Fighting Mental Illness: A Call to Action for Foundations

April 27th, 2011

Next week, Mental Health Month begins. Paul Gionfriddo, who has his own blog, “Our Health Policy Matters,” wrote this post. He is the former president of a foundation in South Florida.

The United States has the highest rate of mental illness in the world. According to Mental Health America, one in four Americans has a diagnosable mental illness each year. Half of us will have one in our lifetime.

The average age of onset of mental illness is age fourteen, and it typically takes ten years after symptoms first present for mental illness to be diagnosed.

The consequences of mental illness can be devastating. Mental illness accounts for 55.7 million ambulatory care visits per year. Serious mental illness, including schizophrenia, bipolar disorder, and severe depression, can reduce life expectancy by twenty-five years or more. Up to 64 percent of jail inmates have mental illness. Up to 25 percent of the homeless population has serious mental illness.  These statistics challenge us to act directly and decisively.

However, states cut mental health budgets by almost $1.6 billion between FY2009 and FY2011, according to the National Alliance on Mental Illness. Many states are likely to make further cuts this year.

The philanthropic community can’t replace these dollars, but it can do three things to respond. Many funders are already doing excellent work in these areas.

Invest in mental illness prevention

While the popular perception is that mental illness cannot be prevented, the reality is the opposite. The National Institute of Mental Health (NIMH) makes prevention an integral part of its vision.

There are environmental factors associated with mental disorders, just as there are with any chronic conditions. Those factors include physical abuse, sexual abuse, psychological abuse, and living with family members who are substance abusers.

In 2008, state child protective services agencies found that 772,000 children were the victims of maltreatment. Many of these kids will develop mental illnesses as a result.

Exposure to violence can cause mental illness in both children and adults. According to the National Institutes of Health/Friends of the National Library of Medicine, post-traumatic stress disorder, or PTSD, affects more than 7.7 million American adults. The U. S. Department of Veterans Affairs says that more than 30 percent of Vietnam veterans, 20 percent of veterans who have served in the most recent Iraq War, and 11 percent of veterans of the war in Afghanistan have PTSD.

Preventing environmental exposures has been an effective strategy for funders. The state of Washington-based Council for Children and Families has made grants throughout that state to fund parent education, home visiting, parent support, and crisis intervention. The United Methodist Health Ministry Fund, located in Hutchinson, Kansas, has just awarded more than $752,000 in grants to five community partnerships specifically targeting young children for mental illness prevention strategies. The Health Foundation of Greater Cincinnati has funded a number of inmate-related programs.

Invest in the integration of mental health, primary care, and other specialty care treatment

We know that integrating high-quality health and mental health care leads to better health outcomes for people with mental illness, and so it is increasingly common to find examples of integrated care initiatives spawned by foundation grants.

The John A. Hartford Foundation’s $11.1 million IMPACT (Improving Mood—Promoting Access to Collaborative Treatment) initiative, the John D. and Catherine T. MacArthur Foundation’s Initiative on Depression and Primary Care (which is winding down), and the Robert Wood Johnson Foundation’s (RWJF’s) Depression in Primary Care Initiative (which has concluded) are three examples of major foundations’ efforts in the past decade to promote integrated care.

There are many targeted local examples, too. The Austin, Texas, integration initiative, called E-Merge, originally funded in 2001 by a three-year grant from the Hogg Foundation for Mental Health, is an ongoing integrated care initiative of Travis County’s community mental health provider and federally qualified health center network. In it, mental health providers in community health centers work side-by-side with primary care practitioners. (Here is a link to a webpage showing the Hogg Foundation’s work over the years in the area of integrated health care.)

The Palm Healthcare Foundation, in Palm Beach County, Florida, gave a 2010 grant to the Mental Health Association of Palm Beach County to apply E-Merge concepts to a broader provider audience. In addition to working with safety-net providers, the association’s Be Merge program now offers training and online toolkits to primary and specialty care providers, along with referrals to collaborating mental health professionals in private practice.

The Milbank Memorial Fund released a report entitled Evolving Models of Behavioral Health Integration in Primary Care (May 2010). It summarizes a number of publicly and privately supported integration initiatives springing up around the country.

