FIRG Seminar – Building a Culture of Health

FIRG Seminar – Building a Culture of Health

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(cheerful piano music) – You know, if you’re somebody like me who’s worked in philanthropy, who spent a career in public health, there’s nobody who it
is a greater privilege to introduce than Rich Besser. And I’m gonna go through four decades of Rich Besser’s history.
(laughing) Very short.
– Thank you. – Rich and I have a
connection in several ways. One is our work together in government, although not closely, but CDC was one of the great agencies, and I’m gonna talk about that,
that I worked a lot with. As Joel has already mentioned, at the Robert Wood Johnson Foundation, we worked there at the same time. I left about a decade ago, but it’s been wonderful to be associated with what Rich is doing there. And thirdly, his membership in the National Academy of Medicine, which is my institution now. He’s a pediatrician and
epidemiologist by training, and was trained at Williams College and at Penn Medical School
at Hopkins, and at CDC. That’s sort of the decade of the ’80s during his training period, and at CDC he worked a lot on the epidemiology of foodborne illness and went from there, moving
into the decade of the ’90s, I’m gonna get this in rough approximation. He then went to the University
of California in San Diego where he was, he directed
the residency program in pediatrics there while
also working in public health with the department, the county department
of health in San Diego, which has been, in many ways, and I don’t know what it was like then, but I assume it has some very innovative and creative activities
that I’m sure he had a role in fostering during his time there. Then you move from the decade of the ’80s to the decade of the aughts,
and he returned in 1998 to CDC, and was there for about 10 years in, initially in infectious
disease epidemiology, working under Moe and Yan, antibiotic-resistant
organisms and so forth, and then he became, during the period of the
concern over terrorism, he was the focal point for coordinating all of CDC’s terrorism
preparedness activities, and then, during the last
year of his period there, with the director, acting director of CDC, I don’t know if you
remember the concern we had about the H1N1 outbreak, but he was the very public focal point for that response capacity while he was the acting head of CDC. And then he went, he was recruited. Moving into this last decade, because of his visibility
and effectiveness both as a manger and as a
communicator in that time, ABC recruited him to be what
I think everybody agrees was the most effective health
and medical editor on the air and did that for ABC for
about eight years or so before he was recruited by
Robert Wood Johnson Foundation in 2017 to come and provide
that kind of communication, policy instinct, basic common
sense, and most importantly, a concern for those who
are most vulnerable. As someone who’d worked both at CDC, worked at the county health department, and saw firsthand in
his reporting experience the circumstances of individuals who are the least
privileged in our society. He developed and engaged those challenges and internalized those
challenges very specifically. So the match between Rich, Rich’s instinct and
background and capacity with the commitment of the
Robert Wood Johnson Foundation to a culture of health,
was a natural marriage, and gives him the opportunity to express his commitment to equity
in a fundamental fashion through the work of the foundation. So it’s a really
wonderful privilege, Rich, to welcome you and introduce you, and thank you for all you’re doing. – Thanks so much, Mike.
