NOVEMBER 17, 2015 I S S U E F O C U S Checking in on Philanthropy’s Investments COLIN PEKRUHN, Grantmakers In Health T he Surgeon General’s Call to Action in 2001 sparked suring large, population-level changes in body-mass index widespread public concern about the rising prevalence (BMI) and behavior. A few funders have adopted metrics to of obesity and overweight in the United States. Since evaluate the impact of their investments across programs at then, many health funders have supported obesity prevention, the portfolio level, such as community-level changes in healthy eating/active living, and healthy living. Their commit- BMI, eating behaviors, and food purchases. The value of ments have ranged in size and scale, from local foundation evaluating at this level is the focus on long-term improve- programs to the Robert Wood Johnson Foundation’s two $500 ments in healthy behaviors. million national initiatives. Cumulatively, this foundation work The Pottstown Area Health & Wellness Foundation is has yielded encouraging signs of progress, especially among very an example of a local foundation using portfolio-level evalua- young children. Looking ahead, foundations continue to exper- tion to assess its investments in healthy eating and active iment with innovative investments and new strategies, many of living. Beginning in 2013, the foundation embarked on a which address challenges to moving the work forward. process to measure outcomes by assessing the extent to which grantee organizations and schools implement best practices PROMISING TRENDS that lead to desired outcomes. Using Algorhythm’s EKOS™ model as an organizing framework, it conducted a literature In 2014, GIH released Foundation Strategies to Promote review to identify strategies that lead to increased community Healthy Eating and Active Living, a scan of the field that levels of, and family engagement in, physical activity and identified areas of progress and continuing challenges. Key nutrition education, and used this information to develop a findings included the following: shared online measurement system for its grants. Beta-tested • Funder support for healthy eating and active living has by a diverse group of grantees, the system uses pre- and recur- grown over the past 15 years and become widespread. ring post-test data to measure each grantee’s progress towards meeting five evidence-based priority outcomes. The system • Foundation boards recognize the importance of healthy allows for automated data collection and provides real-time eating and active living as a priority issue, while also feedback that grantees use to make quick adjustments to understanding that change requires significant investments improve programming and the foundation uses to inform of time and resources. future grantmaking decisions and processes. • A growing body of evidence supports the positive impact of ® Grantee Capacity Building. Grantees’ capacity to effec- grantmaking related to K-12 school environments; early tively implement programs and sustain their visions for childhood; land use; transportation; and safe, health- change remains a major worry for grantmakers, although promoting spaces. many have observed a marked improvement over time. • Funders are focusing on the long-term sustainability of their Funders’ concerns range from gaps in general institutional investments. capacity (in such areas as governance, and program or finan- cial management capabilities) to programmatic Areas where health funders can improve include: increasing competencies (in such areas as grassroots organization, com- the robustness of portfolio-level evaluation, building greater munity awareness building, and policy advocacy). grantee capacity, and investing more in local public policy In the case of public-private partnerships to support advocacy. interventions in healthy eating and active living, funders view inconsistent public-sector leadership and staff capacity ® Portfolio Evaluation. Evaluating grants related to healthy as serious issues. For example, public-sector staff turnover eating and active living is common, but generally limited to can hinder school-based initiatives and built-environment individual grant recipients. Most grantmakers, especially at improvements like “complete streets” and expansions of the local and regional levels, remain focused on process public transportation. Such concerns have given rise to mis- measures and intermediate outcomes of program activities, givings about the long-term sustainability of working with in large part because of challenges in identifying the appro- government, despite the potential these opportunities pre- priate metrics, insufficient resources for large-scale sent. For example, funders who invest in schools worry evaluation, and insufficient time and investment for mea- about the institutionalization of school-based interventions I S S U E F O C U S GIH BULLETIN given ever-changing school budget dynamics, leadership ® Agreement on Targets and Strategies. There is growing turnover, and competing priorities. consensus that a maturing grantmaking field should consider Enhancing the capacity of its grantees is part of The moving towards identifying common, measureable targets. Colorado Health Foundation’s strategic focus on healthy This would address the uncertainty about appropriate short-, living. Through its grantmaking to support healthy living intermediate-, and long-term metrics that currently hinders advocacy, the foundation has furthered larger policy efforts