous approaches to water and land stewardship can help us build a healthier future for all.



Aleena Kawe headshot.

Aleena M. Kawe is CEO of Red Star International, Inc. and enrolled member of the Texas Band of Yaqui Indians.

Wed, 22 Sep 2021 10:00:00 -0400 Aleena M. Kawe Public and Community Health Health Disparities International <![CDATA[Why Building Black Wealth is Key to Health Equity]]>

To dismantle structural racism, says a renowned economist, our nation needs a new narrative—and systems and policies that advance racial and economic justice.

Illustration for racial wealth gap. Illustrator: Cat Willett

Darrick Hamilton, the Henry Cohen Professor of Economics and Urban Policy at The New School, has gained national recognition for shaping policy solutions to close the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black families of resources that accumulate and transfer from one generation to the next. The typical White family has 10 times the wealth of the typical Black family and seven times the wealth of the typical Latinx family. This stark and persistent racial wealth gap has harmed generations, driven disparities and appears to be growing, even after controlling for household characteristics and long-term education and income gains by Black people.

Hamilton’s early experiences provided an ethical orientation toward justice that shaped his career as an economist. Growing up in Bedford-Stuyvesant while attending the Quaker-run Brooklyn Friends School exposed him to two worlds in which fundamentally similar people experienced markedly different life trajectories—primarily due to one group benefitting from greater resources than the other.

In this Q&A, he shares powerful insights on the impact of the racial wealth gap, strategies to address it, and reflections on how events of the past year are shifting narratives and providing hope for change.

What impact does the racial wealth gap have on health?

The racial wealth gap has a clear and direct impact on health. The wealth position a child is born into will shape opportunity, outcomes and health throughout life. Adults living in poverty are more likely to be uninsured and forgo medical care due to concerns about cost, missing work, or finding affordable childcare. While medical debt is the number one reason for bankruptcy, those with wealth have access to resources that support health and can pay for expensive health interventions.

The racial wealth gap is also part of the reason the COVID-19 pandemic drove down life expectancy for Black and Latinx people in the United States, even more than for those who are White. White people in America were better resourced and had greater agency to withstand the pandemic’s effects than Black, Native American and Latinx workers.

What many don’t consider, however, is the everyday stress of living paycheck to paycheck without the benefit of a nest egg to buffer against an unexpected event. Adding to this stress is the psychological burden of race-related stressors tied to every transaction for Black people.

How does the ‘American Dream Narrative’—which centers personal responsibility—harm communities of color and the nation as a whole?

Darrick Hamilton The wealth position a child is born into will shape opportunity, outcomes and health throughout life. —Darrick Hamilton

The nation’s dominant narrative, which states that people can achieve the American Dream of economic success through resilience and grit and by taking personal responsibility, causes great harm. We have stigmatized poverty with racist and misogynistic language such as “welfare queens and deadbeat dads,” instead of acknowledging our history. This narrative perpetuates White privilege and tells those in stigmatized groups that opportunity is there if they seize it and work twice as hard.

Working twice as hard to overcome systemic and structural barriers harms health. Evidence shows how disparities in health outcomes increase with education and income, which contradicts a narrative that emphasizes personal responsibility and hard work.

For example, racial differences in infant mortality actually worsen with higher levels of both education and income. It’s clear that the stigma and burden of overcoming racist structures leads to pernicious health consequences.

Are there solutions to counter this narrative and address the racial wealth gap?

We must move away from incentivizing people to adopt attitudes, norms, and behaviors largely considered beneficial and instead empower them with resources that provide agency to achieve success. And we must recognize government’s responsibility to ensure access and adequate wealth.

To address this, the two anti-racist policies I support are reparations and baby bonds. Reparations are direct and retrospectively acknowledge dignity and redress while addressing resource deprivation. Acknowledgement is critical for dignity and government must take responsibility for state-facilitated exploitation.

However, given our egregious history and especially the on-going ways that capital tends to consolidate and iterate for some at the exclusion of others, a onetime redress is not enough. Everyone has an economic right to wealth and that’s where baby bonds come in. Baby bonds are trust accounts for children. The money is held in public trust until a child becomes an adult. Funds can then be used for buying a house, starting a business, and/or financing education. To redress wealth disparity and advance racial equity, this year Connecticut became the first state to pass a Baby Bonds type program for each child whose birth is covered through Medicaid. The laudable goal is to allow children who don’t have the benefit of inherited wealth to pursue the same asset-building opportunities as others.

How have the past year’s events—the pandemic, economic fallout, racial reckoning and political unrest—shifted the dominant narrative?

The events of the past year have created a pivotal moment when we can change the narrative. The pandemic, the summer of protest in response to George Floyd’s murder, the many dimensions of political unrest, the in-fighting within political parties, all suggest that the system is ripe for change. For example, a silver lining of the pandemic was how it led to unprecedented government interventions like sending people $1,200 checks. When lawmakers decided it was necessary to distribute money broadly and did so, they changed views about what government can do.  

The attitudes of youth are also creating momentum to change the narrative. Young people are speaking up and saying: The status quo isn’t working. We want an economy grounded in justice and sustainability.

That makes this the moment when the system we’ve had in place for 50 years is on the brink, and real change is possible. It’s a moment for social movements and philanthropies to boldly commit to economic justice, a new narrative, and to our values, without pessimism. This is the moment to recognize that economic justice includes wealth, health, the right to a job and to an income, to mobility without threat of incarceration or violence because of one’s identity, and to free mobility without stigma, constraint and fear. A moment, I hope, when we will commit to economic and racial justice for everyone.

How can the New York City Racial Justice Commission influence other communities that want to dismantle structural racism?

The New York City Racial Justice Commission has been charged with remaking the city’s Charter and shaping policy to dismantle structural racism for all in New York City.

One of the biggest impacts we can have is establishing values that emphasize inclusion, belonging, power, equity, access along race and gender as a responsibility of all aspects of government in New York City. Through this commission, I believe that our city, given its size, influence and media, can set an example for other cities, states, and the nation as a whole. That, in and of itself, is valuable.

Dr. Darrick Hamilton is on the National Advisory Committee for RWJF’s Policies for Action. Learn more about the program’s research findings on building an inclusive pandemic recovery for all.


About the Author

Najaf Ahmad

Najaf Ahmad is managing editor of the Culture of Health Blog where she highlights perspectives about how the Foundation is advancing health equity in communities across the nation.


Thu, 9 Sep 2021 11:00:00 -0400 Najaf Ahmad Health Disparities <![CDATA[Closing the Medicaid Coverage Gap is a Health, Economic, and Moral Imperative]]>

Closing the Medicaid coverage gap would save lives, reduce costs, and help eliminate racial and ethnic health disparities such as maternal mortality rates among women of color.

Pregnant woman holding baby shoes.

Editor's Note: This post was updated in February, 2022.

“I am grateful for Medicaid because I can live on my own,” said Theresa, who has Spastic Quadriplegia Cerebral Palsy. Medicaid covers the costs associated with Theresa’s physical and occupational therapy, a wheelchair, and personal care attendants.

“I wouldn’t be alive if it wasn’t for Medicaid,” said Laticia, who received Medicaid coverage while growing up in the foster system that allowed her to receive care for both physical and mental health conditions.

“Medicaid has been a blessing,” said Regina, who relies on Medicaid to cover her daughter’s routine medical and preventive care that would otherwise be unaffordable.

There are approximately 75 million people in the United States enrolled in Medicaid, making it the largest health care provider in the country. And while each participant’s story is unique, Theresa, Laticia, and Regina have at least one thing in common: each lives in a state—Montana, Missouri, and Iowa, respectively—that has expanded Medicaid under the Affordable Care Act (ACA) to provide quality and affordable health care coverage to more of its residents. In fact, 38 states have done so since that landmark law was enacted.

But 12 states have refused to expand their Medicaid programs under the ACA, denying health care coverage to more than two million people—disproportionately people of color—who would qualify for the program if expansion was implemented in those states. These holdout states have refused to budge even as the federal government would cover the vast majority of expansion costs; even as Medicaid expansion states reap a variety of health and economic benefits; and even as the United States remains in the throes of a deadly pandemic.

Statistic card from Medicaid Report.

