• Tue. Mar 21st, 2023

How The Robert Wood Johnson Foundation Has Influenced Well being Policy – And My Personal Life – For 5 Decades


Mar 16, 2023

Private foundations in America play a exclusive and important function in advancing social progress. That is properly identified. What is much less recognized is the influence such Foundations have on men and women who perform inside them. This story is a private 1.

In January, I completed a decade of service on the Board of the Robert Wood Johnson Foundation, America’s biggest philanthropy devoted to well being. Whilst numerous Americans may perhaps not be familiar with this organization, it has produced a main influence on U.S. well being policy and on the well being of all Americans. Additional personally, it has transformed my personal life and pondering as properly.

Understanding the Influence of the Foundation

My expertise with the Robert Wood Johnson Foundation (RWJF) started in 1975. Pretty much 50 years ago, it was my initial time in the RWJF board space. I was accompanying Anne Somers, professor, healthcare professional, and co-author with her husband Herman Somers of the classic Physicians, Sufferers and Well being Insurance coverage: The Organization and Financing of Health-related Care. I had spent a year with her even though a student at Princeton, assisting with analysis in updating her book.

Getting into the striking new Foundation constructing, I was in awe of the spot. I met Gustav O. Lienhard, the storied Chairman of the Board of Trustees, who had served for years at Johnson &amp Johnson with CEO Robert Wood Johnson, and was personally chosen by Mr. Johnson to head the Foundation. The Foundation had been “propelled to complete growth” as explained in its 1972 annual report, transitioning from a neighborhood philanthropy to 1 of national significance practically overnight as Mr. Johnson left a bequest of more than ten million Johnson &amp Johnson shares (valued at about $1 billion) to launch the Foundation to new heights. The report explained, “The Robert Wood Johnson Foundation’s sources represent the biggest single supply of private capital to assistance new efforts in the well being field.”

Although then just a initial-year health-related student, I started to realize the exclusive and main function that foundations, private and public, play in society—the economic sources, the extended-term concentrate, the bridge among the private and public sectors for societal modify, and the higher requirements of accountability and transparency. But I wouldn’t comprehend till years later the function this distinct foundation would play once again and once again all through my life – influencing the policy I introduced in Congress, inspiring the model for a palliative care organization I co-founded, and igniting the require for modify in my personal neighborhood.

Transplantation and Tobacco Cessation

One particular of the earliest intersections of RWJF and my life occurred when I was a heart and lung transplant surgeon at Vanderbilt. In the mid-1990s the Foundation launched a nationwide plan known as the National System for Transplantation which aimed to expand access to transplantation and strengthen the top quality of care for transplant sufferers. I was struggling in my everyday life as a transplant surgeon with the extremely challenges the Foundation had stepped in to address and lead on nationally. In 1989 I had founded the Vanderbilt Multi-Organ Transplant Center, and we started transplanting organs that we newly had the science to transplant. Multi-organ transplantation was in its infancy. Evolving clinical and social challenges would present everyday in this rapid-evolving health-related field. I had written a book known as Transplant: A Heart Surgeon’s Account of the Life-and-Death Dramas of the New Medicine on these very same challenges arising from a vital organ donor shortage for the numerous thousands of men and women who could then advantage from transplantation. Two decades into constructing a platform to engage in main well being challenges of our time, the Foundation had swiftly demonstrated its currency, relevance, and willingness to take on present and emerging challenges, such as organ transplantation in the 1990s.

And in 1991 the Robert Wood Johnson Foundation started to tackle 1 of the most intractable difficulties in the field of public well being — tobacco addiction, starting a 20-year campaign that invested practically $700 million in efforts to avoid tobacco uptake, specially by young children, and to aid addicted customers quit.

As soon as once again, it was private for me. As a cardiac surgeon, the most prevalent process I was performing every single week was coronary artery bypass grafting – opening the chest, stopping the heart, grafting pieces of vein to bypass or jump more than the diseased portions of heart arteries. And smoking was amongst the strongest of all contributors to causing the illness that I was operating on every single day heart illness was the quantity 1 trigger of death in the U.S. So RWJF focused its vast sources on reversing this illness.

