the Commission to Build a Healthier America in 2008. The non-partisan group included individuals from business, academia, and politics and focused on studying ways to improve health in the U.S. outside of the health care system. The commission compiled five years' worth of research into a report it released in 2014. The report focused on social determinants of health and detailed three strategies to improve health in the U.S.: early-childhood education; community-based health initiatives; and preventative care. In 2010, the Robert Wood Johnson Foundation partnered with the University of Wisconsin's Population Health Institute to launch the County Health Ranking program, which calculates and compares the health of each county, nationwide. The counties are measured and ranked on various health and social factors, which include more than 30 indicators such as obesity, tobacco use, mental health, employment and poverty rates, and access to healthy food. Over time, the foundation added coaches and competitions to the program to support communities' efforts to improve local health. This was done in response to growing evidence showing that social factors and individuals' actions could affect a population's health more than the quality of medical treatment. The foundation also partnered with Federal Reserve Banks to engage impact investors, banks, and community developers in health and wellness-based projects through the Healthy Communities Initiative. In 2014, the foundation announced a major shift in its approach to health issues. It had previously focused on specific health issues, and would instead focus on changes that could lead to large-scale social shifts by building what it called a "culture of health." The change built on the Culture of Health Action Framework adopted by the foundation in 2013. Critics of the shift expressed concern that funding for some areas—such as leadership training for doctors, and programs for nursing and health policy—was being discontinued as part of the shift. When describing the changes at the Aspen Ideas Festival, Lavizzo-Mourey said, “We have to make a seismic shift in the way we deal with health, and it has to come from the ground up.” A 2017 survey conducted by RWJF, NPR, and Harvard T.H. Chan School of Public Health found that people in America report that their personal experience with discrimination regularly affects their lives and drives decisions that influence their health, safety, and well-being. Experiences with discrimination correlated to an increased risk for health conditions such as coronary heart disease. In 2018, the