Culture of Health

August 22, 2014
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The Robert Wood Johnson Foundation (RWJF), the leading health philanthropic organization in the nation, endorses a culture of health. Earlier this summer, two representatives from the GLP attended the Aspen Ideas Festival Spotlight: Health, hosted by RWJF. At the opening of the festival, we heard Dr. Risa Lavizzo-Mourey, the President of RWJF, explain that “Building a culture of health is our North Star.” Consistent with the message of the GLP’s Special Report on Health, Dr. Lavizzo-Mourey reminded us that a child’s zip code at birth is as important as his or her genetic code in predicting how long and how well he or she will live.

Throughout the conference, renowned experts emphasized the importance of social determinants of health, including race, education, and poverty. When we compare health outcomes between income groups, the differences are staggering – there are huge gaps in health between African-Americans and White Americans, even after controlling for age, income, education, and insurance status.

Many scholars asserted that investment in education would pay huge dividends in health gains in the future. As the GLP advances our work with Health, we will further explore how health and education—one of our Deep Drivers—are correlated. Work out of Virginia Commonwealth University is further highlighting the link between education and health. Essentially, as education increases, job opportunities increase, as does earnings potential. Higher income affords us healthier foods, access to safer and more walkable neighborhoods, more access to health care providers, etc.

Currently, many groups are working to improve the health of Louisville’s residents. This year, two reports were released: the Health Equity Report from the Center for Health Equity and Healthy Louisville 2020: Creating a Healthier City from Louisville Metro Department of Health and Wellness. In addition, Kentuckiana Health Collaborative is working on how to improve access and overall health among residents of Louisville.

Health is a factor in all three of the GLP’s Deep Drivers, Education, 21st Century Jobs, and Quality of Place. As we advance our work with health, we will further explore the relationship between our Deep Drivers and health.

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Natural Breaks Algorithm

For each indicator, Greater Louisville Project assigns cities into one of three groups (high-performing, middle-of-the-pack, and low-performing) based on how they compare to other cities. The assignment is based on how cities naturally cluster on that indicator. Sometimes, the differences between cities are very small, and the difference between a city ranked 5th and 6th could simply be a matter of the sampling error that arises from using survey data. Thus, rather than always make a division that declares the top 5 to be the top tier, we use a natural breaks algorithm to look for a cluster of cities that is outperforming the rest, a cluster that is about average, and a cluster that is lagging. This clustering gives us a better indication of where Louisville is thriving and where Louisville has room to learn from cities that are doing better.

Z-Scores

Z-scores (or standardization) is a way to combine data with different units of measurement into a single index. The z-score is a measure of how far away a city (or census tract, etc.) is from the average city. In order to be comparable across different units of measurement, the z-score is the distance from the mean measured in standard deviations (e.g. if Louisville has a z-score of 1 it means Louisville is 1 standard deviation above the mean of its peer cities).

Data from the Robert Wood Johnson Foundation's County Health Rankings use z-scores and all z-scores are relative to the mean of Louisville's peer cities. (On the County Health Rankings site z-scores are relative to all the counties in each state - thus z-scores reported by GLP will be different, because we are using a different reference group). The Greater Louisville Project also uses z-scores in our multidimensional poverty index, which compares each census tract to the mean of all census tracts in Louisville.