(audience applauding) Thanks for a very nice introduction, and Joel, thank you so much
for the invitation to be here. So I’ve been at the foundation
for almost two years. Time flies. But when I hit the ground
there almost two years ago, one of the first things
that came across my desk was an invitation from Joel
to come here and speak, and it’s such a wonderful warm community that you’ve created here. But I said no. And I said no because I felt like I knew nothing about philanthropy, and I was gonna be coming to the Mecca of philanthropy and foundations, and I wanted to wait until
I had something to say, and so I put him off for
two years, and now I’m here. But when I first took the job, I reached out to a lot
of people to get advice about what I should do. “I’m in this new job running “the Robert Wood Johnson Foundation. “How can I get up to speed?” And I talked to Tom Frieden
who had just left CDC, and he said, “Do you know Joel Fleishman?” (audience laughing)
And I said, right, same conversation,
he made, you know, maybe he was on the same plane. And I said no. And he says, “Well, read his book.” And so that’s what I did, in the early days of
joining the foundation, I read Joel’s book, and it got me thinking about philanthropy and foundations and the work we do, I think, in the right way. Let me see how to work our clicker. There we go. Perfect. So I’m looking forward to
speaking to you for a while, and then hopefully having a conversation. I like the conversations most of all. I want to talk about
the foundation’s vision for health in America. How do we frame health, and how do we put our
dollars towards that vision? I want to talk a lot about
this concept of health equity, and why we are using the
lens of health equity to inform and drive all of
the work that we’re doing. I’ll share with you
the primary focus areas that we’re doing our grant-making in and give you some examples of our work. Our foundation has been around since 1972. General Robert Wood Johnson, who was the second generation
of the Johnson family, left the bulk of his fortune
to start a foundation that was focused on improving health and healthcare in America. That was pretty much it. In particular, with a focus on those who are are most in need. He had done a lot of charity work within the state of New Jersey, and so we do some extra
grant-making in that area, but within the broad
brushes of what he laid out, over the course of our history, we have worked on that mission. We’re domestic-focused, and it’s on improving
health and healthcare. Early days, until recently we were divided into two primary silos, one
that was focused on healthcare, and the other that was
focused on public health, and in the public health
realm on social factors. We’ve had a lot of
successes over our history. We helped build out the 911
Emergency Response System. We helped contribute in a big way to reducing smoking in America, with putting a big focus on
trying to prevent children from starting smoking in the first place, helped to build out the
field of palliative care. We’ve invested a lot on nurse leadership, mental health, and then
one of our big bets of late has been around childhood obesity and trying to reverse the
trends in childhood obesity, and there’d been great
work done here at Duke to contribute to those efforts. One of the things that we’ve recognized and others have recognized
over the past decade is that, when you think about health, and what it takes to
be healthy in America, healthcare is important. It’s important that you have a connection to a healthcare provider, but that makes up only a very small part of what it takes to have the opportunity for health in America. So about six years ago the
foundation laid out a vision for what we call a culture of health. And it was a recognition
that health takes place due to what happens where
we live, where we work, where our kids to go
school, where they play, and if you’re not looking
at all of those conditions, even if people are connected
to a healthcare provider, you’re not gonna see a healthy society. The exposures early in life, there’s a lot of attention around what are called adverse
childhood experiences, housing, having safe, affordable housing, high-quality schools, food that is healthy and available at affordable
prices, places for kids to play, secure jobs that pay a living wage, and the transportation
to get to those jobs. A healthcare system that
meets the total needs of the people who are within their care, and then removing the barriers to health that are caused by racism
and sexism and ageism, and all different types of discrimination. All of these things are
critically important if we want to build
what we’re referring to as a culture of health in America. As Mike mentioned, I’m a pediatrician, and I’ve been fortunate that, in addition to the other jobs I’ve had, I’ve been able to continue
practicing general pediatrics, and so a half day a week
I work as a volunteer in a federally-qualified health center, and it’s in those clinics, that I see the disparities in opportunity play out in the biggest way. I remember in Atlanta, when I was at CDC, I worked for eight years in a clinic that took care of largely
lower-income Latino immigrants, and a lot of uninsured patients. And I remember this four-year-old boy that we’d been seeing for
a while in the clinic, and he just wasn’t gaining weight. You know, we did a dietary
history, and examined him, and there was nothing
physically that seemed to be wrong with him, but he