Influencing Federal Policy

I carried my operating space experiences and learnings from RWJF’s advocacy into my subsequent profession. I was elected to the United States Senate in 1995, and as the only doctor serving in that physique, I naturally gravitated to well being challenges. This brought me back to the Board space at RWJF to talk about an concern they had been so powerfully major on.

R-Tenn., left, and Sen. John McCain, R-Ariz., meet in McCain’s workplace just after the technique session on tobacco to talk about additional specifics. (Photo by Scott J. Ferrell/Congressional Quarterly/Getty Pictures)CQ-Roll Contact, Inc through Getty Pictures

It was 1998, and I was functioning closely with Senator John McCain (R-AZ) on legislation to let the FDA to regulate tobacco for the initial time, providing the agency the authority to call for the disclosure of solution components, modify warning labels, incentivize safer merchandise, and restrict the advertising and marketing and sale of tobacco merchandise to young children. It may perhaps appear unimaginable now, but then the tobacco sector was unregulated, and we have been attempting to modify that. The group at the Robert Wood Johnson Foundation had come to be the national professionals in tobacco cessation and had been the economic impetus behind considerably of the constructive national modify in minimizing smoking. Their tips and counsel have been important to our efforts.

Regardless of our committed push then, the Senate wasn’t prepared for this subsequent step in furthering public well being. It wasn’t for an additional decade, in 2009, when Congress ultimately acted, and the FDA received the authority to regulate tobacco. But McCain and I set the stage with our 1998 bill, considerably of which was incorporated in the 2009 Household Smoking Prevention and Tobacco Handle Act, and RWJF was a important companion in that work. Certainly, the RWJF investment was central to turning the tide on tobacco addiction in America. Information demonstrated millions fewer smoking in 2010 compared to the 1990s, and smoking prices dropped from more than 25% in 1990, to 19% in 2010, with most recent figures displaying 12.five% in 2020. And parallel to that we have noticed a dramatic fall in deaths from heart attacks (a decline of about 87 deaths per one hundred,000 men and women in 1999 to about 38 deaths per one hundred,000 men and women in 2020) and cardiovascular illness such as stroke (stroke mortality per one hundred,000 declined from 88 to 31 for females and 112 to 39 for guys among 1975 and 2019 in the United States).

I served as Senate Majority Leader from 2003 to 2007, and for considerably of that time I continued to be the only Senator with a health-related background. In that capacity I firsthand witnessed but an additional defining and far-reaching plan of the Foundation – the Well being Policy Fellowship. RWJF smartly recognized the require for far more health-related expertise at the highest levels of government. Hence, this plan, familiar to all in DC, sends mid-profession well being experts to perform in Washington as policy fellows. They are placed in a variety of government agencies, Congressional offices, and believe tanks to achieve direct expertise in shaping well being policy at the national level. Certainly, I was fortunate to have RWJF Fellows serving on my personal well being-connected Congressional committees. The Fellows plan has created a generation of leaders who correctly bridge the gap among policy and well being delivery, integrating expertise and expertise to strengthen well being for all.

Defining the Field of Palliative Care

RWJF by no means rested on its laurels and was usually seeking for the subsequent huge public well being challenge to take on. On the heels of its tobacco perform, starting in 1996, the Foundation embarked on a 15-year work to strengthen finish-of-life care. It primarily defined the field of palliative care in America.

A senior lady at residence getting healthcare.


At the time, research discovered most Americans in the 1990s died in hospitals, typically hooked up to machines or in the ICU, and in numerous instances at odds with their wishes to die at residence with family members. For also numerous the final quite a few months of life have been chaotic, confusing, and frightening. In 1997, RWJF initiated the Advertising Excellence in Finish-of-Life Care plan to determine, market and institutionalize care practices that let seriously ill men and women and their households to method the finish of life in physical, psychological, spiritual, and emotional comfort. It funded 22 demonstration projects building new models of palliative care, 4 demonstration projects that tested models of delivering palliative care inside hospital ICUs, and developed the Mount Sinai College of Medicine Center to Advance Palliative Care. Additionally, it created the initial framework for doctor specialty coaching and certification in Palliative Care.