This is an ongoing injustice that must be corrected as soon as possible. Fortunately, Congress has an incredible opportunity to do so right now. The House and Senate have passed the framework of a $3.5 trillion budget resolution for Fiscal Year 2022 that has the potential to dramatically reshape the health care landscape in the United States. As Congress finalizes this framework over the coming weeks, a permanent closure of the Medicaid coverage gap must be at the top of the priority list.

The Past

Medicaid was created in 1965 and is jointly funded and administered by the federal government in all 50 states. At its inception, the program provided health coverage to those who qualified for other forms of government cash assistance. Over the years, the program expanded to serve not only families with low incomes, but also pregnant women, people with disabilities, and those who require long-term care.

Under the original Affordable Care Act enacted in 2010, states were required to expand their Medicaid programs to any residents whose income levels were up to 138 percent of the federal poverty line (in 2021, the federal poverty threshold is $26,500 for a family of four); substantial federal funding was included in the law to cover the vast majority (currently 90 percent) of states’ expansion costs. However, a 2012 Supreme Court decision eliminated the mandate and instead left the expansion decision up to each state. States have had the option to do so since 2014.

The Present

An overwhelming body of research shows that Medicaid expansion under the ACA has been an unqualified success. In states that have taken this step, the rates of the uninsured have dropped significantly, particularly among communities of color and those with low incomes; participants have experienced improved health outcomes, including reduced incidence of premature deaths and fewer cases of maternal mortality; and state economies have seen lower health care costs along with increased economic activity due to healthier populations. And thanks to subsequent legislation, there are additional federal funding incentives for states to take this step.

There is no health or economic rationale, then, for the holdout states’ ongoing refusal to expand. Ultimately, it is a question of whose lives we value in our country and whose we don’t, and right now, policymakers in 12 states have decided that the lives of more than two million people don’t have value. It should not come as a surprise, then, that the populations most affected by the holdout states’ refusal to expand are the same ones that have been disproportionately affected by COVID-19 and the structural racism and discrimination that have been baked into our country for centuries. People of color represent more than 60 percent of the coverage gap population, and relative to their overall percentage of the U.S. population, both Blacks and Hispanics are disproportionately counted among this group: Black people in America, for instance, represent 14 percent of the U.S. population but 28 percent of the coverage gap population. And while more than 60 percent of those in the coverage gap are employed, many are in low-wage jobs that are more likely to not offer health insurance. For the working poor, there is often no other health care coverage available than Medicaid, and that option is being foreclosed on them in too many places.

As a Black woman and a Black mother, I am also particularly attuned to our nation’s abysmal rates of maternal mortality, and Medicaid’s potential to change the trajectory for Black families. Per the Center on Budget and Policy Priorities, more than 800,000 people in the coverage gap are women of childbearing age. The United States has the highest maternal mortality rate of any developed country in the world, with Black women at the greatest risk for dying before, during, or after the birth of a child. Expanding Medicaid coverage would make it easier and safer for Black women to have healthy pregnancies that result in healthy deliveries and healthy children.

The Future

Prior to my time at the Robert Wood Johnson Foundation, I spent more than a decade as a congressional staffer. I would often hear stories from my constituents—people not all that different from Theresa, Laticia, and Regina—who were forced to make impossible choices due to their limited or nonexistent health care options, from rationing care to deciding whether whatever funds they may have had in a particular month should be used to either pay the rent, buy food, or afford their medication. I suspect Theresa, Laticia, and Regina would be the first to agree that access to health care coverage shouldn’t come down to luck, or good fortune, or living in the “right” state.

Fortunately, there is movement in the right direction. There is growing momentum toward the federal government stepping in to close the gap unilaterally. In holdout state after holdout state, local residents are leaning on state policymakers to finally step up and do the right thing. That gives me hope that we’ll get this over the finish line.

To be sure, our nation’s health care woes go well beyond the Medicaid coverage gap. A recent report from The Commonwealth Fund finds that among 11 wealthy nations, the United States ranks first on health care spending by an astonishingly wide margin yet ranks last among more than 70 health care performance measures—lending more credence to the fact that our current health care system can be more accurately described as a sick care system. In a country as wealthy as ours, we can and must do better. Ensuring that each and every person living in the United States—irrespective of skin color, income level, geography, occupation, or immigration or disability status—has access to quality, affordable health care must be a national priority. There are many steps we need to take to achieve that vision.

But closing the Medicaid coverage gap is the most important step we can and should take right now. It would provide millions of people with health care coverage that would save lives and reduce health care costs. And it would be a significant moment toward helping to eliminate the racial and ethnic health disparities that have persisted for generations, but must no longer be tolerated in our pursuit of a fairer and more just nation.  

Learn about how communities facing deep inequities are taking back power and uniting to shape a future where everyone has a fair chance to pursue healthier lives.



Avenel Joseph

Avenel Joseph, PhD, joined RWJF in early 2020 as the vice president for Policy. She brings a wealth of government, management, and political expertise to leading the Foundation’s Policy office and heading its Washington presence.

Tue, 7 Sep 2021 11:00:00 -0400 Avenel Joseph Healthcare Coverage and Access Health Disparities <![CDATA[The Case for Having Health Equity Guide Community Preparedness]]>

The coronavirus pandemic has exacerbated long-standing inequities in communities across the United States. To prepare for the next crisis, communities must build health equity infrastructure now.

Health equity and community preparedness illustration.

We can’t prevent disasters, but proactively developing strategies to address health equity can ease some of their most harmful effects on people and communities. 

In our research, we’ve found communities that developed these strategies before and throughout the pandemic were better positioned to target resources to address health disparities that were highlighted and exacerbated by COVID-19.

Take Harris County, Texas, for example. In 2014, Harris County Public Health (HCPH) developed a health equity framework that was tested by an outbreak of the Zika virus in the county two years later. This experience informed HCPH’s management of the COVID-19 vaccine rollout and decision to collect vaccination data by race. While the state of Texas’ vaccination strategy emphasized mass vaccination sites, mobile vaccine clinics administered the one-shot Johnson & Johnson vaccine in parts of Harris County that were hit hardest by the pandemic.

Since the pandemic began, we have been studying nine communities as they navigate the challenges posed by the crisis while striving to promote health and well-being. The latest set of reports in the Sentinel Communities: COVID-19 Community Response series, examines the communities’ response to the pandemic over the last year. We hope this research will contribute to a broader understanding of the strategies that can create lasting, equitable change.

Both Harris County, Texas, and Tampa, Fla., had strategies and structures in place to holistically address community health and prioritize health equity before the pandemic. These communities have faced disasters like extreme weather events and disease outbreaks in recent years. They were able to leverage tools and infrastructure from past emergencies to quickly mount a response to the pandemic and its ripple effects—from food shortages to housing crises. 

Using Policy to Address Local Disparities

Before the pandemic hit, efforts to build a more resilient, equitable community were well underway in Tampa. The city has welcomed an influx of newcomers in recent years, pushing residents with low incomes farther away from the city center to neighborhoods where housing costs are lower but public transportation is inadequate. Tampa has been directing resources to address these challenges, which Mayor Jane Castor has identified as priorities for her administration. In 2019, Mayor Castor convened advisory groups of experts to develop priorities and strategies to expand access to affordable housing and improve Tampa’s transportation infrastructure.

Work to improve economic opportunity in Tampa has continued throughout the pandemic. Mayor Castor established the Economic Advisory Committee in August 2020. This diverse workgroup of 23 community stakeholders was tasked with developing recommendations to reduce poverty, reduce gender and racial disparities in income, and expand economic diversification. Their recommendations, released in April 2021, focused on four key areas: promoting inclusive economic growth, reducing poverty, committing to racial equity, and emphasizing educational opportunity. These recommendations have spurred initiatives to close the digital divide and address the racial unemployment gap.

The intent of these actions is important, but communities also need to measure their impact. Last year, our colleagues launched COVID-19 U.S. State Policy database (CUSP) to assess the equity implications of state-level policies similar to those that Mayor Castor has enacted. 

Having Equity Drive Collaborations 

Equity has been at the center of Harris County’s pandemic response, informing decisions around COVID-19 testing strategies and communication with residents of color. HCPH stood up its Incident Command System and within it, a Resilience and Equity Branch which used the Social Vulnerability Index from the Centers for Disease Control and Prevention (CDC) to prioritize testing locations to enhance equity. Outreach teams were deployed daily to community events in areas with high percentages of residents of color.

