What if Our Systems Actually Served ALL of Us?

Together we can rebuild systems so they work for us all, leading to a future where health is no longer a privilege but a right.

One of the most powerful decisions I made as a physician had nothing to do with the medicine I prescribed. It was about advocating for a young mother to get time off work to care for her child.

As providers, we know that healthcare is just one small slice of what influences health. So much more of health is about whether our patients have the resources they need to live well, whether their communities support healthy living, whether they have a say in the policy decisions that affect their lives, and the narratives they see about health and racial equity in our culture.

That’s why at RWJF we’re focused on identifying and disrupting the embedded structural racism in our government and economic systems, as well as our communities. The term “systems” sounds technical and complex. But a system is simply a set of interconnected pieces that work together—the way the gears, chain, and pedals are all critical parts that work together to make a bicycle go. Similarly, the institutions and organizations that underpin our society, from healthcare to community development to government and media, are also systems. 

Over time, our political leaders have built systems that do not work for all of us. RWJF shared earlier this year our focus on dismantling structural racism as one of the biggest barriers to health in America. We also shared our three ambitious goals to transform health within our lifetime. In this piece and in more content to come, we’ll show how together, we can rebuild our systems so they work better for all of us. We see this as the clearest pathway to a future where health is no longer a privilege but a right.

Our systems fail too many of us

As an inpatient pediatrician caring for children who were sick enough to be hospitalized, I witnessed firsthand what they experience when systems don’t work for all of us.

One patient, an elementary school-aged girl named Sonia¹, had a condition that required life-changing abdominal surgery followed by ongoing, intensive at home care and emotional support. Her mother, like any mom, wanted nothing more than to be there for her daughter. But she couldn’t get time off work to be at her daughter’s bedside. She worked on the cleaning crew at the local airport—a job that did not offer sick leave. Her job would be at risk if she missed another day.

In that moment, I was furious (but not surprised) at the ways my work felt like an uphill battle against immoveable systems. But I was also determined: I called the mother’s boss to explain why it was essential for Sonia’s care that her mother be with her. And, I gave him my thoughts on compassion and flexibility. This wasn’t unusual. I frequently had to advocate on behalf of my patients with people in positions with great power to influence the health of these children and the wellbeing of their families. Many times, I got nowhere, but in this case, the employer listened. He gave Sonia's mom the time off to be with her in the hospital.

That story has a happy ending for Sonia and her mom. But they are just one family. Millions of others across the country are in similar situations. Convincing one boss to make a one-time exception will not change the economic system. Making this experience a reality for families like Sonia’s requires that we align our state, national and local policies, and our shared set of narratives, around caregiving to support our collective wellbeing. If we did that, my call would have been unnecessary.

Driving change that supports everyone

Sonia’s mother trying to care for her daughter was not an isolated case. We know from the data that if you are a person of color, an immigrant, if you are disabled or living below the poverty line, or if you live in a rural area, you are much more likely to have hurdles blocking your way to health and safety. Racism affects all people, and racist structures worsen health outcomes for people of all races.

We owe it to all our children and their children to build systems that get rid of the hurdles between them and health and wellbeing. Rather than asking each of us to swim upstream through dangerous rapids to get to health, why not clear the way so the stream can carry us all toward health?  Why not make health the default rather than the result of luck or privilege?

Clinicians, policymakers, patients, journalists, community developers, organizers and funders, together, have incredible power to shape the way our systems work. And their work will only succeed when it’s done in deep collaboration and with respect for those who our systems consistently fail.

How do we know this is possible?

Systems are not machines. They are made up of people. They are made up of us. We can either keep things the way they are, which isn’t working for many of us—or work for a better tomorrow. One policy, one investment, one decision at a time, we can create something new together. Because when our systems work better for that mom, doing her best to be there for her children—they will work better for all of us. Our fates are linked.

No single individual or organization can make this kind of transformation happen alone. But together, we can do more than we might imagine. That’s why RWJF is committing our focus and our resources over the long haul.  We hope you’ll join us in paving the way to a future where health is no longer a privilege for some, but a right for all of us.

¹ The patient’s name has been changed to protect privacy.