Traditional and Unexpected Partners, From All Aspects of American Life, Must Come Together to Develop Public Health Solutions

Philadelphia, Pennsylvania, is the poorest of the 10 largest US cities, and for many years, it was also one of the unhealthiest. However, since the early 2000s, the City of Brotherly Love has lived up to its slogan by bringing together a broad array of nontraditional partners to build a healthier community, including government agencies, nonprofits, businesses, academia, and health care providers.

These partnerships have put in place a myriad of initiatives: making all indoor and outdoor public spaces smoke-free, passing a comprehensive nutrition-labeling law for chain restaurants, and adding more than 30 miles of bicycle lanes and 18 miles of trails. The city rewrote its development plan and zoning code with an eye toward healthier neighborhoods, adopted healthier food standards for all city-run facilities, and worked with more than 900 corner stores, restaurants, and farmers’ markets to sell healthy, affordable food. Media campaigns were aimed at reducing the consumption of soda and salt, unhealthy drinks were removed from school vending machines and fried foods from school cafeterias, and earlier in 2016, the city voted for a municipal tax on sugary beverages. All these efforts played a part in a 6.5% decline in Philadelphia’s childhood obesity rate since 2006,¹ including relatively large reductions among African American and Asian children. Philadelphia is one of the very few US communities to see such a decline.

I am highlighting Philadelphia, not only for its achievement in reversing childhood obesity rates, but also because it is a shining example of the innovative and effective solutions that can emerge when all sectors partner to tackle some of our most intractable problems.

POOR HEALTH IN AMERICA

Clearly, poor health in America is one of those problems. The Centers for Disease Control and Prevention reported² that the US death rate increased in 2015 for the first time in a decade, driven by increased mortality from drug overdoses, suicides, and Alzheimer’s disease. The death rate from heart disease is inching up after a long decline. The suicide rate³ recently hit a 30-year high, the gap in life expectancy⁴ between rich and poor in America widened significantly from 2001 to 2014, and a 3.8-year gap⁵ is seen in the life expectancy between White and African American people.

Medical science has produced a multitude of breakthroughs in treatments and interventions over the past few decades, but those advances are not translating into better health for all. The problem: some 80% of a person’s health is influenced by social determinants far outside the clinic’s walls. Decrepit housing, poor schools, exposure to violence, a lack of safe places to play and exercise, food deserts, economic insecurity, and racial discrimination all have a major effect on an individual’s well-being. A series of city and regional maps (funded by the Robert Wood Johnson Foundation) that correlate life expectancy with neighborhoods⁶ show that where you live can be a greater determinant of longevity than your genetic code.

ACTION AREAS AT WORK

Addressing and fixing these social determinants of health is one of the “wicked problems” so many communities grapple with—problems that are so complicated, and continuously changing, that the solutions are neither clear nor static. A variety of partners, traditional and unexpected, representing all aspects of American life, must come together to develop smart, innovative solutions.

The Robert Wood Johnson Foundation has developed an Action Framework⁷ that we hope will encourage organizations to broaden the discussion about health, set goals, and reach out to others to build a healthier America. The framework has four Action Areas: (1) make health a shared value, and a priority, for all; (2) foster cross-sector collaborations; (3) create healthier, more equitable communities; and (4) strengthen the integration of health systems and services.

Examples of these Action Areas are at work throughout the nation in states such as North Carolina, South Carolina, California, New Jersey, and Pennsylvania.

Raleigh-Durham, North Carolina

The Raleigh-Durham area of North Carolina has struggled for decades to overcome high rates of obesity and chronic disease, unemployment, poverty, and racial inequities. In 2014, The Partnership for a Healthy Durham was created to address these issues; today, it has more than 500 members, including government agencies, private companies, and community organizations. Among its initiatives, the partnership joined forces with the area’s two leading medical facilities to improve access to health care for low-income, uninsured residents. More than 700 clinicians have volunteered to treat some 4300 patients.

Spartanburg, South Carolina

Spartanburg, South Carolina, put a plan in place to reduce adolescent pregnancy rates, engaging unique partners such as churches, barbershops, and the city’s recreation department. Adolescent pregnancies decreased by 53% overall in less than a decade, and a 55% decline was seen among African American girls.

San Diego, California

Starting in 2010, the Live Well San Diego, California, initiative—a coalition of community members, businesses, schools, faith-based organizations, and local government—set 10-year goals for building a safer and more resilient city. It turns parking lots into parks, helps older persons age in place, and promotes community policing. Data tracking the county’s progress are shared openly with the public, and the entire community is invited to provide ideas.

Healthy Futures Fund

In 2014, Morgan Stanley, the Kresge Foundation, and the Local Initiatives Support Corporation established the $100 million Healthy Futures Fund to expand access to health care and affordable housing for low-income people, supporting the construction of 500 affordable housing units with co-located health clinics, serving an estimated 75 000 people nationwide.

Camden, New Jersey

Campbell’s Soup committed $10 million to cut hunger and childhood obesity rates in half by 2020 in the Camden, New Jersey, area, where it is headquartered. The company is working through a coalition of 10 community and educational organizations.

Philadelphia, Pennsylvania

The Children’s Hospital of Philadelphia and the city joined forces to open the first-of-its-kind community center in May 2016, combining a pediatric clinic, community health center, library, recreation center, and green space. Doctors can write a prescription for physical activity at the recreation center; the recreation center can refer young people to the library for help with school; and parents can improve their job skills, all in one place.

AND MORE INITIATIVES

Partnerships like these are serving as models by sharpening the connection between health and a strong, sustainable economy. To replicate such efforts across America, the Robert Wood Johnson Foundation and the Reinvestment Fund, a community development financial institution, recently launched Invest Health, an initiative that brings together diverse leaders from midsized US cities to address entrenched poverty, poor health, and a lack of investment. Invest Health has awarded $3 million to 50 cities to support programs that are creating affordable housing, safe places to play and exercise, and quality jobs.

Cross-sector collaborations are also being championed by Living Cities, a coalition of 22 of the world’s largest foundations and financial institutions. Its Racial Equity Here initiative supports five US cities committed to improving racial equity through a range of partnerships: Albuquerque, New Mexico; Austin, Texas; Grand Rapids, Michigan; Louisville, Kentucky; and Philadelphia.

There are countless such initiatives, but many more are needed. Corporations, financial institutions, colleges, elementary to high schools, hospitals, nonprofits, law enforcement, and government must break out of their silos and seek partners they may not have considered if they are to help their communities move toward health. We have much to learn from one another. As Albert Einstein once said, “We cannot solve our problems with the same thinking we used when we created them.”