Harris County’s focus on combating health disparities stems from the health equity framework the county established in 2014. Since then, this explicit commitment to equity has shaped day-to-day public health operations, including efforts to utilize data to target policies to areas of the community most in need.

Where Do We Go From Here?

Leaders in Harris County and Tampa have made health equity a priority in regular policymaking and in their response to the pandemic, but they are limited in their authority. While state leadership in Texas and Florida pursued aggressive reopening policies, local public health officials developed more cautious approaches to reopening, guided by CDC recommendations. 

The tension between state and local leaders played out north of Harris County, in Dallas. After the city prioritized racial equity in their vaccine strategy, the state threatened to send fewer vaccine shipments.

Local efforts to promote health equity are also limited by state inaction on Medicaid expansion. Texas and Florida are among the 12 states that have refused to expand Medicaid, exacerbating health disparities for people of color and adults with low incomes. As Dr. Richard Besser writes, “...populations disproportionately affected by COVID-19 are the same populations most likely to be uninsured. These are not coincidences, but patterns that reflect our nation’s past and present.”

Our research has made it clear that the time for prioritizing equity is now, before the next disaster strikes, whether it is a health crisis, a natural disaster, the effects of climate change, or social injustice. For the health and well-being of our communities, we must integrate equity planning into normal routine operations so we are better prepared to weather the next crisis—and address inequities communities face every day.

We can't afford to ignore the hard-learned lessons of COVID-19.

Read the latest set of reports in the Sentinel Communities: COVID-19 Community Response series.



Carolyn E. Miller is a senior program officer in the Research-Evaluation-Learning unit of RWJF. She brings to the Foundation a long and diverse career in private sector, government, and academic research.

Anita Chandra is vice president and director of RAND Social and Economic Well-Being and a senior policy researcher at the RAND Corporation.

Tue, 24 Aug 2021 13:00:00 -0400 Carolyn Miller Public and Community Health Disease Prevention and Health Promotion National <![CDATA[How Taking a Simple Quiz Reaffirmed My Love For Global Learning]]>

Can the bold ideas needed to advance health equity be found beyond our borders? A global learner reflects on the value of looking abroad for solutions and the 12-question quiz that can help us all get started.

The Blue Marble

One out of four people living in the United States today are either immigrants or children of immigrants. That’s approximately 85 million people, all of whom have connections to other countries and cultures. I’m one of those people. While I was born in Michigan and call New Jersey home today, I’ve spent considerable time visiting, living and working in Mumbai—the city my parents migrated from and where my public health career kicked off.

My connection to my country of origin—through ties to family and friends, time spent living and visiting there, language and culture—has profoundly shaped me and made me the person I am today. Perhaps most importantly, though, it has fostered a deep appreciation for the many different ways people experience, live day-to-day and move through the world—and the great possibilities for learning this brings. Years ago, as a new mother in the United States, I benefited enormously from Indian postpartum food traditions, lovingly prepared for me by my mother and mother-in-law. Now, with school-age children, I wonder which Indian teaching methods could be helpful, trading notes with my cousins and their kids.

These types of exchanges have enriched my life, and I often hear the same sentiment from friends and colleagues with immigrant backgrounds from various other countries. Moreover, they remind us that the way things are done in the U.S. isn’t the only way to do things. Countries around the globe, from Brazil to Malawi, are finding creative ways to overcome similar health challenges to the ones we’re facing in the U.S. By looking beyond our borders, we can uncover new inspiration for advancing health and health equity across our communities.

An Intriguing Proposition

Knowing we have so much to learn from other countries, I was excited when a group of colleagues and I were asked to beta test RWJF’s now fully launched Blue Marble Quiz. We were told the quiz had been designed to help more people discover the value of global learning.

As someone who sits on the Foundation’s Global Ideas for U.S. Solutions team and shares in this mission, it was a promising proposition. But I did wonder how it could be done in just 12 questions. It seemed too good to be true, knowing how challenging it can be to spark this type of interest. In fact, just last year, 73 percent of U.S. foundations surveyed by Candid said their grantmaking was rarely or not at all inspired by solutions from around the globe. Could a quiz help change that?

The first question flashed on the screen: How are you connected to various cultures and countries? Quickly checking off several of the answer choices, I was delighted by the questions that followed, all of which invited quiz-takers to reflect on how global learning shapes how we think and what we do. I felt like many of my own life experiences were showing up in the questions. At the same time, the quiz also recognizes that living in another country—or even visiting one—is not a requirement for global learning: having friends from different cultures, listening to music of other countries, watching global news, trying new cuisines—all of which can happen right in our own backyard—can shape our thinking, too.

I was having a lot of fun reflecting on each question. Was the rest of the beta testing team having a meaningful experience with it too? I couldn’t tell. All I could hear was the quick, off-beat sound of mouse clicking. I took that as a good sign and continued on my exploration.

The Blue Marble

Once I answered the last question, the quiz tallied up my score to reveal my result: Blue Marble All the Way.

Blue Marble All the Way.
Earth seen from Apollo 17. The earth seen by the Apollo 17 crew in 1972.

This category and the quiz’s name are inspired by the Blue Marble image of the Earth taken by the Apollo 17 crew in 1972. It was the first photo to capture the world in its entirety and forever changed the way we see it. The astronauts described a profound shift in their perspectives as borders and divisions vanished and one fully connected entity came into view.

Similarly, when we take a step back from our own country—either literally or figuratively—we start to see our home, our work, our challenges and potential solutions with new eyes.

I enjoyed reading about the other categories I could have fallen into as well—from Buy Local to I’ll Cross That Bridge. Each one celebrates the different places our ideas can come from, recognizing that all perspectives hold immense value on the journey toward health equity.

While not a scientific survey, the questions in the quiz are informed by resources and research that speak to the benefits of looking abroad for inspiration, ideas, and solutions. The quiz makes all of these materials available at the end—they range from articles to podcasts to a spinning globe of radio stations you can tune into. I enjoyed this TED talk by Angela Oguntala, who encourages us to consider visions of the future by looking abroad, with examples from Kenya, Bangladesh, and the Caribbean. I also learned that, according to an MIT study, having close interpersonal relationships with people from different cultures can actually spur creativity, innovation and entrepreneurship.

“Creativity is about connecting dots,” I read in an MIT Sloan interview with the lead author of the study, Jackson Lu. “When someone enters a close relationship with a person from a different culture, they collect more dots to connect to the ones they already have.”

How could these connections benefit us in workplace settings? How might they prove useful as we seek solutions to social challenges? I thought back to my ties to India and wondered how my own interpersonal relationships there might continue to fuel outside-the-box thinking, personally and professionally.

A Journey for All

Suddenly, I noticed the sound of mouse clicking had petered out and my colleagues were starting to look up from their laptops. A robust discussion ensued. Some pointed out how the quiz helps people see they have more exposure to global ideas than they realize, others reflected on the resources that stuck out to them—demonstrating that this simple tool could spark provocative conversations about how we learn from the rest of the world and the value those insights hold for advancing health equity.

Since the quiz was launched, we’ve heard from people whose curiosity has been similarly sparked, like the co-chair of a sorority committee who used the tool to lead a teen youth group discussion about how to be a global citizen and peers who have been inspired to add more international news stories to their daily reading.

Global learning can often be seen as exclusive and distant, but the quiz opens up pathways for it to be inclusive and accessible for all.

What if the key to advancing birth equity could be found within Rwanda or the bold approaches needed to address the climate crisis were taking root in New Zealand? Twelve simple questions might kick-start a learning journey that could surface the solutions you’ve been looking for.

Take the quiz and explore the intriguing resources to see where in the world your ideas come from.



Shuma Panse

Shuma Panse, senior program officer, joined the Robert Wood Johnson Foundation in February 2016, bringing extensive experience in business engagement on health, public-private partnerships, and global health.

Thu, 12 Aug 2021 13:00:00 -0400 Shuma Panse Public and Community Health Built Environment and Health International <![CDATA[Database Tracks Health Equity Implications of State COVID-19 Policies]]>

A publically available database is helping researchers, policymakers, journalists, and others understand how over 200 state policies implemented during the pandemic are impacting health equity.

COVID-19 U.S. State Policies image.

Rapid response is synonymous with moments of crisis. From first responders to communication experts, responding quickly to a crisis is critical for community health and well-being. But what about rapid response research? 

