Looking Beyond Our Borders for Better Results

NPR’s Joe Palca recently did a segment about City Health Works, a Robert Wood Johnson Foundation (RWJF) grant recipient that employs peer health educators to help Harlem residents manage their chronic health issues. As Palca explains, founder Manmeet Kaur modeled City Health Works on a program in South Africa that capitalizes on shared life experiences to drive behavior change. At the end of the segment, Palca comments on the “irony” of a wealthy country like the United States learning from a country that spends considerably less on health care than we do.

The thing is, it’s not ironic to learn from other countries—whether or not they’re well resourced. The United States spends more on health than any other country, but our money isn’t getting us where we need to be. Instead, we rank close to the bottom among high-income countries for life expectancy and other health indicators. Even the most privileged in our society are unhealthy relative to their peers in other high-income countries. So looking outside our own borders for ways to improve our health care could actually be the smartest thing we’ve ever done.

Consider: An excise tax on sugary beverages in Mexico has led to a decrease in their consumption and an increase in Mexican residents’ awareness of the tie between those beverages and chronic health problems such as obesity and diabetes, which have grown to epidemic proportions in Mexico—as they have in the United States.

In Wales, there has been a significant reduction in violence due to a model that uses police and hospital data to help people working in law enforcement, public health agencies, schools, hospitals, and community organizations understand where, when, and why violence is more likely to happen and then use that information to develop more effective interventions. The model saves lives—and may help prevent the trauma that leads to long-term behavioral and physical health issues—the sorts of issues we see in communities plagued by violence across the United States. 

In Jordan, Microclinic International has tapped into people’s social networks to help those who are fighting chronic illnesses such as diabetes and heart disease. The approach reflects and responds to the outsized burden these chronic health issues are placing on the health care system in Jordan—a burden felt in United States as well.

You can see the potential. And so can we. RWJF has always been committed to improving the health of Americans, and working with employers, policy makers, urban planners, educators, and other stakeholders to do so. For the past decade, the foundation has dedicated resources to learn from pioneering ideas that help us anticipate the future and transform our strategies. Often, these ideas have come from other industries and from people who work outside the fields of health and health care. So it only makes sense now to expand our boundaries even further and invest in learning as much as possible about promising approaches in our areas of focus.

 To that end, we are looking forge new relationships. We’re engaging current grantees that have international networks. We’ve sought out their valuable guidance and will continue to do so. We’re also investing some of our initial funding in organizations—such as the International Partnership for Innovative Healthcare Delivery—that can accelerate the growth of our networks. And we’re hopeful that practitioners and funders who work in other countries will share ideas with us—as well as alerting us to areas of need and opportunity.

Additionally, we want to learn how to evaluate the potential of great practices in other countries to work well in the United States. There are significant differences in health care systems—and the cultural contexts in which those systems exist—between other countries and the United States. So even if an approach has been effective elsewhere, questions abound: Does the country’s health care payment system or approach to medical education allow for easier implementation of an approach? What might we need to adjust for success within our payment system? What role has a country’s culture—its religious identity, social values, political ideologies—played in the success of an approach? What silos might we need to dismantle to achieve success in the United States? What is the kernel of innovation? What variables can we relinquish? When it is impossible to remain loyal to a model, are there other valuable outcomes that could burgeon regardless?

To help answer those questions, we’re engaging others in our discovery process and asking them to consider the factors needed for adaptation. For example, our support allowed 10 US leaders to participate in a “study tour” of Guadalajara, Mexico to see how the democratization of street space can promote healthy behaviors through the Open Streets model.

We’re also engaging in “pair-wise” funding: funding an organization in another country while making a grant to a US-based organization with a shared mission. We do this to make it easier for the foreign organization to share knowledge, and for “receptor” cites in the United States to learn as efficiently as possible. In the case of the Cardiff Violence Prevention Model, we made a grant to the CDC Foundation to implement and document the model in the United States through community partnerships in Atlanta and Philadelphia. The same grant provides support to Cardiff University to evaluate these partnerships and provide technical assistance.

And, again, we’re looking to practitioners and funders in other countries to share ideas with us about new ways to assess new approaches. 

Staying True to Principles, Even as We Expand Our Horizons

When we set out to undertake this challenge, we met with colleagues at foundations that had been working globally for years. They urged us to be authentic, approaching our new relationships with transparency about our goals. They reminded us to be respectful—of new cultures and the expertise of those with whom we engage. They told us to take risks—and to fail. But the advice that most resonated with me was the guidance to remain committed to our mission and values.

And if there is any irony in our efforts to expand our horizons, that’s it. Ultimately, our goal is to distill what we learn to reveal new directions for our work. But the more we seek to change, the more we are staying the same. We have always been committed to improving health in the United States. We have always been dedicated to rigorous research and evaluation of our investments. And we have always recognized that we must work with others to achieve our goals. None of this has changed. In fact, this expansion to learning and experimentation has only reaffirmed our commitments.

Around the world, effective approaches for overcoming health challenges are saving lives, reducing costs, and allowing people to live healthier lives. We urge other foundations and organizations to join us, and re-commit to their missions and values, even as they seek new and more effective solutions to the problems they seek to solve.

Read more stories by Brian Quinn.