and many evaluation efforts. There is also a growing sense that built the capacity of leading community organizations working there should be greater agreement and coordination on best to change the policy environment. Foundation staff are inter- bets for investment. Addressing these challenges could viewing advocacy organizations to assess the needs of the field, include better dissemination of research and evaluation organizational policy goals, and challenges facing both the reports among funders, creating common messages, and organizations and the success of healthy living policies. developing a common theory of change. Neighborhood youth are being canvassed to identify their pri- ority issues and how their voices can or could be better heard. ® Importance of Unique Funder Roles. Health funders The interviews and canvassing will inform the foundation’s bring different resources, perspectives, and capabilities to policy advocacy grantmaking as well as its efforts to enhance their work; often these differences relate directly to their community capacity, with the goal of empowering youth to geographic focus. Local, state, and national funders have become civically engaged advocates for healthy living. unique roles to play that can complement and broaden the work of promoting healthy living and reducing the rate of ® Local Public Policy. Relatively few local and regional foun- obesity. This interrelationship is particularly evident in pub- dations fund advocacy or community organizing related to lic policy, where national funders can take on large policy healthy eating and active living. In some cases, the necessary issues and provide supports for state and local funders to nonprofit capacity does not exist. In other cases, local pursue national policy implementation along with state and grantmakers feel more comfortable directly funding local local policy advocacy work. government institutions, typically public school districts, to The Robert Wood Johnson Foundation is taking advan- encourage and facilitate policy change. These efforts range tage of this complementarity of roles by moving from early from funding districts to develop and implement compre- work that supported specific local initiatives and programs to hensive policies on school wellness, to providing needed a focus on building the supports and infrastructure that analyses and data to inform local policymakers (e.g., nutri- advance the overall movement and allow for state and local tional assessment of school meals, student BMI tracking). innovation. An early instance of this transition was the foun- The Horizon Foundation works locally on policy advo- dation’s Healthy Kids, Healthy Communities national cacy, using a strategy designed to enact regulatory change program, which focused on providing training and technical across multiple providers and institutions. The foundation assistance to states, communities, and localities to inform and found early success through advocacy for the adoption of guide policy adoption and implementation to support child- child care center licensure requirements that reduce children’s hood healthy weight. A current example is the foundation’s screen time, increase their access to healthy beverages, and support of Voices for Healthy Kids, a joint initiative with the support breastfeeding. Next, the foundation launched American Heart Association that provides grants and techni- Howard County Unsweetened, a communitywide advocacy cal assistance to state coalitions’ mobilizing campaigns. campaign aimed at making healthy beverage options more accessible. The foundation has also engaged in state-level ® Importance of National-Local Policy Interrelationships. policy work, such as its partnership with the American Heart Policies have a bidirectional influence on outcomes that Association and others to support Sugar-Free Kids Maryland, directly and indirectly affect populations. Thus, a federal pol- an effort to reduce sugar consumption in the state. icy, like reauthorization of the Child Nutrition Act, can have Observing that many local nonprofits are undertaking significant intended and unintended consequences when similar work to promote healthy behavior change and reduce implemented at the local level. It is important for funders to obesity rates, the foundation has adopted a collective-impact consider how state and federal policies could play out in their approach to coordinate grassroots efforts in policy advocacy own communities and what their role might be in the process. in Howard County and the state of Maryland. It selectively Convening local, regional, state, and national grantmakers for identifies and partners with diverse organizations from across conversations and possible collaborations potentially brings sectors and brings them together to coordinate, in support of important perspectives to the table. the common goal of promoting healthy behaviors. CONCLUSION NEXT STEPS FOR HEALTH PHILANTHROPY The outlook for health philanthropy’s continued leadership in Focusing on portfolio-level evaluation, grantee capacity build- reducing obesity rates and promoting healthy living is very ing, and local public policy advocacy can improve the work of positive. Foundation leadership, staff, and boards recognize that individual grantmakers and address significant areas of need. progress will take time and patience, and grantmakers have excit- There are additional steps that can potentially advance the field. ing new opportunities that may help turn the tide on obesity.