Culture of Health: A Vision of Health Equity

In 2014, the Robert Wood Johnson Foundation (RWJF) made a long-term commitment to ensure that all of its programming focuses on improving population health, health equity, and the well-being of all Americans. The commitment toward promoting a Culture of Health represented a shift to viewing health as more than just health care, with a focus on addressing health inequities. An Action Framework, inspired by 10 underlying principles for a Culture of Health, helped to propel and guide RWJF’s efforts. The social justice unrest in 2020 and the pandemic reinforced the importance of this work and sharpened its focus on racial equity, emboldening the promise of a Culture of Health for the nation.

RWJF is funding Westat’s efforts to evaluate and measure progress in fostering a Culture of Health. “Our work with RWJF on a Culture of Health actually began in 2015 when we assisted the Center for Public Program Evaluation with phase 1 of the Culture of Health Progress Report,” says Debra Rog, Ph.D., a Westat Vice President for Social Policy and Economics Research and Principal Investigator for the project. “This involved assessing the early awareness of the Culture of Health vision and Action Framework. The results were generally positive—showing that many people were familiar with the Culture of Health vision and that their work was aligning with the Action Framework.”

As Westat began working on phase 2 of the Culture of Health Progress Report, it conducted a range of developmental evaluation activities. “A key product of Westat’s collaborative work with RWJF is a Theory of Change,” notes Dr. Rog. “The theory highlights the Foundation’s roles in building a Culture of Health, including direct and indirect pathways (working with external actors) to shifting mindsets, practices, policies, conditions, and systems to achieve improved population health, health equity, and well-being.” The Theory of Change guided the development of a long-term evaluation plan, highlighting measures of short-term indicators of progress, longer term outcomes, and ultimate improvements in population health, health equity, and well-being.

Westat is now conducting phase 3 of the Progress Report. A key activity in this phase has been conducting a background study to inform the long-term evaluation plan by identifying the areas of the Foundation’s work that are aimed at the indicators of progress.

“We will synthesize this information across RWJF’s themes, teams, and units to determine which areas of RWJF’s investments to explore further and where we should measure proximal changes believed to be linked to changes in both short- and long-term outcomes,” says Dr. Rog. “We will finalize the set of measures and collect baseline data on them, working closely with the RAND Corporation and other key stakeholders to determine the best measures for tracking ultimate improvements in health.”

Of the Culture of Health, Dr. Rog says, “the work is immensely rewarding. It is very satisfying to be studying this very important and timely work.”

Support for this evaluation was provided by a grant from the Robert Wood Johnson Foundation.