Challenging Our Comfort Levels: Lifestyles, Research, and the Ongoing Legacy of the Robert Wood Johnson Foundation

Abstract

Life unfolds as a series of nonlinear biological and environmental interactions mediated through semi-permeable membranes. Complexity is its character. Research is designed as carefully crafted observations filtered through semi-artificial controls. Simplicity is its aim. The tension is clear and the consequence can be limiting. Science startles when it finds power in singularity, but it matures when it reveals the nature and impact of multiplicity. Both as individuals and as scientists, patterns of behavior to which the dominant incentives have been directed over the past half century have left us sluggish in our lifestyles and constrained in the reach of our research. Ten years ago, the Robert Wood Johnson Foundation (RWJF) set out to change this. As an expression of the overall population health strategy of the Foundation, the Active Living family of programs has challenged us not only to greater motion in our lifestyles but to greater ambition in our research endeavors—to look directly and creatively at concepts, issues, and approaches most central to fostering broad health findings and gains. Informed by a generation of insights establishing that health is determined neither by fate nor by accident, but by the intersecting dynamics within and among five domains of influence—genetic predispositions, social circumstances, physical environments, behavioral choices, and medical care 1 —the Foundation committed to building the field of population health. Its aim was to contribute to population health science much as it had contributed over the previous quarter century to growing the field of health services research. The Foundation had important experience on which to build. In the face of the devastating impact of substance abuse on the lives and health of certain populations, it had begun in the late 1980s to combat drug and alcohol abuse, and it expanded its focus during the 1990s with a major commitment to fight tobacco as the nation’s leading single cause of preventable death. In 1999, RWJF decided to devote half of its resources to prevention and population health. Two new Foundation initiatives—on population health science and on physical activity—were established to complement its strong leadership to counter substance abuse and to strengthen front-line community capacity for behavioral and social interventions important to health. The population health science initiative was designed to serve as an incubator for the training, leadership, and research necessary to advance the frontiers of the field. Along with the launching of a variety of creative projects, its two flagship efforts are the Health & Society Scholars (H&SS) program and the Young Epidemiology Scholars (YES) program. H&SS is a 2-year post-doctoral program intended to attract the nation’s most promising minds to interdisciplinary collaboration in health research. YES is a regional and national competition introducing and encouraging our brightest high school students to become interested and engaged in projects in epidemiology as the basic science of population health. Both are aimed at creating the first generation of scientific and program