wasn’t gaining weight. And it wasn’t until the registrar really developed a
relationship with his mom that she was willing to say to him, “Well, he’s hungry; we
don’t have enough food.” And it was, that was the cause
for his not gaining weight, but because he was an
undocumented immigrant, he didn’t have access to
a lot of the programs, the safety net programs that are there to prevent people in this
century in America going hungry. So we connected him to food
banks and those kinds of things, but that was the issue for him. In New York City, I worked
at a clinic in Harlem, and 80% of the kids we saw
were in the foster care system, and I remember this grandmother. She lived in Staten Island, and she would travel about two hours to come to the clinic up in
Harlem to have the kids be seen, and I would do my history
and physical, and you know, having come from CDC, I’d talk the about the importance of physical activity, and that CDC recommends
an hour five times a week for kids in those age ranges, and that was really important, and what kind of, what were
they doing after school, what physical activity were they doing? And she said, “Well,
they’re in the apartment, “and there’s not much physical
to do in the apartment.” And I said, “Well, you know,
they gotta get outside, “and you know, play, you know,
play is really important.” And she said, “It’s not safe. “My kids can’t go out. “My grandchildren can’t
go outside and play.” And so she was forced to make a decision in the interest of her
children to keep them inside. You know, one of the
risk factors for obesity is screen time, so they’d
be inside on the couch, in front of a screen, but she
didn’t have the opportunity, those kids didn’t have
that opportunity to play. Another child in New York, a three-year-old who was
having frequent visits to the emergency room for asthma, and we eventually ended up
doing some allergy testing, and the little child was
allergic to dust mites, which are a very common
cause of asthma in kids, and they’re found in
the dust in apartments. Her landlord had no interest
in remediating the apartment, so we treated the asthma. These are what we talk
about and think about when we think about
opportunity for health. And now I’m working in
a clinic in Trenton, which is about 15 miles
away from the foundation, and about two months ago
I saw a mom in there. Her five-year-old son has severe
developmental disabilities, and she’s been waiting two years to get him the special ed
services that he’s entitled to, and we know that early
access to those services can have a big influence, a big impact in terms of life trajectory. So at the foundation when we think about building a culture of health,
we think about health equity, these are the faces and the voices that I try and keep in mind, and it’s the power I think
of the stories we can tell about the experiences
of people across America that can help bring to life
what we’re talking about there. You know, we talk about
personal responsibility as being important to health, and it is, it’s critically important that
people make healthy choices, but one of the things that
we like to hammer home is that the choices people make depend on the choices that they have. And for too many people in America, the healthy choices
aren’t the easy choices. They’re not there for them to make. So equity, I want to talk about equity and why we are so focused
on equity at the foundation. One of the things I found
during the eight years I spent in media is that the words you
choose are really important, that words have a lot of power. And the wrong word can
immediately put up a wall. You know how it is Thanksgiving dinner when someone says something,
and all of a sudden, you look around the table, and half of the crowd at
the table have shut down. Words can build walls, they
can also build bridges. You know, if you do the research and understand how words play out. At the foundation, one of the
things that we’ve been working really hard to do is to
explain the difference between, there we go, between equality and equity. They sound a lot the same, I hear people use them interchangeably, but we mean something very different. So the top picture, imagine a scenario where we
want people to ride bikes. Riding bikes is good for your health, it’s good exercise, it’s a
great way to be outdoors. So the top is what we mean by equality. Everyone there is given a really
nice, high-quality bicycle, and everyone is given the
same bicycle and told, “Get out there, get on that
bike, and go for a ride.” Well, if you look there,
the woman on the far left, she has a disability. And so the bike she got, it
looks good sittin’ there, she can hang her clothes on it, but there’s no way she’s
gonna ride that bike. The next one over is a guy like me, so very tall, he’s given a bike. If he rides that bike
for long periods of time, he’s gonna end up with a backache. The woman next to him,
the bike fits her well, she’s gonna do great. And then you look at the little kid, his feet don’t even reach the pedals. So he’s not gonna have the
healthy outcome you’d like. That’s equality. When we talk about equity,
what we’re talking about is giving people what they need
to make the healthy choice. So the woman on the left has
a different type of bicycle she’s able to ride. I’m riding on one where I’m
gonna be very comfortable. The woman has the same bike as before, and the little kid has
a bike that fits him. So that’s what we mean
when we talk about equity, giving people what they
