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Foundation's Vision Expands Into More Holistic Approach to Healthcare

Robert Wood Johnson Foundation’s forum on ‘Culture of Health’ initiative draws state leaders

howard- perry-catino
Heather Howard, director of Princeton University’s State Health Reform Assistance Network (left), Dr. Ruth Perry, executive director of Trenton Health Team, Annette Catino, CEO of provider-owned insurer QualCare Inc.

The nation’s largest health-focused foundation is touting a wider-ranging approach to public health, including initiatives to give people more access to fresh produce, encourage designs for “walkable” towns and cities, improve public parks and transportation, and provide people with better housing.

Plainsboro-based Robert Wood Johnson Foundation is kicking off what it promises will be a decades-long effort to build what it calls a “Culture of Health” -- and some of the leading voices for health and healthcare in New Jersey are embracing its vision. (Full disclosure: The Robert Wood Johnson Foundation provides funding for NJ Spotlight’s health coverage.)

The “Culture of Health” approach will help the foundation determine how it disperses the $400 million in grants it awards annually. This will likely have significant consequences for New Jersey, where the foundation has historically made 10 percent of its contributions.

While the foundation is continuing to provide support in areas where it has a lengthy track record -- such as efforts to reduce childhood obesity and curb tobacco use -- it’s aiming to knit these projects together into a broader effort to foster a culture in which it’s easier to make healthy choices.

“Essentially, we have a culture that leads to our population being unhealthy,” said Dr. John R. Lumpkin, a foundation senior vice president.

Lumpkin said several individual projects that the foundation has funded in recent years fit its new vision -- including adding two miles of bike lanes in Vineland, renovating a community center in Perth Amboy, and supporting Dr. Jeffrey Brenner’s hot-spotting effort in Camden, where healthcare is targeted at people who can benefit the most.

Foundation officials said it will take a broad coalition of public officials, business executives and leaders at other nonprofits to make change happen.

But the foundation -- which legally cannot lobby -- intends to inform debate by increasing access to indicators of public health. For example, it is sharing with transportation planners project study results that show that increasing the use of public transit can lead to weight loss.

It’s also working to bring together policy, business, and community leaders -- and encouraging local health officers across the state and country to convene similar groups in their communities.

One example of this coalition-building could be seen at a recent forum at the foundation’s headquarters that drew top state officials, along with private-sector and nonprofit executives. Each participant cited examples of ways to promote health outside of traditional healthcare services.

State Health Commissioner Mary E. O’Dowd said the state is trying to take a broad approach in using every tool at its disposal to achieve public-health goals. She cited discussions with hospital executives, federal nutrition funding, and changes in hospital regulations that make it easier for mothers to breastfeed their newborns. .

State officials are discussing with business leaders the advantages of encouraging breastfeeding and childhood immunizations, by pointing to evidence that healthier residents will be more productive.

Heather Howard, director of Princeton University’s State Health Reform Assistance Network, said one way that communities can become healthier is by considering the impact of new projects, much as towns typically consider the effect of developments on taxes and school enrollment.

“What’s it going to be mean in terms of more cars on the road, how walkable the community is, how many stores might be there where people could buy fresh food,” are issues that should be raised, said Howard, a Princeton councilwoman and former state health and senior services commissioner.

Dr. Ruth Perry, executive director of Trenton Health Team, noted that access to transportation, quality housing, and healthy food are among the “social determinants of health.” Her organization works to coordinate the healthcare of residents across different city agencies.

She cited as an example a resident who visited hospital emergency rooms 465 times in 2010. She had significant mental health, substance abuse, and housing issues that required several healthcare and social-service providers working together to reduce her reliance on hospitals.

Annette Catino, CEO of provider-owned insurer QualCare Inc., said her company is already thinking in terms of residents’ health rather than simply funding healthcare services.

“It really is pretty simple – we would much rather spend money to help people have productive, healthy lives than have them unfortunately spend their lives in the emergency room,” Catino said, adding that chronic conditions are particularly important to address.

O’Dowd added that insurers should also consider funding programs that have been proven to lead to positive health outcomes, such as home visits by nurses to new mothers.

Lumpkin noted a major historical example where the culture changed to encourage health before laws were changed -- the period before clean indoor-air laws were enacted to ban smoking. It took years of discussions among business leaders and the public to build consensus around the need to curb indoor smoking.

Foundation officials pointed to additional strategies for building a culture of health. For example, the local communities are striving to improve their performance on the foundation-funded countyhealthrankings.org, which shines a light on counties that are succeeding – and failing – at a variety of health measurements. The site also provides a list of public-health strategies that research has shown can help improve these scores.

Howard said this would lead to residents asking: “What are you doing for me to make my community healthier?”

Foundation Chief Science Officer Alonzo L. Plough said this has led the foundation to gather information in areas that were traditionally far afield from healthcare, such as the quality of housing and whether a neighborhood is designed to be easy to walk in.

Hospital systems and health insurance companies could become important in supporting efforts to make their communities healthier, as the payment system for healthcare shifts from paying fees for each service toward paying providers more if their patients are healthy.

“They begin to realize it’s not just what happens in the doctor’s office or the nurse practitioner’s office or the hospital that has an impact on how much it’s going to cost us, it’s what’s happening in people’s homes,” Lumpkin said.

Dr. James D. Marks, a foundation senior vice president who oversees grants in New Jersey, said healthcare providers are increasingly taking a broader view of health as well.

“If a family lives in an apartment with a lot of mold, and they’ve got asthma, we’re going to have a lot of repeat hospitalizations and emergency-room visits,” Marks said of healthcare providers. “And is there a way we can be supportive for refurbishing that, perhaps, low-income apartment building?”

Plough said the foundation is looking to systematically increase public awareness of innovative approaches to improve public health. “It’s a 20-year agenda,” Plough said of building a culture of health. “There will be short-term successes, but this is a long-term shift that requires a lot of engagement.”

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