New Data on How We're Measuring a Culture of Health

It's been four years since the Robert Wood Johnson Foundation (RWJF), along with the RAND Corporation, began using a set of national measures to help track our journey toward a culture where every person has a fair and just opportunity to live the healthiest life possible—regardless of where they live, how much they earn, or the color of their skin.

Our goals were to offer some catalytic signals of change with a focus on broader social and economic drivers of health, well-being, and equity. The initial set of measures were used to track how diverse stakeholders, including those outside the traditional health sector, were advancing health and well-being—and if and how health equity was improving.

Developing a clearer picture of what is changing via the Culture of Health measures can guide those who are working collaboratively to accelerate improvements. We offer a few highlights from recent updates to the measures (see also https://www.rwjf.org/en/building-a-culture-of-health.html) and share some data on our progress to date.

What Has Changed?

Since 2015, what do the data tell us about our progress in creating a Culture of Health in America?

We are seeing small but positive changes in the appreciation of the social determinants of health and the need for broader community health investments. However, there has been less movement in many of the structural and systems-level factors that critically influence health, well-being and equity.

Here are just a few examples:

• There is greater understanding that diverse factors influence health. A critical component of a Culture of Health is the shared understanding that we're all in this together that we recognize our health is interdependent with others around us. We measured these values and beliefs about health as part of National Survey of Health Attitudes. In 2018, 37 percent of surveyed adults (vs. 34% in 2015) believed that one's surroundings (both other people's behaviors—and factors like physical environment, social support, and community safety) strongly influence health and well-being.

• Consumer experience with health care is improving. According to the most recent Consumer Assessment of Healthcare Providers and Systems Survey, 18 states earned the highest consumer experience rating (five stars) in 2017. This reflects improved subjective consumer experience in care, including ease of navigation, transparency, and communication within and across health systems.

• Access to care is still a struggle for too many. On the other hand, we have seen little change with respect to access to care and services. There have been no improvements in access to dental care (about 39% continue to report receiving dental care in the past year). Treatment rates for mental illness and substance dependence or abuse also show no improvement, having held steady for the last four years with only 40 percent of those needing treatment having received it.

• Progress is stalled on key conditions that create healthier, more equitable communities. These conditions that represent some of the most entrenched, systemic issues are usually not tracked with other health measures even though they are key influences on health. There has been no change, for example, in the number of states with cross-sector climate action plans. At a local level, there has been little change in racial residential segregation in neighborhoods, which is linked to poorer health and economic outcomes. This degree of racial segregation is largely unchanged from 2015, with white residents in America still living in the least diverse neighborhoods.

What Do These Changes Mean?

To summarize, people are expanding their views of what influences health and there have been some targeted improvements in health care and public health access. A key objective of the newly updated Culture of Health measures is to catalyze more discussion and action across sectors. We welcome growing interest in areas that these measures represent—from a focus on community health amenities like public libraries—to the importance of managing the effects of toxic stress in childhood reflected in the appointment of the California surgeon general.

Yet, the critical systemic changes needed for more transformative health improvements have been slower to follow.

Looking Ahead

RWJF will continue to monitor changes in structural determinants of health because doing so is essential to truly understanding progress in health equity. We also will support further work to spur progress in health care and social, economic, and environmental drivers of health. A fuller description of these measures and the data underlying them can be found at https://www.rwjf.org/en/building-a-culture-of-health.html. Exploring them can illuminate trends and help to pinpoint areas where targeted efforts may pay dividends. For instance, our failure to make significant—or any—progress in addressing decreased life expectancy; continued challenges associated with high rates of chronic disease; and increasing rates of maternal mortality are gravely concerning and demand investigation.

RWJF and its partners are committed to building public will to change our culture into one that values health everywhere, for everyone. With so much at stake, this imperative should be widely recognized as a national priority.

Success is within reach, but it will take a real commitment to turning research into action, and vision into a reality where we can all live the healthiest lives possible.

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Alonzo L. Plough, Ph.D., M.P.H., is chief science officer and vice president, Research-Evaluation-Learning at the Robert Wood Johnson Foundation. Anita Chandra is vice president and director of RAND Social and Economic Well-Being and a senior policy researcher at the RAND Corporation.

This commentary originally appeared on Robert Wood Johnson Foundation's Culture of Health blog on September 12, 2019. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.