Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, will be a keynote speaker at the opening session of APHA’s 139th Annual Meeting, which takes place later this month in Washington, D.C. She is the recipient of APHA’s 2011 Presidential Citation Award for her outstanding leadership in public health policy — an honor that is not bestowed every year, but only on occasions of unusual merit.
Lavizzo-Mourey joined the Robert Wood Johnson Foundation in 2001 and has served as its fourth president and CEO since 2003. Considered a national leader in the movement to improve health and prevent disease, Lavizzo-Mourey said she was drawn to the foundation by the opportunity to “alter the trajectory and to push society to change for the better.” Before joining the foundation, she served in a number of influential positions, including deputy administrator of the U.S. Agency for Health Care Policy and Research, now known as the Agency for Healthcare Research and Quality. Lavizzo-Mourey has also served on the federal Task Force on Aging Research and as co-director of a congressionally requested Institute of Medicine report on racial disparities in health care, among many other appointments.
Q: The Robert Wood Johnson Foundation has a mission of improving the health and health care of all Americans. Can you describe the vision that drives this mission, and some of the biggest lessons learned so far?
The foundation’s work is driven by a guiding belief that all Americans deserve the opportunity for a long, healthy and fulfilling life. We also recognize that how healthy we are and how long we live depends on many factors, including education, income, the safety of our neighborhoods, whether we smoke, how active we are, and what and how much we eat. To improve Americans’ health, we need to look at where people live, learn, work and play to get at the factors that shape health even more profoundly than the health care we get when we’re sick.
With this in mind, I think a lesson that we, like many other organizations, are factoring increasingly into our work is that improving America’s health requires leadership and action from every sector, including public health, health care, education, transportation, community planning, private business and other areas. As health is linked to virtually all aspects of our lives, we need to engage partners across the spectrum of interests —inside and outside the health care system — to create changes that will support better health in our homes, schools and communities. And the best place to start is for everyone to work together and build on what we already know is working.
Q: The connections between the places people live, work and play and their health are becoming more evident every day, and is a theme we’ll be exploring at the 2011 APHA Annual Meeting. Can you tell us about some of the foundation’s efforts to help all Americans benefit from conditions that prevent illness and promote health?
Twenty years ago, the foundation began a bold initiative to halt the rising, devastating toll of tobacco use in this country. We devoted considerable financial and human resources to tackle the problem, put our reputation behind the goal and worked closely with a range of government, private sector and community advocates — and we have seen tremendous progress marked by declines in both adult and youth smoking. We’ll need to deepen that partnership to get smoking rates even lower. And we’re already applying the lessons from our tobacco campaigns to other ‘big bets’ to get to better health faster and curb the billions of dollars America spends each year to treat preventable illnesses. Reversing the childhood obesity epidemic, which we see as one of the biggest health threats this nation faces, is an example. Our work in this area includes a range of initiatives at the local, state and federal levels to change public policies and local environments in ways that promote nutrition and physical activity.
This work is aligned closely with several major investments we are making that employ a cross-sector approach to strengthening America’s public health system. The Health Impact Project, our collaboration with the Pew Charitable Trusts, is focused on advancing the use of health impact assessments to identify and address the potential impact on health of proposed projects or policies in sectors outside health and health care. And just this month, we’re announcing new community grants for leaders from health, business, education, policy and other sectors that will use data from the County Health Rankings to implement policy or systems changes that address different social and economic factors that impact health.
One somewhat related development we are really excited about is a partnership with the Federal Reserve Banks of Boston, San Francisco, New York, and most recently, Dallas, to strengthen community development initiatives by addressing the social and environmental factors — things like housing, income and education — that influence health. These efforts can play an invaluable role in improving health and reducing disparities, and offer an important avenue to bring sectors together to help people in ways that none are likely to be able to achieve alone.
Q: The foundation has a long history of supporting public health efforts and investing in research aimed at improving public health practice. One area the foundation has especially focused on is public health accreditation. Why do you believe the movement toward accreditation is so important? How do you think accreditation will help public health adapt to a quickly changing health care landscape?
Public health departments have always played a leadership role in addressing some of America’s most pressing health problems. They are on the front lines fighting chronic and infectious diseases, keeping communities safe from health threats and providing services like flu vaccines and high blood pressure screenings that people depend on to stay healthy. That said, without consistent standards, people have not been able to know exactly what they can expect from their health departments, and there hasn’t been a mechanism to assure that our public health dollars are delivering the best possible services.
With the official launch of the Public Health Accreditation Board (PHAB) — with support from RWJF and the Centers for Disease Control and Prevention — America’s public health departments now have a system to enable them to really hone in on those activities that are most effective in keeping people healthy and safe. Behind accreditation is a dedicated public health movement toward continuous quality improvement so health departments can focus their scarce resources on those practices that are shown to work best for their specific communities. In addition to being a boon for accountability, the PHAB system provides an unprecedented vehicle for showing accountability and making the value and impact of public health clear to elected officials, governing bodies and the public.
Q: Tell us about the role of public health systems research in creating more streamlined and effective public health agencies and how the foundation is supporting such efforts?