need to make the choices, the healthy decisions easy. And when it comes to overall health, opportunities and barriers relate to a lot of different things. They relate to income
and gender, geography, physical abilities,
age, sexual orientation, immigration status, and
you can go on and on. But one of the areas where it’s clear, there’s more and more data
that it impacts on health, and that’s racism and discrimination. And we feel it’s very important to have that be part of the conversation. It’s one of the hardest things
in America to talk about, but it clearly provides a barrier for health for so many people. I like to frame the issue
around racism and discrimination and opportunities around American values. You know, in America, we have a value that everyone is created equal. We pledge allegiance in schools with liberty and justice for all, we talk about America as
the land of opportunity, and we talk about the American Dream as what we’re all striving
for, but as a nation, we haven’t fully lived up to that ideal, and if we’re willing to acknowledge that, and look for how and have
conversations around that, we believe we can make progress, and our history has been
filled with barriers set up at every level of our society, deeply rooted, many times intentional, and they continue to limit
opportunity for many today. There’s some groups who’ve
had a lifetime of benefits and opportunities because the
system was set up that way, and conversely, there’s some groups who’ve had barriers and burdens, nothing having to do
with how hard they work, how much education they have, society has set it up that way. So one of the things
that we’re looking to do is to help address those barriers so that opportunity is
there for all in America. When I arrived at the foundation, we had a team that was focused
solely on health equity. That’s where they did their grant-making. They had a pretty robust portfolio. But as we thought about health equity, and its role in the work we were doing, what we recognized, that by
having health equity over here, on one team in one program, it
was giving the wrong message. It was saying that, “Yeah,
we’re doing health equity. “Now we can do everything else.” What we recognized that we had to build health equity into all of our programs. Every program area now
has put health equity into their strategic plans, is looking to see how what they’re doing is increasing opportunity for all. It’s aspirational, we’re
not all the way there, but you know, we dissolved
the health equity team about a year ago. We now have each of the managing directors in each area who’s responsible for equity, each team has health equity plans that are woven into their
other strategic plans. We’re looking at how we
can measure our progress in that area, and it’s a
commitment that we’re making, not just in terms of our work, but to push with our grantees as well, to see how can we put health equity through everything we do. And when it comes to racism
and structural racism and how that plays out, one of the things that we
think can be very helpful is using data to shine a
light on what this looks like. ‘Cause it’s one thing to sit around and talk about these words. It’s easy to shut that down. It’s a little harder
when you’re sharing data. We’ve been using the
county health rankings. We’ve supported them
for the past 10 years, and these are a ranking of health status in just about every county in America. Within every state they’re ranked, from best health to worst across 40 specific health measures, conventional health
indicators such as things like rates of diabetes and
smoking, obesity, teen births, premature deaths, but we
also included in there factors that influence
health and well-being, things like unemployment, failing schools, substandard housing, segregation
rates, persistent poverty. And last year, for the first time, we looked at the data, not just in terms of place and health, but place, health, and race, to see well, what’s that look like,
you know, across America? Are there any patterns we could see? And there were. There were patterns. It was eye-opening but not
surprising that really, across every county, whether
you were a highly-rated county or a lower-rated county,
black Americans, Latinos, and Native Americans
fared worse than whites. And that’s something that isn’t surprising but should be unacceptable. One example, here’s some
data that was part of that. Black babies across America are more than twice as
likely to die as white babies before reaching their first birthday. So in terms of numbers, 11.1
deaths per thousand babies for babies born to black mothers, 4.9 deaths per thousand babies for babies born to white
mothers, and that’s CDC data. And you say, “Well, you know, “maybe it has to do with a difference in “education or income. “Maybe race is a marker for that.” Well, here’s some data from Brookings that I want to walk you through. This breaks down infant mortality by race and education level. So if you look at the X-axis, it’s years of school
attainment, so on the far left, it’s having attained an eighth
grade or less education, and on the far right,
it’s an advanced degree. The darker bars are for black women, the lighter bars are for white women. And what you see here is
that the infant mortality for babies born to black
women with an advanced degree is higher than that for
babies born to white women with an eighth grade or less education. That should be unacceptable. That should force you to say, “Why? “What’s underlying this? “What can we do to change that situation?” And once a baby’s born, the situation doesn’t become
