Health Affairs

Here a few more blog posts I came across that you may want to check out.

Global Health And Development

“The Problem That Nobody Wants to Think About,” Louis Boorstin, Nov. 19, on the Foundation Blog of the Bill and Melinda Gates Foundation. Boorstin is the deputy director of water, sanitation, and hygiene at the foundation. Using the hook that Nov. 19 was World Toilet Day, Boorstin writes that “the slum dwellers in Port au Prince [Haiti] are keenly aware that cholera has descended on their communities.” He points out that many of the people at risk for cholera “and certainly their leaders, recognize that poor sanitation is contributing greatly to the spread of this dread disease.” Boorstin notes that in certain parts of the world, lack of adequate sanitation is a real problem: For example, according to data he cites, “half the population of the developing world—that’s 2.6 billion people, mostly in rural areas—either have no toilet at all or use one so primitive that it’s not safe.”

Some five years ago, the Gates Foundation began looking into the subject area of water, sanitation, and hygiene, and subsequently, in 2009, it decided to focus its work in that subject on sanitation, he says. This work is part of the Gates Foundation’s Global Development Program.

“Questions for Melinda Gates,” Mitch Nauffts, Oct. 26, on the Foundation Center’s PhilanTopic Blog. Nauffts describes here an interview with Melinda French Gates, cochair and trustee of the Gates Foundation and wife of Bill Gates. The interview that Nauffts mentions is by Deborah Solomon and appeared in the New York Times Magazine on Oct. 24. Nauffts notes that, in general, in Solomon’s interviews, she “likes to poke and prod, isn’t afraid of controversial subjects, and can dish out snark with the best of them”! Nauffts then comments, “Sometimes it works; sometimes, not so much.” In this interview, he maintains, three of Solomon’s questions tried “to get Gates (who attended an all-girls parochial high school) to criticize the [Catholic] Church’s stand on abortion.”

In the short New York Times interview, Gates seems to confidently and diplomatically answer Solomon’s often pointed questions. For example, Solomon asks why the Gates Foundation doesn’t do more grant making in the United States, where, for example, it could “try to solve the health care crisis.” Gates responds, “As a foundation, first of all, you have to focus.” She goes on to say that the foundation, in fact, does have a United States program (as well as programs on Global Health and Global Development). According to the foundation’s Web site, health is not a topic of the U.S. program, though.

Nauffts, the blogger, asked a few Foundation Center colleagues “what they would ask Melinda Gates if she happened to drop by their office.” A list of eleven questions follows in his post, including “Does the Gates Foundation have too much influence in the areas in which it works?” and “What is the most critical issue not funded by the Gates Foundation that you’d like to see other grantmakers address?”

Health Reform

“Putting Our Health First,” by Robert K. Ross, Nov. 2, on the California Endowment’s (TCE’s) Bob’s Blog. Ross, who is president and chief executive officer of the endowment, explains that its “mission is to expand access to affordable, [high-] quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians.” To accomplish that, he says, “we must move beyond the heated rhetoric coming from all sides in the debate over the new health [reform] law,” to learn about what is really in the law and to ensure that it “is the very best it can be for Californians.”

TCE has gotten physician Mehmet Oz (“Dr. Oz,” who rose to fame on The Oprah Winfrey Show) “to lend his celebrity” to the endowment’s outreach effort on health reform. Oz has done a public service announcement for the endowment already; click here to watch it. It is on the “Helpful Resources: The New Health Law and You” page of TCE’s website.

Ross mentions various benefits of the Accountable Care Act in a bulleted list. Speaking of the “overheated rhetoric from all sides,” he then refutes some of the complaints about the law. He focuses on complaints from the right, not the left, though. He rallies readers with some words of encouragement: “Whether or not you supported the law, it’s up to all of us to make it work on behalf of our health, of our family’s health, and of the health of our state economy.”

Related resource:

“Health Reform: Staying Alive,” by Leif Wellington Haase, Nov. 5, on the New Health Dialogue (a New America Foundation blog). Haase is a senior fellow with New America’s Health Policy Program; his work focuses on California. Please note that the New America Foundation is a nonpartisan public policy institute, not a philanthropic foundation.