One area where the foundation has a long history, and that we take great pride in, is our commitment to rigorous research and evidence to guide our social change investments and to inform health policy decisions at the federal, state and local levels. Our investments in public health systems and services research fall squarely into this area, with the goal of providing public health practitioners and policy-makers the data they need to make well-informed decisions about how health departments should be financed, staffed and structured. We view public health systems and services research as informing the field of public health in the same way we are informing childhood obesity prevention efforts through our Active Living research program, which is building a body of evidence about the importance of physical activity and identifying which policies and programs most effectively support activity. In essence, we see our research as demonstrating what works to achieve social change.
Q: For several years, the foundation has supported a range of policies and programs to expand health coverage and maximize enrollment in existing coverage programs. What are some of the key lessons from this work and how are they being carried forward in the foundation’s continued efforts to promote health care coverage, especially within the context of health reform?
Approximately 50 million Americans are currently living without health insurance, including more than 7 million children. Our work shows that health insurance matters. Lack of coverage often leads to unnecessary suffering, delayed diagnoses and premature death. When people have health insurance, they report better health, both mental and physical, and better access to care — and they suffer less financial stress.
And it’s not just the uninsured who suffer. Studies have shown that insured people in communities with high uninsurance rates have less access to health care and report less satisfaction with their care than people in communities with low uninsurance rates. For decades, we have funded research and policy analysis to offer solutions to this stubborn problem, provided technical assistance to states as they work to expand coverage, supported consumer advocates who have ensured that ordinary Americans are not forgotten in the process of reforming our health system, and served as a nonpartisan convener for all stakeholders who have been interested in finding solutions.
The passage of the Affordable Care Act was a watershed moment, but there’s still much to be done. While health reform provides the opportunity for a significant expansion in coverage, these gains are far from assured. We have learned over the years that policy-makers, researchers and consumers are all necessary to make lasting changes, and we have a vital role to play in supporting these activities as the nation moves towards covering nearly everyone who lives in the United States. With federal reform in place, our attention is on the states, where implementation efforts are taking place and coverage goals will be realized. We will focus on state implementation by providing technical assistance, supporting consumer engagement, monitoring and evaluating the implementation process, and disseminating what individual states are learning broadly so other states can learn as well.
Q: You were a delegate to the recent U.N. Summit on Noncommunicable Diseases. What do you see as the greatest opportunities for addressing this global challenge?
This was just the second time that the U.N. has convened a special meeting around a health issue (the first was around HIV/AIDS), and the pressing nature of the topic was evident in the numbers that were the backdrop for the meeting. Globally, 36 million people die annually from non-communicable diseases such as cancer, heart disease and diabetes. This adds up to 63 percent of deaths each year worldwide — and they are preventable.
It was an honor to be asked to be part of the U.S. delegation and have the chance to take part in the discussion — and both surprising and a little bit heartening to hear how consistent many of the policies being advanced globally are with what we are trying to do more of here in the United States, i.e. protect people from secondhand smoke, reduce salt intake, promote physical activity and healthy diets and increasingly, create partnerships that reach beyond health and health care to take action in our schools, workplaces, households and communities.
One important development from the meeting was the U.N.’s release of a political declaration, including sections on reducing risk factors and creating health-promoting environments. And an important point that I think many took away was that to help win the global fight against non-communicable diseases, all nations need to apply what we can learn from other countries beyond our borders that are facing very similar public health challenges — and from leaders around the world who are on the vanguard of addressing the risk factors.
Q: Here at home, the United States is challenged with glaring racial and ethnic disparities in chronic and other preventable disease. Can you talk about some of the efforts that are starting to make a difference as well as the consequences of not taking action?
Disparities of race, ethnicity, gender, class, economics and education block the path for millions of Americans to good health — from birth until death. Look at just one major population health indicator: the infant mortality rate for black babies in Washington, D.C., is nearly five times higher than it is for white babies across the river in Virginia. But health disparities are not just about rich versus poor, or majority versus minority populations. On average, middle-class Americans die up to two years earlier than their more affluent counterparts, and education has been shown to play a particularly significant role in people’s health. College graduates outlive high school graduates by more than six years, and adults who don’t finish high school are four times more likely to be in fair or poor health.
It is with these kinds of gaps in mind that a focus on health disparities cuts across much of our work to address the root causes of our nation’s health problems. One specific program is New Connections, which is designed to expand the diversity of perspectives that inform our grant-making strategy and increase our exposure to experts from historically under-represented research communities. That said, if we are going to close America’s health gaps, efforts by our organization and others who are committed to improving Americans’ health will need to be bolstered by leadership in all sectors to work across communities to address the multiple factors in our economic, social and physical environments that influence health. With this in mind, it is encouraging that in addition to addressing disparities, the new National Prevention and Health Promotion Strategy, released by the Department of Health and Human Services and endorsed by 17 government department heads from agriculture to education, outlines specific program and policy actions that can be undertaken in our homes, schools, businesses and other community institutions to prevent disease, promote health and control costs. Moving forward, the strategy should include an even stronger commitment to research and data that demonstrate both the health and economic benefits of prevention, particularly for policies and programs outside the clinical setting.
For more information on the Robert Wood Johnson Foundation and their efforts to improve health, visit http://www.rwjf.org/. For more on APHA’s 139th Annual Meeting, visit http://www.apha.org/meetings/AnnualMeeting/ .