The Role of Law in Advancing a Culture of Health

A culture of health is one in which being healthy is a high value, where healthy choices are the easy choices, and everyone has access to high quality, affordable health care, regardless of background or circumstance.

The Robert Wood Johnson Foundation (RWJF) is working across all its portfolios to advance a culture of health. “Culture” includes the values we share within the settings we share. It exists in our behaviors and beliefs at all levels of social organization: in neighborhoods, schools, workplaces, towns, and regions as well as at the national level.

Law permeates culture. It sets rules that define minimum standards of behavior, expressing social expectations and disciplining violators. But law also affects behavior indirectly, as others observe the new behavior, perceive its feasibility and beneficial consequences for health, and then adopt it as their own. Over time, the legal rule becomes a behavioral norm.

Through these behavioral changes, law also influences what people know or believe to be true, and shapes what people value. The mere debate on a potential law can bring attention to a problem, change public perceptions, motivate practice innovation, and drive voluntary change. Laws sometimes command and punish, but more often work by teaching and preaching. Effective public health laws start with some people changing behavior to obey the law, but the new behavior really takes hold when others pick it up through networks of social communication and observation. Beliefs and behaviors are modeled by those in our immediate setting and by the media, and as those models become the norm, a new culture of health emerges.

For example, laws and regulations from school boards removed junk foods and sugary drinks from our schools. But they also awakened communities to the broader issue of childhood obesity and the need for children to maintain a healthy weight, and expressed a social commitment to solving this problem. Similarly, the need for preventing road injuries and deaths led to laws that regulate the design and use of safety belts. Evidence of the lives saved as a result of those seatbelt laws reinforced public views, and the change in social norms regarding seatbelt use – reinforced by law – was the long-term driving force for permanently increased safety belt utilization. Now, because we have seen a cultural shift, we take buckling up for granted, and punishment and enforcement is less necessary.

Progress toward a culture of health can also be seen in health care services. As the various provisions of the Affordable Care Act are being phased in, there is already a shift in the social norms of the health professions, bringing a team-based approach and increasing the emphasis on prevention and health management rather than treatment alone. Every day, the ACA reinforces the belief that health care can and should be accessible to all.  

The Public Health Law Research (PHLR) Program’s mission is to inform the public and policy-makers about how laws influence health. Law is at the core of a culture of health. The foundation of theory and evidence PHLR has developed in its first five years can be brought to bear to show the many pathways through which legal activity can influence a culture of health and to measure how effectively law is contributing to the overall progress of the RWJF Culture of Health initiative.

The PHLR program is well placed to tackle a range of questions about our progress toward a culture of health:

  • What are the most powerful strategies for using law to achieve a culture of health?
  • If we change the laws that govern how we deliver health care or how we pay for it, how will that influence cultural change in neighborhoods, schools, workplaces, towns, regions, and at the national level?
  • How can we use law as an index of changes in the culture of health?
  • How do beliefs about health interact with other values and concerns about government interventions?
  • And, how do we take advantage of law’s teaching power even when political barriers prevent laws from being enacted or enforced?

Getting the answers to these and other similar questions as they affect a range of current public health challenges is critical to strengthening law’s contribution to a culture of health.

Learn more about the RWJF Culture of Health initiative by clicking here.