I initially wrote this article in 2017 while I was sitting in a hotel room in Washington, DC, at a meeting of the Robert Wood Johnson Foundation Culture of Health Leaders program. The previous summer, I wrote a grant proposal to be part of this new program and was fortunate enough to be selected as one of forty people in the initial cohort. I’m going to reflect on my experience in the program at the end of this article, but here’s the article I wrote back then:
The Robert Wood Johnson Foundation was endowed by the guy who made the Johnson and Johnson company into a global powerhouse in medical products and pharmaceuticals. It is the largest philanthropic organization in the world dedicated to the promotion of health. Like other such healthcare-related foundations, the RWJF supported all sorts of research and education for many years. However, a couple of years ago, the foundation decided to rearrange the way they did things, coming up with the “Culture of Health” program. The idea was that the foundation would start focusing their funding on projects designed to specifically address the way healthcare is delivered. There are four branches of the Culture of Health program. The Health Policy Research Scholars is directed at providing opportunities for graduate students to use their educations to study and help implement new ideas in how health policy is developed and implemented at the government level. The Interdisciplinary Research Leaders program is designed to help teams of researchers from different areas of sciences and healthcare to work together to address complex issues. The Clinical Scholars program is for health professionals who are working on new ways to improve health care delivery. The Culture of Health Leaders program, the one that I’m part of, is designed to take people from a wide range of disciplines, including business, health care, social services, education and so forth, help train them on leadership skills and issues around community health so that they will be in a position to work collaboratively with all the different players in the community that impact the health and well-being of the population.
Things like the Culture of Health initiative are where science and society meet most directly. The RWJF has, historically, spent hundreds of millions of dollars a year funding research projects that related to improving medicine and healthcare, using the common model of just asking for proposals from clinicians and scientists on various topics, then picking the best ones to support. The reason they shifted to the single focus of the Culture of Health was because they determined, after a great deal of research, that there was a very fundamental issue in healthcare that wasn’t really being addressed, and until that issue was addressed, health care delivery could never get anywhere near as efficient and equitable as it should be and must be. That issue is how people—all people—can get access to the health care that they need to live the healthiest lives they can. They then determined that, since they were looking at a new model of health care delivery, they would have to find new ideas and train the people that would be needed to implement those new ideas and make it happen. So the Clinical Scholars program and the Interdisciplinary Research program funds clinicians and related professionals who have projects directed toward how to best provide quality health care to everyone in an environment of limited resources. The Health Policy Scholars program helps people train for and choose careers that will impact direct policy decisions. The Culture of Health Leaders program will help train people to work with everyone in the community, from the citizens to the community service organizations to the government to the health care providers, to implement new ways to make sure that everyone has access to the very best, most efficient care possible.
The background to all this is that, as we all know, medical care is changing. Not only is the actual capability of our providers, our hospitals and our technology constantly improving, but the ways medical care is paid for and the way patients and their caregivers will be working together to heal the sick and, just as importantly, keep people healthy, is also rapidly evolving. Health care has, historically, been focused on making sick people well, which kind of makes sense, when you think about it. The thing with that approach, however, is that waiting for people to have a heart attack, for instance, and then keeping them alive afterwards and then providing the support to help them get back to normal is not really as desirable as keeping them from having the heart attack in the first place. What we are learning is that keeping the community healthy is a much better way of addressing health than waiting for something bad to happen and then responding to it. Certainly, things will still happen and the health care community will stand, as always, ready to deal with it, but from an efficiency standpoint, as well as a quality of life perspective, keeping people healthy is a better approach. It’s not just the health of individual people that is impacted by this idea, either. It is the health of the entire community.
Think about the issue of jobs. If you owned a business and needed to build a new factory, you would look at many factors as you tried to determine where to build your facility. You would consider such things as access to resources and transportation, quality of the community and schools, availability of a work force with the right abilities and cost. Cost is, of course, going to be a major deciding factor. If you narrow your choices of where to build down to two places and everything is pretty much the same between the two of them except that the health statistics of one community are better than those of the other, you will choose the healthier community. Why? Because the healthier community will cost you less in terms of your health care costs, in terms of time lost due to sickness and in terms of more productivity. Businesses look at health care costs much as they look at taxes. It is a cost of doing business and if they can lower that cost by building in a healthier community, they will.
We are, in this country, embarking on a new approach to medicine in which all people will have access to good health care and where we will foster a Culture of Health in our communities. We will seek to enable people to live healthier lives where primary health care is more about working with people to help keep them healthy than it is about dealing with the consequences of not managing their health issues. It is a great task we have before us, but we, as a community have a lot of unique resources available to us that very few towns of our size have. We have a large and terrific health care infrastructure, dating back to the 1950’s. We have great community organizations dedicated to moving us forward. We have excellent educational institutions. We have great community leaders. Most importantly, we have a lot of good, strong, decent people who are up to the task of changing our current culture to one of a Culture of Health. It is one of the primary keys to helping to raise our community up and help it move into the new age of the twenty-first century as a vibrant, economically viable town. We have all we need to be an example of everything a rural community can become, as we make the transition from our old economy to a new one that is geared to navigate the challenges of the future. We can do this.
