In his recent blog post, Robert Wood Johnson Foundation’s Dr. James Marks writes: “What are the barriers to better health…and where does health really start? Only when we answer these questions honestly and see health in this broader context, will we begin the real work…”

We couldn’t agree more — and this “real work” must be an ongoing and participative process, like peeling back a never-ending and infinitely complex onion to see what’s inside.

The RWJF Commission to Build a Healthier America’s recommendations report is a wonderful milepost, filled with evidence and stories of hope. Also wonderful is an open question (overheard as a candid aside between Commissioners at one of RWJF’s public hearings): Is anyone even listening? And if not, we might ask, Why is this so? Questions like these invite a deeper inquiry that must unfold if we are to begin the real work of profound and sustainable change.

As we examine the societal, structural and contextual conditions that lead to poor health, we must also consider what values — what ways of thinking and acting and being — led to these conditions in the first place. As Churchill said, “We shape our buildings, then our buildings shape us.”

The good news is that coming together to consider questions that matter is intrinsically healthy. In coming together we re-connect with what is most important. We create inclusive environments where every voice can be heard. And we begin to see that the exterior conditions in which we live and work are manifestations of our collective interior conditions, and that means we can change them together.

The “real work” is interior work. And this work is always now.

Last night’s 60 Minutes was a powerful reminder of the interconnectedness of it all: “It’s the next thing in the recession: communities cutting back on services like schools or cops or public hospitals because tax revenues have fallen with the economy.”

In this story, it’s Las Vegas cancer patients who can no longer receive life-giving therapies from University Medical Center (UMC), a safety net for two million people that, due to state budget cuts, closed its outpatient clinic for chemotherapy.

As UMC CEO Kathy Silver explains, “Obviously, our gaming and tourism is tanking. The construction industry has been decimated. And all of those things cause big, gaping holes in the state budget. The hardest-hit area for us was the Medicaid budget.” While Las Vegas is experiencing its biggest downturn ever, the crisis is being felt by all cities, says Silver. “I think this is happening, to some degree, to probably every public hospital across the country. I think it’s happening to us to a greater degree because…we’re sort of the epicenter of what’s happening. We’re a demonstration project…of all the things that can go wrong at once.”

I remember reading a year ago about cuts to a small but vital resource in Portland, Maine, which helped that city’s growing number of Somali immigrants learn essentials like how to read a bus schedule and how to cook using an indoor gas stove, as well as more commonly considered guidance on local education, health and job programs. It was likely a $15K save to the budget, but the impact of helping new citizens regain a sense of belonging and control was invaluable (and, now missing, is likely showing up in all sorts of ways the city and its people are paying for many times over).

Back in Las Vegas, Dr. Nick Spiritos, who worked at UMC’s now-closed women’s clinic, continues to provide treatment to displaced cancer patients through his own upgraded facility, which he financed. Patients pay only if (and what) they can afford to; Dr. Spiritos and his partners cover the rest.

As the Nevada state legislature considers a proposal that would cut millions more from the UMC budget, public comments on the 60 Minutes site voice ideas, frustration, anger, and offers of support:

“One way many people can help out these patients is by simply coming back to Las Vegas (so that) more revenue from casinos is pumped back into our state budget.” … “Can you tell me how I can help the woman who does not have any insurance?” … “If we all encouraged everyone we know to send $1.00 to Dr. Spiritos foundation, imagine the help that could be done.” … “Considering its wealth, Nevada is already one of the worst states for funding education, mental health, and drug treatment. Tourists from around the world should consider boycotting Las Vegas and the casinos here until this city and state helps its people.” … “How do I get a hold of Roy Scales (profiled in the story)? He helped (me) through some of the most difficult days of my life…When he was in Pittsburgh about 14 years ago we were both down on our luck.”

There is something we can do, not just to ameliorate the impact of the current crisis but also to avoid another one. Remember that what we’re seeing and what we’re not seeing – all of it and all of us – we’re all connected. And, be there for each other.

On April 2, the Robert Wood Johnson Foundation Commission to Build a Healthier America releases 10 recommendations for dramatic improvements in the health of all Americans. The recommendations are rooted in a twin philosophy: good health requires each of us to make healthy choices and society to help remove the obstacles preventing too many Americans from making healthy decisions.

Commissioners release their report 9:30am-11:30am (Eastern) in Washington, DC, and will also host a live Twitter chat from the event (follow RWJFCommission or add to the conversation by using the event hashtag, #cbha).

CIGNA, which launched Communities of Health (CoH) last year, applauded the Commission’s recommendations, and called on all leaders to join in a movement to improve community conditions that influence health. 

The CoH team will be at the event and we look forward to working together with all toward real, sustainable change.