16.2 What Is a Healthy Community?

The RWJF Culture of Health Initiative

Since 2013, the RWJF has focused on a Culture of Health initiative to improve population health, well-being, and equity in America (Chandra et al., 2017). To work toward national health equity, the RWJF identified 10 principles key to facilitating a culture of health.

The RWJF also operates under the knowledge that health is not just the result of individual choices and behaviors and that social, economic, environmental, and other factors interact in complex ways to shape the health of individuals and communities. To that end, the RWJF Culture of Health initiative focuses on community-based determinants of health such as care access, economic stability, housing, and food, as opposed to health interventions for specific disorders and conditions.

The RWJF Culture of Health Action Framework

Community involvement and mobilization play a large role in advancing the RWJF Culture of Health initiative. The organization has built an action framework so that efforts addressing the varied and complex factors that affect health in America may be evaluated efficiently to allow program revision or change in support of meaningful improvement (Li & Pagán, 2016). The Culture of Health Action Framework is used to identify and organize priorities under four distinct action areas (RWJF, 2018):

• Making health a shared value
• Fostering cross-sector collaboration to improve well-being
• Creating healthier, more equitable communities
• Strengthening integration of health services and systems

Making health a shared value means that society must commit to implementing social systems and power structures that allow all individuals and groups to access good health care (Chandra et al., 2016). Mindset and expectations, sense of community, and civic engagement are noted as three drivers of change toward making health a shared value, which can be measured by aspects such as internet searches for health-promoting information and volunteer participation and voter turnout in specific communities (RWJF, 2018).

Fostering cross-sector collaboration to improve well-being means encouraging or incentivizing organizations outside of those traditionally or directly associated with health care (e.g., transportation and housing) to work together to support better health across communities. Because societal barriers to health are beyond the control of individuals and disproportionately impact some groups more than others, health is the responsibility of communities, care systems, businesses, and other organizations across sectors and classes (Tan et al., 2019). Effective collaborations can have lasting impact on health equity and community well-being, and involvement of sectors outside of health care is central to comprehensive health promotion (Towe et al., 2016). Measurements and exemplars of hospital partnerships, business leadership in health, support for working families, and collaboration among communities and law enforcement agencies can indicate progress in this action area (RWJF, 2018).

Creating healthier, more equitable communities can occur through sustained changes to health policy that support healthful physical spaces, increased access to resources, and changes in cultural norms related to health (Dubowitz et al., 2016). The built and physical environments, social and economic environments, and policy and governance models of communities can support health and equity across communities. The RWJF (2018) identifies community walkability, public libraries, youth safety, housing affordability, residential segregation, early childhood education enrollment, climate adaptation and mitigation, and air quality as measures for determining positive change toward healthier and more equitable communities (Figure 16.3).

Figure 16.3 Public libraries are a community structure offering many health supports to all members of a community. This photo shows a children’s library room, where kids and families can spend time reading, playing, and learning for free. Public libraries host community events, many of which are health-focused. (credit: “Children’s Room Visitors” by NPL Newburyport Public Library/Flickr, CC BY 2.0)

Finally, strengthening integration of health services and systems refers to creating a revised system of health care in the United States that involves interaction among medical care, public health, and social services. Such interactions help maximize health and well-being, ensure equal access and opportunity to achieve health, and increase client engagement, shared decision-making, and transparency in the health setting (Martin et al., 2016). With the effective implementation of Culture of Health initiatives, communities should see increased access to comprehensive public health services, health insurance coverage, and routine dental care (RWJF, 2018).

Table 16.2 lists examples of how different organizations can contribute to the four Culture of Health Action Framework areas RWJF promotes. View the table and consider how nurses could work with community members and agencies to promote a culture of health.