Skip to content
Search

Latest Stories

Top Stories

Seeding systems change through the vital conditions for health and well-being

Becky Payne is the President and CEO of The Rippel Foundation, which is committed to fostering an equitable future for health and well-being. From 2002-2021 she served in a variety of leadership roles within the U.S. Centers for Disease Control and Prevention (CDC), where she was responsible for designing and launching new, large-scale initiatives.

At $4.3 trillion or almost $12,000 per person annually, America’s health care spending far outpaces that of any other industrialized nation. Despite this, Americans die younger, have the highest rates of preventable illnesses, and see physicians less often. Communities of color are even worse off: they have less access to care and poorer health outcomes when compared to White Americans. These phenomena are uniquely American but not new. COVID-19 laid bare these longstanding disparities and gave new urgency to advancing health equity and racial justice.


In Spring 2020, I was leading Community Mitigation as part of the Federal government COVID response and tasked to develop a plan that addressed the escalating behavioral and substance use crises. Like many others, I recognized the disparities on full display: high infection and mortality rates, exploding mental and behavioral health issues, and food and housing insecurity were a result of decades of failure to invest in the conditions that truly produce health, especially in communities of color. This meant we had to resist the muscle memory of throwing a band-aid on the crisis and be honest about what created it.

Sign up for The Fulcrum newsletter

We needed more than a call for increased spending or additional staff. If we wanted a different future, we needed a different approach, one that recognized that only 10% of health outcomes can be attributed to clinical care. The majority of a person’s health outcomes are determined by factors that are non-medical, such as humane housing, meaningful work, building wealth, access to reliable transportation, a healthy environment borne of a thriving natural world, and a sense of belonging and civic muscle. These are the vital conditions for health and well-being. There are seven in total, and they are essential to shaping our well-being. When I first learned about the vital conditions framework, I saw its potential to provide the scaffolding on which we could develop a better system to tackle disparities and build health equity.

The resulting Equitable Long-term Plan for Recovery and Resilience (ELTRR) was unveiled in November 2022. It brings together more than 44 federal agencies around 78 specific recommendations for coordinated interagency action that shifts from a heavy focus on siloed urgent services, like acute care or addiction treatment. The sheer number of agencies involved is notable, but the real promise of the federal plan is that it bridges across agencies and creates opportunities for departments with overlapping and complementary interests to work together using resources they already have. And it makes sense: if we hope to address the mental health crisis, we need to fix the things that are straining our mental health to begin with. Treatment alone will not reverse the trend. We need agencies to work together as they have never done before to create more opportunities for people to build wealth, have meaningful work, and live in safe neighborhoods. States and communities need flexibility with federal funds to support solutions identified and led by communities, especially communities of color.

Government agencies are not the only ones shifting their focus to vital conditions. Community-based organizations, coalitions, and individual stakeholders are finding success in changing systems using the lens of vital conditions. We must support more of their efforts, like those happening in Florida and Wisconsin.

Following the tragic Parkland school shooting, stewards in Palm Beach County formed BeWellPBC with the goal of addressing mental health challenges and creating a community where every person feels hopeful, supported, connected, and empowered. Community members, organizations, and local government agencies are using the vital conditions as a framework to explore how to reallocate resources and create more equitable regional systems for health and well-being. They have developed a workforce plan to address the shortage of behavioral health providers at every level of education, from high school students to working professionals, creating immediate employment opportunities, supporting retention for those already working, and retaining talent in the community. Their efforts are having an impact on multiple vital conditions, including meaningful work and wealth, lifelong learning, basic needs for health, and belonging and civic muscle. Their high school certification program has been adopted statewide, bringing much needed relief to the workforce crisis across the state.

In the Fox Cities region of central Wisconsin, civic leaders began to reflect on how various factors including a changing economy, increased diversity, and shifts in educational outcomes would affect the future of the community. They formed the inclusive community-wide initiative Imagine Fox Cities, inviting participation of hundreds of people across sectors to community conversations where they shared their perspectives. As Hmong, Black and Latinx voices were heard, it became clear that many struggled with feelings of belonging in the community. Belonging lies at the heart of the vital conditions. Community members realized that to build a thriving future for all area residents, they first had to commit to investing in belonging. They aligned resources from multiple stakeholders and sectors, including the local health systems, to do so. Now, four of the regional health systems and the five health departments are all using the vital conditions to organize their community health improvement plans. The commitment to belonging is ensuring that their planning is more deeply anchored in community voices and more likely to advance their equity goals.