This progress and advancement of the field of finish-of-life care considerably impacted my life 20 years later – and via that in the end the lives of scores of thousands of other folks across the nation. Throughout the early 1990s I was operating the Transplant Center at Vanderbilt and weekly performing heart and lung transplant procedures. Sufferers referred to us for transplantation had a terminal diagnosis (till ultimately transplanted) as a result, I became deeply involved in managing the care of person sufferers at the finish of life, as they waited weeks and months for a donor organ to come to be out there. I saw that with a committed group-primarily based method that incorporated the family members, sufferers could reside a considerably greater top quality of life, even with a terminal diagnosis. RWJF’s palliative care models validated with information my personal private experiences, demonstrating the require at scale for this kind of multi-discipline, group-primarily based care for these with critical and terminal illnesses.

Following leaving the Senate in 2007, I had the chance to contemplate this require far more seriously. I and colleague Brad Smith, whose brother was a palliative care medical doctor, observed that palliative care was readily out there in urban regions close to big teaching hospitals but not for sufferers in suburban and far more rural regions. It was an access concern – an equity concern. And we set out to aid resolve it.

Utilizing the Robert Wood Johnson Foundation model, in 2013 we co-founded and subsequently grew the neighborhood-primarily based, palliative healthcare organization Aspire Well being, which expanded to 34 states inside 3 years, serving thousands of men and women in suburban regions who would not otherwise have that life-altering care. Aspire became the biggest non-hospice, neighborhood-primarily based palliative care organization in the nation, taking to scale learnings from the Robert Wood Johnson Foundation models. We worked straight with Mount Sinai leadership. This story is an instance of how private foundations in our nation play such a exclusive function in synergistically bringing the private and public sectors with each other to the betterment of humanity.

Commission to Make a Healthier America and Social Determinants of Well being

In the years among leaving the Senate in 2007 and constructing Aspire, I engaged in my initial substantive volunteer project with the Foundation. I received a contact from my pal Dean Rosen, who was functioning with the Foundation in DC, and he asked if I would contemplate spending time on an fascinating, upcoming project with RWJF that would concentrate on how a neighborhood impacts an individual’s well being. It would center on the non-health-related determinants of well being – now known as the social determinants of well being.

Social Determinants of Well being mechanism notion.


From February 2008 to December 2009, I served on the Foundation’s Commission to Make a Healthier America, chaired by former CMS Administrator Mark McClellan and former Director of the White Property Workplace of Management and Spending budget Alice Rivlin. Led by then-Commission employees director and Harvard Professor David Williams (at the moment on the Board of the Foundation and chair of the Division of Social and Behavioral Sciences at the Harvard T.H. Chan College of Public Well being), we have been joined by 12 brilliant and diverse believed leaders who challenged the status quo on well being and healthcare. Collectively we looked outdoors the technique for approaches to strengthen well being for all, in the end issuing ten substantive suggestions for action.

Now, social determinants are a typical component of our well being and wellness vernacular, but 15 years ago, we have been just scratching the surface of the concern. Handful of realized that social determinants drive as considerably as 80 % of well being outcomes. This was the initial time social determinants as a field have been comprehensively defined we realized that exactly where you reside, perform, play, and pray had a higher influence than your medical doctor. We popularized creating the healthier selection the simple selection. Whilst we are nevertheless grappling now with how to address and incorporate these external variables in our standard healthcare systems, RWJF’s Commission as soon as once again pioneered the way in altering the dialogue.

And we make on this new understanding in so numerous approaches now. For instance, in my present position founding and constructing healthcare organizations in the private sector (with Cressey and Firm and with Frist Cressey Ventures) to aid resolve the wants of vulnerable populations, we spot a specific emphasis on social determinants, for instance meals (Mom’s Meals), digital access for the underserved (Thrive Well being), neighborhood solutions at residence (CareBridge), and residence accessibility for these with disabilities (Lifeway Mobility).

$1 Billion Dollars to Address Childhood Obesity Epidemic

Following my numerous influential experiences with RWJF, I committed to joining its Board of Trustees in 2013. The Foundation normally requires on the genuinely huge challenges of our time. One particular of its main challenges of concentrate had come to be our nation’s crippling, childhood obesity crisis. In the early 2000s, childhood obesity had reached epidemic proportions, and in 2007 the Board committed $500 million to fight this phenomenon, with a aim to reverse the epidemic. In 2015, we as a Board committed an more $500 million (for a grand total of $1 billion dollars) more than ten years to continue the bold initiative. Learnings from this perform have considerably influenced federal policy on college meals, meals help, and the Specific Supplemental Nutrition System for Ladies, Infants, and Kids (WIC).

