Vulnerable Populations
Improving health among the most vulnerable requires acknowledging that factors such as poverty, violence, inadequate housing and education contribute to poor health.
If your family is not well off, your community lacks resources, your school is unsafe, chances are you will not be well either. You will simply live a shorter and sicker life than those more fortunate.
This can seem like an overwhelming challenge, but these problems are not insurmountable. The Robert Wood Johnson Foundation’s Vulnerable Populations Portfolio identifies new pathways to improved health by recognizing the critical relationship between our health and where and how we live, work, learn and play. Our programs create sensible solutions that allow people to overcome the social barriers that stand in the way to better health.
As policy-makers struggle to make the best use of limited public funds, our programs offer practical opportunities to make better use of those resources. Perhaps more importantly, they offer an opportunity to overcome some of the seemingly intractable problems we face as a society. For these reasons, we place considerable importance on ensuring that thought leaders and policy-makers in particular are familiar with the programs we fund.
A key element of our strategy is to identify successful programs that have potential beyond the communities where they are already working and to support their growth into new communities. We support this strategy in two ways. The first is by initiating and supporting programs that allow community level efforts to develop and take shape, relying on local strengths and resources.
We are using this approach through Start Strong: Building Healthy Teen Relationships, a new national effort that is exploring community level approaches in 10 cities that have the potential to prevent relationship violence by ensuring that young people’s first relationships are healthy ones—laying the groundwork for a lifetime of relationships free of violence. We expect that this effort will reveal the ways in which current prevention efforts can work together to reduce violence not only in the funded communities, and will help other communities address this challenge.
But once we discover models that succeed within a single community, we help those models gain traction in other communities, often in partnership with new funders—which is the second piece of our strategy to achieve greater spread for the effective programs.
One of the best examples is THE GREEN HOUSE® Project. This effort is reinventing long-term care by creating a home for 10 to 12 elders who require skilled nursing care and want to live a rich life. Green Houses are a radical departure from traditional skilled nursing homes and assisted living facilities, altering size, design, and organization and staffing to create a warm community. Their innovative architecture and services offer privacy, autonomy, support, enjoyment and a place to call home. Green House homes are developed and operated by long-term-care organizations in partnership with THE GREEN HOUSE Project and NCB Capital Impact.
RWJF provided grant support to NCB Capital Impact with the hope of developing 50 Green Houses by 2010. However, that goal was met in December, when elders moved into the 50th Green House—this one in upstate New York.
As we look ahead, we will continue to identify these kinds of inspired approaches, and in taking models that have been successful in improving health for one group of people and expanding their reach. An example of this the Juvenile Offender Community Health Systems initiative which will replicate, in three California counties, a model that connects Federally Qualified Health Centers (FQHC) with juvenile detention centers, so that released juveniles see the same providers in the community as they see when they are in detention centers. This model achieves better continuity of care and an immediate point of contact that can help to prevent recidivism. The three pilot sites will be an expansion of the Robert Wood Johnson Foundation’s Community Oriented Correctional Health Services (COCHS) work, which integrates FQHCs with adult corrections.
We’ll explore new opportunities to improve health and create opportunity for young men at risk. Young men today face enormous challenges—gangs, addiction, crime and mental health problems have put a generation of men at risk. To help them overcome these challenges, we joined with Ashoka’s Changemakers to host Young Men at Risk: Transforming the Power of a Generation, an online competition to develop the best approaches to help men navigate their way to a successful and healthy adulthood. We’ll also be developing additional programs in this area.
Ralph Waldo Emerson said that success can be defined as “an improved social condition” and “to know that one life has breathed easier because you have lived.” As we contemplate the potential successes of this work, we see a future where vulnerable people have the opportunity to find their path to better health, whether they represent the thousands of elders who need long-term care and who could flourish in a Green House. Or families trying to keep their families safe against shooting and other forms of violence. Because regardless of the circumstances into which we are born, we should all have an opportunity for better health.
For additional information about our initiatives and objectives, visit www.rwjf.org/vulnerablepopulations.
Green Houses Growing in Numbers Across the States
Source: NCB Capital Impact, 2008.