COVID-19 has epitomized a complex crisis of infectious disease, food and housing insecurity, and mental distress. People who are Black, Latinx, Native American, and living in low-income households are the most vulnerable to these conditions. It is clear that health and social policies enacted during the pandemic will affect communities for decades to come. 

To inform rapid response research and policymaking, my team at Boston University and I developed the COVID-19 U.S. State Policy database—also known as CUSP—in 2020. This resource aims to inform health and social policy decisions that promote health equity and focuses on policies that affect vulnerable and historically excluded populations. Now over a year after its inception, we are assessing what we have learned and where we have yet to go.

How It Started

States responded to the pandemic with a wide range of polices, from stay-at-home orders and closing businesses, to unemployment insurance and minimum wage changes. Many of these policies were aligned with the Robert Wood Johnson Foundation’s (RWJF) health equity principles for recovery during the pandemic. With support from RWJF's Evidence to Action program, we started the CUSP database.

As we saw the pandemic exacerbate disparities stemming from structural racism and inequitable policies, we wanted to document policies so researchers could evaluate their impacts on populations most affected by COVID-19 and its repercussions. 

While Black and Latinx people were more likely than White people to die of COVID-19, in the database we captured some policy decisions that explicitly disadvantaged Black and Latinx people. For instance, the Advisory Committee on Immunization Practices recommended prioritizing essential workers for vaccines, and most states planned to do so. But after a federal government recommendation to prioritize people aged 65 and older, most states shifted to age-based vaccine priorities. While 21 percent of the White population is older than 65, just 12 percent of Black people and 8 percent of Latinx people are over 65. Age prioritization is then, by design, saying Black and Latinx will be less likely to get the vaccine.

Tracking multiple social policies at once also revealed a pattern of exclusion. CUSP captured how state minimum wage policies systematically excluded some people such as tipped workers. These workers are predominantly Black, Latinx and Native American. We saw a similar pattern with unemployment insurance; without federal intervention through congressional action, many people may be excluded from unemployment insurance because they earn too little to qualify or because they are independent contractors. The same pattern of exclusion emerged with paid sick leave; even in states with paid sick leave, the policy typically only applies to full-time workers and excludes contract or gig workers.

The CUSP database is designed to facilitate research to inform policy action around responses to the pandemic and beyond. By merging CUSP policy data with outcomes data from datasets such as the Household Pulse Survey, SafeGraph mobility data, or the Understanding COVID in America study, researchers can evaluate and inform policies that shape enduring improvements in health. Because of systemic racism, it is especially important to evaluate outcomes disaggregated by race and ethnicity. The policies that can be evaluated go well beyond COVID prevention, to policies that support food and housing security, paid sick leave, and unemployment insurance. We regularly update the database, prioritizing policies most relevant to people’s health and well-being in the present moment.

Where It's Going

Over a year into the project, it’s clear that the need for rapid response research is bigger than any one team can undertake and manage. Public health researchers and economists must join in thinking about how best to design policies that simultaneously protect people from COVID-19 and from economic precarity.

Currently, a larger emphasis has turned to focusing on strategies for increasing vaccine equity. Increasing vaccine access takes on greater importance in a context in which many remain unvaccinated and there are no OSHA (Occupational Safety and Health Administration) standards to protect low-income workers with mask mandates or other measures. As we document in CUSP, few states have workplace safety standards either. 

Researchers working on CUSP also continue to focus on policies that have historically left people vulnerable in our country, even before the pandemic. For example, 3 percent of households experience food insecurity every year, and Black families in the United States have experienced food insecurity two to three times the rate of White families over the course of the pandemic. CUSP data on state policies such as unemployment insurance amounts and the dates and types of eviction freezes can inform the extent to which these policies reduce the number of households that experience food and housing insecurity.

Where We Must Go

COVID-19 highlighted that our health is inextricably linked to our neighbors, co-workers, health care providers, delivery service workers, teachers, and our communities. More so, it crystalized that our health and economic policies do not adequately or equitably protect our well-being as a nation. There’s an urgent and continued need for more research on which policies have been most effective for supporting people to inform federal and state actions. What we learn from the CUSP database and how we apply that knowledge to federal data sets is critical to supporting a culture of health, dismantling racist policies, and building a future where all can thrive.

I invite you to explore the CUSP database and share with members in your community. Together we can ensure our policymakers center equity in all decisions.


About the Author

Julia Raifman, ScD, SM is an assistant professor at the Boston University School of Public Health, where she conducts policy research on health disparities and population health.

Wed, 28 Jul 2021 14:00:00 -0400 Julia Raifman Health Disparities Healthcare Coverage and Access <![CDATA[Nurse Leader Shares Five Lessons on Breaking Down Barriers to Vaccination]]>

A nurse leader who has been vaccinating a diverse community offers a candid assessment of false starts, wisdom gained, and the best way forward.

Vaccine barriers illustration.

Maria S. Gomez is a public health nurse who received a Presidential Citizens Medal in 2012 from President Barack Obama. She along with other colleagues founded Mary’s Center in 1988 an innovative community health center in the D.C. region that has been using an integrated model of health care, education, and social services for more than 30 years. Today, it serves over 60,000 people each year. Here, Gomez shares lessons learned through Mary’s Center vaccination program.

Lesson One: No Wrong Door

Mary’s Center’s vaccination program didn’t have an easy start. Like the community we serve, our team was fearful and struggling in the pandemic. Suddenly, there was a vaccine that offered promise to keep us safe, but people were confused and anxious about it. It fell to us to provide information—but first we had to educate ourselves. There was no shortcut and no chance of success unless we did. So we put in the time, even holding Town Hall Meetings with our team of nearly 800, to learn and become effective messengers.

We learned that for some in the Mary’s Center community, a lack of trust stemmed from our country’s history of medical abuse—and not just horrors like the Tuskegee syphilis study but also more recent atrocities including involuntary sterilizations of Puerto Rican women and of women detained at the U.S. border. Many in our community have experienced those abuses well.

Some worried about being a burden on their host country by taking a shot someone else might need more. Some feared that accepting the vaccine could make it harder to get immigration papers. Some were deterred by misinformation about a fee associated with the vaccine or visit to get the vaccine.

We learned to address all of this. We initiated conversations with everyone and tackled worries head-on. There was no wrong door to come through to talk about the vaccine. If you came to Mary’s Center for a child’s check-up, dental care, a pre-natal exam, or to pick up a check to pay the rent, you had a conversation about vaccines. By talking and listening, we learned what strategies made our clients feel safer and more comfortable with being vaccinated.

Lesson Two: No Wrong Messenger

We soon saw everybody as a vaccine messenger. As our staff and their family members were vaccinated, we shared the joy that came with their newfound freedom to move around more freely. When a teen came in for homework help, we suggested she encourage her grandmother to get a vaccine. Sometimes our best messenger was the person focused on mopping the floors, because the client she was chatting with had been doing the same thing at his job a few hours earlier.

People may not trust the medical establishment, but they trust their own doctor or nurse practitioner. It’s powerful when our clients see their doctor on Facebook or YouTube talking about the vaccine! I’m so impressed with what our Black community has been doing with barbershops and hair dressers; it works because there’s so much trust and the vaccinators are right there.

Mary’s Center has partnered with our local utility company, Pepco, in two ways. First, to administer their philanthropy commitment to keep the community connected to their utilities, and second, to vaccinate their line workers so they are safe when they are working in the community. We partnered with local chambers of commerce to reach small businesses that employ our clients. And we’ve learned the power of telehealth; it has saved lives and been especially important for the disability community and those facing mental health problems in the pandemic. Without telehealth, we would have lost many more people to drug overdose and suicide.

Lesson Three: No Wrong Moment

We believe fervently that there should be no wrong moment to get the vaccine. I’m convinced that it was a mistake to have limited vaccines only to seniors and people with certain pre-existing conditions at the beginning of the roll-out. We had to follow these strict rules or we would not have been allowed to continue vaccinating our community.

But I wish we didn’t have to turn away the young woman—and others like her—who struggled to take a day off of work to bring her grandparents in for a vaccine, but could not get vaccinated herself. Being forced to turn away people who wanted shots was painful. And, as we expected, now we are struggling, not always successfully, to get them back.

I hope when we look back at how we handled this pandemic, we will acknowledge that not doing so was a mistake we need to fix.

Lesson Four: Take Care of Your Staff

I’ve learned a lot about how to be an effective administrator during crisis. I learned that administrators need to stay out of the way, create a MASH unit, and give your team the tools and resources they need.