Invest in policy education and mental health advocacy

Education is the key to changing the way policy leaders and members of the public think about mental health and mental illness. Policy initiatives are often influenced by either of two perceptions—fear of people with mental illness or a belief that the underlying condition is behavioral, not medical.

The philanthropic community can help change these perceptions.

The Maine Health Access Foundation is already doing its part. It provided funding to the Maine Children’s Alliance to produce a 2011 document entitled “A Guide to Challenges in Children’s Mental Health: The Views of Maine Stakeholders,” an informative twelve-page summary of the perspectives and policy recommendations of eight organizations involved in children’s mental health in the state.

As is the case in Maine, many nonprofits around the country are doing excellent work in the mental health field. Whether they work in prevention, treatment, or public education, it is not hard to find them—as the funders referenced in this post have done—and to support their efforts.

May is Mental Health Month–a good month to rededicate ourselves to the notion that, together, we can end the mental illness epidemic in our lifetime.

Mental Health America is the national group behind the tradition of celebrating Mental Health Month in May. Visit this website for more information:

The Three Most-Read GrantWatch Blog Posts during March 2011

April 25th, 2011

We list below the three most-read posts during the month. Take a look in case you missed one of these when the original tweet or e-alert went out.

1. “Foundation Blogs Round-up: Health Reform, Disparities, Global Health, Obesity, and More,” by Lee-Lee Prina (Feb.17, 2011).

Heading the top-three list is a round-up (selected sampling) of posts on a variety of topics from several other philanthropy-related blogs. In addition to the topics mentioned in the title above, there are brief descriptions of posts on environmental health (the Green and Healthy Homes Initiative funded by the Open Society Foundations); health care delivery/specialty care for the underserved/telehealth (Project ECHO, funded by the Robert Wood Johnson Foundation); health care for the elderly (the Donald W. Reynolds Foundation’s creation of a collection of geriatric educational materials called POGOe, which is now integrating materials from a John A. Hartford Foundation initiative); and substance abuse (a post on methadone treatment, also on the Open Society Foundations Blog). In addition, two philanthropy news items are geared toward foundation staffers.

Does the foundation you work for have a blog that includes posts on health care? Is it listed on the “GrantWatch Blogroll” (list of other blogs)? If not, please let me know.

2. “Funders Meet with SAMHSA Official; Explain How Foundations Can Work with Government,” by Janice Bogner of the Health Foundation of Greater Cincinnati (Mar. 17, 2011).

In the next most-read post during March, Janice Bogner, a senior program officer at this regional foundation and a licensed independent social worker, enumerates the Top-Ten Things Foundations Can Bring to Partnerships with Government. For example, foundations can provide “nonpartisan analysis and study” and can “jump-start government priorities.” She notes that the Behavioral Health Funders Network presented this list to John O’Brien, senior adviser on health care financing at the Substance Abuse and Mental Health Services Administration (SAMHSA), who breakfasted with network members in early March. The event took place in Los Angeles, during the Grantmakers In Health annual meeting. In Bogner’s work at the foundation, she focuses on the topic of severe mental illness.

3. “Issue Brief and Polls on Health Reform Released by Foundations: What Are They Telling Us?” by Lee-Lee Prina (Mar.15, 2011). The third-most read post during March mentions three-foundation-related products on health reform. One is about people who are misinformed about the status of the 2010 health reform law (that is, the Affordable Care Act). My information comes from a column by Drew Altman, who heads up the Henry J. Kaiser Family Foundation. In his column he reports on the February 2011 Kaiser Health Tracking Poll. Another item is on the projected effects of health reform in Colorado—this information comes from a study funded by the Colorado Trust and the Colorado Health Foundation. The third item is on Kentuckians’ views of the health reform law; the source here is a poll funded by the Foundation for a Healthy Kentucky and the Health Foundation of Greater Cincinnati.

Job Hunters: Ever Consider Working for a Foundation? Check Out These Openings.