what we’d like to see either. We’ve funded some work by Raj Chetty and colleagues at Harvard University, his colleagues at Opportunity Insights. They do work on upward
mobility and downward mobility, but the goal when you
think about, you know, opportunity in America and
the American Dream is that, you know, regardless of
where you’re born in America, you can pull yourself
up by your bootstraps if you’re hard-working. So what they did was they
tracked upward mobility for more than 20 million children. They broke data down by
race and family income, and they linked census and tax data, so they were able to
look intergenerationally over a span of nearly 30 years,
so a long period of time. So first, let’s take a look at low-income and the ability to move up. So this is looking at children born in lower,
in the lowest quartile, or quintile in America. In that group, 2.3% of black boys born in low-income
households were able to rise over that period to high-income, compared to 9.2% of white boys born into low-income households. Looking at those born into
high-income households and their ability to stay at that level, for black boys, 17% in
high-income families were able to stay at high-income, compared to 39% of white
boys in high-income families. There’s an incredible
graphic in the New York Times when this study came out that’s animated, and you can see the movement of children across different groups that
kind of gives that feel, but it’s important to
look at these kind of data and ask the question why, what
is it that’s driving this, and what can we do to
make a difference on that? We think a lot has to do with opportunity and what’s taking place across America, and that fits in with our desire to try and build that
culture of health here. When we think about a culture of health, it can be daunting because it encompasses every aspect of society. So within the foundation, we’ve been going through a lot of work to try and focus down
in terms of the areas that we’re gonna do our grant-making. We can’t address all of these issues. We can talk about a lot of ’em, and hopefully catalyze action by others, but we’ve tried to focus down our efforts. Our endowment is about $11 billion, which means that we spend
about $500 million each year on the problems that
we’re trying to address. Our goal is to exist in perpetuity. You know, we can talk about that later. But we feel that’s very important, and we want to target our efforts to increase our effectiveness. We’ve got four focus areas, and in all of our work you’ll
see some similar themes of trying to shift mindsets around what it takes to be healthy, what the drivers of health are, what it means for health opportunity, and we do a lot of work
in each of our areas around advocating for policies that lead to more opportunity
for health and well-being. So the four big areas, and I’ll go into them in a
little bit, healthy communities, healthy children and families, transforming health
and healthcare systems, and then leadership for better health. Our work in helping to build
and create healthy communities is all about thinking
about what does it take in a community to provide
that environment that, where health thrives, where
health is that easy option. And it’s not limited to the health sector. So it’s looking at what policies can encourage healthy living. How do you generate data
and share the kind of data that I was showing you to
help communities identify and address the problems that they see? We want to make health and
health equity key considerations and how communities are
planned, designed, and built. You know, I’m seeing a lot
of wonderful urban renewal taking place that’s leading
to the people who live there, who had robust communities,
being marginalized. Not a place in town for them. So how do you do urban development that doesn’t lead to
gentrification and displacement? We’ve seen places in America where that’s being done beautifully. How do you get those models to
be the model for the nation? How do we encourage different sectors to come to the table to collaborate, to invest together in
improving community health? I was at one meeting, and I was talking to a woman who worked on
community housing development, and through one of our programs, it brought together public health and the housing development
sector, and she said, “I’ve been working in
this field for 20 years, and I had no idea how important the work “that we were doing was to health, “that what we’re doing is
a health intervention.” And she said, “This is amazing!” And she had found the religion
really, of that connection, and when you can see that spark take hold and help foster that, you have some hope that the kind of development
that’s gonna lead to increased opportunity’s gonna happen. And then how do you empower people within their own communities
to know what it takes, and to have the ability and the agency to identify and solve the
problems that they see? That’s an important part
of what we want to do. Healthy children and families, there’s a recognition that early
is so critically important, that children’s brains
are developing so rapidly, that if we wait until kids hit school, we’ve really missed a
lot of opportunity there to make the kind of
difference that we want. So we’re doing a lot of work in this area of trying to shift mindsets around the importance of investing in children. Everyone says they love children. Everyone loves children. Who can not love children? Well, if you look at where our dollars go, you would say we hate children. Because if we look at the federal budget, it is not being invested around children. If you look where we put your money, it’s not around children, and