Edward A. Reynolds West Side Higher College on February five, 2015 in NYC to assistance a selection by the Robert Wood Johnson Foundation to commit $500 million more than the subsequent decade to finish childhood obesity. (Photo by Andrew Burton/Getty Pictures)Getty Pictures

Inspiring Neighborhood Action in Nashville

My time on the Board informed and inspired my subsequent neighborhood venture in true time. As a Nashville native, I’ve extended taken pride in my city’s national leadership in the field of healthcare solutions it was, at the time that I joined RWJF, residence to 17 publicly held healthcare service organizations with national attain. These organizations would routinely obtain awards for their outstanding top quality of care delivered about the nation.

But my eyes have been broadly opened 1 afternoon when our Foundation’s initiative to make information sources about county-level well being outcomes was becoming presented. Far from the outstanding top quality I had assumed, I discovered we in Nashville had embarrassing well being disparities and general poor well being. Regardless of our wealthy neighborhood healthcare sources, Nashville had greater prices of obesity, greater prices of infant mortality, greater smoking prices, and greater prices of hypertension compared to all our peer cities. A fellow board member asked me why this was, and I honestly didn’t have the answer – but from that day forward I became committed to figuring it out.

Drawing heavily on what I had discovered from my participation on the Foundation’s Commission to Make a Healthier America, in 2015 I brought with each other our city’s healthcare executives, non-profit and faith-primarily based leaders, neighborhood activists, and neighborhood elected officials to kind a neighborhood-primarily based collaborative committed to moving the needle on Nashville-Davidson County well being measures. We launched NashvilleHealth, and now, now eight years later, it continues to forge revolutionary partnerships to advance well being equity in our city.

In 2019, this exclusive collaborative performed the initial countywide well being assessment in practically 20 years. Then, following the pandemic in 2021, NashvilleHealth comprehensively evaluated our city’s response to COVID-19 and issued 28 actionable suggestions for future public well being preparedness and crisis response readiness. And it helped plant the seeds for the now burgeoning, statewide information collaborative lately launched at Belmont University just final year. This movement is all thanks to that original information gathered, analyzed, and publicly shared in the RWJF County Well being Rankings that produced clear the require for action.

RWJF: The Subsequent Ten Years

My term on the Board has expired and an additional will fill my spot. As I appear back on the final decade of service, and on all the Robert Wood Johnson Foundation has achieved in that time and in the years ahead of, there is no query this organization has been a force altering for fantastic the trajectory of well being and wellbeing in America. It has also been, as I have shared, a force for fantastic in my life, shining a light on exactly where new well being policy, neighborhood action, and private sector healthcare innovation can be so worthwhile.

The Board has demonstrated a sensible strategic path more than the years, and I know that will continue. It is not my spot to advise at this point, but I do have a private hope. It is that the Foundation does contemplate in the future what the Planet Well being Organization (WHO) has known as “the single largest well being threat facing humanity.” That threat is climate modify. The Foundation has usually been ahead of the curve in tackling our most considerable barriers to well being, and the reality of a altering climate and intense climate events is in my thoughts amongst the greatest challenges to well being ahead of us.

I appear forward to seeing the modify RWJF will make probable more than the subsequent ten years.

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I am a heart and lung transplant surgeon, former U. S. Senate Majority Leader, and Chair of the Worldwide Board of The Nature Conservancy. I am committed to applying innovation, technologies, and leadership to creating true improvements in American well being and healthcare. I founded and serve as chairman of Hope By means of Healing Hands, a international well being organization NashvilleHealth, a neighborhood collaborative committed to enhancing the well being and properly-becoming of all Nashvillians and SCORE, a collaborative K12 education reform organization. I began the Vanderbilt Transplant Center, now the busiest heart transplant plan in the planet, and serve as a senior fellow at the Bipartisan Policy Center, exactly where I co-chair their Well being Project. I am a founding companion of Frist Cressey Ventures, and chair the Executive Council of the well being service investment firm Cressey &amp Firm. I also host the podcast “A Second Opinion: Rethinking American Health”.

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