RWJ Foundation report urges state to pursue Culture of Health: ‘This is about much more than health care’

By Anjalee Khemlani
New Jersey | Apr 17, 2019 at 11:00 am

The Robert Wood Johnson Foundation released a report Wednesday with policy priorities the state should pursue to establish what it termed a “Culture of Health.”

The report covers an array of ideas that combine elements of social determinants and population health — ideas that the health care provider industry of New Jersey has been pursuing in recent years.

Giridhar Mallya, a senior policy officer at RWJF, told ROI-NJ the idea behind the report was to leverage the momentum of the new administration — which is focused on health care disparities in the state — and highlight the sectors which need to take on more responsibility in achieving a healthier New Jersey.

The report’s conclusion highlights this message:

“Building a Culture of Health will require unprecedented collaboration across all sectors and all communities.

“It will require assuring that those who have been pushed to the margins are brought back into the circle and have what they need to make healthy choices.

“It will require the directing of resources to communities that have suffered from generations of under-investment.

“It will require implementing evidence-based, equity-producing policies like those recommended in this report.”

The report includes the following 13 policy priorities the state should pursue, some of which Mallya acknowledged have either recently been implemented or are already policy, in part, in the state:

  • Improve maternal and infant health outcomes by enhancing care, supports, and prevention;
  • Ensure maximum uptake of the recently expanded paid family leave benefit, particularly among low-income workers;
  • Increase access to high-quality early education for all of New Jersey’s 3- and 4-year-olds, with a continued focus on children living in poverty;
  • Boost the incomes of families supported by low- and moderate-wage workers to promote financial stability and economic opportunity;
  • Ensure New Jerseyans have equitable access to safe, affordable, and stable housing in the communities where they choose to live;
  • Prevent childhood lead poisoning by maximizing state and federal funding and ensuring properties are lead-safe through inspection, remediation, and enforcement;
  • Expand equitable access to healthy food in communities and schools;
  • Ensure all roads, sidewalks, and public transit systems are safe and accessible to all potential users;
  • Reduce tobacco use disparities through price increases and cessation programs;
  • Shift the health care system’s focus toward delivering whole-person care, working with other systems to promote overall health and well-being;
  • Ensure access to comprehensive, integrated mental health and addiction services;
  • Improve access to health and social services throughout the state by leveraging technology;
  • Foster collaboration within and across state agencies to improve health equity.

These aren’t all short-term goals, Mallya said, nor can they be achieved without determining the cost to implement and sustain the programs.

“No one policy that we recommend is going to change the health of state,” he said. “It’s a generational endeavor. For a lot of these things, incremental is likely more feasible.”

And it requires a shift not only in the way health care is delivered — such as focusing on crafting more creative value-based care reimbursement structures — but also the input of a wide variety of sectors including housing, food, insurance and the state Department of Human Services.

“We have a clear recognition that health care stakeholders need to be part of the solution, but are likely not going to be leaders in designing, implementing and financing the programs,” Mallya said. “So, this is about much more than health care.”

Historically, funding for new programs have come out of the health care providers pockets or from grants, only recently have payors become part of the mix — such as in the case of RWJBaranabas Health and Horizon Blue Cross Blue Shield.

The same can be true of Medicaid and Medicare, as has been done in other states, Mallya said.

For example, pilot programs can be developed and implemented in target areas, and the state’s Medicaid program can address social issues like housing or food.

The key is that policymakers can make some of the recommendations happen through legislation or through changing the operations and jurisdiction of state agencies.

“State leaders are often looking for advice on where to start,” Mallya said.

“We want to provide a comprehensive menu of options with scientific support and benefit communities and close health gaps.”

Anjalee Khemlani | akhemlani@roi-nj.com | AnjKhem