even where we love children, we don’t love their
families, so we can say, “I love kids, but I don’t
want to give their families “what it takes, what those families know, “know that their children need.” If we supported families
to be able to provide what they know their kids need, they would do it. It’s like the grandma
I was tellin’ you about in Staten Island. She knows what her kids need. She just doesn’t have the opportunity to let her kids go outside to play. So we’re working here to try
and create the conditions that help children
achieve the best physical, social, and emotional health possible. And a lot involves supporting
policy and systems change so that families have what they need to raise those healthy kids. Transforming healthy
and healthcare systems comes out of one of our initial
silos around healthcare, and here, it’s trying to say,
what can we do to try and push this $3 trillion behemoth to truly address the issues and needs of the patients who come into the system? How do we help make the case,
how do we align the system so that it truly is paying for value? Where truly, we are paying
to keep people healthy? So that when someone encounters the system like I was seeing these children, it was part of the responsibility
of that healthcare system was to have that connection
to social services and public health so that they’re working in an integrated fashion
to build a healthy nation. It’s very exciting some
of the things going on in North Carolina, and
I really look forward to learning more about
what North Carolina’s doing around that. I think the nation’s gonna
learn a lot from all of you. And then leadership for better health, you know, the Robert
Wood Johnson Foundation, I think if we’re known for
anything around the nation, people tend to have heard of the Robert Wood Johnson Clinical Scholars, and leadership development has
always been part of our DNA. It’s been something that we
feel is really important, and when I came on board, and
I was on my listening tour, one of the things people said
to me over and over again is that the most important
thing we’ve done as a foundation was investing in people,
investing in people who could then identify
problems and work to solve them. And I think that’s right. And we now have four new
change leadership programs that are all about trying
to catalyze that change at the community level that
I’ve been talking about. Each one has a slightly different focus. One is connecting academic practitioners with people who are in
the community working to be able to do that
community-based research to understand what really works. One is pulling together groups
of people on a clinical team to address clinical challenges that they’re seeing in their community. One is called Culture of Health Leaders, and that’s people not just
from the health sector, we have people in that
who are in economics, law enforcement, foster
care system, city planning, faith leaders, who are
all coming in saying, “Well, how do I help change the system “to allow for health and promote health?” And then we have a program called the Health Policy Scholars, and this program is designed
to take people who are in advanced programs getting degrees who represent underrepresented
groups in the policy arena, many are minority communities or first in family to go to college, and give them the skills so that they can participate actively in the policy debate and policy change. About two weeks ago we had a meeting of our leadership institute,
and it was out in Indianapolis, and it brought together 450 people who were in these programs. And it was the second time I’ve gone to one of these meetings, and it’s like a faith revival. As a Jewish guy, I don’t know, it’s what I imagine a
faith revival could be. (audience laughing)
‘Cause I haven’t been to one, but from what I’ve seen
on television anyway, it was amazing. You go in there, and it’s 450 people who believe that they are gonna change
the way America works, and that they are gonna
address these problems that are big and messy and so hard to get our arms around ’em, and I came away from every conversation believing they’re gonna get it done, and it is absolutely inspiring. It’s, I know that there are people from both Duke and Chapel Hill
who are in these programs. They are absolutely
terrific, and they’re new, and we’re gonna keep adapting
them and changing them, and getting them so that
they’re working really well, but people had asked me, “Why did you get rid of the
Clinical Scholars Program? “It was the best thing ever!” And it was, and there’s forms
of it that are going forward, and those folks are leading
in many different ways, but if we want to change what’s going on on the ground in communities, I think it’s the folks in these
Change Leadership programs who are gonna get that done. So those are our four big areas of focus. I now just want to give you a few examples of some of our work before we get into the
conversation part of this. I’ve talked a lot about data. As Mike said, I’m an epidemiologist. I love data. I think data is critically important to informing conversations, to illuminating the problems
we’re talking about. One of the first data
areas that we invested in was zip code maps. And these are those maps
that show life expectancy by different areas. Here’s one of them, for, oh, it just happens to
be the Raleigh-Durham, North Carolina area.
