Creating a Culture of Health

Alonzo Plough believes we need to change the way Americans think about health. Period. To do this, Plough, the vice president of Research-Evaluation-Learning and chief science officer at the Robert Wood Johnson Foundation, has embarked on bold effort to create a culture of health.

Plough will introduce the Foundation’s initiative to a Mailman School audience in the year’s first Grand Rounds on September 10 at 4pm in Alumni Auditorium. Plough’s talk, and the conversation sure to follow, is the first exploration of “Next Gen Population Health,” where national figures visit campus to discuss what we must do as a society to create population health.
 
Plough’s career has spanned academia, government, and philanthropy, from coast to coast. After completing training in epidemiology at Yale, he started his career in academia, with appointments at Boston University, Tufts, and Harvard. He then became a director of public health, first in Boston, then in Seattle before joining the California Endowment in 2005. In 2009, he was named director of disaster prevention and response at Los Angeles County. He assumed his current role in January.
 
For its inaugural issue, Transmission connected with Plough to consider topics like redefining popular notions of health to the promise of physical activity data from smart phones and “wearable” technologies.
 
A lot of people think of health solely in terms of a clean bill of health from an annual doctor’s appointment, but is there more to it?
 
There’s much more to health than that! Even in 1948, the World Health Organization defined health as more than the absence of illness. Health includes wellbeing, a dimension of spirituality, and mental health.
 
So where is the U.S. in terms of creating a culture of health?
 
In terms of health measures, many other advanced industrialized countries have incorporated a much clearer sense of wellbeing into health and social policies. The U.S. lags behind on health because our understanding of health is anchored to medical care.
 
We have many different communities in America, some of which support an environment that allows for healthy choices, and some which don’t. It’s about more than an individual’s behaviors and choices; there is a deficiency in equitable neighborhood and living contexts in which the healthy choice is the easiest choice.
 
Things like bike lanes, farmer’s markets, and the Affordable Care Act signify a shift in our health culture, but there are still deeply entrenched problems with inequality. How can we fix these disparities? 

The first step is raising the national consciousness that inequality in health outcomes is a shared national problem and making sure people understand that promoting wellbeing requires linkages among health-enhancing policies, deep community engagement, and building social networks. This requires a cognitive shift in how people think about what improves health and wellbeing versus only  treating illness.

Second, we need more than just the healthcare system involved. Corporations and businesses have a stake in the communities in which they are situated, and need to realize that their family leave policies, sick leave policies, and daycare policies are all part of the health equation. That will go a long way to creating health-affirming qualities across sectors.

We must also build equitable communities and environments where work and play are health-affirming. Your zip code should not be a negative determinant of your health.

Finally, we need better integration of prevention, healthcare, and social services through the life-course. We must reimagine and integrate that service context into the right kind of support at the right time—and at the right cost.

How important is the corporate sector to creating health?

Absolutely critical. I learned from being in public health practice—particularly when there were emergencies and disasters—that much of the infrastructure is in the private sector. When running emergency health services in LA County, we made arrangements with movie studios to use their mobile generators in the event of disaster—instead of worrying about stockpiling our own supply.
 
As Chief Science Officer at the Robert Wood Johnson Foundation, how do you measure the Culture of Health?

Along with some existing measures, we’re developing ways to show movement we think of as critical to developing a culture of health. In a set of about 30 measures, some examples of what we are tracking include housing adequacy, the percentage of school districts around the country that have full-day kindergarten, and the prevalence of universal preschool. These are evidence-based approaches to make sure developmental opportunities in early childhood are maximized. We’re also working with the American Hospital Association to develop a measure for how hospitals are building wellbeing through effective community partnerships. The Vitality Group is working with us on a similar measure to track corporate involvement in creating community wellbeing.
 
For those who can afford it, digital devices are a new trend in personal health. How does this relate to the culture of health?

These technologies are an indication of more attention to physical activity, which would certainly be a component of the culture of health. The use of the wearable technologies isn’t spread uniformly in the population, but smart phones with exercise apps are breaking the digital divide.
 
These devices should give us better information on physical activity than surveys, so we’re trying to use “big data” from smart phones and wearables to develop some analytics. We have grants and partnerships in development that seek to understand people’s health-seeking behavior in terms of web information sources, and we are also in talks with the device manufacturers.
 
Thanks for taking the time to answer these questions ahead of your Grand Rounds talk.
 
Thank you. I’m looking forward to getting a chance to learn more about what you’re doing at the Mailman School.