Being transparent has been essential. I cried many times with my staff. I admitted when I didn’t have answers. I stressed that we were in this together. I told them when we had enough money to stay afloat for the next week or month, and when nothing was guaranteed after that. I was in the trenches with them and made sure they saw me.

There were practical considerations. We had to feed our staff because nothing was open. And there was psychological stress. The social determinants of health were very real for our team. They have partners who are in construction, child care, sanitation and grocery workers who had to show up for work; some of them got sick and some died.

Never forget that your community is your staff—and you are nothing without them. Stay out of their way and they will deliver miracles.

Lesson Five: Time Is On Your Side

We’ve been rushing a lot over the last year. We rush to meet an established timeline, a goal set by the President, or a city directive. But sometimes people need time. Taking a vaccine can be a big decision. People need time to process it. In time, they will convince themselves to get the shot. When your grandpa has gotten the shot, you see that it’s safe. The 16-year-olds now getting their shots are the best voices for their parents. But parents also have a responsibility. We’re telling parents: You don’t give your child a choice to take showers, drink or smoke. Why give them a choice about whether to take a shot that can save their life?

As health care providers, scientists and leaders, we need to give our community time. I believe we will get there, to 80 or 90 percent of people being vaccinated, if we keep using social media, holding meetings, talking one on one, enlisting influencers like religious leaders and teachers, and doing all the things we know how to do best. It works. We just need to keep doing it and give people some time to normalize this activity, as we have with our childhood immunizations.

Dr. Rich Besser and Dr. Julie Morita shared why equity must be front and center in the distribution of vaccines. Read their op-ed.




Maria Gomez portrait.

Maria S. Gomez is president and CEO of Mary’s Center, and an RWJF Award for Health Equity 2019 winner.

Mon, 19 Jul 2021 10:00:00 -0400 Maria S. Gomez Public and Community Health <![CDATA[How Supporting Men as Caregivers Advances Gender Equity]]>

As the pandemic forced women out of the workforce in record numbers, a new survey reveals that men overwhelmingly value care work and want to share it equally with their partners. But the lack of supportive workplace cultures and public policies prevent them from doing so. Where do we go from here?

A father and son stand together in a field.

As pressure mounts to address the many challenges brought to the fore by the pandemic, our nation is experiencing a reckoning in caregiving, and what it means for families and our economy. A new nationally representative survey conducted by New America and funded by the Robert Wood Johnson Foundation, revealed that although our cultural norms have not caught up with our ideals of gender equity, men overwhelmingly value care work, and want not only to participate, but to share it equally with their partners. However, the lack of supportive workplace cultures and public policies keep them from doing so.

The pandemic has forced women out of the labor force in record numbers. Back in December, at the height of this trend in the labor market, 100% of job loss was attributed to women. According to Gallup, pandemic job losses show that an estimated 2.3 million women left the workforce, compared with about 1.8 million men. As our country begins to recover, and school and child care options become more predictable, experts say policymakers and business leaders must support women to help them once again make up nearly half of the labor force.

During the past year, many women have struggled to meet a drastic increase in responsibilities at home. This involved juggling the care of children, overseeing virtual schooling, caring for sick family members—all while continuing to work. Not only is this care uncompensated, but many workplaces don’t provide women with the flexibility—or schedule control—needed to balance it all. Many, particularly single mothers, had no choice other than to leave the workplace. Other women persisted, suffering increased stress, exhaustion, sleeplessness, and burnout. There is little public policy that supports for caregivers, resulting in these unfair and often impossible tradeoffs.

In the New America survey, we found that men agree it shouldn’t be this way. At the same time, many feel trapped by policies and cultural expectations that tie men to work, and women to care. In our focus groups, many men across race and ethnicity said that in order to be engaged in caregiving, feeling supported as caregivers at work, and being able to take paid caregiving leave, was critical. This helped them fulfill roles as the involved fathers, sons and caregivers that they aspired to be. It also helped their wives and partners combine work and care to live the kind of lives they hoped for, too. And yet this support—before and during the pandemic—is all too rare. The United States is the only advanced country that does not guarantee paid maternity leave, and is one of a handful that does not guarantee paid paternity leave. We are among the handful that do not guarantee paid sick or vacation days. We do not invest in universal childcare in the way that our peer nations do, nor give workers voice, say and autonomy over the time, manner and place of their work, as other countries with stronger trade unions or legislation that gives workers schedule control and flexibility.

These new findings show the ongoing need to counter the cultural narrative that caregiving is exclusively women’s work and advance equitable public policy solutions. Men are echoing this message.

Challenging Stereotypes, Broadening Horizons

Care work, both in family life and as a profession, is still viewed as “women’s work” and this outdated stereotype limits the potential of men as well as women. We spoke to men who are nurses, childcare workers, and home health aides. They are proud of their care work and find it challenging and fulfilling. Yet one in five reported feeling stigmatized as caregivers just because they’re men. Care professions, which are female-dominated and where women of color are overrepresented, are among the fastest growing as the population ages. Yet, unlike computer programming and data, another fast-growing, male-dominated industry, care work pays poverty wages and offers few benefits, if any. We need to elevate the value of these often invisible care jobs and make them good jobs for everyone.

We also found that, contrary to stereotypes, many caregiving men, particularly those who care for children or adults with special needs, perform many of the same “hands on” intensive, intimate care activities commonly associated with women, like bathing and dressing. About two-thirds of these caregiving men wind up needing to reduce work or drop out of the workforce, which is the same rate as women. Men with these more intensive caregiving responsibilities are also experiencing far greater work-family conflict, stress, and burnout, than are fathers of children with no special needs, or men with no caregiving responsibilities.

Traditional gender norms are powerful at work and at home. Women are still expected to serve as primary caregivers for family members—from infants to elderly family members. These outdated views harm men, women, children and entire families. They prevent women from advancing professionally, create stress, and overwhelm relationships and compromise personal wellbeing. As the pandemic has vividly revealed—with women taking on the bulk of caregiving and homeschooling—these views prevent men from being the active and engaged caregivers that our research affirmed they want to be.

We found that an overwhelming majority of men say that care work at home is as valuable as paid work, (more than 80 percent) and that men and women should share it equally (90 percent.) Yet, we found that it rarely works out that way. And that men and women have very different ideas about what sharing care equally means. Among adults over 18, four in 10 said that, when a family member needs care, the responsibility falls primarily on women. Men also tend to think they do more and share care equally—62 percent. Only 33 percent of women agreed. Rather, nearly two-thirds of the women surveyed said care duties fall to them, compared to 25 percent of men who thought women bore the brunt of care.  

Black Fathers Who Care

We also explored stereotypes about race and found evidence showing the strong role Black men play as fathers and caregivers, and how Black fathers face particularly difficult barriers to engaging in care.

There has long been a false cultural narrative about Black fathers, even though data suggest they are among the most active parents of any racial or ethnic group. What we found reinforces this fact pattern: there are no differences in the contributions of fathers or attitudes toward care based on race or ethnicity.

Similar to their counterparts, Black fathers and caregiving men valued care as much as paid work. They also thought men should share caregiving equally with women, and they said being engaged fathers and caregivers is important to their identity.

Our survey also found that more Black fathers than White fathers believe it's important for them to feed, dress, and provide care to younger children. We also found that Black fathers and caregiving men often face higher barriers to giving care, due to structural racism, discrimination at work, and the mass incarceration system.

All men, across race and ethnicity, anticipated needing time off work to give care. Three in 10 anticipated needing time off to care for an infant and nearly half of all men expected they would need time to care for an adult—again, the same rate as women.

This is where structural racism is again relevant. As we mentioned before, the United States does not have a national public paid family and medical leave policy. Only a handful of states mandate this benefit and companies voluntarily only cover about 20 percent of the workforce, mostly in white collar and large companies. We found that a similar percentage of Black and White fathers used savings to cover the costs associated with their recent leaves—paid or unpaid. However, twice as many Black fathers (30 percent) as White fathers (15 percent) used savings they had specifically set aside for health needs to fund their time off from work. This reveals real barriers to care that disproportionately burden Black fathers.

Envisioning a New Way

This research was built on exploring the perspectives and experiences of a wide variety of caregivers. The research team was very much steeped in the issues of gender equity, roles, and balance. And yet, many of us were surprised by what we heard from the survey respondents. It just goes to show that this area of social science is a rich one, with lots of stones still left unturned.

