How Media Shapes the Public Discourse and Influences Health

This chapter describes the multiple roles of modern media in determining not only what consumers know, but also how and what they think. The exponential growth of ideologically driven cable channels and social media, dovetailing with cutbacks in newspaper staffing and coverage, point to the many ways that the power and reach of media are shifting even as they continue to reshape American society and norms. In this environment, multiple media compete for viewers, readers, and listeners who will click on their websites, buy their products, sign their petitions, and often accept their spin, especially if it reinforces personal perspectives. Thoughtful information about complex public health issues is easily lost in that context, leading too many people to base their decision-making on incomplete, biased, and even inaccurate information. For the news media to help build a Culture of Health, people need to understand how it works, what it does, and how it can be used for widespread benefit.

Driving Innovation Through Medicaid

This chapter highlights the expanding use of Medicaid to address social determinants of health, particularly housing instability and opioid addiction. Medicaid today is a core component of the nation's health care system, providing health coverage to more than 66 million people. With one in five Americans participating in Medicaid, the program has the reach and influence to play a key role in promoting health and health equity, especially through research and demonstration waivers that allow states to experiment. The chapter then offers examples of innovative programming and service delivery in three states and looks at a major insurer’s commitment to address the root causes of homelessness among its Medicaid beneficiaries. However, the significant infrastructure and start-up costs involved in implementing Medicaid reforms loom as potential barriers. Health care and social service providers will need to develop new information systems, recruit and retrain providers, and establish data-exchange protocols in order to realize the benefits from the federal infusion of new money into Medicaid.

Achieving Health Equity for Immigrants and Their Children

This chapter presents a data-based portrait of American immigrants. Nearly 44 million immigrants live in the United States, and their health, and that of their children, is directly affected by their legal status and by U.S. policy. Indeed, public policy at both the federal and state levels—including Deferred Action for Childhood Arrivals (DACA), changes in “public charge” rules, and eligibility for driver's licenses and prenatal care—are all significant influences on health status and access to care. As such, ensuring that immigrant families are supported requires health care providers, policymakers, and community leaders to acknowledge the myriad factors influencing the health of their immigrant constituents. It is a path that will improve well-being for immigrants, while offering benefits more broadly as people work toward health equity.

Chapter 6 Spotlight: Fathers Mentoring Fathers

Vance Simms, Founder/Executive Director, Father Matters A package of chocolate chip cookies, a pot of coffee, and four kitchen chairs in a studio apartment in San Jose, Calif., set the stage for the inaugural meeting in 1997 of what would evolve into Father Matters. Now located in Phoenix and built on the idea of fathers mentoring fathers, Father Matters provides support to fathers as young as 15 and to mothers as well, serving about 3,800 people each year...

Employers as Shapers of Health

This chapter assesses the role of employers as Culture of Health mediators. With their significant influence over the lives of their workforce, employers have the authority to make choices that either promote or inhibit a Culture of Health within their organizations. They also may play important roles in building a Culture of Health in the communities in which they are located and where their employees live. The chapter then considers the approaches taken by three types of employers—Fortune 500 companies, a large retail chain, and the military. Two studies of Fortune 500 companies examine corporate transparency in reporting health-promotion policies and efforts to create healthy work environments and strengthen communities. Another study illustrates the feasibility of stabilizing work schedules of low-wage retail workers to benefit workers as well as store sales.

Chapter 11 Spotlight: A Private Insurer Tackles Social Determinants

Ana Fuentevilla, MD, MHCDS, Chief Medical Officer, Optum Population Health Solutions (former Chief Medical Officer, UnitedHealthcare Community & State). UnitedHealthcare (UHC) provides health coverage to nearly 49 million people in the United States and around the world, 1 including 6.7 million Medicaid beneficiaries who live in 30 states and Washington, DC. Medicaid members receive coverage through a system of managed care overseen by the company’s Community & State division...

The Green Health Care Revolution

This chapter discusses the green health care revolution, a movement that includes efforts to: reduce greenhouse gas emissions; reduce toxic chemicals and materials in hospital buildings and operating rooms; streamline and improve supply chains; reduce material, water, and energy waste; foster farm-to-table food options; enhance green investment opportunities; and improve waste disposal practices. It traces the evolution of the movement since 1996 and the founding of Health Care Without Harm (HCWH). The challenge, however, remains daunting. An estimated 10 percent of harmful U.S. emissions still originate from health systems, making them significant contributors to the problem of climate change. According to a recent study, the U.S. health care sector would be the world's 13th-largest emitter of greenhouse gases if it were ranked as a nation. Nevertheless, support for greening health care is building.

Chapter 9 Spotlight: A Just Recovery for Puerto Rico

Just two months after Hurricane Maria hit Puerto Rico in September 2017, Elizabeth Yeampierre returned to the home of her ancestors. “I went with a really heavy heart,” she said of her return to Puerto Rico. “My heart literally hurt.” The devastation was excruciating to see—neighborhoods completely destroyed, the grief of widespread death, the struggle to clear the wreckage and rebuild without electricity, food, running water, or supplies. “It was like a chapter out of Octavia Butler’s...

Pathways to Change in Rural America

This chapter explores the reputation and reality of the nation's less populated regions, which one in every five people in the United States call home. Too often, the rural designation implies an environment in which poor health and diminished opportunities are the norm. Though the chapter contributors acknowledge the enduring economic, social, and educational inequities that pervade these regions, they are equally invested in capitalizing on the inherent strengths of the rural heritage. Using examples from several Southern, rural communities that are among the poorest in the country, yet also offer pockets of hope, the contributors show that it is possible to reshape the narrative of rural living. To enhance health and well-being in rural America, policymakers and advocates must build on the unique challenges, strengths, and opportunities in rural populations. Changes that leverage local resources and strengths to better serve residents are vital, and some of them are surprisingly simple and often community-driven.

Conclusion

This concluding chapter looks at the Robert Wood Johnson Foundation’s (RWJF) renewed resolve to highlight connections, rather than differences, when it talks about common problems, and to take evidence-based action grounded in that shared understanding. Despite an abundance of political rhetoric, this book has shown that there is ample enthusiasm for doing just that. A cross-sectional movement to address climate change is on the rise, bringing together businesses, hospitals, and activists. The opioid epidemic and its intersections with rural health and mass incarceration are gaining attention across partisan divides. Medical systems are integrating the social determinants of health into their care interventions, and novel payer initiatives are making it feasible to pilot test and evaluate innovation. Resilience also has come to the forefront as people learn more about the risks associated with childhood trauma, weather-related and human-spawned disasters, and community fragmentation, as well as the protective factors that can counter those stressors and foster personal and collective renewal. Ultimately, the pursuit of health equity remains the underpinning of everything the RWJF does. As they explore further the cultural aspect of a Culture of Health, they are bolstering their commitment to empower historically marginalized people.