It’s now two years later:
I have just completed the three-year program and I can say without hesitation that I am not the same person I was when I started. The program staff did a marvelous job of putting together a curriculum designed to help us all become more effective leaders in our communities so that we could lead a transformation in health all across the country. Over those three years, our cohort physically met as a group 11 times, for a total of maybe 40 days. Those convenings were packed with all sorts of learning and development opportunities. They brought in a national leadership development company to help us discover and assess our strengths and weaknesses as leaders and to teach us the best ways to work with individuals of all different backgrounds and how to engage effectively with communities. They brought in people to talk to us about their own communities and the things they had done to overcome challenges. They assigned me an executive coach to help me hone my leadership skills. We read lots of books and had discussions about them. We did all sorts of online coursework. We wrote grants. We put together presentations and then shared them with our colleagues. We’ve learned how to “build our brands” and how to get our messages out to the public. We’ve learned the immense power of networks and how to build them. I’ve been in leadership positions in the military and civilian life for a long time, but I learned a great deal in those three years that I didn’t know that is helping me right now to better do the work in my community that I’m going to spend the rest of my career doing.
I’m very grateful for all of that and it will serve me and, hopefully, my community, well for years to come. The leadership training made me better, but it was the other stuff I learned in this program that changed me. Our cohort is filled with a dazzling array of some of the most talented, brilliant, passionate, dedicated people I’ve ever met. They, and the program staff, have all become very, very special to me, mostly because of the fact that they are wonderful people, but also because they taught me more about humanity and how to find my own than I had managed to learn in the fifty years before I met them.
I met them for the first time in the fall of 2016 in Princeton, New Jersey, at a Marriott hotel next to the headquarters of the Robert Wood Johnson Foundation. Now, I’ve been to my share of meetings and conferences, but as soon as I stepped through the door, I knew this one wasn’t like any of the others. First off, it seemed like I was the oldest one there. The room looked similar to the student center at a university—full of kids. It turns out there were actually a few people older than I, and a few more about the same age, but most of my new colleagues were in their twenties and thirties. So, that was different. Most of the people in meetings I go to are older, like me. Secondly, it appeared that half or more of the people in the room weren’t white. There were several Hispanics, a few Asians, and quite a number of black people. That was definitely different. Most of the people in meetings I go to are white. Also about half the room was female, which was also a little different, because most of the people in meetings I go to are men, although that can vary a bit, depending on the meeting. So, that was what I saw when I walked in. I knew I was in a different sort of group than any I’d been in before. But wait! There’s more!
There’s also the stuff you don’t see. As I got to meet my new colleagues, I found out they were from all over everywhere, from Oregon to Alabama and New Mexico to New Jersey. Most of them were from urban places, but there were a few from rural areas, too. There were a couple gay guys. There were a couple of lesbians. There were a couple of people who I have now learned to refer to as “non-binary” meaning they didn’t adhere to strict gender identities. A couple of people were, basically, anarchists. The majority of them were quite liberal. It was, as a whole, a very different group, indeed, than any in my experience. On that first day, I felt like a stranger in a strange land, which was very unusual for me. I was out of my comfort zone.
Over the course of the next three years, I was always slightly uncomfortable in this group. Part of that was just the diversity of backgrounds, personal characteristics and philosophies. By virtue of my time in the military and my time at various universities as student and faculty, I’ve spent a lot of time in what I thought were diverse environments and I’d never felt any discomfort with any of it. This was different though, and it took me a long time to figure out why. The real issue behind my discomfort was that, even in a diverse group, I had always been part of the majority group before, and I wasn’t in this one.
While I might have always been a little uncomfortable in this group, I would also make it clear that I always looked forward to getting back together with them at the next meeting like it was Christmas. Everything else aside, I liked these people a lot from the very beginning. As I mentioned, we learned a lot in our various courses and sessions and so forth, but just talking to these people, hearing their stories, and sharing our experiences was pure magic for me. For instance, one day during a session, the guys in our cohort sort of mutinied. When our session was over and we were supposed to move on to the next thing, we refused. We were all sitting around in a big circle, and we had started talking about race. Not “race” in the sense you see on the news or read about online, but “race” in how it was part of our own lived experiences. My God, that discussion, and the one we set up later to dip a little more deeply into that well, were probably the most impactful discussions I’ve ever been part of. The power of the stories we shared, of growing up black in Jim Crow Georgia and of growing up white in rural Kentucky, of trying to survive as a young, gay black man in Chicago during the AIDS epidemic, was staggering. It’s amazing how different the stories about going to the grocery with your grandma can be.
We are now, officially, alumni of the first cohort of the RWJF Culture of Health Leaders Program. At our last meeting, we all got up to say a few words about our experiences in the program. I’ve been speaking in public for decades, and I generally have no problem with it. However, I’m a pretty emotional guy, and I can’t talk about things that hit me in the heart. I had to write down my eulogy for my mother and get someone to read it for me at her memorial. When I stepped up to the podium at our last meeting to say my piece, I found I couldn’t say anything. I finally got out a few words, but Lou Gehrig’s farewell speech it wasn’t.
If I thought we were truly at the end, I would be inconsolable. These people and the changes they have wrought upon me mean far too much to me. But we’ve taken steps to ensure we stay connected. I’ve interacted with several of my colleagues—my friends—already on a few projects. We’ll get together again as we all go forward, but they will all be with me every day as I try to do my part to build a better future in my little corner of rural Kentucky.