By Steven H. Woolf, MD, MPH
This year marks two important transitions for the Center on Society and Health. In 2017, the Center celebrated its 10th anniversary, having been chartered by the VCU Board of Visitors in 2007. And this year marks a transition for me: after founding the Center and serving as its director for the past decade, I have assumed a new role as Director Emeritus and have passed the administrative baton to Derek Chapman, PhD, who will serve as Interim Director.
These transitions provide a nice opportunity for a moment of reflection, to take stock of the Center’s accomplishments and consider its future. It’s worth remembering that the Center on Human Needs—the Center’s original name when founded in 2007—began as an experiment. We were uncertain at the time whether the proposed center would fill a need, or be sustainable, but the value proposition was always clear. The nation lacked a nonpartisan research group that tracked the social and economic wellbeing of Americans. VCU had an opportunity to fill that void by launching a unique program with a bold mission to operate at the intersection between science and policy: to communicate high-quality evidence to policymakers and other change agents who were in a position to improve the living conditions that shape health and social mobility.
The Center began as a virtual enterprise. We had a website, energized faculty, and a vision, but we had no office space, no furniture, no staff, not even a paperclip. We have traveled far in the past decade and have grown dramatically—in staff, grants, relationships, and visibility in our community and academia. Eleven years after the experiment began, the Center on Society and Health is nationally known for its expertise and regularly churns out a rich portfolio of reliably high-quality work. Its “secret sauce” remains the blending of four areas of excellence: (1) user-oriented research and scholarship, (2) policy outreach, (3) community engagement, and (4) strategic communication. Put simply, this combination allows the Center to apply the scientific skills of its team and the VCU faculty, staff, and partners to deliver information that is useful (and understandable) to decision-makers and the public—and this work is made special by incorporating the voice and wisdom of the marginalized populations we care most about.
Our mission is to raise awareness about the social, economic, and environmental factors that shape health. We exist within a school of medicine, but our message is that health is about more than health care. Access to health care is vitally necessary in this country, but it is not sufficient to achieve meaningful change in population health or to resolve health inequities. Health is shaped by education, income, and the physical and social environment in which we live and work. And these conditions, in turn, are determined by policy choices made at the national, state, local, and neighborhood level. Our Center seeks to inform those choices, so that decision-makers better understand how the choices they make affect not only health outcomes (and health care costs) but also the social and economic wellbeing of the population.
This is cross-sector work: it requires relationships outside the world of health care and even public health. The Center has built relationships with leaders on Capitol Hill and elsewhere in Washington, DC; state government officials; the business community and employers; investors, bankers, the Federal Reserve, and local foundations that invest in community economic development; hospitals and health care systems; housing authorities; transportation officials; urban and regional planners; faith-based organizations; and community groups.
As academics, we are certainly capable of publishing research articles and presenting at scientific conferences, but our Center has worked to master a different art of communication to reach people who do not read scientific journals. We have learned how to get the point across to busy policymakers and executives who need an elevator speech or one-pager, journalists who want a succinct story or headline, CEOs who want the bottom line for their business, and a public that wants key takeaways in plain English and without a partisan slant. Our center has explored a variety of modalities (e.g., issue briefs, infographics, maps, and interactive web tools) and a variety of venues—from testimony on Capitol Hill to media appearances—to reach key audiences.
Our most important audiences are vulnerable populations, the members of our society who experience the greatest health inequities and struggle the most with multigenerational poverty, marginalization, discrimination, and toxic stress. Our Center is perhaps proudest of our engagement of residents—our community-academic partners—in the East End, a largely African American neighborhood of Richmond that confronts the urban challenges of poverty, unstable housing, gun violence, and food insecurity with a passion for finding solutions. Since 2011 we have engaged these residents as coequal partners, building on a relationship of trust to learn from their lived experience and understand the social determinants of health through their eyes and not just through journal articles and secondary data. Our community-academic partners, many of whom live in public housing, serve fully as co-investigators, helping to choose projects, design analytic plans, interpret results, and communicate findings to audiences. My proudest moments are to see our community partners and team members empowered to advocate for themselves and their neighborhoods and to speak truth to power in pressing community leaders to restore social justice.