The attitudes and norms of breadwinner-homemaker families that were mainstream a generation ago clearly do not apply today, and by extension, many of the assumptions and expectations leaders use to inform decisions and design policies are often built upon a faulty foundation of stereotypes—ones that never really rang true for many in the U.S. in the first place. Having an accurate picture of how gender shapes care and caregiving at home and in the care economy, and understanding the motivations, goals, and barriers experienced by those who are engaged in these roles, are essential building blocks to creating the necessary new policies, workplace practices and cultural norms that will lead to a stronger, healthier and more equitable future.

Learn more about how men view their caregiving experiences and explore the many benefits of supporting male caregivers.


About the Authors

Brigid Schulte is the director of the Better Life Lab, the work-family justice program at New America, a nonpartisan think tank, that uses narrative to move public policy, workplace practice and culture so that people of all genders and racial and ethnic identities can thrive, with decent, dignified work and time for care and connection across the arc of their lives.

Jennifer Ng’andu, managing director–Program at RWJF, helps lead grantmaking activities to advance social and environmental changes that help ensure that all children and their families have the full range of opportunities to lead healthy lives, while providing a strong and stable start for every child in the nation.

Thu, 15 Jul 2021 13:00:00 -0400 Jennifer Ngandu Child and Family Well-Being Health Disparities <![CDATA[How Do We Advance Health Equity for Asian Americans?]]>

Advancing health equity for Asian Americans requires a new narrative and solutions that acknowledge our diversity. This can help address discrimination, poverty, poor health, and more.

Woman holding poster. Photo credit: Jason Leung, unsplash

Both of us are proud of our immigrant roots and the paths our families forged after coming to the United States. Mona’s parents arrived from India, and Tina immigrated from South Korea as a toddler with her family. As members of the Asian American community, the past year’s wave of hate crimes has been painful and traumatic. But it is not new. What is new, though, is the attention these incidents and the Asian American community as a whole are receiving.

At times, these crimes bring back terrifying memories. Mona was just 10 years old when a hate group in Northern New Jersey sent a racist letter threatening Indians to a local newspaper, and the newspaper published it. The deep societal racism that letter exposed was manifested through verbal abuse, brutal assaults, and murders that occurred time and again over many years. Mona grew up hearing racist comments from police officers and teachers and seeing South Asian businesses and homes, including her own, vandalized.

At times, they remind us how few people seem to consider the intergenerational trauma and challenges faced by Asian Americans. Tina’s parents grew up in South Korea during the Korean War and her father remembers his family losing everything. Arriving in a new country not speaking the language while trying to navigate a culture with a different set of values was incredibly difficult for her parents. Adding to their stress was the need to lean heavily on their children to negotiate, translate, and serve as intermediaries with authorities and agencies.

At times, they compound the numbness and hurt we feel in the face of sometimes-profound insensitivity and endless microaggressions that add up over time and contribute to chronic stress that undeniably harms health.

After a lifetime of enduring microaggressions and racism, and a year of publicized hate crimes, most Asian Americans feel a degree of othering. The past year has put these issues front and center in the public discourse, but it’s important to know that what our community is experiencing is not new.

From displacing indigenous peoples, to slavery, to internment camps, our nation’s history is characterized by racism against people of color, including Asian Americans. One case in particular fueled the modern-day movement for Asian American rights—the murder of a Chinese American man, Vincent Chin, which took place 39 years ago this June. Chin was bludgeoned to death during his bachelor party at a bar in Detroit by two white men who blamed Japan for losing their automobile manufacturing jobs. There are echoes of Chin’s murder in hate crimes we see today, and in the pain that is triggered for Asian American families who endured grave injustices.

In addition to race-motivated mass murders and acts of violence, the United States has a long history of anti-Asian policies rooted in systemic and structural racism. For instance, discriminatory immigration laws in the 1800s (such as the Chinese Exclusion Act) and U.S. Supreme Court rulings (e.g., United States vs. Bhagat Singh Thind) in the 1900s legalized bias and exclusion. In fact, it wasn’t until 1952 that people of Asian ancestry won the right to become citizens. This history has ramifications still, to this day, and has shaped current narratives and policies that impact Asian American and Pacific Islander (AAPI) communities and other people of color. Our Executive Vice President, Julie Morita, wrote about her Japanese American parents who suffered in U.S.-sanctioned internment camps during World War II and these days hear “all-too-familiar vitriol toward Asian Americans being spewed from the dark and angry corners of social media and beyond.”

So while the bigoted rhetoric about COVID-19 may have exacerbated hate against Asian Americans, it has been with us for generations. What may be changing, however, is the increasing political power of the Asian American community, unprecedented recognition of hate crimes against Asian Americans, growing solidarity across races, and increased determination to defeat white supremacy.

Working Toward Solutions

Our history and experiences fuel our passion for RWJF’s commitment to ensuring everyone in America has a fair and just opportunity to thrive. We are proud to work alongside others who are striving to dismantle structural racism. We know that doing so will require increased funding for AAPIs and a new narrative that acknowledges, rather than masks, the vast differences within our community. And as researchers, we understand that doing so will also require better, more nuanced data.

The pervasive and false “model minority myth” has driven misunderstanding, division, and inaction. Historically, the term “model minority” was used to pit Asian Americans against other communities of color, and it is harmful on many levels. Grouping together very diverse communities and conveying the falsehood that all Asian Americans are doing well masks grave hardship among segments of the population. In fact, the Asian American community has the greatest income inequality of any racial or ethnic group. The model minority myth erases the needs of those who do not fit the stereotype. It is a primary reason so few resources have been invested in Asian Americans. Quite simply, not everyone is doing well and suggesting otherwise disincentivizes investments and fosters division, rather than solidarity, among people of color.

The complexity of Asian American communities* has been a barrier to conducting the kind of research needed to understand and address discrimination, poverty, poor health, and other problems. Asian Americans include people from this country and those from more than 65 countries. We have very different life experiences, speak different languages, and are diverse in other ways. Too often we don’t ask survey questions or conduct focus groups in other languages. But with the resources and technology we have today, that should change. We should be able to improve language access and develop surveys in culturally sensitive ways.

Doing so allows for a closer look at the data—data disaggregation, in research parlance—that can reveal real-life problems and point the way to solutions. Instead of looking at overall results of a survey or study, breaking out the data into sub-categories can reveal patterns that would otherwise be masked. In one example, a National Nurses United report on COVID-19 deaths among health care workers found that 31.5 percent of the registered nurses who had died of COVID-19 and related complications were Filipino, even though Filipinos make up just 4 percent of registered nurses in the United States. Only by disaggregating the data was this shocking and tragic disparity revealed.

RWJF is supporting data disaggregation, community power, narrative change, and other research projects that help advance health equity. We are also working collaboratively with diverse communities of color; one example is a powerful guide for community leaders and advocates who want to advance health equity through changes in the way data are collected, analyzed, and reported.

Among other projects, the Foundation is:

  • supporting the Asian & Pacific Islander American Health Forum as it advances the health and well-being of Asian Americans, Native Hawaiians, and Pacific Islanders, as well as the AAPI Civic Engagement Fund to re-grant to organizations that are addressing hate crimes that target the Asian American and Pacific Islander community through education, data collection/analysis, narrative change, and other AAPI community-led initiatives;
  • funding studies to identify barriers that impede compliance with federal race and ethnicity data collection and reporting standards; and to examine and monitor opposition to data disaggregation from a social and social justice perspective; and
  • supporting the Native Hawaiian and Pacific Islander (NHPI) Data Policy Lab to demonstrate how its culturally grounded and community-driven research efforts to document COVID infection rates can serve as a model for other communities to counter their underrepresentation in data.

Fostering Racial Solidarity

In addition to this work, conversations across races are essential right now. We must recognize the unique needs of communities that are experiencing racism at the individual, institutional, and structural levels, in this country and by this country. Just as with other Black, Indigenous, and other people of color (BIPOC), Asian Americans suffer from housing and employment discrimination, high rates of uninsurance and low access to mental health services.

The national reckoning with race and the hard conversations it has driven are giving us hope that we can join together with others in acknowledging past wrongs—a first step in finding solutions and hope for the future. We stand in solidarity with all communities that have endured racism and discrimination.

