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Props to RWJF for Improving #CultureofHealth, & the power of social media

In my last post, I explained why I felt that #CultureofHealth wasn’t quite working for me, and I proposed that we try to brainstorm complementary memes.

In particular, I was concerned that an intense focus on “being healthy and staying healthy” might not offer enough support to those who struggle with illness, or to clinicians whose work it is to care for “sick people.”

The CEO of the Robert Wood Johnson Foundation, Dr. Risa Lavizzo-Mourey, was kind enough to write a response on THCB, and several people commented on both posts.
Furthermore, on October 17th, Dr. Lavizzo-Mourey posted a comment announcing that RWJF had made some tweaks to their message, to better clarify that a Culture of Health includes everyone, “be they sick or well.”
I am, of course, hugely grateful to RWJF for taking the time to thoughtfully consider the issue. 
I’m also especially grateful to those who took the time to comment and relay their own reactions to RWJF’s previous definition of a Culture of Health; I’m sure this input was vital to the process of considering the Culture of Health messaging.
In this post, I want to share the “tweaks” so far in defining the Culture of Health. I’ll also share some of the complementary meme ideas I heard from other people this month. And then I’ll close with some thoughts on the power of blogging and social media.

Culture of Health before and after

“We believe an American Culture of Health is one in which:

  1. Good health flourishes across geographic, demographic and social sectors.
  2. Being healthy and staying healthy is valued by our entire society.
  3. Individuals and families have the means and the opportunity to make choices that lead to healthy lifestyles.
  4. Business, government, individuals, and organizations work together to foster healthy communities and lifestyles.
  5. Everyone has access to affordable, quality health care.
  6. No one is excluded.
  7. Health care is efficient and equitable.
  8. The economy is less burdened by excessive and unwarranted health care spending.
  9. The health of the population guides public and private decision-making.
  10. Americans understand that we are all in this together.”
As I said, other people’s comments provided truly vital input to the conversation. I especially want to highlight Dr. Peter Elias, a remarkably thoughtful primary care physician who I know through the Society of Participatory Medicine. He commented:

“[This] talks about being and staying healthy, but doesn’t speak to the people who are ill and struggle for even some improvement in health, let alone those who just want dignity and comfort because health is no longer an option for them. 

I think I understand the intent: a society that values the things that foster health. But the message I hear (and my patient heard) is that health is not just the goal, but the only acceptable state. That’s pretty hard on the ill. It lends itself to a culture of blaming patients for their misfortunes, something I see on a regular basis. 

How does a dying patient related to a culture of health? Probably by feeling alienated, disrespected and disposable. How will clinicians behave in a medical culture of health? Will they be unwilling to care for patients who cannot become healthy or do not try hard enough (by someone’s definition) to get healthy? 

I fear that a culture of health would make it less acceptable to care about those who are not healthy.”

Again, it is a HUGE credit to Dr. Lavizzo-Mourey and RWJF that they really took these comments under consideration. They could have ignored me and Dr. Elias and kept doing what they do, and we all still would have mostly kept loving them because their foundation plays a vital role in improving health and health care.
But instead, RWJF made some modifications. And here’s how they are now defining a Culture of Health:

We believe an American Culture of Health is one in which:

  1. Good health flourishes across geographic, demographic and social sectors.
  2. Attaining the best health possible is valued by our entire society.
  3. Individuals and families have the means and the opportunity to make choices that lead to the healthiest lives possible.
  4. Business, government, individuals, and organizations work together to foster healthy communities and lifestyles.
  5. Everyone has access to affordable, quality health care because it is essential to maintain, or reclaim, health.
  6. No one is excluded.
  7. Health care is efficient and equitable.
  8. The economy is less burdened by excessive and unwarranted health care spending.
  9. The health of the population guides public and private decision-making.
  10. Americans understand that we are all in this together.

This, in my mind, is a big improvement.

Now, having just read Atul Gawande’s new book (which is mostly about supporting the well-being of aging adults during their last years of vulnerability, even though it is being hyped as an “end of life” book), I am very much thinking about how do we make sure the healthcare system offers older adults more of the right care and less of the wrong care.

And I can’t say that the points above — or the Culture of Health mantra for that matter — provide a lot of guidance. Instead, I’m feeling much more inspired by the Lown Institute, who recently emailed me the following statement:

“We are assembling a national network of impassioned medical students, residents, senior clinicians, patients and community groups who have joined us in building the RightCare Alliance, a movement dedicated to ensuring that human presence is central to scientific ministrations. Members of the RightCare Alliance are creating programs for transforming medicine, by addressing issues of overuse and underuse of our existing healthcare system and working to ensure that the heart of medicine is preserved over the business of healthcare.”

(Sign me up!)

In truth, the scope of what health, health care, and healthcare cover is likely too big to be adequately represented by any one meme, or even 10 point bullet list.

There is addressing upstream health factors, there is getting people to adopt healthy behaviors, there is the patient-healthcare system interaction when someone relatively healthy comes in with an acute problem, there is the the hard work of helping people manage their chronic illness for decades, and then there is my favorite work: helping aging adults with multiple medical problems make the most of their health and their situation. (Plus there are hospitalizations, surgeries, rare diseases, and even the possibility that much of how sick or old we feel is being driven by our mental attitudes.)

At this time, as best I can tell, RWJF is not focusing on either aging or the optimal primary care of aging adults with multimorbidity.

That’s ok. We all have our piece of health care (and healthcare, which I define as the professional services often covered by insurance) that we are going to work on.

We just may need to be more clear in the future, in specifying which part of health care we are talking about, in order to focus on the right memes and priorities.

Complementary meme ideas

Several people endorsed “Culture of Care,” but here are some others that came up during the #CultureofHealth conversation:
  • “Care can be complicated, but then so can people”
  • How about: “Wellness didn’t work out…now what?” or “Prevention: the things you do before you get sick.”
  • #cultureofcare also communicates more partnership opportunity, IMO.
  • “Collaborative Team”
  • #Cultureoflove
  • #CultureofCaring
I myself brainstormed several in the comments thread (which no one really responded to but I’ll share them here anyway):

  • Culture of Caring & Better Health
  • Culture of Optimizing Health & Wellbeing
  • Culture of Comprehensive Health Care
  • #CultureofBetterHealth
  • #BetterHealthBetterCare
  • #CultureofHealth&Care
If you particularly like any of the above, I hope you’ll speak up in the comments below.

In closing: the power of social media

Obviously, this whole affair is a testament to the power of social media and the public conversations it enables. 
Before the blogging era, a small fry such as yours truly could never have had her opinion heard by the leadership of a big foundation. Blogging and social media also make it easy for others to add their opinion. 
After all, a blogger’s work matters the most when it 
  • Gives voice to what many others were thinking, but didn’t have the time or capacity to say prominently.
  • Sparks constructive conversations among a group that might not otherwise be talking to each other.
It also helps to have a bigger blog give you a microphone, and I’m indebted to Matthew Holt and John Irvine of The Health Care Blog for enabling me to share my thoughts with a much bigger audience than I’d ever reach on my own.
The morals of the story: 
You can’t make change alone. 
Conversations are important. 
Social media facilitates those conversations, and can allow small players to be heard by big players. 
It is hard to capture everything we want in health care with a single meme.
Comment. Tweet. Blog. Make change.

Reader Interactions

Comments

  1. pheski says

    The unspoken corollary of of "you can't make change alone" is "but you can't start change if you don't speak up."

    Thanks for speaking up, and doing so in a way that made it easy for others to hear, understand and support what you said.

    Change is a team sport.