Health Affairs

The author is the new president of Grantmakers In Health, an organization of health funders. It is based in Washington, D.C.

In the past thirty years, health philanthropy has undergone major changes, and the field continues to evolve. In its role of advising and informing health funders, Grantmakers In Health (GIH) has been an active part of this evolution. We are interested now in a variety of developments that will change the landscape of health philanthropy in coming years.

When GIH began in 1978, the community of health funders consisted primarily of private and community foundations and corporate-giving programs. Health grant making consisted mostly of support for charitable organizations and causes; there were few of the major initiatives that are now commonplace. Then—as now—many funders had small staffs who found it difficult to keep abreast of the information they needed to make informed decisions. To help funders connect and share ideas, GIH was formally incorporated in 1982, with support from the Robert Wood Johnson Foundation and other foundations. Having an organizational frame of reference helped the field evolve into the complex entity we know today as health philanthropy.

The early ‘80s is also when conversion, or legacy, foundations began to emerge. These new foundations were created when nonprofit health care organizations were converted to for-profit status. In such cases, federal law requires that proceeds from the sale of tax-exempt entities’ assets be directed toward charitable purposes. Conversion foundations quickly caught on, and in the fifteen-year period beginning around 1985, more than 130 were established.

These “new health foundations” doubled the dollars available for health-related grant making and made more than $15 billion in assets available to local communities. Staffing them brought new people into the field to serve as foundation presidents and board members, some of whom had a limited health background or limited familiarity with philanthropy. An additional challenge was that some of the new health foundations were required to institute community advisory processes that were a sharp departure from traditional foundations’ operating styles. As a provider of technical assistance, GIH played a vital role during this period by providing information about best practices to new funders and creating opportunities for funders of all types to learn from each other.

Several recent developments signal new directions in health philanthropy. One is the strong and growing interest in what is variously known as impact, mission-related, or social investing. These terms refer to financial investments by foundations or other entities that, like grants, advance mission, but, unlike grants, also recover the foundation’s or other investors’ principal or earn a financial return. Impact investments often enable foundations to achieve a type or scale of social impact that grant making alone would not. Many foundations use impact investments to deploy a greater-than-usual share of their resources to advance their mission and to ensure that those resources are not working at cross-purposes with their overall mission and grant strategy. Read the rest of this entry »

The author, the CEO of Weight Watchers International, describes a new initiative that the company launched with the U.S. Conference of Mayors. Cities can apply now (please see below).

Cities today face huge health challenges. For residents, cities are the guardians of public health. For municipal employees, cities serve as health care providers. In both cases, mayors and city councils must juggle these two roles at a time of fiscal crisis, high unemployment, and an ongoing obesity epidemic, which threatens the health of millions of Americans.

The corporate world, of course, faces its own challenges. To be successful and competitive, we need a vibrant, healthy workforce. We, too, must find ways to control employee health care costs.

So why not find ways to better tackle these problems together?

That is why Weight Watchers recently announced an initiative with the U.S. Conference of Mayors through which Weight Watchers will provide up to $1 million in grants to help foster healthier cities. The goal: Support behavior change to reduce the incidence of weight-related chronic diseases, from heart disease to type 2 diabetes, which fuel health care costs and undermine productivity and quality of life.

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The president and CEO and the vice president of policy and communications at the Connecticut Health Foundation describe its new approach and the successes of its grantees.

Foundations often employ the twin strategies of grant making and commissioning and advancing objective policy research, but rarely do the twain meet.

Since its inception in 1999, the Connecticut Health Foundation has commissioned research to identify and advance policy solutions to health issues in Connecticut and has enjoyed success in making known the potential health implications of policy changes. At the same time, we have awarded grants to advocacy groups that are working on the same issues as we are, but with fewer resources.

What if we bolstered their capacity to commission their own high-quality research? And what if we also empowered these groups to select research topics that advanced our shared goals? After all, they know more about the priorities of the people most affected by health policies, and, as a result, could make more effective messengers.

These questions led to the Integrating Health Policy Research and Advocacy Initiative, an experiment in grant making. Through a request for proposals (RFP), we invited applicants to propose policy research projects that both supported our foundation’s strategic objectives and met the applicants’ own needs.

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My GrantWatch column in the newly released February 2013 issue of Health Affairs focuses on what foundations around the country have been funding in these areas. Of course, the column includes only a sampling of foundation-funded activities. The column is free access to all.

Health philanthropy has been exploring patient engagement in its grant making as well as continuing to fund in the “older” areas of patient safety and health care quality. The theme of the journal’s February issue, which was funded by the Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation, is the “New Era of Patient Engagement.” As our editor-in-chief Susan Dentzer explains to readers in her column introducing the issue, “patient engagement is variously defined.” She points out that the Institute for Healthcare Improvement, once led by Don Berwick, says that patient engagement encompasses “actions that people take for their health and to benefit from care.”

Then there is the similar term, “patient activation.” In this issue of Health Affairs, Judy Hibbard of the University of Oregon and her coauthors describe it as “understanding one’s own role in the care process and having the knowledge, skills, and confidence to take on that role.” Well, enough about definitions!

In my GrantWatch column, I mention two Institute of Medicine reports funded by groups of foundations. You may want to check these out for background reading on the topics of patient engagement and quality of care. Also, I list some components of the Affordable Care Act that are related to these concepts.

Patient Engagement

Read in this section of the column about the Gordon and Betty Moore Foundation’s huge Patient Care Program. This funder has allocated $500 million over ten years for this effort. (Yes, you read that right!)

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This is a slightly modified version of a post that appeared on Health Affairs blog on January 28.

Health Affairs readers may have noticed something a little different about the Narrative Matters essay in January’s issue. The essay, “To Fight Bad Suga’, Or Diabetes, My Neighborhood Needs More Health Educators,” by Joseph West of Sinai Urban Health Institute, is the first to include the Policy Checklist, a new feature that will accompany all of our Narrative Matters essays going forward.

The feature points readers to related readings, enacted or proposed legislation, current or planned governmental and private initiatives, and other resources that can help to round out  perspectives on a given health policy issue. In the case of the checklist accompanying West’s essay, about the need for more community health workers to serve residents in one poor Chicago community devastated by diabetes, the checklist points to Affordable Care Act grants for outreach to medically underserved populations, community-based diabetes management projects like the CDC’s Project DIRECT, and Health Affairs papers on a national diabetes prevention strategy and on the measured benefits of community health workers.

With the generous support of the W.K. Kellogg Foundation, Narrative Matters personal essays have always connected personal stories to these sorts of relevant and highly topical policy issues in the health care system. Over the years, Narrative Matters essays have taken on topics ranging from the US mental health care system to oral health care to end-of-life care. Many have generated significant discussion and reflection in health care and health policy circles, and advanced the policy debate on several fronts. Read the rest of this entry »