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Research Questions

  1. How can the commonly understood concepts of cultural identity (e.g., ethnic or religious; lesbian, gay, bisexual, transgender plus; military) and organizational culture be harnessed to develop a Culture of Health?
  2. How can incentives be used to promote individual health and engage investors and leaders within organizations or governments to promote health and well-being broadly?

In 2013, the Robert Wood Johnson Foundation embarked on a pioneering effort to advance a Culture of Health. This report focuses on two questions that are central to understanding how individuals and sectors think about health and are motivated to promote it: How can the commonly understood concepts of cultural identity (e.g., ethnic or religious; lesbian, gay, bisexual, transgender plus; military) and organizational culture be harnessed to develop a Culture of Health? How can incentives be used to promote individual health and engage investors and leaders within organizations or governments to promote health and well-being broadly?

This report draws on 43 one-hour semistructured interviews that RAND researchers conducted with stakeholders whose work focused on cultural alignment, incentives, or both to learn how organizations are addressing and leveraging culture and incentives to promote health and well-being, as well as to identify facilitators, barriers, potential best practices, and lessons learned. Key findings include the following: Equity is often addressed in silos, which impedes progress toward a unified goal of health equity for all; members of specific cultural groups need to be given a voice in health-related activities; systems are built around prevailing cultural norms, making it challenging for those working with specific cultures to make cultural adaptations; and not all incentives are monetary. Recommendations include institutionalizing practices that ensure ongoing input from marginalized populations, identifying ways to help smaller organizations overcome structural inequalities, and institutionalizing health promotion efforts in sectors other than public health or health care to sustain collaborative efforts.

Key Findings

Cross-Cutting Themes

  • Establishing health as a shared value is an important but challenging step in promoting health and well-being.
  • The importance of both individual and community health and well-being needs to be acknowledged.
  • Data can support the development of shared values.
  • Stakeholders spoke of equity as requiring integration, collaboration, and thinking about health equity from a broader perspective than just health or resolving health disparities.
  • Equity is often addressed in silos, which impedes progress toward a unified goal of health equity for all.
  • Structural inequity among organizations serving different communities can pose a barrier to progress.
  • Addressing equity takes time and effort.

Themes Related to Addressing Culture and Cultural Differences to Promote Health and Well-Being

  • Addressing culture presents opportunities and challenges.
  • Members of specific cultural groups need to be given a voice in health-related activities to reach the outcomes they desire.
  • Meaningful community engagement takes time and money.
  • Systems are built around prevailing cultural norms, making it challenging for those working with specific cultures to make cultural adaptations.
  • Organizational culture plays an important role in how well organizations address cultural differences.

Themes Related to the Use of Incentives to Promote Health and Well-Being

  • Incentivizing individuals requires a mix of short-term and long-term incentives that align with individual preferences.
  • Closed-loop systems promote investment in individual-level incentives and facilitate sustainability.
  • Not all incentives are monetary.
  • Some incentive models, like Pay for Success, have the potential to act as a catalyst for systems change, but they require government buy-in.

Recommendations

  • Identify best practices for developing a shared definition of health within communities.
  • Remove restrictions around diversity and equity efforts.
  • Institutionalize practices that ensure ongoing input from marginalized populations.
  • Create flexibility in funding structures for well-justified efforts to build trust among disadvantaged populations.
  • Strengthen research around the role of organizational culture in promoting population health and well-being.
  • Identify ways to help smaller organizations overcome structural inequalities.
  • Institutionalize health promotion efforts in sectors other than public health or health care to sustain collaborative efforts.
  • Develop strategic approaches and tools for use by those who are interested in pursuing work in the Culture of Health framework.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Cross-Cutting Themes: Shared Values, Community Health, Data, and Equity

  • Chapter Four

    How Attention to Culture and Cultural Differences Can Promote Health and Well-Being

  • Chapter Five

    Incentives to Promote Health and Well-Being

  • Chapter Six

    Key Findings, Implications, and Next Steps

  • Appendix A

    Pay for Success Related to Health and Well-Being

  • Appendix B

    Interview Protocol

  • Appendix C

    Recruitment Materials

Research conducted by

This research was sponsored by the Robert Wood Johnson Foundation and conducted within RAND Health.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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