In 2014, the Robert Wood Johnson Foundation (RWJF), the second-largest funder for health in the United States after the National Institutes of Health, proposed a new framework for improving population health and reducing health inequities in the United States. The core of RWJF’s ‘‘Culture of Health Action Framework’’ is the goal of ‘‘making health a shared value’’ by achieving what some describe as a ‘‘cultural shift’’ in the United States.
In an article recently published in Population Health Management, six medical anthropology colleagues and I, all of whom have worked with RWJF as fellows or grantees, offer a constructive critique of the Culture of Health initiative. Along with my co-authors Sarah Willen, Seth Holmes, Denise Herd, Mark Nichter, Heide Castañeda and Helena Hansen, I have been following the development of the Culture of Health concept and related programs for years. We have all been delighted to see such a large Foundation take a holistic approach to tackling health inequities. Notably, with the Culture of Health RWJF resists the allure of the quick fix in favor of confronting structural forces that lead to health inequities. Many new RWJF-funded initiatives, including those that seek to shape government policies, track hyperincarceration rates, and build cross-sector collaborations, recognize the different levels at which inequalities are born and perpetuated and aim to confront their root causes. Still, we remained concerned that the Foundation was relying on ideas like “culture change” that oversimplified the challenges and potential solutions at hand and which, in some cases, had ugly historical connotations.
In this article we suggest that RWJF address three challenges to achieving a “Culture of Health” as RWJF conceives it: (1) clarifying and demystifying the concept of “culture” to bring it more in line with contemporary anthropological understandings of this concept; (2) contextualizing population health understandings of “community” and community interventions within the networks of power and inequality in which communities are embedded; and (3) confronting the crises of trust and solidarity in the contemporary United States that are currently making it so difficult to rally people to a cause such as health equity. While giving credit where credit is due, the authors offer an invitation to RWJF to think more deeply about what the Foundation means by a “Culture of Health” and what the best means are to achieving it.
—By Katherine A. Mason