April 21st, 2011

For those who want to change jobs or find a job, here is a selected sampling of positions that appear to be still open. Please note that I am only mentioning here a few pertinent details. I have put links to URLs for fuller descriptions of the positions, with all of the caveats, limitations, etc.! Make sure to read the full job descriptions to confirm all information I have listed.

I found at least one of the job descriptions to be a bit unclear, but I wanted to at least notify GrantWatch readers and others about these openings. Happy hunting!

Communications Manager

The W.K. Kellogg Foundation is looking for someone with a bachelor’s degree in a relevant field (communications, English, journalism, or marketing) and “five to seven years of internal/external communications experience” obtained through work at, for example, an agency, a corporation, and/or a large nonprofit. The job description notes that “high tolerance for ambiguity and ability to adapt quickly to change” are required. As far as I can tell, the position is based in Battle Creek, Michigan. Read about the other requirements for the job here.

Deputy Director—Developing Country Immunization Programs

This position is in the Bill and Melinda Gates Foundation’s Global Health Program and is based in the funder’s Seattle office. “Deep knowledge of immunization programs in the developing world” is required. Among the qualifications requested are an M.D., Ph.D., or M.P.H. in public health, health policy, or a related field and “a minimum of 10+ years of experience working in developing world immunization programs and a total of 15 years overall experience in public health.” The foundation says that the job involves up to 30 percent travel. Find a full position description here.

There are many other Global Health Program jobs listed today on the Gates Foundation Web site. Most are based in Seattle, but I saw two jobs based in India. You just need to do a search under “Global Health Program” and specify whether you prefer a certain geographic location.

Evaluation Officer

The Missouri Foundation for Health seeks someone “to conduct and communicate evaluation activities in support of organizational learning and the achievement of impact.” The position description says that “a master’s degree in [an] appropriate discipline or profession” is preferred, “plus six to nine years of successful evaluation research and analysis in health care, [a] community-based setting, academia or other applied social research environments.” Read about other qualifications here. The position is based in St. Louis. Up to 25 percent of the job involves travel.

Federal–State Health Policy Officer

This position is at the Commonwealth Fund’s Washington, D.C., office. The foundation seeks someone with a master’s degree in a field related to health services research, health policy, or health economics and “five years’ related work experience, with demonstrated health policy experience, involving knowledge of and experience working with government and organizations at the state and national level.” Read about other desired qualifications for this new position here.

Program Officer—Health Care Coverage and Cost

This opening is in New York City at the New York State Health Foundation. The foundation seeks someone with “a strong knowledge of health insurance coverage and cost issues and policies.” Requirements for this job include a graduate degree in health, public health, public policy, education, nonprofit management, or a relevant discipline and six or more years of experience “in developing and managing programs to improve health or health care.” A candidate for this position must be able to travel. Read more here.

Program Officer or Senior Program Officer

The Robert Wood Johnson Foundation (RWJF) has an opening at either of these levels in its Research and Evaluation department. The person selected will work with the RWJF’s Health Insurance Coverage Team. The deadline to apply is May 2, and the foundation notes that this “is a three-year, renewable term appointment.” Read about qualifications for the position here.

The RWJF also has an opening for a Social Media Manager in its Communications department. This job also involves working with the foundation’s innovative Pioneer program team. The deadline to apply is April 29. The foundation notes that this is “a three-year, renewable term appointment.” Read the job description here.

Senior Associate, Food Safety Campaign

The Pew Health Group, part of the Pew Charitable Trusts, posted this position, based in Washington, D.C., on March 30. Read about Pew’s work in food safety (reducing health threats from food-borne pathogens) here. Among the requirements listed for this job are the following:

• “Advanced degree (at least a Master’s Degree) strongly preferred.”

• “Four to eight years of relevant professional experience, and/or a Ph.D. plus comparable experience, including demonstrated research, analytical and writing skills. Experience in food safety, nutrition, or agricultural policy preferred.”

• Occasional overnight travel.

Please note that, as of now, this position is only funded through April 2014, so read the caveats. Position details are here.

