Chandra Anita, Acosta Joie, Carman Katherine Grace, Dubowitz Tamara, Leviton Laura, Martin Laurie T, Miller Carolyn, Nelson Christopher, Orleans Tracy, Tait Margaret, Trujillo Matthew, Towe Vivian, Yeung Douglas, Plough Alonzo L
Rand Health Q. 2017 Jan 13;6(2):3. eCollection 2017 Jan.
Because health is a function of more than medical care, solutions to U.S. health problems must encompass more than reforms to health care systems. But those working to improve health, well-being, and equity still too often find themselves traveling on parallel paths that rarely intersect. In 2013, the Robert Wood Johnson Foundation (RWJF) embarked on a pioneering effort to advance a Culture of Health initiative. A Culture of Health places well-being at the center of every aspect of life, with the goal of enabling everyone in our diverse society to lead healthier lives, now and for generations to come. To put this vision into action, RWJF worked with RAND to develop an action framework that identifies how the nation will work toward achieving these outcomes. This article provides background on the development of this action framework. The Culture of Health action framework is designed around four action areas and one outcome area. Action areas are the core areas in which investment and activity are needed: (1) making health a shared value; (2) fostering cross-sector collaboration to improve well-being; (3) creating healthier, more equitable communities; and (4) strengthening integration of health services and systems. Each action area contains a set of drivers indicating where the United States needs to accelerate change and a set of measures illustrating places for progress. Within the primary Culture of Health outcome---improved population health, well-being, and equity---the authors identified three outcome areas: enhanced individual and community well-being, managed chronic disease and reduced toxic stress, and reduced health care costs.
由于健康不仅仅取决于医疗保健，美国健康问题的解决方案必须超越医疗保健系统改革的范畴。但是，那些致力于改善健康、福祉和公平性的人仍然常常发现自己走在很少相交的平行道路上。2013年，罗伯特·伍德·约翰逊基金会（RWJF）发起了一项开创性的努力，以推进健康文化倡议。健康文化将福祉置于生活方方面面的中心，目标是让我们多元社会中的每个人现在及子孙后代都能过上更健康的生活。为了将这一愿景付诸行动，RWJF与兰德公司合作制定了一个行动框架，确定国家将如何努力实现这些成果。本文提供了这一行动框架的发展背景。健康文化行动框架围绕四个行动领域和一个成果领域设计。行动领域是需要进行投资和开展活动的核心领域：（1）使健康成为一种共享价值；（2）促进跨部门合作以改善福祉；（3）创建更健康、更公平的社区；（4）加强卫生服务和系统的整合。每个行动领域都包含一组驱动因素，表明美国需要在哪些方面加速变革，以及一组衡量进展的指标。在主要的健康文化成果——改善人口健康、福祉和公平性——中，作者确定了三个成果领域：增强个人和社区福祉、管理慢性病和减轻毒性压力，以及降低医疗保健成本。
