September 27th, 2011
Why did the Duke Endowment decide to select disease prevention as one of its three major funding areas in health care? Why would a private foundation invest in programs and infrastructure to prevent disease when the number of uninsured is growing and there is not enough funding available to treat people burdened with chronic disease?
The Duke Endowment’s health care program area has always recognized the importance of prevention. Beginning in 1925 the first director of the then-hospital section of the Duke Endowment, Watson S. Rankin, argued that basic medical service must include the “practice of preventive medicine,” according to the book Legacy to the Carolinas.
Over the years, the Duke Endowment, which funds in North and South Carolina, has funded efforts such as Safe Kids (a community education program that focuses on injury prevention) and screening programs for early detection of chronic disease or domestic violence and child abuse. The programs were successful and furthered our efforts around prevention. However, programs aimed at strengthening not-for-profit hospitals and increasing access to high-quality health care were considered priorities for endowment funding.
In 2006 the Duke Endowment’s Committee on Health Care carefully reviewed and discussed the health care environment, the health of residents of the Carolinas, and the endowment’s approach to grant making. Data sources, such as the Robert Wood Johnson Foundation–supported county health rankings and state rankings on obesity compiled by Trust for America’s Health, helped us recognize that even with the best medical treatment, residents of the Carolinas, when compared with other states, are not as healthy. In addition, the rising costs of health care and the increasing number of the uninsured were identified as areas of concern.
Prevention was viewed as an evolving field, and it was noted that its application in clinical practice, health policy, and community health programs have been shown to improve the public’s health. The committee concluded that implementing effective preventive strategies held much promise in regard to improving health status and ultimately decreasing health care costs and improving quality of life. The recommendation to select prevention as one of the endowment’s three major goals and areas of priority funding in health care was presented to its trustees.
The board approved the recommendation. This action initiated a strategy to promote the importance of prevention in the field and to encourage collaborations on prevention with other health funders, hospitals, and health care organizations. The logic we used was that by seeking strategies to advance prevention and by focusing our funding on evidence-based programs to improve health, we would encourage hospitals and other grantees to become more engaged in effective programs to prevent chronic disease.
Our work in prevention over the past five years has included partnering with other health funders, including the Kate B. Reynolds Charitable Trust, BlueCross BlueShield of North Carolina Foundation, and the North Carolina Health and Wellness Trust Fund, to support the North Carolina Institute of Medicine to develop a statewide prevention plan. The Duke Endowment has also collaborated with the North Carolina Hospital Association, South Carolina Hospital Association, and NC Prevention Partners to create a culture of wellness in our region’s hospitals. We supported the establishment of the North Carolina Center for Hospital Quality and Patient Safety and the South Carolina Institute of Medicine and Public Health. We have also taken a lead role in helping North Carolina develop and implement a program to achieve its Healthy People 2020 goals.
The Duke Endowment believes that if residents of the Carolinas have good health, the costs of health care will decrease and residents’ quality of life will improve. We must work together with public and other private resources to fund effective programs and organizations that address prevention. We must also align resources and goals with the Affordable Care Act of 2010 and national efforts such as Triple Aim and Healthy People 2020. Improving public health and decreasing preventable disease and accidents is everyone’s responsibility.
Editor’s note: Read more about the Duke Endowment’s funding in health care here.