Can Philanthropy Tackle Congressional Dysfunction? Grantmakers In Health Wanted to Know

November 25th, 2014

On November 6, Larry Kramer, president of the William and Flora Hewlett Foundation in Menlo Park, California, spoke at the Grantmakers In Health (GIH) Fall Forum. He is a chief architect of Hewlett’s nascent Madison Initiative, which aspires to help restore room in Congress for the kind of negotiation and compromise that is necessary for members of Congress to act and solve problems. In the words of the foundation,

This requires that Congress represent and balance the diverse and often conflicting array of interests, ideas, and agendas of the American people; that the public believes in the legitimacy of the process through which Congress is working; and that the process can support the refinement and improvement of past decisions as new circumstances arise.

Coming just two days after the 2014 midterm elections, Kramer’s speech describing this ambitious goal was not only a timely topic, but also an opportunity for health funders to reflect at the broadest level on the political processes that ultimately shape health policy.

Congressional dysfunction, and the threat it poses to the integrity of the democratic process, is the impetus for the Madison Initiative. As Kramer described it, political dysfunction has become so extreme that moving policy at all—much less in a productive direction—is virtually impossible. The problem cuts across all fields and sectors and affects everyone. It is acutely evident in Congress, but there are also troubling signs that it is seeping downward to the local level. Because of this dysfunction, Kramer has previously observed in the Stanford Social Innovation Review blog, “Solving problems at scale has become nearly impossible now that political polarization has all but extinguished rational debate and smothered any ability to compromise.”

Kramer cited political reactions to the Affordable Care Act (ACA) as just one example of the dysfunction that the Madison Initiative will address. Other major policy reforms have been accepted at some point, even if they were controversial initially, he said. In contrast, in the current era, there continue to be calls for the repeal of the ACA, nearly five years after the law took effect.

What Is the Problem with the Democratic Process?

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Funding Social and Economic Interventions to Improve Health: Health Legacy Foundation Strategies

November 24th, 2014

Nearly $1 billion in grant funding is awarded each year by health legacy foundations (which some call “conversion foundations”). These foundations are formed with proceeds from mergers and acquisitions of nonprofit health care entities and currently operate in forty-three states across the country. At least 306 of these foundations have been established over the past three decades, and in 2010, their combined assets totaled more than $26 billion.

Although this figure may not seem so impressive on a national scale, health legacy foundations can have an enormous impact at the community level. Most of these funders originated from a nonprofit hospital and restrict their giving to one or two counties, frequently mirroring the hospital’s service area.

For some communities, the millions of dollars in new philanthropic assets represent unprecedented potential to support local charitable initiatives. How health legacy foundations use these funds to respond to community health needs is a crucial issue.

The November 2014 issue of Health Affairs featured my GrantWatch article, coauthored by Bill Brandon of the University of North Carolina-Charlotte, that examined social determinants of health in communities where health legacy foundations have been established. Compared to communities without health legacy foundations, communities where these foundations are located had significantly higher proportions of racial minorities and multiple socioeconomic factors that rendered them more vulnerable to health disparities and poor health.

On the other hand, communities with health legacy foundations had lower rates of uninsured people, lower rates of preventable hospitalizations, and a better supply of physicians and dentists.

Certainly, health legacy foundations need to assess the needs and resources within their own communities before developing and prioritizing grant-making strategies. However, our study’s findings underscore the need for health legacy foundations to consider social and economic interventions as viable options for improving community health.

Many health legacy foundations have developed grant-making initiatives aimed at improving socioeconomic status. These foundations offer examples of promising strategies for health legacy foundations and other grantmakers to consider in their pursuit of better health status. Several of these initiatives are described below. Read the rest of this entry »

Game Changers: Philanthropy’s Role in Eliminating Mental Health Disparities

November 17th, 2014

“We believe funders are game changers; we have a significant opportunity to change the health care landscape,” said Rick Ybarra, program officer for the Hogg Foundation for Mental Health, located in Austin, Texas. Ybarra, together with Octavio Martinez, executive director of the Hogg Foundation, and Enrique Mata, senior program officer for Paso del Norte Health Foundation, located in El Paso, Texas, met with three dozen foundation leaders in early November during Philanthropy Southwest’s 2014 Annual Conference in Phoenix, Arizona. The panelists sought to show funders how their differing efforts, ranging from small to large in scope, can add up to help eliminate mental health disparities among racial and ethnic minorities.

The session built on the August 2013 Grantmakers In Health (GIH) special report, A Window of Opportunity: Philanthropy’s Role in Eliminating Health Disparities through Integrated Health Care. The report recommends four overarching approaches for funders to consider as ways to promote systems change and facilitate the integration of primary care and mental health services. These approaches have been shown to work in eliminating health disparities:

1) grant making: take risks, involve community members, include a broad range of grantees, fund planning and preparation efforts, focus on evidence, partner with other organizations;

2) educating: develop internal expertise at foundations, emphasize research and evaluation, share knowledge and lessons learned with stakeholders;

3) convening: serve as a neutral convener, bring experts together, form learning communities, provide safe opportunities for “daring dialogues”; and

4) advocating: support policy fellowships, host a legislative summit, promote policies for sustainability of funded projects, facilitate a policy workgroup, be a voice for cultural and linguistic competency.

Panelists emphasized that regardless of the approach, it is important for foundation staff and trustees to see firsthand the needs in their communities. Read the rest of this entry »

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