Information Dissemination

“Helping You Find Emergency Information When You Need It,” by Roni Zeiger, Nov. 11, on Google.org Blog. (Google.org is the philanthropic arm of Google, the company.) Zeiger, a physician who is chief health strategist at Google, reports that, as of Nov. 11, in thirteen countries, including the United States, Google was to have begun “displaying some combination of special search results” for searches related to poison control, suicide, and “common emergencies, such as fire, medical and police emergencies.” For example, in the United States, when one does a search on www.google.com for “suicide,” the National Suicide Prevention Hotline’s phone number will appear at the top of the results page. In countries including France, Italy, Switzerland, and the United Kingdom, people will see one or more of these “special search results,” if they search under certain key words. Zeiger says, “We looked for hotlines that are available nationally and 24/7.” Also, Google hopes to help travelers to, as well as residents of, these thirteen countries with the common emergency info, “as some countries have different numbers for different emergencies.” Here is the example (for France) that the blog post points to.

Have a happy and safe Thanksgiving! And, hopefully, no emergencies will befall you this weekend!

Mental Health

“Sanctioned Abuse in Armenia’s Hospitals,” by Anahit Papikyan, Nov. 11, on the Open Society Foundations Blog. Papikyan, who is the Public Health Program coordinator at the Open Society Institute Assistance Foundation—Armenia, writes that “the right to be treated in a safe environment, free of abuse, harassment, and neglect” is not always being extended “to people living with intellectual disabilities or mental health problems” in this Eastern European country. This is even after Armenia adopted a law comporting “with international norms” in mental health.

The foundation sponsored human rights experts to visit psychiatric hospitals and monitor conditions therein. He quotes from their reports: “A male nurse beat a patient who tried to run away”; “many patients are subjected to physical abuse, they are forced to. . . do the work that the clinic staff should do”; in a driving rainstorm, “a barefoot patient washed the car of a hospital employee.” Shocking stuff.

Papikyan states, “The government of Armenia should take measures to close these abusive institutions”; he recommends that “people with mental health disabilities . . . receive care within their communities.”

George Soros, an investor and philanthropist, “established the Open Society Foundations, starting in 1984, to help countries make the transition from communism,” the foundations’ website says. Now there are numerous Open Society grant-making organizations; they are located in the United States, Africa, Asia, Europe, Latin America and the Caribbean, and the Middle East.

It’s once again time for a visit to GrantWatch Blog’s Blogroll to point out some recent posts on philanthropy-related blogs that you may find informative. Here’s my selected sampling.

Global Health

“Saving Kids, Beating Pneumonia,” Doug Holtzman, Nov. 12, on the Foundation Blog of the Bill and Melinda Gates Foundation. Holtzman, a senior program officer in the Gates Global Health Program, points out that “this preventable disease is the leading cause of child deaths in developing countries.” Vaccines and antibiotics can prevent kids from dying from pneumonia, he says. Rwanda is the first developing country to introduce pneumococcal vaccines to its children. With support from the GAVI Alliance, which itself receives funding from Gates and many other funders, “Rwanda has vaccinated 90 percent of its children against pneumococcus, the leading cause of fatal pneumonia.”

Because of an Advanced Market Commitment agreement among drug companies GlaxoSmithKline and Pfizer Inc., several governments, and partners (including the Gates Foundation), the per-dose cost of the vaccine has drastically declined, Holtzman states. So, forty-seven other countries are expected to introduce pneumococcal vaccine by 2015. Read Holtzman’s other recommendations for what should be done to reduce deaths from pneumonia and how to lessen child mortality in general.

Health Reform

“Is Reasoned Discussion of Health Reform Possible?” by James (“Jim”) W. Squires, Nov. 1, on the Endowment for Health’s Insight blog. In this post—written before Election Day—Squires comments that both the “conservative” viewpoint and the “liberal/progressive” viewpoint “have been demonized during the current [election] season and have become unrecognizable.” He ends with a wonderful quote by William Penn:

I expect to pass through life but once. If therefore, there be any kindness I can show, or any good thing I can do to any fellow being, let me do it now and not defer or neglect it, as I shall not pass this way again.