*The authors recognize that Asian Americans are a distinct population from Native Hawaiians and other Pacific Islanders (NHPIs). The U.S. Office of Personnel Management recognized these are unique groups nearly 25 years ago, in 1997. However, we include NHPIs in our discussion of solutions in this post because, historically, many organizations have worked to support both communities under the term AAPI.

Learn about how we’re working to strengthen the evidence base that can guide our nation toward a more equitable future.


About the Authors

Tina Kauh

Tina Kauh joined RWJF in 2012. As a senior program officer within the Research-Evaluation-Learning Unit, she develops new research and evaluation programs, supports the development of team strategy, evaluates the work of grantees, and disseminates key learnings.

Mona Shah

Mona Shah, a senior program officer in the Research-Evaluation-Learning unit, joined RWJF in 2014. Drawing on her deep commitment to research and its potential to impact health and health care, she praises the Foundation’s work in making its extensive research accessible to the public and policymakers alike.

Wed, 23 Jun 2021 13:00:00 -0400 Tina Kauh Health Disparities <![CDATA[Making Data Accessible For Small Communities]]>

An online resource is putting the power of data into the hands of small communities to help them see where they stand on key measures of health.

Medical graphic.

Editor’s Note: This piece was originally published in the Grantmakers In Health Bulletin.

In Clifton, New Jersey, data on children in poverty, data on obesity, and data on the percent of uninsured residents revealed such pronounced disparities among neighborhoods that the city approved a satellite health office. Now, residents who previously had difficulty getting health screenings, immunizations and other necessary public services have better access.

In Waco, Texas, a nonprofit organization used the COVID Local Risk Index, a measure of city and neighborhood-level risk of COVID transmission and mortality, to pinpoint the level of COVID risk by neighborhood. Comparing this data to the city’s COVID cases added vital context to community preparation for and response to the pandemic.

Both of these cities used data from the City Health Dashboard ("Dashboard"). Launched in 2018, the Dashboard addresses the problem of data inaccessibility for cities and communities.

Just as health disparities disadvantage people of color and those of less financial means or educational attainment, so does data inaccessibility. Based largely on a combination of where they live and how easy it is to access and use data, some people can get the data they need to advocate for better, more inclusionary practices and adequate resources necessary for healthy communities. Others can’t—either because they don’t know where to find the data they need, don’t have the expertise to use it, or it doesn’t exist. Low data capacity makes it hard to get information, interpret it, and then use that information to take the steps needed to improve public health.

The Dashboard recently partnered with New Jersey Health Initiatives (NJHI)—a statewide grantmaking program of the Robert Wood Johnson Foundation—to change that, by providing community organizations, their partners, and the communities they serve accessible data that can make a difference.

The Dashboard provides more than 35 health-related metrics and updates them regularly. The Dashboard is especially useful because it provides data at the census tract level (neighborhood-sized geographic areas of 1,200 to 8,000 people), essentially enabling health advocates to know what’s happening in individual communities. That is crucial, because—in part due to segregation by race, ethnicity, income, and other factors—stark health differences often exist in nearby neighborhoods, even in the same small municipality.

Until recently, that was not much help to smaller communities. The Dashboard initially launched with data from the 500 largest U.S. cities, those with a population of at least 66,000. However, in April 2020, the Dashboard added data on over 250 smaller cities across the United States, including 18 in New Jersey—10 of which are in NJHI’s newly launched Small Communities Forging Hyperlocal Data Collaboratives Initiative. NJHI’s grants to organizations in those communities, all located in southern New Jersey, will equip advocates with detailed measures of the factors that shape health to guide local solutions. This pilot project will be a model for other states and for regions within New Jersey.

Take a virtual tour to learn about all of the metrics, features, and resources the Dashboard has to offer.

What sort of data does the project make accessible? In Egg Harbor City, New Jersey, the cardiovascular disease death rate is 358 per 100,000 people, compared to an average of 211 per 100,000 across all 750-plus cities on the Dashboard. The city also has a relatively high uninsurance rate among residents—23.2 percent, compared to 11 percent across other Dashboard cities. This is priceless information for community health advocates and local governments.

With granular, easy-to-use data that includes categories such as percent uninsured, childhood poverty, housing cost burden, and walkability, concerned residents can identify actionable gaps in health and its drivers, so they can target programs and policy changes and build broad coalitions to address them. NJHI will also train advocates to develop expertise to interpret data and put it into action. The Dashboard welcomes these kinds of partnerships to build data capacity in communities.

In “A Study in Scarlett,” Sherlock Holmes observed, “It is a capital mistake to theorize before one has data.” But you can’t use what you don’t have. Putting more data—and the ability to use it—into more hands allows people to help their communities be places where everyone has the opportunity to live their healthiest possible lives.

By putting data into more hands, the City Health Dashboard is helping support communities where everyone has the chance to live their healthiest possible life. 


About the Authors

Ben Spoer, PhD, manages the data team at the City Health Dashboard.

Becky Ofrane, MPH, is a public health researcher leading partnerships for the City Health Dashboard.

Tue, 22 Jun 2021 12:45:00 -0400 Becky Ofrane Health Disparities <![CDATA[Reclaiming the Narrative of Black Fatherhood]]>

Fathers play a critical role in the healthy development of children and families. This is why it's important to address structural and systemic barriers that prevent Black men from being fully present in their children's lives—so that all families have a chance to thrive.

Black father holding his baby. Illustration by Cat Willett

My wife and I have been married since 2019, but we’ve known each other since we were 14-year-olds. We are raising a blended family. She has a daughter who is 9 and a 7-year-old son. I have a son who is 8, and together we have a 2-year-old son.

The pandemic has profoundly shaped my parenting experience in numerous ways. I had to transform my house into a combined virtual school, daycare, and work setting. The last year has negatively impacted our seven year old, who is autistic, mostly due to disruptions to the in-person support that he needs to truly thrive. Navigating these evolving dynamics, while working, running a household, and trying to stay sane has been extremely challenging. But being present in my children’s lives makes every moment worth it.

My father left when I was 3 years old. Because he wasn’t in the picture for my upbringing, in some ways, I am trying to reach an ideal as a father that I couldn’t actually see as a child. Something inside pushed me to be different, to counter the “absent Black father" narrative.

When I was younger, my perception of a father’s role was very different than it is now. I grew up in Newark, New Jersey, where norms for a Black child, a Black young adult, and a Black man could be stifling. The limits were very clear on what society deemed appropriate for a Black man, and how you were supposed to interact with others. I was never comfortable with those unwritten rules.

Dwayne Curry shares a powerful spoken word performance about his experiences as a father.

Once I began surrounding myself with other fathers of color, I started to realize I wasn’t alone. Media, television, and popular music perpetuate this idea that Black dads aren’t in their children’s lives, and that’s simply not true. Good Black fathers do exist, but it’s taken more time for our experience and contributions to be recognized.

It is so important and powerful for a child to have a father figure. I see that my kids’ view of fatherhood is being shaped by what they see in me.

Parenting in a Pandemic

Before COVID-19, my wife was working full-time at a university. After giving birth to our son, I supported her decision to leave her job so that she could dedicate more time to care for our children and our home. Caring for four children, including one with special needs and another who just learned how to walk, especially during the pandemic, is not a one-person job. It requires flexibility and patience. Even tasks as simple as taking out the garbage become complicated if the timing isn’t perfect.

One of our most challenging times during the pandemic was when my wife became ill and we worried that she may have contracted the virus. As we awaited her test results, she was quarantined in our room for several days while I took on the responsibility of caring for our children and for her. During that time, my family depended on me most as a father and husband, but I still needed to work in order to provide food and housing for all of us.

It’s difficult to give 100 percent of who you are to each of these distinct roles, and I struggled silently in fear of imposing guilt on anyone who depended on me. Even after my wife recovered, I suffered through many sleepless nights, anxious about who I was letting down each day—my kids, my wife, or my coworkers?

As I became better at expressing my feelings to my wife and colleagues, I also gradually began to better balance my roles. I didn’t want to be that dad who is always working and isn’t present in my kids’ lives, and they all understood that. I’m grateful to have the flexibility to be the best father, husband, and professional that I can be. Every day during my lunch period, I put my youngest down for a nap. Feeling his small hand grab my finger as he says “Dada, go to sleep?” is my signal that it’s time for the highlight of my day. My wife and I alternate helping our school-aged kids with their homework, preparing lunch, and taking the entire bunch outside to play. The silver lining in these times is how closely I get to watch my kids grow up before my own eyes.

