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ISSN: 1547-3570
ISBN: 978-111-9-00078-5
Risa Lavizzo-Mourey
The theme of this year's Anthology is discovery—discovery of new ideas and innovations; discovery of approaches to solve seemingly intractable social problems; discovery of ways to transform a routine city hotline into one serving a new group of needy individuals.
The volume begins with a chapter that explains how the Foundation finds ideas. That is followed by three chapters on the pioneer portfolio. One describes the pioneer team's approach to seeking out innovators, and the other two highlight new ways to solve problems that the pioneer team discovered and the Foundation funded—sharing physicians' notes with patients through the Open Notes program, and using video games to promote health.
The next five chapters examine how the Foundation has been addressing one of the nation's most important health issues, the epidemic of childhood obesity. These chapters present the Foundation's approach to reducing childhood obesity, look at the policy research generated by Foundation grantees, describe Foundation-funded efforts to enhance the built environment, and examine programs to improve nutrition in the nation's schools (the Healthy Schools program) and to combat childhood obesity at the community level (the Healthy Kids, Healthy Communities program).
The volume concludes with a chapter on how committed individuals found a way to use Los Angeles County's 211 social services hotline to identify children with developmental disabilities and refer them to the services they need.
A book about discovery resonated with me, for, beginning in mid-2012, the Foundation went through its own process of discovery as we crafted a strategic plan whose centerpiece was an entirely new vision. We were looking to build upon the Foundation's work over its forty-year history to find bold ways to help make the United States a healthier nation. The process took more than a year, involved the entire staff, and was overseen by the Board of Trustees.1 From the very beginning, the Board instructed us to cast a wide net and avoid simply making incremental changes that would look to the past but not the future. It admonished us not to repeat the mistakes of the eighteenth-century British, who wasted their time building speedier sailing ships just as steam-powered ships were rendering them obsolete.
Our discovery process began with a concerted effort to learn everything we could about what health and health care were likely to look like in the future. We sought the counsel of experts. We compiled, read, and discussed the most thoughtful analyses of where health and health care were heading. And we examined the issues in staff meetings and retreats, including an all-staff “learning session,” in which participants were asked to consider how health and health care were likely to change over the next twenty years, what the Foundation's blind spots were, and how the Foundation could improve its work.
To provide a context for the learning session, the Foundation commissioned the Institute for Alternative Futures to explore four scenarios for health and health care between 2013 and 2032. The first was slow reform accompanied by improved health (largely through prevention); the second was a worsening of the current system, with a consequent deterioration of health; the third was using Big Data to generate major health gains; and the fourth was creation of a culture of health.
As a result of these various efforts, we were able to identify trends that should inform the Foundation's work in the future, among them:
The next step in our process of discovery was trying to understand how the Foundation could have more influence in bringing about the kinds of changes that would lead to a healthier America. For answers to this, we reached beyond health and health care and sought the guidance of experts in other fields. We asked five luminaries to prepare analyses based on their expertise and to lead a discussion at a second all-staff learning session. The experts were Sinan Aral, an MIT professor and leading expert on social media and networks; Dan Ariely, a highly regarded behavioral economist and author of Predictably Irrational; Sara Horowitz, the creator of the Freelancers Union and winner of a MacArthur Foundation Genius Award; Michelle McMurry-Heath, a physician and biochemist who is currently a high-ranking official at the US Food and Drug Administration; and Dan Wagner, a data analysis expert widely credited for the voter microtargeting that helped swing the 2012 presidential election.
Among the insights to emerge were the following:
Proceeding along a parallel track, the Foundation's teams were reviewing their own successes and failures and were consulting their grantees, colleagues, and consultants for ideas about how their work, and that of the Foundation, could be improved. The teams presented their ideas and plans to the senior staff, which guided the strategic planning process. In addition, recognizing that its work did not exist in a vacuum, the Foundation commissioned analyses of what other foundations in health and related fields were doing.
This process of discovery culminated in the decision to adopt a new vision—one that would commit the Foundation to advancing “a culture of health.” This new vision is not simply tinkering; it is new and aspirational, and gives the Foundation the opportunity to stimulate a nationwide conversation about what it means to be healthy and how the nation can become healthier. This vision reaches the very essence of society—its values.
In a way, the new vision completes a transition. Between 1972 and 1990, the Foundation focused almost exclusively on improving health care; from 1991 through 2013, it was devoted to improving both health care and health. With its new vision, the Foundation can concentrate on the nation's health. This does not signify that we are abandoning or minimizing our commitment to improving access to affordable and high-quality health care. Rather, we view health care as one important contributor to health, along with behavior, genetics, and the socioeconomic environment in which people live. We are aware of the many challenges the new vision will entail, but we are prepared to meet them. And we are in it for the long haul.
We are grateful to all those whose efforts made this volume of To Improve Health and Health Care XVI: The Robert Wood Johnson Foundation Anthology possible. Within the Foundation itself, Risa Lavizzo-Mourey has given the Anthology her full support at all times; Fred Mann has provided wise counsel; Mimi Turi, Megha Sanghavi, Marianne Brandmaier, and Carol Owle handled financial management adeptly; Hope Woodhead supervised the design and distribution of the book, aided by Joan Barlow; Mayra Saenz also helped with the book's distribution; Patti Higgins did internal fact checking and copy editing, giving us the assurance that dates and monetary amounts are accurate; Rose Littman, Tina Hines, and Joan McKay were invaluable in arranging meetings between the San Francisco–based editor and the staff at the Robert Wood Johnson Foundation; Carole Harris served as a link between the Princeton/Washington-based editor and the San Francisco-based editor; Mary Beth Kren was invaluable in locating hard-to-find documents and reports; Andrew Harrison provided materials from the Foundation's archives, including the oral history; Deb Malloy, who has been of immense help in a variety of ways since the Anthology series began, assisted this year in reviewing chapters prior to their being posted on the Foundation's Web site; and Alexa Juarez provided research assistance in gathering materials for authors.
We wish to thank those who read chapters in draft form and who offered helpful comments on all or some of them—Risa Lavizzo-Mourey, Fred Mann, Dwayne Proctor, Paul Tarini, and Brian Quinn.
Special thanks are due to four Foundation staff members. Molly McKaughan, who has collaborated with the Anthology editors for many years, suggested topics, recommended authors, and cast a keen editorial eye on every chapter. Amy Woodrum, an extraordinarily talented research assistant, carried out the task of gathering information for the authors with alacrity and good cheer and, in addition, conducted research, did fact checking, and helped with the editing. She was a partner in all aspects of this publication. Penny Bolla was the model of efficiency and commitment in seeing that chapters were posted to the Web in a timely and accurate fashion. Sherry DeMarchi did what can only be termed an amazing job handling the distribution of the book and in bringing the mailing list up to date.
Beyond the Foundation's staff, we are indebted to Susan Dentzer and Jim Knickman for serving as the outside reviewers for the Anthology. Their analysis of the draft chapters strengthened the volume immeasurably. Jim Morgan, our copyeditor, once again added grace to the prose in every chapter. Carolyn Shea continues to be without peer as a fact checker. Ilan Isaacs proofread the galleys and caught errors that had escaped other readers.
At Jossey-Bass, we thank Seth Schwartz, Justin Frahm, Melinda Noack, and Donna Jane Askay.
Finally, we are saddened by the death of Andy Pasternack in 2013. Andy, who as the health series editor at Jossey-Bass, was a partner in the Anthology series from its birth. He was a tireless supporter, an able problem-solver, and, most important, an extraordinarily decent human being.
SLI/DCC