Squires, founding president of the endowment, which is located in Concord, New Hampshire, was a practicing physician and ran (unsuccessfully) as the Republican candidate for governor of the Granite State in 2000. He also founded the first health maintenance organization (HMO) in the state. According to an Apr. 23 article in the New Hampshire Business Review, Squires is a “strong” supporter of health reform who still sees “the insurers’ point of view.”

“Post-Election: Getting Past Rhetoric and Moving Toward Reality,” Ned Calonge, Nov. 12, on the Colorado Trust’s Community Connections blog. Calonge, president and chief executive officer of this statewide funder, talks about Colorado Amendment 63, which “was defeated, but by a margin that suggests there is significant concern” about the “important” individual mandate provision of the federal Patient Protection and Affordable Care Act. (That provision requires citizens and legal residents of the United States to have health insurance.) Calonge, also a physician, comments, “What is clear is that health care reform is an issue that has become far too politicized, generating a remarkable amount of misinformation and misunderstanding, which inhibits our ability to make essential improvements in efficiency, effectiveness and access.” He wants a “return to the real issue: the health and health care of Coloradoans.” Good idea!

Calonge mentions a big new initiative “to help Coloradoans better understand—and have a say in—how [their] health care and coverage can be strengthened.” The initiative was launched Nov. 8. The trust is putting in $7.6 million for this effort, along with $2 million in additional support from the Colorado Health Foundation.

Hospitals in California

“State Doing Little to Track Hospitals with Severe Seismic Risks,” Christina Jewett of California Watch, Nov. 7, in California Health Report, which has initial funding from the California Endowment. Jewett reports on “serious structural weaknesses at more than a dozen hospital buildings” in California. She says that state authorities and hospital officials have discovered the problems but “have taken few steps to notify the public about the facilities or require a detailed inventory of hundreds of other potentially dangerous sites.” Jewett reminds us that “the threat” of a major earthquake is “always looming in California.” Read much more in this post from California Watch, the state’s largest investigative reporting team—funded by the James Irvine, William and Flora Hewlett, and the John S. and James L. Knight Foundations, as well as the California Endowment. California Watch is a project of the nonprofit Center for Investigative Reporting.

Veterans’ Health Care

“Winning the War at Home: The Imperative for Philanthropic Intervention in Veterans’ Wellness,” Nancy Berglass, Nov. 9, in the Council on Foundations’ (COF’s) Re: Philanthropy blog. Berglass has several affiliations: She directs a donor-advised fund of the California Community Foundation (CCF) called the Iraq Afghanistan Deployment Impact Fund; she is a nonresident senior fellow at the Center for a New American Security (CNAS), an independent and nonpartisan research institution in Washington, D.C.; and she is principal of Berglass Community Investment Consulting, in Los Angeles. The CCF is in LA as well.

In this COF post, Berglass says that we know that the wars in Iraq and Afghanistan have been expensive, but, in addition, the effect on veterans and their families “has been enormous.” She also says, “If not dealt with efficaciously, the wounds of war will present significant challenges to public health and safety for generations to come.” Citing published research, she notes the percentage of active-duty military personnel who are on antidepressants (a “staggering 17 percent”). The U.S. Department of Defense and Department of Veterans Affairs bear primary responsibility for veterans, but as urgent as the needs are and as big as these departments are, Berglass says, they are not managing to handle vets’ needs by themselves.

Nonprofits, though, are helping out in communities nationwide, she notes. “Grantmakers are in an extraordinary position to support” nonprofits’ efforts, and funders should step forward, she says, “before individual needs become crises.” Funders can help veterans “through existing grant programs” in areas such as public health and substance abuse. Philanthropy will even need to become “culturally competent in the military milieu”—that is, sensitive to the experiences of those who have served in the military, she says. She also says that many grantmakers should consider funding “the efforts of organizers and advocates, whose work to change laws and protocols” may finally permit “siloed federal agencies” to partner effectively with the many “capable nonprofits nationwide” to help veterans.

This post seems to preview some of the contents of a twelve-page policy brief that Berglass wrote for the CNAS. The brief was released on Veterans’ Day 2010.

The California HealthCare Foundation (CHCF), based in Oakland, announced its Health Innovation Fund on November 8. The total amount of money alone that has been allocated for this investment fund will attract notice. And what is also interesting is that this fund allows both nonprofits and for-profit companies to apply for money.