Senior Associate, Pew Children’s Dental Campaign

The campaign “seeks to improve access to dental health care for disadvantaged children.” This position, based in Washington, D.C., is at the Pew Center on the States, a Pew Charitable Trusts division. Among the requirements is a bachelor’s degree (however, “a graduate degree in public policy, public health, political communications, and/or a closely related discipline [is] strongly preferred”). Also, a candidate needs to have at least four years of “relevant professional experience.” The candidate should understand “the importance of policy-relevant research behind issue campaigns” and be familiar with the oral health field’s current trends, top thinkers, and major concerns. This job involves domestic travel, including trips to Pew’s Philadelphia office “as needed.” Please note that as of now, the dental campaign initiative is funded through June 2013. Read more about the job here.

Senior Program Officer—Health Care Financing and Efficiency

This position is with the Gates Foundation’s Global Health Program and is based in the foundation’s Seattle office. Among the qualifications for this job are the following:

• “Advanced degree in Health Economics, Public Policy, Health Policy or [a] related field—or equivalent combination of education and experience (PhD preferred).”

• At least eight years experience in development finance and policy.

Having foreign language skills is a plus (French preferred). A candidate must be able to travel domestically and internationally; the job is up to 40 percent travel. Read the full position description here.

Roundup of Recent Blog Posts: Environmental Health, Medicaid, Global Health, & More

April 14th, 2011

I have rounded up a list of recent posts from health philanthropy blogs and philanthropy-in-general blogs that caught my eye. For more blog reading, see GrantWatch Blog’s Blogroll (look to the right!).

Environmental Health

“Good Health Should Begin at Home, so Why Is Housing Making Kids Sick?” (Apr. 10). Ben Starrett tells us that “generations of chronic disinvestment in low-income communities have left more than six million families trapped in unhealthy and energy inefficient housing.” He raised the question of how do we create green and healthy homes in poor communities across the country and “establish a new way of approaching home repair and improvement.” Starrett, who is executive director of Funders’ Network for Smart Growth and Livable Communities, points us toward the holistically oriented Green and Healthy Homes Initiative, supported by that network. His post, which mentions the asthma problem and preventable injuries in the home, was on the Council on Foundations’ (COF’s) “Re: Philanthropy: What Matters Now?” blog.

Editor’s note: Did you know that the next issue of Health Affairs (journal) will be devoted to environmental health? It will be released May 4—watch for it! The issue will include a broad-based GrantWatch essay on funding by foundations in the area of environmental health. The journal received funding from the Kresge Foundation for this thematic issue.


“Arizona Bill Would Drop 160,000 People from Medicaid” (Apr. 12). Maureen West writes about Republican Gov. Jan Brewer’s signing of a bill that would cut the state’s contribution to the Arizona Health Care Cost Containment System (Arizona Medicaid) by $500 million in fiscal year 2012 (which begins July 1). West says that this action is “prompting immediate threats of a lawsuit and a new advocacy campaign by nonprofit and other hospitals.” People will be cut from the Medicaid rolls “gradually,” she explains in the Chronicle of Philanthropy’s “State Watch” blog. Also, the bill reduces reimbursements to health care providers by 5 percent. West notes that the federal government must still sign off on the Medicaid changes but adds that a spokesperson for Brewer says that lawmakers are optimistic that approval for them will be granted. (I wonder if that will cause any Arizona health foundations to make any modifications to their funding priorities.) “State Watch” blog reports on “how state and local budgets affect nonprofits.”

Global Health

In “A Clearer View: Global Health Pilots Reporting Program” (Apr. 12), Tachi Yamada, who leads the Bill and Melinda Gates Foundation’s Global Health Program, writes that the foundation is now going to report data on that program to the Organization for Economic Cooperation and Development (OECD). The OECD’s Development Assistance Committee collects info on “the types and flow of humanitarian aid,” Yamada explains. Advocates, policy makers, and researchers use that data. In this pilot program, Gates “is the first private foundation to share” information on its global health giving and will begin with 2009 data. People will be able to compare Gates’s funding data with those of other donors (primarily the governments of thirty-two OECD member countries).