(audience laughing) – [Man] Oh, it just happens. – And these maps were done
through a collaboration with Virginia Commonwealth University Center of Society and Health. If you look along Interstate 540, you’ll see there that the
life expectancy is 88 years. If you look at the neighborhood just a little north of there,
it’s 11 years less, 77 years. In Princeton, where I
live, it’s about 88 years, and 87 years in the clinic where I work. Same county, 14 miles away, it’s 74 years. So 15 miles, 13-year difference. It’s absolutely unbelievable. But just a few months ago, we took this a step further, and working with the CDC’s National Center for Health Statistics, we funded something called USALEEP. It’s United States Small Area Life Expectancy Estimate Project. And what this allows you to do is look at life expectancy
by census track. So if you go to this website,
it’s off of our website, it allows you to type in your
address, and it will give you the life expectancy for your neighborhood, and what we hope is is
that these kind of data will allow community leaders to zero in on disparities within
their own jurisdiction and work to say, “Okay, well why? “Why are we seeing a
difference in life expectancy “in these areas that are
located so close together?” And hopefully work then to
address some of those problems. When we think about what it takes to build a culture of health in America, it involves so many different sectors. It involves partnerships in a big way. And we ware really excited about some of the partnerships we have, and the partnerships
that we are going to be engaging in in the future. And one of those partnerships that I’m really excited about
is with the Y, the national Y. We feel that this work, the
work I’ve been talking about, is most effective when it’s
done with the organizations that are deeply rooted in community. And the Y defines deeply
rooted in community. There are more than 10,000
Ys across the nation. 22 million members. They have the kind of reach that we could never get to on our own. And they are also surprisingly
to a number, to many people, they are one of the biggest purveyors of daycare services in the entire nation. They’re one of the biggest providers of diabetes education in the nation. And they want to be recognized
as more than a swim and gym. You know, you think think about the Y, yeah, that’s where you go shoot hoops, you know, swim and gym. They want to be recognized
as a real change-maker within their community, as an organization that can strengthen social
cohesion and build opportunity in the communities in which they’re in. So it’s a perfect partnership for us. They can help shift mindset around what it takes to be healthy. We can help shift mindset
around what the Y is engaged in, and our data can help with that. And so let me show you what they’ve done with some of that zip code data. – [Narrator] The zip code you’re born into can determine your future, your school, your job, your dreams, your problems. But at the Y, we create
opportunities for everyone, no matter who you are
or where you’re from. For a better us, donate
to your local Y today. – So that’s so much more
powerful coming from the Y than if it were coming from us. It’s that idea of unexpected messengers. So hearing this from the
Y about the connection between place and opportunity
is really powerful. Just last week, we announced
another new partnership. This one is with the NAACP. And people say, “Well, why would “the Robert Wood Johnson Foundation, “which is focused on health, “partner with the nation’s largest “civil rights organization? “What’s that have to do with health?” Well, it has a lot to do with health. And I love people asking us that question, as to why are we engaged there. When you think about civil rights, you think about agency, you think about people having that ability to make change within their community. Civil rights is about that. It’s about providing that engagement. And when we think about how can we reach to African-American
communities in America, having a voice that rings
true in those communities like the NAACP is really important for us. They have a 110-year history of, and leverage with deep
roots in communities. And for us, to get them moving forward with a health equity
message, thinking about how what takes place in
community isn’t just about the ability to write,
to vote, and get out, but how the conditions in their community affect the health of people
within their community, I think is gonna be really terrific. We’ve worked with them for about 10 years. They were very, have been very
active in our obesity work, but this partnership takes the
work to a much broader level in thinking about them
as a strategic partner to help move forward with the
health equity message as well. And when I talk about partners, it’s, we have special partners that are involved with some of our program work. One of our, my favorite
partners is Sesame Street, and I got to do a couple of PSAs and go on-air with the
Muppets, which was like, a major highlight.