The CHCF Health Innovation Fund is targeting nonprofit organizations and for-profits that have “innovative services, devices, and technologies that can significantly reduce costs and improve access to care in California,” according to an e-alert. Those submitting proposals need to have a focus that “is aligned with CHCF’s mission to ensure affordable, [high-]quality care for underserved populations,” the foundation said. It also seeks to support entrepreneurs with proven track records “for developing scalable, sustainable businesses in the health care market.”

Margaret Laws at the CHCF is heading up this effort. She explained in the e-alert, “We know there are entrepreneurs who seek to combine their goal of succeeding in the marketplace with their drive to contribute to society,” and the foundation can help them attain both goals. Laws points out on the foundation’s website, “New and exciting ways to deliver care for underserved populations often can’t get the same kind of funding and support as high-cost and high-tech medical advances because the traditional funding sources—like venture capitalists and banks—are [often] focused on larger, more profitable investments.” Health Innovation Fund money can thus catalyze development of products and services that help the underserved.

I asked Laws how the funding would be classified, as some of it will go to for-profit companies. She replied in an e-mail that the money awarded “can be anything from a recoverable grant to a loan to an equity investment.” (A recoverable grant is one that is partially or totally repaid if the project meets its revenue targets, she explained. If revenue targets are not met, such a grant is forgiven and is written off as a regular grant. Among the advantages of a recoverable grant is that the paperwork is simpler than that for a loan.) The funding agreement will depend on the individual applicant’s circumstances. The key is to have a “sustainable, scalable” business model, Laws added.

The Health Innovation Fund “will provide funding at all stages, with a primary focus on early development” of projects, the e-alert noted.

The fund makes program-related investment (PRIs), which are described here. The fund is part of CHCF’s Innovations for the Underserved program, which makes both grants and PRIs and is directed by Laws. (You can read more about PRIs on the Foundation Center’s Web site.)

Read all of the fine print when applying for the Health Innovation Fund—this is different than applying for a grant! Those applying should also make sure to read the section on “significant impact” under “Investment Criteria.”

Applications for funding will only be accepted through Angelsoft, a secure online system.

The CHCF notes on its website that “the full review and approval process can take three to six months, as all PRIs will undergo extensive due diligence” and must be approved by the foundation’s board.

California voters rejected a ballot measure to legalize recreational use of marijuana. I was watching CNN’s report on how the measure had fared. Reporter Ted Rowlands was in Oakland, standing next to a woman who presumably supported the initiative; she was holding a pan of baklava, a Greek dessert, that was laced with pot. An interesting visual.

So I thought I would mention today what some foundations have funded related to substance abuse prevention or treatment.

Award

“Crusader against Substance Abuse Receives Institute of Medicine’s 2010 Lienhard Award,” Robert Wood Johnson Foundation (RWJF) press release, Oct. 11.

Joe Califano Jr., founder (in 1992) and chair of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, received the 2010 Gustav O. Lienhard Award, which is funded by an RWJF endowment. Califano, a former U.S. secretary of health, education, and welfare, was honored “for his leadership in catalyzing federal action to curb smoking and his broader efforts to reduce the toll of addiction and substance abuse, as well as for his contributions to improving public health in general,” the release announced. CASA’s “research promotes understanding of substance abuse as a chronic disease, a critical step to gaining insurance coverage for treatment and overcoming its stigma.” The IOM award comes with a $40,000 prize, which Califano is donating to CASA.

Califano is author of several books, including High Society—How Substance Abuse Ravages America and What to Do about It.

Over the years, the Lienhard Award has honored experts in a variety of health fields; winners include Jack Wennberg, Bob Brook, Ken Kizer, Phil Lee, Lester Breslow, and many others. In other words, award recipients are not limited to those in the field of substance abuse prevention.

Past RWJF National Program

Funding for the RWJF’s Substance Abuse Policy Research Program (SAPRP) was authorized through 2009. Read some results of research funded by the SAPRP here.

Open Society Foundations’ Efforts

Well-known investor and philanthropist George Soros established the Open Society Foundations, beginning in 1984. Open Society has foundations, offices, institutes, and initiatives in a number of countries around the world, including Afghanistan, and in the American cities of Baltimore, New York City, and Washington.