There are thousands of stewards across the country working to expand the vital conditions to address long-standing inequities in health and well-being. While the road ahead is long, I know we can make progress together. After nearly three decades in public health, I believe we have the power to shape a future in which all people and communities can thrive—no exceptions. It will require everyday acts of courage to resist short-term solutions and invest adequately in long-term approaches that establish and expand the vital conditions we all need and deserve. Individual stewards, community organizations, and governments at all levels have a role in that effort.

Read More

Trump to the Nation: "We're Just Getting Started"

U.S. President Donald Trump speaks to a joint session of Congress at the U.S. Capitol on March 04, 2025 in Washington, DC. President Trump is speaking about the early achievements of his presidency and his upcoming legislative agenda.

(Photo by Mandel Ngan-Pool/Getty Images)

Trump to the Nation: "We're Just Getting Started"

On Tuesday, President Donald Trump addressed a joint session of Congress, emphasizing that his administration is “just getting started” in the wake of a contentious beginning to his second term. Significant themes, including substantial cuts to the federal workforce, shifts in traditional American alliances, and the impact of an escalating trade war on markets, characterized his address.

In his speech, Trump highlighted his actions over the past six weeks, claiming to have signed nearly 100 executive orders and taken over 400 executive actions to restore “common sense, safety, optimism, and wealth” across the country. He articulated that the electorate entrusted him with the leadership role and stressed that he was fulfilling that mandate.

Keep ReadingShow less
Veterans diagnosed with asbestos-related diseases should apply for compensation

An individual applying for a program online.

Getty Images, Inti St Clair

Veterans diagnosed with asbestos-related diseases should apply for compensation

In 1922, the U.S. Navy identified asbestos as the most efficient material for shipbuilding insulation and equipment production due to its heat resistance and durability. The naturally occurring asbestos mineral was also the most abundant and cost-effective material on the market. During the difficult WWII years, asbestos became critical to the U.S. Military, especially for the U.S. Navy and the U.S. Air Force: shipping and shipbuilding were essential, and parts of the military aircraft and incendiary bombs also contained asbestos.

Even as demand exceeded supply, in 1942, a presidential order banned the use of asbestos for non-military purposes until 1945. The application of asbestos-based material by the Military continued to increase until the 1970s when its carcinogenic nature came to light, and the use of asbestos started to be regulated but not banned.

Keep ReadingShow less
S.E. Cupp: Where is the Democratic Party’s Ronald Reagan?

President Joe Biden and President-elect Donald Trump arrive for the inauguration ceremony in the U.S. Capitol rotunda in Washington, D.C., on Jan. 20, 2025.

Getty Images/TCA, Melina Mara/POOL/AFP

S.E. Cupp: Where is the Democratic Party’s Ronald Reagan?

With all the attention deservedly on President Trump and what he intends to do with his defiant return to the White House, there’s a more than good chance we’ll spend the next four years consumed once again by all things Trump.

There’s already been a dizzying amount: a giant raft of executive orders; attacks on a constitutional amendment; his threats to invade sovereign nations; a seeming Nazi salute from one of his biggest surrogates; his sweeping Jan. 6 pardons; his beef with a bishop; his TikTok flip-flop; his billion-dollar meme coin controversy; scathing new allegations against one of his Cabinet picks; unilaterally renaming a body of water; a federal crackdown on DEI; promises of immigration raids across major cities. All this in just the first three days of Trump’s second term.

Keep ReadingShow less
Linda McMahon Confirmed as Trump's Secretary of Education

Linda McMahon, President Donald Trump’s nominee to be Secretary of Education, testifies during her Senate Health, Education, Labor and Pensions Committee confirmation hearing in the Dirksen Senate Office Building on February 13, 2025 in Washington, DC.

(Photo by Win McNamee/Getty Images)

Linda McMahon Confirmed as Trump's Secretary of Education

On Monday, the Republican-controlled Senate confirmed Linda McMahon as the new U.S. Secretary of Education in a 51-45 vote along party lines.

McMahon, a former professional wrestling executive and head of the U.S. Small Business Administration during President Donald Trump's first term, takes on the role amid the administration’s stated goal of dismantling the department. While the White House has already implemented staff and program cuts, formally eliminating the department would require congressional approval, as it was established by an act of Congress in 1979.

Keep ReadingShow less