America’s National Malaise and How to Solve It

Something is going very wrong in America. The Centers for Disease Control and Prevention (CDC) just reported that the U.S. death rate rose last year for the first time in a decade, driven by increased mortality from drug overdoses, suicides, and Alzheimer's. Even the death rate from heart disease is inching up after a long decline. “We are not accustomed to seeing death rates increase on a national scale,” CDC researcher Andrew Fenelon told the New York Times.

Unaccustomed perhaps, but not unexpected, given the dismal health data of the past several months: the suicide rate hit a 30-year high; life expectancy for white women declined for the first time since records have been kept; the gap in life expectancy between rich and poor in America widened significantly from 2001 to 2014; and a decades-long decline in the death rate of middle-aged white Americans reversed in recent years, a backslide experienced by no other industrialized nation.  Plus there continues to be a four year gap in the life expectancy of whites and African Americans, which means 265 African-Americans die prematurely every day.

It’s clearly time to rethink how we invest in health. We have to figure out how to create the conditions that give everyone in America the opportunity to live the healthiest life possible, regardless of race or economic status.  The good news is we may already have a solution in hand. A bottom-up movement  is taking hold in communities across the nation to improve the social, economic, and physical well-being of all their residents.

New York Times columnist David Brooks has highlighted such community efforts as part of his recent focus on the national malaise. In his May 17 column, "One Neighborhood at a Time," Brooks wrote about the racial, social, and economic gaps that have opened up across the country, and one community’s efforts to close them. Lost Hills, California, a farming town in the Central Valley, is flooding the zone with health clinics, pre-K facilities, housing projects, gardens, sidewalks and lights, a new community center and a new soccer field. “Through the day, people have more places to meet, play and cooperate with their neighbors,” Brooks writes.

Lost Hills does not stand alone. Almost daily I learn about another public-private partnership that is putting in place creative solutions to community-specific problems -- setting up job training programs, improving high school graduation rates, building safe parks, bike paths and playgrounds, opening grocery stores in food deserts, placing clinics in areas with few health care resources, helping families raise healthy children. Take a look at Everett, MA; Kansas City, MO; Brownsville, TX; Spartanburg County, SC; or the Menominee Nation, WI., to name just a few that are building inclusive movements to improve their communities.

Those particular towns and cities are all winners of the Robert Wood Johnson Foundation’s Culture of Health Prize, awarded each year to as many as 10 communities that have put in place successful collaborations to improve the lives of all their residents. To make sure such efforts are replicated across the U.S., RWJF and the Reinvestment Fund recently launched Invest Health, an initiative that brings together diverse leaders from mid-sized U.S. cities that are coming up with innovative solutions to some of the nation’s deepest challenges, such as entrenched poverty, poor health, and a lack of investment.

Invest Health has already awarded $3 million to 50 cities to support programs to create affordable housing, safe places to play and exercise, and quality jobs. And Invest Health is not just handing out money. Teams from the selected cities will have access to faculty advisors and coaches, and share what they've learned with a broader group of local stakeholders.

Living Cities, a coalition of 22 of the world's largest foundations and financial institutions,  just launched its own community-based effort, Racial Equity Here, that supports five cities committed to improving racial equity  through a range of collaborative programs. Albuquerque, Austin, Grand Rapids, Louisville, and Philadelphia will focus  on increasing opportunities for youth and young adults ages 16 to 24, who are disproportionally out of school or work. 

There are countless other such initiatives, but still more are needed. Corporations, financial institutions, colleges and K-12 schools, hospitals, non-profits, law enforcement, government -- all have a critical role in helping their local communities create better environments and opportunities for everyone. As Mr. Brooks wrote in an April 29 column, we need “a ladder of hope” for people across America who are falling through the cracks. All of us have a responsibility to hold that ladder.

To learn more about what the Invest Health participants are doing, visit the project website. And please share in the comments about community-based efforts that you know of to improve the nation’s health.