■“Drug Control, Criminalization, and Global Health: A Conversation with UN Special Rapporteur Anand Grover,” Open Society Foundations and Human Rights Watch, audio discussion, Oct. 26. (Daniel Wolfe, who is director, international harm reduction development program, at the Open Society Foundations, is also a speaker.)

According to the foundations’ website, Grover speaks about a United Nations (UN) report he wrote in which he found “that the current international drug control regime is damaging the health and human rights of people who use drugs.”

In the report, released in August, he makes a statement that may generate controversy in some quarters: Broad implementation of harm reduction initiatives “and of decriminalization of certain laws governing drug control” would “demonstrably” improve the health and welfare of drug users as well as the general public. (An example of a harm reduction technique is needle exchange programs for injecting drug users.)

The above audio discussion falls under the International Harm Reduction Development Program of the foundations’ Public Health Program. (Yes, it is a program within a program.)

■Here is another Open Society report on substance abuse:

From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland, Joanne Csete of Columbia University, Oct 2010. Although regarded as conservative, the Swiss have approved low-threshold methadone programs, needle exchange, and even a “very small” heroin-assisted therapy program, the report says. However, in 2008 the Swiss public rejected the “decriminalization of cannabis” (marijuana). One lesson learned from the Swiss drug policy experience was “the importance of scientifically rigorous investigation of new programs and of letting science be a basis for policymaking.” This report falls under the Open Society Foundations’ Global Drug Policy Program, which works with the harm reduction program mentioned above.

■The Open Society Institute (OSI)-Baltimore, a private operating foundation that is part of the Open Society Foundations, has an initiative called Tackling Drug Addiction, which “aims to increase the access of uninsured drug-dependent citizens to comprehensive services that respond to their individual needs,” according to the foundations’ website. To do this, the initiative “is helping Baltimore City [Maryland] to develop a sustainable, high-quality treatment system that uses research-based clinical practices and that benefits from interagency coordination.” Also, the initiative seeks to show policy makers and the public “that sound treatment practices and policies will save lives, reduce crime, rebuild families and communities, and use public funds wisely.” OSI-Baltimore maintains that “the success of this approach may have national significance as the public seeks alternatives to the nation’s ineffective ‘war on drugs.’” OSI-Baltimore now has funders in addition to George Soros; it also seeks funders. For details, click here.

Here are four other foundations that fund in the area of substance abuse prevention/treatment:

Conrad N. Hilton Foundation, based in Los Angeles. Note that this foundation “does not encourage unsolicited proposals”; it describes itself as a “proactive” grant maker.

Health Foundation of Greater Cincinnati, located in Ohio. This foundation funds in Cincinnati and certain counties of Indiana, Kentucky, and Ohio.

MetLife Foundation, located in New York City. Under its health program, this corporate funder “continues to address the issue of substance abuse among young people” through a public information campaign, according to its Web site.

New York State Health Foundation, located in New York City. This “conversion” foundation, which funds in New York State, has a funding priority area on integrating mental health/substance use services.

Related resources:

“Legalize-Marijuana Measure Loses in California,” David Crary and Lisa Leff, Associated Press, in the San Francisco Chronicle, Nov. 3. According to this article, voters in California did not approve Proposition 19, which would have allowed the legalization of marijuana for recreational use in that state. The reporters note that “every major newspaper, both political parties, the two candidates for governor [of California] and all but a handful of leading politicians came out against it.” Medical marijuana is already legal in California.

“Marijuana to Blame for Increased Drug Use in 2009, Government Report Says,” Peter Maer, CBS News, Political Hotsheet blog, Sept.15. This article is about the federal Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) annual National Survey on Drug Use and Health. National Drug Control Policy Director Gil Kerlikowske (the Obama administration’s “drug czar”) says in the blog post that marijuana “’may have properties that have medicinal values that should be tested,” but that marijuana  is not medicine but “an entry drug.” Kerlikowske also discusses the California ballot initiative. The blog post notes that the administration “remains strongly opposed to legalization of marijuana.”