Health Promotion and Disease Prevention

“Are We Underestimating Why People Engage in Unhealthy Behaviors?” (Apr. 8). Academics or others, such as public health policy makers, often believe that they “know what is best for people,” but they may “underestimate” how much “people actually prefer to engage in unhealthy behavior,” Kevin Volpp, who directs the Leonard Davis Institute of Health Economics at the University of Pennsylvania, writes. (I suppose my late-night snacking is an obvious example of this!) Volpp says that this was one of the key themes from a recent symposium, held Mar. 24–25 and funded by the Robert Wood Johnson Foundation (RWJF). The symposium convened behavioral economists, clinical health services researchers, and funders from around the United States, Volpp writes in the RWJF’s “Pioneering Ideas” blog. Attendees were put in workgroups on such topics as adherence to medications, obesity prevention, and payments to health care providers. The idea was to obtain “fresh insights” by teaming “content experts with smart people who had never worked in those areas.” Read about the interesting ideas that germinated from this symposium on behavioral economics.

Foundations in general

“Council on Foundations Puts Philanthropy on Trial” (Apr. 13) reports on a (mock) “trial” held “to debate whether foundations are fulfilling their mission of advancing the common good.” The “prosecutor” was Gara LaMarche, president of the Atlantic Philanthropies, and the “defense lawyer” for philanthropy was Ralph Smith, executive vice president of the Annie E. Casey Foundation, at this “trial” held at the Council’s big meeting this week up in Philadelphia. Read what the verdict was! This post by Caroline Preston was on the Chronicle of Philanthropy’s “Conference Notebook” blog.

The Foundation Center’s Philanthropy News Digest’s PhilanTopic blog (Apr. 12) has more on the Council meeting and a link to a video of the mock trial in its post called “We Interrupt This Program. . . .”

Here are links to a few more views on the “trial” from the Council’s own “Re: Philanthropy” blog. Rick Cohen (Apr. 12), Akhtar Badshah (Apr. 13), and Kisha Green Dimbo (Apr. 13) are the bloggers. The first blogger writes for NonProfit Quarterly; the second is with Microsoft; the third is with the Council.

Informative, Timely, Foundation-Funded Work on Medicare Released

April 12th, 2011

Many of you have heard news reports about Wisconsin Republican Congressman Paul Ryan’s controversial proposal for Medicare contained in a broader fiscal year 2012 federal budget proposal. He proposes a “premium-support model” (some call this payment a voucher) for beneficiaries, beginning in 2022; Medicare would make a payment to a health plan chosen by the beneficiary, thus subsidizing its cost, Ryan’s plan says.

It has also been widely reported that President Obama is going to announce a proposal tomorrow at 1:35 p.m., EDT [apologies for the incorrect time listed before!] to reduce the country’s debt, and that plan will include a reduction in spending on Medicare. Also, private philanthropy has funded an educational briefing and research on the massive Medicare program.

Capitol Hill Briefing:

At the bipartisan Alliance for Health Reform’s “Medicare: A Primer” briefing, Juliette Cubanski gave an excellent introduction to, or review of (depending on your background) the Medicare program and described what is in store for it under the Affordable Care Act, as enacted. Cubanski, a Henry J. Kaiser Family Foundation (KFF) staffer, explained Parts A, B, C, and D of this huge and complex federal program. And I must say that her presentation was in plain English and nicely organized.

Unfortunately, I did not make it to downtown D.C. to attend the Mar. 11 briefing, which the alliance and the KFF cosponsored. Instead, I was able to sit in my office and skim through the seventy-page transcript that the alliance graciously made available on its website. (The Webcast is also posted there.) Here are some highlights of the briefing.

Cubanski mentioned some changes that the Affordable Care Act will make to Medicare. One example: By 2020, the health reform law will phase out the so-called “doughnut hole” (coverage gap) in the Part D prescription drug benefit, in which beneficiaries find themselves paying out of pocket until their catastrophic drug coverage kicks in.

Also, Cubanski pointed out that Medicare is not just for elderly people; it covers those with permanent disabilities. Social Security certifies that such folks cannot work anymore; then they must wait two years before qualifying for Medicare.

