Emergency room doctors in Wales were faced with a mystery. They noticed that the number of patients coming in with facial cuts spiked around midnight, but they couldn’t find an explanation in police reports.
The doctors shared their observations with the Cardiff police and realized that patients were getting injured in bar fights around closing time. As a result, the police knew where and when to increase their presence and pushed for a local ordinance requiring pubs to switch to plastic glassware after a specific time. Problem solved.
An ocean away, the solution to this puzzle piqued the interest of the Robert Wood Johnson Foundation, the largest public health funder in the U.S. Understanding why requires a deeper look at one of the foundation’s more recent projects: importing ideas from abroad to promote better health at home.
The foundation seeks out successful practices and innovations in other countries and finds partner cities and organizations to partner to adapt them for the U.S.
With the Cardiff example, the foundation partnered with the U.S. Centers for Disease Control and Prevention to get hospitals to share anonymized data with law enforcement to identify violence hotspots. Thanks to the practice, police in the Atlanta metro area identified a shopping mall parking lot as a hotspot, and increased patrols and lighting in the area, said Karabi Acharya, a RWJF director leading the international program.
As with most of RWJF’s initiatives, this project is rooted in the foundation’s goal to build a “culture of health” in the U.S. The foundation embraced this ambitious umbrella for its work several years ago, in part because of what it learned from its wide-ranging work to reduce childhood obesity. Leaders realized that more access to doctors wouldn’t help kids suffering from obesity as much as changes in lifestyle, like moving more, and changes in larger systems, like expanding the availability of healthy foods.
Since then the foundation has focused growing attention on the social determinants of health, looking beyond healthcare services and "upstream" at the root causes of poor health—including at issues like housing, transportation, and education.
“When we came up with the culture of health vision, there was a recognition that the foundation was going to be going into a lot of areas that we knew very little about traditionally. There was a lot of emphasis on learning in general,” Acharya said. “You only need to look at how we stack up against our peers in other OECD countries to see we’re near the bottom. We are not doing well. It became an obvious of question, of maybe we need to learn more from them.”
Acharya believes something special happens to how we think about our home when we go abroad. She likes to compare it to how NASA’s first photograph of earth from space changed how we see the world. “Suddenly you’re looking back and seeing how the country works or doesn’t work in a totally new perspective,” she said.
Seeing how another community handles the same problem you have “makes you recognize how much of it is socially constructed, and how little of it is immutable,” Acharya said. “It’s very empowering. It gives you the possibility that, ‘Well, I could change this.’”
The program started about two-and-a-half years ago. So far, it's brought ideas home from about 30 countries, Acharya said. The foundation relies on several methods to find projects. Since moving into the international space, RWJF has expanded its network to include organizations working locally abroad.
The foundation also puts out calls for proposals for domestic groups interested in adapting initiatives they’ve heard of in other countries. The foundation plans to ask for ideas addressing social isolation in its next request for proposals, Acharya said.
“It’s a pretty huge mandate, because the world is a pretty big place. And culture of health, as we know, is also pretty huge, far, far beyond health care,” she said. So far projects pursued by RWJF have ranged from a Swedish disease registry adapted by Dartmouth to replicating tactics to reintegrate at-risk youth popular in Latin America in New Orleans.
The foundation recently led a study tour in Copenhagen that looked at how the city incorporates the spirit of inclusion into the design of public space. The group looked at how not only how large public spaces, like parks, are designed, but also how something like a trash can can be designed in a more thoughtful, compassionate way.
The hope is that the group of city planners will push for public policy that supports a more inclusive use of public space at home, Acharya said.
Next up, the foundation wants to work more with low-income countries, Acharya said. The foundation focuses on reaching marginalized and under-resourced populations at home, she said. “Some of those places look a lot like lower-income countries, and these places have developed a lot of solutions that actually work.”
Not many funders are following this model. Plenty of foundations export ideas, but not many import them, Acharya said, but she hopes some follow step.
“We live in a global world, and I think as Americans we can get a little too comfortable with blinders on,” she said. “This is a way to look at what else is going on around us and learn from it.”
As we've reported often, a wide range of funders—including those focused at the state level—are now thinking more broadly about health and doing more grantmaking upstream. RWJF works with many of these funders and so its findings from this global work have a good chance of percolating down locally.