There is no question that health reform is crucial. To attain true health reform, however, we need to focus on keeping Americans healthier in the first place and not just treating them after they become sick. If we want to improve the health of the communities we serve, of an entire state, or of the entire nation, we need to act upon the fact that our health is shaped far more by the places we live, learn, work, and play than by what happens in clinics and hospitals (Robert Wood Johnson Foundation 2008).

For the past decade, HIV/AIDS-related conditions have been the leading cause of death for African-American women ages 25-34 in the United States (CDC 1999). Over the past two decades, our local foundation has seen this national epidemic take root in our local community in Washington, DC, where we now have 10 times the rate of HIV/AIDS per capita compared to the rest of the country.

When the Whitehall Studies were first published, they identified not only a social gradient that correlated the relationship between social status and life expectancy, but new variables to consider when predicting population health outcomes. These variables included the economic, social, and physical environments in which people live.