She also noted that vision and dental benefits are not covered by Medicare, nor is long-term care for extended care in a nursing home. She said that many elderly folks have supplemental insurance, in addition to Medicare, to cover such things as Medicare deductibles, coinsurance, and premiums. Retiree health plans from former employers are one form (actually, the primary source) of that supplemental insurance, but that is “eroding,” as fewer employers are offering that now.

Bill Scanlon, an economist who is a consultant to the National Health Policy Forum and formerly was with the U.S. Government Accountability Office (GAO), was the next speaker. He got into some complex topics relating to Medicare payments to different providers. (Best to get that information directly from the transcript!)

Scanlon pointed out that Medicare is changing the way it pays for durable medical equipment (such as hospital beds, mail-order diabetic supplies, power wheelchairs, and walkers). Medicare discovered it had been overpaying for such items. So, now, it is lowering the fees, and it has started some pilot competitive bidding programs in certain regions of the United States.

A pharmacist and lawyer, Mark Hayes, who worked for former Sen. Chuck Grassley (R-IA) and now is with the law and lobbying firm of Greenberg Traurig, told attendees about the new Independent Payment Advisory Board (IPAB), which has a goal of reducing health care spending. If Medicare “exceeds certain spending targets,” IPAB recommends savings proposals, he explained. The secretary of Health and Human Services must implement the proposal unless Congress enacts legislation” with equivalent savings.” The board, which is expected to begin work in 2012, is called for under the Affordable Care Act.

Jonathan Blum of the Centers for Medicare and Medicaid Services (CMS) said that in 2011 Medicare’s focus is on prevention and wellness Later, Hayes mentioned that Medicare sends his elderly parents a reminder about preventive care if the program has not recently seen a claim for some preventive benefit.

Someone in the audience commented that payment cuts are looming for physicians, but they have so much student debt. Scanlon said, that, despite all of this, physicians “remain the highest-paid occupation” in the United States and there are still plenty of applications to medical school. One way to address this is to see if medical education can be made “more efficient.”

Blum mentioned that under the Affordable Care Act, there is a new office for “dual eligibles” (people eligible for both Medicare and Medicaid) at CMS. Melanie Bella is already onboard directing that office; she is getting ideas from states about how to better integrate and care for “duals.”

Cubanski’s KFF colleague, Tricia Neuman, pointed out at the start of the briefing that Medicare, a federal entitlement program, “is never far from national policy discussions.” One reason for that, she said, is that Medicare is now 15 percent of the federal budget. Also, Neuman was right on the mark when she commented at the March briefing, “Medicare could pop back on the front burner of discussions if and when Congress gets down to work for real on the federal budget deficit.” Well, that happened a few weeks later, in early April, when Republican Rep. Paul Ryan, chairman of the House Budget Committee, released his proposed budget for fiscal year 2012. (See below for more on that.)

Issue Brief:

In 2010, payments to private Medicare Advantage plans “exceeded average costs in fee-for-service Medicare nationally by 8.9 percent,” but at least this percentage “represents a decrease relative to 2009,” according to an Apr. 1 e-alert. That year, payments to Medicare Advantage plans were 13 percent greater than fee-for-service costs. (For this analysis, posted payment rates to Medicare Advantage plans during 2010 are compared to an estimate of fee-for-service costs for the same beneficiaries in the same year, Guterman explained to me.) Researchers Brian Biles and Grace Arnold of George Washington University and Stu Guterman of the Commonwealth Fund prepared the issue brief “Medicare Advantage in the Era of Health Reform: Progress in Leveling the Playing Field,” which Commonwealth funded. The e-alert also notes ways that the Affordable Care Act addresses Medicare Advantage plans.


The KFF reminds us that “several major deficit-reduction and entitlement reform proposals include raising Medicare’s age of eligibility from 65 to 67 as a way of improving Medicare’s solvency.” This report, Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform, released Mar. 29, estimates expected effects on out-of-pocket costs of elderly people who would be affected by this change and on employers, the federal budget, Medicaid, and others. This study assumes implementation of the Affordable Care Act in 2014, as passed, and the higher eligibility age being effective in 2014 “with no phase-in.” However, authors Tricia Neuman and Juliette Cubanski of the KFF and Daniel Waldo, Franklin Eppig, and James Mays of Actuarial Research Corporation devote a page to likely effects of the higher eligibility age in the absence of the health reform law; they base these remarks on previous work by them and by others.