Supporting Caretaking with Policy, Culture and Leadership

I recognize that I am blessed to be able to find balance. Many obstacles prevent fathers from being fully present in their family's day. Because of the environment I grew up in, I intimately understand the forces holding people back. I’m referring not just to a culture that only encourages men to pursue a very narrow set of traditionally masculine career paths, but also systems that make it difficult for men to take time off when they have a new baby or a sick parent. There is no question that policymakers can do more to break down those barriers with reforms like paid family leave.

There’s a role for employers here, too. It’s really important to build a culture that doesn’t just extend paid family leave benefits, but also encourages employees to use them when needed. I used to be nervous to take time off when someone in my family got sick. This added anxiety and stress made the situation even more difficult. I no longer feel that way, and wish others had that autonomy. I am grateful that I can take time off and be an active parent and caregiver during this devastating time. 

There’s also a cultural piece—caregiving responsibilities can impact someone’s career growth. It’s so important for those in senior positions of power to understand this. Even if you have the right policies in place, people may judge or subtly dismiss those who actually take time off to provide care. Supervisors must lead by example, and be aware of implicit biases. 

These false archetypes of what a leader looks like can influence decision-making. Even a well-meaning supervisor could ask themselves, “Should I avoid giving more responsibility to someone who is a caregiver?” They may have good intentions, but that outlook could hold someone back. It’s not just about having the right policies on the books, it’s making sure they are implemented equitably as well.

Bringing it Home

I’ve also seen what male caregiving can do to help a family grow and thrive. When my wife was raising her son who is autistic, as a single mom, her caregiving role was overwhelming. Depending on the resources available to you, based on where you live and your level of support from family or friends, single parenthood may be extremely tough. You may be constantly putting out fires, burned out, and strained. You may not have the flexibility to plan for the future if your present feels like a nightmare. How can you think about investing if you can’t even pay the bills? There were little to no resources available to her and her children in the city where she lived, so she relied heavily on her mother to navigate through that phase of her life.  

For me to take on the role as her partner has had a great impact on me. I also see that my wife now has more freedom to dream. She became a certified life coach, discovered her passion for psychology and is taking college courses. We launched a podcast together where we have real, honest, and transparent discussions about relationships, family, and careers. To hear her aspirations and see her grow is breathtaking. At the same time, our son’s development has gone through the roof. This has been so uplifting for all of us.

As someone who has been impacted by false narratives, and is working to bring about a new one, I’m grateful to be involved in this work. In my life at home, I know that I may not always have the perfect words to express how I feel on command, but my children know that I love them, and my wife does too, because I show them every day. There is nothing more important to me than that.

Like me, many men of color take pride in caring for their children and families. To read more about our experiences, check out the new brief A Portrait of Caring Black Men and Every Family Forward’s Man Enough to Care series, including their thought provoking survey of real men who care for others.


About the Author

Dwayne Curry

Dwayne Curry joined RWJF as a program officer in 2019. Through his work he strives to ensure that all families, no matter their background, have access to the resources they need to raise thriving children.

Wed, 16 Jun 2021 09:45:00 -0400 Dwayne Curry Child and Family Well-Being Early Childhood National <![CDATA[Three Ways to Advance Health Equity Through Research]]>

Learn about how we’re working to strengthen the evidence base that can guide our nation toward a more equitable future.

A diverse group working on a project.

The pandemic and this past year’s racial reckoning have given us a decisive moment. We have an opportunity to build a movement for positive change and collective healing. Part of the national awakening is recognizing the urgency to improve public health and advance equity. Today, multiple organizations and people across sectors are eager to do their part in creating a better, more equitable future.

My colleagues at the Robert Wood Johnson Foundation and I, too, seek bold and lasting change. We believe our path forward must be rooted in the best available evidence. What we need now, urgently, is research on how to eliminate inequities in health outcomes by addressing structural racism. How do we create evidence-based policies and practices so everyone has fair and just opportunities to thrive? 

Long-established biases in our research field have determined who conducts research, and they tend to favor the same institutions and individuals. We also have deeply held beliefs about which types of research are valuable, and too often this constrains innovation.

To advance toward our goal of achieving health equity, we need to expand traditional research approaches to include more perspectives, ideas, and methodologies. When we do, I believe we will enhance our rigor and excellence. Here is what it might look like—and what we are practicing in our own work:

1.    Lived Experiences Are Valuable

Individuals who experience in daily life what researchers study as “societal problems” bring essential knowledge to our fields. We should value and encourage those with diverse life experiences to enter the research field because their experiences can help us understand where barriers exist and how to overcome them. We can then apply this additional knowledge into actionable evidence to improve health equity.

Achieving health equity requires that our research truly reflects the country’s demographics. And it’s not just researchers. It should be every institution that touches research, including academia, publishing, and philanthropy. At our foundation, we have made a diversity, equity, and inclusion commitment to recruit leaders and staff from diverse backgrounds, perspectives, expertise, and/or lived experiences. We have worked on this for years, and will continue to strive for fair representation. (You can see our latest demographic report that is inclusive of staff and trustees.) Diversifying who conducts research makes evidence stronger and helps us put that evidence into action.

2.    Research Should be Centered in Communities

Academia has long cherished randomized control trials as a gold standard of research (to name one example). But COVID-19 has underscored the need to address nuanced community conditions and dynamics through a broader set of methodologies in order to advance health equity.

That’s why we’re investing in research that either takes place within communities and/or meaningfully engages community members. We welcome eclectic, mixed methodologies connecting quantitative and qualitative data that can produce both authentic community partnerships and solid research evidence as well as actionable policy change.

Research should also be accountable to communities—and not simply extractive. What we learn from community-based research can be applied right back in communities, initiating an evidence-to-action pathway. RWJF invests many of its research dollars through our “For Action Programs,” namely Policies for Action, Evidence for Action, Systems for Action, Health Data for Action, and Health Equity Scholars for Action. I invite you to explore how emerging research from these centers is being applied in real life.

3.    Data Needs to be Complex and Nuanced to be Useful

Evidence is only as strong as its data. Yet too often we base evidence on data collection and reporting that itself carries elements of structural racism. 

One example is insufficient disaggregation of race and ethnicity in current data systems. Grouping all Asian populations without regard for the different cultures, languages, immigration histories, or wide variations in health, education, and wealth is problematic. Too often, race and ethnicity information for populations is not collected, analyzed, or reported, or it is discounted. Look at data collected for American Indian and Alaska Natives, Middle Eastern and North African peoples, and Native Hawaiian or other Pacific Island populations, for example. The lack of good population-level data on disability is another example. These flaws render populations invisible, mask unique needs, and hide strengths and assets. It leads to poorly informed decisions that affect lives and wellbeing. This lack of disaggregation was clearly part of the problem in our national response to COVID-19. 

Another example is siloed data. As the COVID-19 pandemic swept the nation, there was a delay in recognizing its impact on incarcerated populations. We had health data, and we had data on incarcerated people. Yet, criminal justice-related data are not routinely connected to population health data systems. The pandemic response could have been improved with better data interconnectivity and more comprehensive and equity-focused frameworks. 

To this end, RWJF has created a National Commission to Transform Public Health Data Systems. The commission will reimagine how data are collected, shared, and used, and identify what’s needed to update our public health data infrastructure to improve health equity.

Toward Bold and Lasting Change

When some groups lack equal opportunity to live to their full potential, our nation cannot achieve its full promise. Through our funding approaches, we are supporting the researchers to further develop action-oriented, mixed-method approaches that address urgent problems that constrain health equity. Here at RWJF, we don’t have all the answers but we are eager to continuously engage, have exploratory conversations, debate openly and, most importantly, to support the work to bring about change. I hope you will help us strengthen and accelerate the evidence that will help our nation achieve better health and equity for all.

I invite you to sign up for RWJF’s funding alerts. We will notify you of our next round of funding.


About the Author

Alonzo Plough

Alonzo Plough, chief science officer and vice president, Research-Evaluation-Learning, is responsible for aligning all of the Foundation’s work with the best evidence from research and practice and incorporating program evaluations into organizational learning.

Tue, 8 Jun 2021 13:45:00 -0400 Alonzo L. Plough Health Disparities