Laurie T Martin, Linnea Warren May, Sarah Weilant, Joie D Acosta, Anita Chandra
Rand Health Q. 2018 Jan 29;7(2):5. eCollection 2018 Jan.
In 2013, the Robert Wood Johnson Foundation embarked on a pioneering effort to advance a Culture of Health. This report focuses on two questions that are central to understanding how individuals and sectors think about health and are motivated to promote it: How can the commonly understood concepts of cultural identity (e.g., ethnic or religious; lesbian, gay, bisexual, transgender plus; military) and organizational culture be harnessed to develop a Culture of Health? How can incentives be used to promote individual health and engage investors and leaders within organizations or governments to promote health and well-being broadly? This study draws on 43 one-hour semistructured interviews that RAND researchers conducted with stakeholders whose work focused on cultural alignment, incentives, or both to learn how organizations are addressing and leveraging culture and incentives to promote health and well-being, as well as to identify facilitators, barriers, potential best practices, and lessons learned. Key findings include the following: Equity is often addressed in silos, which impedes progress toward a unified goal of health equity for all; members of specific cultural groups need to be given a voice in health-related activities; systems are built around prevailing cultural norms, making it challenging for those working with specific cultures to make cultural adaptations; and not all incentives are monetary. Recommendations include institutionalizing practices that ensure ongoing input from marginalized populations, identifying ways to help smaller organizations overcome structural inequalities, and institutionalizing health promotion efforts in sectors other than public health or health care to sustain collaborative efforts.
2013年，罗伯特·伍德·约翰逊基金会发起了一项开拓性努力，以推动健康文化的发展。本报告聚焦于两个对于理解个人和部门如何看待健康以及如何被激励去促进健康至关重要的问题：如何利用文化身份（如种族或宗教、女同性恋、男同性恋、双性恋、跨性别者及其他群体、军人）和组织文化这些普遍理解的概念来发展健康文化？如何利用激励措施来促进个人健康，并促使组织或政府内部的投资者和领导者广泛地促进健康和福祉？本研究借鉴了兰德公司研究人员对利益相关者进行的43次为时一小时的半结构化访谈，这些利益相关者的工作重点是文化协调、激励措施或两者兼具，以了解组织如何应对和利用文化与激励措施来促进健康和福祉，同时识别促进因素、障碍、潜在的最佳实践以及经验教训。主要发现如下：公平问题往往在各自为政的情况下得到解决，这阻碍了实现全民健康公平这一统一目标的进展；需要让特定文化群体的成员在与健康相关的活动中有发声的机会；系统是围绕主流文化规范构建的，这使得与特定文化打交道的人在进行文化调整时面临挑战；而且并非所有激励措施都是金钱方面的。建议包括将确保边缘化人群持续参与的做法制度化，找出帮助较小组织克服结构性不平等的方法，以及在公共卫生或医疗保健以外的部门将健康促进工作制度化，以维持合作努力。