Survey Result:

Only 29 percent of Americans polled for a News IQ quiz in late March correctly stated that “the federal government spends more on Medicare than on scientific research, education or on interest on the national debt.” Read more about that Pew Research Center for the People and the Press quiz of approximately 1,000 adults and other recent surveys from that Pew project that mention Medicare in “Daily Number: Balancing Budgets: Is Medicare a Solution? Is It a Problem?” The Pew Research Center is a subsidiary of the Pew Charitable Trusts.

Related resources:

“Generational Divide Colors Debate over Medicare’s Future,” David Leonhardt, New York Times, Apr. 5. This columnist cites some interesting research by Gene Steuerle and Stephanie Rennane of the Urban Institute, which compared Medicare taxes paid versus benefits received for various groups of Americans.

“Medicare Cost Would Rise for Many under Ryan Plan,” Janet Adamy, Wall Street Journal, Apr. 6. The article notes that the solution of Paul Ryan, House Budget Committee chair, for reducing spending on Medicare “is to end the current Medicare program for people born in 1957 and after.” Read his plan here: see especially pages 44–47.

“Obama’s New Approach to Deficit Reduction to Include Spending on Entitlements,” Zachary A. Goldfarb, Washington Post, Apr. 10.

It Is National Public Health Week: A Sampling of Foundation Funding in Public Health

April 6th, 2011

Apr. 4-10 is National Public Health Week, I found out when reading Yahoo’s health reform Twitter feed. The American Public Health Association (APHA) is spearheading the week’s activities. The week’s theme this year is “Safety Is No Accident: Live Injury-Free.” Following is a selected sampling of what some foundations are funding in public health.

Do You Live in a Healthy County? Find Out Here.

Marin County, a suburb of San Francisco, was recently ranked the healthiest county in California. And in Alabama, Shelby County, the fastest-growing county in that state, came in at number one.

Where I am getting this information? On Mar. 30 the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation (RWJF) published online the County Health Rankings of almost every county in the United States. The rankings look at various measures affecting health, such as access to healthier foods, air pollution levels, rates of smoking, and rates of obesity. According to an RWJF e-alert, this “is the only tool of its kind that allows people to see how their county compares with [other counties] in their state and against national benchmarks in areas like diabetes screening rates or number of uninsured adults, and makes it possible for leaders in all sectors to identify gaps and work together to develop solutions.” As you can see, not all of the measures pertain to public health per se, but there is certainly information that is relevant to public health.

“The County Health Rankings confirm the critical role that factors such as education, jobs, income, and environment play in how healthy people are and how long they live,” a press release explains. In other words, “much of what affects health occurs outside of the doctor’s office.” These factors are called “social determinants of health”; you may have heard this term used by researchers. The rankings look at more than 3,000 counties, as well as the District of Columbia.

To determine the “Health Outcomes” rankings, you just click on your state (or Washington, D.C.) on a map of the United States. A listing of how the counties ranked pops up. (Montgomery County, Maryland, where my employer, Health Affairs journal, is located, ranked second-healthiest in the state—whew!)

Go to the FAQs; they are worth your time to read.

Antibiotic Resistance

While I am on the subject of geography and health, a new online tool called ResistanceMap allows one to track “the rapid rise of antibiotic resistance.” This resistance occurs when bacteria are able to survive even after treatment with a course of antibiotics. The maps, developed by Extending the Cure, a research project funded in part by the RWJF, indicate regions of the United States where this public health threat is especially severe. The maps change colors to show the resistance level each year from 2000–2009. For instance, I looked up the resistance of E. coli (a major cause of community-acquired urinary tract infections) to the drug ciprofloxacin for people being treated on an outpatient basis. Read the Mar. 3 press release announcing ResistanceMap. The RWJF’s funding of this work falls under its Pioneer Portfolio.


