American Foundations: Roles and Contributions has recently been published by Brookings Institution Press. Helmut K. Anheier and David C. Hammack edited this 450-page volume.
Overview of the Book
The product of a three-year project supported by the Aspen Institute’s Nonprofit Sector and Philanthropy Program, the volume provides the most comprehensive assessment to date of the significance and impact of the nation’s large foundations. In its eighteen chapters, leading researchers explore how foundations have shaped–or failed to shape–each of the key fields of foundation work. Chapters draw widely on published and unpublished sources. (The published sources are, in fact, much more extensive than is often suggested.) Several of the chapters also rely on analysis of the Foundation Center’s database containing basic information on nearly 150,000 grants made in 2001. American Foundations takes the reader on a wide-ranging tour, evaluating foundation efforts in education, scientific and medical research, health care, social welfare, international relations, arts and culture, religion, and social change.
Each contribution to this volume stands on its own, but all authors considered a standard set of questions. To what extent do foundations emphasize Relief of Immediate Needs, Philanthropic Innovation, or Control of Charitable Assets? What roles do foundations play?
With regard to meeting immediate needs or providing basic services, all contributors agree that foundation resources are much too limited to substitute for government or the market and that foundations can complement government only to a very limited extent.
With regard to philanthropic innovation, it is clear that whereas there was a classic era in which the Carnegie, Rockefeller, Rosenwald, and several other foundations could create entirely new institutions and even fields, foundation resources are now in almost all cases insufficient for such grand initiatives. Foundations can now join campaigns to change social perceptions, foster recognition of new needs, encourage the empowerment of the socially excluded, explore new directions for policy, and stimulate social entrepreneurship.
To an extent that usually goes unacknowledged, foundations also control charitable assets, by supporting charitable and religious institutions and seeking to preserve cherished values and traditions—religious as well as secular.
Because their resources are dwarfed both by the profit-seeking economy and by government, foundations are simply not able to play the role of redistributing wealth. Foundations do play the roles of entrepreneur, institution builder, risk absorber, and broker. And foundation actions are sometimes fairly criticized for insufficiency, particularism, paternalism, and amateurism.
Overall, editors David Hammack and Helmut Anheier say in the concluding chapter that foundations play an essential part in the philanthropic activity that does much to define the United States. Making use of their great freedom, foundations pursue an extraordinary variety of aims. The editors write:
Americans have criticized foundations for . . . their alleged conservatism, liberalism, elitism, radicalism, devotion to religious tradition, hostility to religion—in short, for commitments to causes whose significance can be measured, in part, by the controversies they provoke. Americans have also criticized foundations for ineffectiveness and even foolishness.
Throughout the history of U.S. foundations, there has been a persistent and significant mismatch between aspiration and available resources—a discrepancy that continues and is even widening today. . . . In the second and third decades of the twentieth century a very few foundations were indeed sufficiently wealthy, . . . yet the foundation experience of that relatively short and unsettled period continues to cast a shadow on current perceptions and practices. By contrast, the experience of more recent decades shows that foundation resources—despite significant growth and despite the vast resources added to the field by the Bill and Melinda Gates [Foundation] and other foundations—are quite limited, relative to their ambitions, and are likely to remain so for the foreseeable future. Given this persistent mismatch between objectives and means, it is no surprise that foundations have rarely made contributions, positive or negative, on their own; rather, they work, typically and necessarily, in some form of partnership.
As for the book’s editors, Anheier is dean of the Hertie School of Governance, in Berlin, Germany; academic director of the Center for Social Investment at Heidelberg University; and professor of public policy and social welfare at the University of California, Los Angeles (UCLA). His publications include Creative Philanthropy, written with Diana Leat (Routledge, 2006) and Nonprofit Organizations (Routledge, 2005)
Hammack is Hiram C. Haydn Professor of History at Case Western Reserve University, in Cleveland, Ohio, where he also is a leader of the Faculty Council of the Mandel Center for Nonprofit Organizations.
Chapter on Foundations and Health
Daniel M. Fox, president emeritus of the Milbank Memorial Fund, wrote the book’s chapter titled “Foundations and Health: Innovation, Marginalization, and Relevance since 1900.” Dan shared with the GrantWatch Blog some selected excerpts (with minor edits) from the chapter.
The ideas, political skills, and cash of the donors, directors, and staff of American philanthropic foundations have affected the health status of millions of people during the past century. Foundations in health have innovated and temporized. They have sustained some organizations, promoted radical change in others, and helped to invent more than a few. They have embraced public advocacy and avoided it. In doing their work in health, foundations have collaborated as well as contended with leaders in government, universities, hospitals, and the medical profession.
This chapter assesses the influence of leading foundations on health policy and practice. I define “leading foundations” as those whose trustees, staff, and money had, at least for some years, effects that can be documented on significant issues in health affairs, nationally, as well as internationally. Some of these foundations have been among the largest endowments; others have been middle-sized; a few have been relatively small.
Most foundations, unlike these leaders, have been passive donors to health care organizations. They mainly responded to proposals to meet the immediate or short-term needs of medical schools, research organizations, hospitals, and—in the first four decades of the twentieth century—patients. Moreover, as the health sector grew to become the largest sector in the American economy, foundation giving declined in relative importance to spending by government, employers, and individual consumers.
I summarize the history of the leading foundations in health during the past century in three words: innovation, marginalization, and relevance. From the early twentieth century through the 1920s, leading foundations collaborated on innovation with central actors in health policy and practice. They planned and implemented new ways to organize education for the health professions, basic and clinical research, and the delivery of services in hospitals and ambulatory settings. From the early 1930s through the 1980s, the work of leading foundations, though respected by central actors in health policy and practice, was marginal to the major issues that preoccupied them. Since the early 1990s, the work of leading foundations has been consistently relevant to major issues in health policy and practice in the United States and of growing importance in the area of global health.
The principal finding of this chapter is that foundations influenced the resolution of significant health problems when their goals were congruent with the goals of key decision makers in health affairs and when these decision makers judged foundation staff to be trustworthy and their cash to be helpful. Foundations have sometimes helped to make history, but they have rarely made it themselves.
Two Other Chapters to Check Out
The book also includes a chapter titled “The Robert Wood Johnson Foundation’s Efforts to Improve Health and Health Care for All Americans,” which was written by James R. Knickman, formerly of the RWJF and now president of the New York State Health Foundation, and Stephen L. Isaacs, president of Health Policy Associates, in San Francisco, and a partner in Issacs/Jellinek, a consulting firm that advises foundations.
There is also a chapter on “Foundations and Public Policy” by Steven Rathgeb Smith of the University of Washington’s Evans School of Public Affairs.