“Proposition 19: Legalize Marijuana in CA, Regulate and Tax,” semiofficial election results of California statewide general election, Nov. 2, 2010, on the website of California Secretary of State Debra Bowen. Results were updated Nov 4, 2010.

Watch the video posted on CNN’s This Just In blog on Nov. 3; it features CNN journalists Ted Rowlands (reporting from Oakland) and Anderson Cooper; as well as that baklava mentioned earlier.

Many aspects of the Affordable Care Act were caught up in the swirl of political rhetoric leading up to this week’s midterm elections. Discussions emanated from the nation’s capital into the Heartland, leaving health and social services providers, as well as citizens, feeling bewildered by the polarizing rhetoric and hungry for facts.

Serving in the role of convener, honest broker, and catalyst to improve the health of Kansans, the Sunflower Foundation hosted a two-day meeting in Lawrence, Kansas, to explain key elements of the Affordable Care Act to its grantees and the public at large. Instead of engaging in the political, the foundation chose to engage in the practical—to provide a framework to help nonprofit grantees and the public to learn what is (and isn’t) in the Affordable Care Act, and what they will need to do as the law begins to affect health and the health care system.

Engaging Grantees

Two speakers provided an initial grounding on the first day of the conference, which was designed for Sunflower Foundation grantees. Martie Ross, an accomplished health care attorney in the Kansas City area with the law firm Spencer Fane Britt and Browne, provided the “ABCs of the ACA” to a group of about eighty participants from sixty-five nonprofit organizations in the state. Next, Reena Singh from Community Catalyst, in Boston, focused on the important role of engaging communities and consumers as various elements of the Affordable Care Act take shape at the state level.

Breakout groups that reflected attendees’ major interest areas encouraged networking and collective reflection on what participants had learned about the health reform law. Input from each group back to the main gathering identified what remained unclear and what elements of the act presented unique challenges to attendees’ organizations or constituents. The breakout sessions were valuable to the Sunflower Foundation as well, because participants shared ideas of how philanthropic support might be leveraged to improve nonprofit organizations’ ability to respond to the health reform law. The sessions served, in many ways, as a giant focus group, providing insights that could prove useful in the Sunflower Foundation’s targeted communications and funding.

Bringing in the Public

The second day of the conference included the grantees as well as some 125 members of the public. The day began with a panel of leaders who are involved with implementing the Affordable Care Act in Kansas. On the panel were Sandy Praeger, state insurance commissioner; Andy Allison, executive director of the Kansas Health Policy Authority (the state’s principal health care and Medicaid agency); Jen Brull, president of the Kansas Academy of Family Physicians (and a physician in private practice in Plainville, Kansas); Susan T. Sherry, also from Community Catalyst; and Sharon Homan, vice president for public health at the Kansas Health Institute. Marcia Nielsen from the University of Kansas Medical Center provided an introductory overview of the health reform law and moderated the panel.

The conversation ranged from a discussion of the statewide health insurance exchanges to the challenges of managing the care of chronically ill patients in primary care settings to preventing illness through comprehensive public health and prevention programming. Sue Sherry stated that there will be “lots of choices for consumers and organizations, and now is the time to figure out how to work together”—a sentiment strongly endorsed by the Sunflower Foundation.

One hour of the session was dedicated entirely to audience questions. These ranged from issues germane to specific sectors (for example, nursing homes) to the primary care workforce and current payment disincentives for medical students to choose primary care. Brull’s comment that “we won’t have fixed anything if we only shuffle money” received applause from the audience.

To cap the conference, the keynote speaker was John McDonough, an architect of and an expert in health reform at both the state (Massachusetts) and federal levels. The audience was riveted by McDonough’s engaging discussion of the ten titles of the Affordable Care Act. He presented information that solidified participants’ understanding of key elements of the law.

Attendees left feeling energized and thinking about how they can seize the opportunities afforded by the Affordable Care Act to provide services and care to Kansans. In addition, the Sunflower Foundation was seeded with a wide array of creative suggestions on how to fuel and catalyze local response. The foundation hopes that the conference promotes a ripple effect of participants taking what they learned and continuing the conversation with their patients, clients, colleagues, and communities.

Participants’ PowerPoint presentations from the forum are available on the Sunflower Foundation’s website, http://www.sunflowerfoundation.org.