Richmond is a unique place for this to occur. Issues of race are visible across the country but have special poignancy in this city, where 18th century slave ships docked at Shockoe Bottom, where Jefferson Davis commanded the Confederacy in the Civil War, and where a string of large statues to honor Confederate soldiers were erected along Monument Avenue during Reconstruction. Modern-day Richmond understands this history but is committed to progressive change. City leaders, the business community, and voters are committed to addressing racism, combating poverty, and bringing investment to neglected neighborhoods. It is an intermediate-sized city, big enough to have the full host of urban challenges but small enough for key stakeholders to know each other well and join hands in collective efforts at cross-sector solutions. The city recently won the Culture of Health prize from the Robert Wood Johnson Foundation. And Richmond leads a politically “purple” state that is under close scrutiny by the nation as midterm elections approach.
The Center’s work to address these issues, in Richmond and elsewhere, was important in 2007 but is crucial in today’s America, for several reasons. First, decisions in Washington and state capitols are threatening access not only to health care and public health services but also to education, jobs, income, housing, child care, food security, and clean air and water. Enterprise zones and other programs to invest in neglected communities are being curtailed. The ramifications to health and the wellbeing of communities are large. Second, an uptick in racist expression and other forms of discrimination (directed toward women, immigrants, Muslims, Jews, and the LBGTQ community, among others) threaten the marginalized populations served by our Center. Third, programs like ours that are committed to nonpartisanship find it more challenging to find common ground in an increasingly polarized society. Knowing how to communicate across the aisle in ways that encourage dialogue and compromise, while avoiding language that shuts down conversation, has never been more important. Finally, the stakes are large. US life expectancy stopped increasing in 2012 and has been decreasing for the past three years. America’s health, and the future of our children, hangs in the balance. As I have told my staff, our work has never been more consequential.
That is why I am turning my focus to public policy and communication and handing over administrative responsibilities for the Center to Derek Chapman, PhD. Derek has served as Associate Director for Research at the Center since December 2013 and will transition smoothly into this role. He brings unique skills to the job, having worked for 13 years in state health departments, including as Virginia’s state maternal and child health epidemiologist. For more than four years, Derek led the Center’s quantitative research programs, including some of our most visible work. For example, Derek’s team produced the Center’s widely known life expectancy maps. These maps, which are available for more than 20 US cities and rural areas, show that newborns in some urban neighborhoods can expect to live 15-20 fewer years than those born in a neighboring zip code or census tract. And Derek is now working with scientists and community leaders from California to Washington, DC to develop cutting-edge healthy places indices that map wellbeing by census tract and identify policy action priorities for closing gaps.
I grew up in the 1960s and watched young people join the Freedom Riders to defend minorities in the Deep South; lead protests to end the Vietnam War; and advocate for civil rights, a clean environment, and the women’s movement. It seemed to work. America seemed to “grow up.” I lived much of my adult life believing that our country would no longer fight pointless wars and that we had entered a new period of tolerance in America committed to social justice. I thought I lived in a more mature society that, to paraphrase Martin Luther King, Jr., was prepared to worry less about skin color than the content of people’s character. I saw a black man elected president. I watched the Supreme Court uphold same-sex marriage. And now, suddenly, I am transported back to my childhood. Civil rights regulations, from voting rights to fair housing, are being rolled back. Residential segregation has increased. The risk of nuclear war is back. Social media is awash in hate speech. White supremacists now march openly (unhooded) in the streets.
But I take heart in today’s young people. Like the young people of the 1960s, today’s youth are not afraid to speak out and are determined to advocate for themselves, their country, and, indeed, for the planet itself. Their energy and courage in speaking out against gun violence gives me hope for the future. And I am heartened to watch the women’s movement take on new life in the past year in an arc leading from the Women’s March in January 2017 to the MeToo and Time’s Up movements and a growing slate of women seeking elected office. White males have dominated the leadership of this country for 242 years. It’s time for a change and some fresh ideas.
It’s impossible to predict what the future will bring to the Center or, more importantly, to our country. These are turbulent times. I am comforted in knowing that the Center on Society and Health is not alone; it is joined by other partners across the country with shared values and a commitment to move beyond lectures and white papers to achieve meaningful change in the conditions that shape health and economic opportunity. Our colleagues at other academic institutions run amazing centers and programs—too many to list here—and networks like the Interdisciplinary Association for Population Health Science, the Build Healthy Places Network, and Shelterforce are highlighting how public policies can improve economic opportunity and health together. Working together, there is much that can be accomplished. The Center on Society and Health enters its second decade with an exciting vision and much to do, and we invite others with shared interests to join us.