(audience laughing) But when you think about trusted voices, and whose voices may be able
to resonate with people, Big Bird cuts across the
political spectrum pretty well. He’s got that ability. And so we’ve been working
with Sesame Street on that area of adverse
childhood experiences. And Sesame Street has done a lot of work to think about what could they do to help buffer those
experiences in kids’ lives. Because it’s clear that if
you can provide that buffer, if you can provide some support to kids who are having some of
those traumatic events, you can make a big
difference in their life. So Sesame Street started something called Sesame Street in Communities, and you can go to the website
sesamestreetincommunities.org and see their materials. They have their materials that give adults advice and tools to
help work with children, so it’s material for
parents, for teachers, for daycare providers, for others, that can help kids dealing
with simple things, the simple life issues of
loneliness and temper tantrums. They have things in there on how to get kids to brush their teeth, but then they have materials
for kids who feel unsafe because of violence, kids
who’ve been subjected to abuse, dealing with homelessness. They have a wonderful set
of videos in helping a child deal with an issue, who has
a parent who’s incarcerated. There’s discussion guides, activities, and tools that can be used,
and it’s absolutely terrific. And I want to end with
one more last example that brings together a
bunch of these themes, and it’s talking a little bit about what’s been going on
in Richmond, Virginia, and I think we’ve got somebody
here from Richmond, Virginia. Good to see you. – [Audience Member] Nice to see you. – So Richmond won a
Culture of Health prize. We give prizes out each
year to communities that we feel are really working towards what it is I’ve been talking about, trying to address the fundamental nature of conditions in a community to allow people to lead healthy lives. These aren’t communities
we’ve paid to do this. It’s communities that we see that are embodying what
we’re talking about. So yeah, I’ll talk a little bit about Richmond in the Q and A. You could add a little more if you’d like. So a quarter of the city residents, and four out of 10 kids in
Richmond live in poverty, and in the East End neighborhood, it’s more like two-thirds of
families that are impoverished. So about five years ago,
city organizations decided that they were gonna work together to try and reduce poverty rate and increase economic opportunity
and improve public health. So the mayor’s office, some
of the leading health systems, so Bon Secours, and VCU,
public health department, the public housing
authority, and residents came together and they created something that no other city had created before. It’s the Office of City Wealth building. It connects residents with
education and job training and employment through
public-private partnerships. It works to provide
that kind of opportunity that’s essential for health. It put centers in every
public high school, so it’s providing intense mentoring, skills training, and college prep. In the six largest public
housing developments, they hired residents there to work in newly-created health resource centers, so it was providing
employment, empowerment, but also providing important services, and there they work alongside public health and housing officials to help residents get health insurance, nutritional and mental health counseling, and other services that
they are entitled to, and that they need. And then for some families, they are providing intensive
wraparound programming that gives life skills beyond employment to help them escape the
intergenerational poverty that plagues so many cities. We believe that this approach
of shifting the mindset around what you really need to do if you want to address health, putting in place policies and
programs is the way to go. It’s gonna take time. It’s gonna be important
to continue to evaluate and see what’s working, and to not give up if short-term data are not showing impact, and see, can you shift the
narrative around communities that have had this
intergenerational poverty? So you know, in closing,
as a philanthropy, we are taking on really
big issues and challenges, and we want to change how
people think about health and what it takes to create opportunity. We want to work towards policy changes because that’s how things
will change for the long run. We want to work to remove
barriers and create opportunity, stimulate conversations
that are challenging but so important to have, and we want to continue
to challenge ourselves and have others challenge us as well. We want to challenge
those we collaborate with to do a better job on
recognizing the direct connection between health, well-being, and
the larger issues of equity. And as we do this, as we do this work, we want to consistently and
constantly and intentionally be asking, “Who’s being left out?” We want to ask ourself,
“Who’s benefiting the most “from the work that we’re doing? “Whose life experiences are missing?” And, “How could that be
skewing what we’re doing, “our efforts and our outcomes?” We want to ask our partners
and our collaborators and our grantees to make
sure that they’re inviting all voices to the table for their work. When we think back to our
founder, Robert Wood Johnson, you know, he believed that good health enhances every aspect of our nation, and we believe that too, and
we hope that our mission, by working to raise the
health and well-being of everyone in America, that we’re doing something that our founder would be proud of today. Thank you very much.
(audience applauding) – [Joel] Thank you, wonderful. Really inspiring. – Thank you. – We’ll get the same feeling
as a faith meeting here. (laughing) Okay, thank you very much, Rich for this. Thank you very much. We’ve really run out of time. We could’ve gone on for a while longer, but I can’t think of a
more important topic. I can’t think of better
treatment of it that I’ve heard, and so it’s really been
wonderful to have you here. Thank you very much, we
hope you’ll come back. (audience applauding)
– Thank you very much.

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