In Sep. 2010, the Institute of Medicine (IOM) released a report that includes content on “superbugs” (defined here as multidrug resistant bacteria), such as methicillin-resistant Staphylococcus aureus (better known as MRSA); “the role of health care facilities” in antibiotic resistance; and how the Alliance for the Prudent Use of Antibiotics (APUA) is responding to the global resistance crisis .You can read the report titled Antibiotic Resistance: Implications for Global Health and Novel Intervention Strategies: Workshop Summary online for free or purchase the 496-page paperback report, online, for $85.50. Two foundations—the Burroughs Wellcome Fund and the Merck Company Foundation—are among the numerous funders of this publication. Eileen R. Choffnes, David A. Relman, and Alison Mack served as “rapporteurs” at the workshop.

Related resource:

“CDC: Salmonella in Turkey Burgers Resistant to Antibiotics,” Atlanta Journal-Constitution, Apr. 5. The Centers for Disease Control and Prevention (CDC) has found that certain frozen turkey burgers are infected with a strain of Salmonella bacteria, and that strain “is resistant to many antibiotics,” reporter George Mathis says in the article. Read detailed information from the CDC about these incidents here. The agency notes that the resistance “can increase the risk of hospitalization or possible treatment failure in infected individuals.”

Food and Health

Shelley Hearne, managing director of the Pew Charitable Trusts’ Health Group, commended enactment of U.S. food safety legislation. Pew, a public charity, issued a statement titled “Pew: Enactment of Landmark Legislation Will Limit Dangers in the U.S. Food Supply,” Jan. 4, after the U.S. Congress passed, and President Obama signed, the law. Hearne noted that this was a “historic bipartisan effort.” Pew has initiatives in both Food Safety and Produce Safety; they are part of its Health Group’s work. I hope that the new law can help avert outbreaks such as the following.

Related resource:

“CDC: Salmonella in Turkey Burgers Resistant to Antibiotics,” described above.

Global Public Health

The Open Society Foundations have a Public Health Program. The term “public health” seems to be used a bit more broadly in this program than it often is. (For example, this program includes projects on both mental health and palliative care.) The foundations’ program is mainly active in Central and Eastern Europe, Central Asia, Southern and Eastern Africa, Southeast Asia, and China, according to the foundations’ website.

An Open Society Foundations fact sheet released in March says that the medication naloxone is “safe and effective,” says author Roxanne Saucier, in treating overdose among people who inject heroin or other opioid drugs. The nine-pager is titled “Stopping Overdose: Peer-Based Distribution of Naloxone.”

Health Professions Education/Public Health

“Fairbanks Foundation Gives $20 M to IUPUI Public Health School,” Indianapolis Business Journal, June 15, 2010. This grant from the Richard M. Fairbanks Foundation, its largest ever, is for establishing a public health school at Indiana University, the funder says on its website. The school, which will focus on urban health, is expected to open in fall 2011. Click on the above link to the business publication to find out more about this huge grant for a public health school on the university’s Indianapolis campus (called Indiana University-Purdue University Indianapolis).

Click here to find out about the Fairbanks Foundation’s funding in health. Please note that this foundation generally funds only in the Greater Indianapolis area (especially Marion County), according to the FAQs on its website.



The 2009 H1N1 Influenza Vaccination Campaign: Summary of a Workshop Series, another IOM report, focuses on this campaign to prevent what some called “swine flu.” Because of the spread of the H1N1 virus, the World Health Organization declared in June 2009 “that a global pandemic was under way,” the report reminds us. The vaccination effort was one of the largest public health campaigns in U.S. history, and in the first three months of the campaign, a quarter of the U.S. population was vaccinated, the report notes. Topics covered include vaccine supply, vaccination rates in certain populations, and funding and payment issues. Two foundations—the RWJF and the United Health Foundation—are among the numerous funders of this report, which was released in Oct. 2010. Read the report for free online or purchase it online for $31.05. Clare Stroud, Lori Nadig, and Bruce M. Altevogt served as rapporteurs.

Improving the Health of Fourteen California Communities

Read about the California Endowment’s ten-year initiative called Building Healthy Communities. For more information, including a list of the fourteen California communities that are participating, visit

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