How New Jersey Can Build a ‘Culture of Health’ and Fill in Notable Gaps in Care

Lilo H. Stainton | April 18, 2019 | Health Care
New report presents a roadmap to help policymakers create more effective and equitable healthcare programs in Garden State

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New Jersey does well in many ways when it comes to efforts to build healthy communities, resulting in high enrollment in early childhood education, generous paid family-leave policies, and low smoking rates among adults.

But these strengths mask significant health disparities related to race, income and geography, according to a new report from the Robert Wood Johnson Foundation and Rutgers University. And existing programs often don’t serve all who are eligible. Together, these gaps in care take a toll on the health of communities and contribute to the nearly 6,400 unnecessary deaths each year in the Garden State, the authors note.

On Wednesday, leaders from RWJF and Rutgers gathered in Trenton to release the report, “Building a Culture of Health: A Policy Roadmap to Help All New Jerseyans Live Their Healthiest Lives.” It’s the product of nearly a year’s worth of research and hundreds of interviews with community healthcare providers, patients and other stakeholders. (RWJF also supports NJ Spotlight.)

The report includes 13 multilayered recommendations designed to help policymakers give parents and new families a stronger start, improve community health, and create more effective and equitable programs. And to properly implement these initiatives, the authors urged officials to better engage community members, simplify and streamline the processes involved, and focus assistance on those most in need.

“New Jersey is a leader among states when it comes to the overall health and well-being of its residents, but a new policy focus is needed to help give every New Jerseyan a fair and just chance to live their healthiest life,” the report states.

A red flag for maternal, infant health outcomes

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Among other things, the report flags the need to improve maternal and infant health outcomes, in which New Jersey has among the worst racial disparities nationwide. (Black mothers here are more than three times more likely to die from pregnancy-related issues as white woman.) Expanding affordable housing is also a priority, it said, since the Garden State has among the highest costs of living and a a foreclosure rate twice the national average.

The state must also do more to boost enrollment in existing programs, including the earned-income tax credit, which benefits low- and moderate-income workers; one in five eligible residents does not claim this credit, according to the report. And officials need to better promote food-assistance programs like Women and Infant Children (WIC), a program that reaches just half of those who qualify.

In addition, the authors said the Garden State must address several larger challenges, like shifting toward a system of more integrated care, where behavioral and physical health treatments are coordinated and providers focus on the whole person. Patients with multiple, complex diagnoses are more expensive to treat and, while New Jersey outspends many other states on medical care, a lot of residents remain in poor health.

“These are the things we think are the most sensible investments for the state to make. And we realize that private industry and philanthropy also have a role to play,” explained Giridhar Mallya, a senior policy officer with the foundation, and one of the authors.

The foundation will work with other organizations to support implementation of these goals, and the report will also inform its own grant process, he said. “It’s really with the implementation of policies and enforcement where the equity issues play out,” Mallya added.

Impact of housing, poverty and race

The 75-page report, which includes some 400 references, echoes a growing understanding of the role social determinants, like housing, poverty and race, play in an individual’ s health. A February report from the nonpartisan Trust for America’s Health reached similar conclusions. “We need strategies that go beyond the doctors’ office,” Mallya said.

The authors credit state leaders — particularly under Gov. Phil Murphy — for recognizing these connections and addressing the gaps in outcomes through programs like Nurture NJ, First Lady Tammy Murphy’s effort to improve maternal mortality rates, and the Department of Health’s investment of $4.7 million in doulas and other community health workers. State lawmakers have also proposed more than a dozen bills to address maternal mortality challenges, the authors note.

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But more work is needed to advance a universal culture of health, notes the report, which calls for more collaboration among agencies and a focus on building programs from the ground up to ensure residents have a real voice in the process. “The report is very clear: If we truly want to improve health and well-being in our state, we must make sure that opportunity is there for everyone. This is what we mean by health equity,” said Dr. Richard Besser, president and CEO of the foundation.

Several authors also said that, while a number of these ideas have been highlighted in other research, this report is unique in its breadth and depth; it relies on more data than most, is soundly grounded in proven science, and is informed by significant community input. It also comes at a critical time, given the growing disparities in outcomes and a greater public appetite for addressing these gaps, they added.

“The priorities in this report were identified as the real challenges to being healthy that New Jerseyans face each day, and the policies are supported by the best available evidence,” said Joel Cantor, director of the Rutgers Center for State Health Policy, whose team also contributed to the report. “These are not just pie-in-the-sky ideas —they have been vetted to ensure there are ways to build support for and implement them.”

Avoiding cultural bias

Specifically, the report called for ensuring that the state’s ongoing effort to reduce maternal mortality is truly inclusive, with input from marginalized communities, and with a full continuum of maternal care (including before women conceive and between child-births), and engage all types of providers. It should also do more to expand home health visits for new mothers, and make sure the workers making these visits are trained in avoiding cultural bias.

In addition, the authors urged the state to further promote the benefits of its newly expanded paid family leave policy — which has been shown to improve health outcomes — and to simplify the application process. They also urged officials to try and boost enrollment in the EITC program, and to carefully track the impact of the new minimum-wage law.

The report also called for greater investment in early-childhood education programs and flagged the need for more low-income housing, urging officials to build on a number of partnerships that involve healthcare systems. And it highlighted the need for greater investment in preventing lead poisoning, more public transit, and safe streets where people can walk and play.

Authors also urged state officials to work harder to expand access to healthy food, through existing programs (like free school lunches) and new partnerships; one in 10 New Jerseyans is considered food-insecure. And they called for more focus on reducing smoking, including raising the cigarette tax, as several nearby states have done.

In addition, the report flags the need to address several complex, systemic challenges to ensure patients are treated as a whole person and that they receive integrated behavioral and physical healthcare. The authors praised the state’s recent efforts to better coordinate but urged it to further expand the use of managed care and seek lessons from others to improve collaboration among various state departments.

“People’s health needs go well beyond the capacities of a single state agency, so creatively combining funds within and across agencies can foster multi-sector strategic planning, efficiency in resource use, and improved individual and community well-being. While New Jersey has experimented with such models, some states are going much further,” the report notes.