New perspectives on how philanthropy can improve community health
The health and well-being of people are intimately linked to the living conditions in their communities, conditions which structure the opportunities and avenues for well-being throughout life and even intergenerational. Philanthropic efforts to improve community health must address the many systems that shape living conditions by focusing not only on who, What, Where or finance, but just as important, on How? ‘Or’ What to finance.
The Urban Institute recent full review of health-focused community development investments made by the Robert Wood Johnson Foundation between 2013 and 2019 provided a wide range of information on how philanthropic investments can drive the lasting systems change needed to improve the health, well-being and equity of communities across the country.
Drawing on dozens of interviews with beneficiaries and partners, community development intermediaries and philanthropic leaders; collective impact research and social responsibility; and Urban’s expertise, we have identified three key recommendations (among others) that are particularly important for donors seeking lasting impacts on community health and well-being:
- Target the root causes of community health inequalities in the United States by dismantling systemic racism, centering community power and responsibility, and investing in children and families;
- Engage and lobby the health care sector to redirect significant resources to community health and development, where so many non-medical drivers of health and well-being are embedded;
- Direct multiple forms of philanthropic power and influence towards true systems change – permanent imprints on policies and practices, so that power and control is transferred to people and places who need it most.
Three key recommendations
The first calls for a fundamental commitment to tackle the many systems that produce conditions of inequality and inequity in health, in particular systemic racism and the injustices that result from it; accountabilityâBy self-determination and control over the necessary resources â the people and places most affected by marginalization and exclusion; and investing in the early ages and stages of life to account for the cumulative benefits of health promoting factors over the life course.
Mid-term adaptations to the Challenge of strong, prosperous and resilient communities (SPARCC) âa multi-site initiative involving local efforts in six regions to build healthy communities â including recognition racial equity as a primary driver of community health outcomes, and ensuring that community development capital strategies reflect community-based approaches. And while it may be tempting to focus exclusively on the people and places that have been most affected by systemic marginalization – they are certainly in the best position to explain how it works and with what pernicious effects – it is essential that we also examined and held accountable those who had more Power and privilege, because they are usually the ones who have the most control over decision-making, even at the hyper local level.
A second recommendation arises from the fact that to nearly 18% of gross domestic product (GDP) and growing, the healthcare sector consumes a disproportionate share of the country’s resources. Cross-national evidence consistently shows that the US spends more on health care (by far) than other high-income countries and yet have one of the worst health and survival outcomes. This significant and growing “health disadvantage” in the United States spans decades and is found at all ages, both sexes, and among all racial and socioeconomic groups.
The country is not spending its health care dollars wisely, with necessary redistributions within the health care system and, equally important, a shift in some of those health care dollars to other areas. These include the tradition communautary development areas such as housing and the built environment, but also education, employment and youth development. The Democracy Collaborative, for example, works with health system leaders to proactively address the economic and racial inequalities in community conditions that create poor health. It is important to recognize, however, that redirecting health funds (at scale and in a sustainable manner) to communities will not be without complications and resistance, and philanthropic health funders have a role. important to play in this change.
Finally, the many systems that generate the large and growing forms of inequality in the country, be it inequalities in health, income or wealth, generally work. as designed. It follows that solutions must also focus on systems, and in particular on how they are designed to function, distribute resources and impart energy.
If we think of system change in terms of ‘permanent imprints’ on policy and practice, then philanthropic funders should think of How? ‘Or’ What they contribute to sustainable transfers of power to people and places that have been subject to long-term disinvestment and marginalization. Traditionally, philanthropy has deployed its financial resources through granting of grants. However, as an important center of power, philanthropy must use all the resources at its disposal, including its social, moral, intellectual and reputational capital.
The important role of philanthropy
The opportunities for philanthropy, especially health philanthropy, to improve the health, well-being and equity of the community are enormous and still largely untapped. Many efforts across the country are aimed at more equitable policies and practices â some are just beginning, and others have long and rich histories in their communities.
But it takes power to move power, and to do so in a way that is both effective and sustainable. Health philanthropy can be a major force and accelerator in these efforts, and together with grantees and other partners, can help to change systems and resource flows in ways that optimize health in sub-communities. invested across the country. The country deserves no less.