Healthcare philanthropy keeps getting more ambitious, and we've written a lot about the Robert Wood Johnson Foudation's bold push to create a "culture of health." But where the Kresge Foundation is going with its health funding is another great example of how funders are thinking bigger.
Last month, the foundation said it was zeroing in on two profound challenges to creating a healthier America: First, addressing the upstream causes of bad health; and second, getting community partners to work together to foster better health and more effective healthcare systems.
Let's start with the idea of looking upstream, which is super-hot right now. The number of times we’ve heard health-focused philanthropies—especially those that deal with public health—trot out the term in the last four months is staggering. Funders seem to have declared war on Band-Aid fixes for obesity, smoking, bad diet, diabetes. Like counter-insurgency experts, they want to get at the causes of these problems—going upstream, taking on these problems at the source.
A prime target is the very organization of American society. The way we live, move around, and consume direct us to poor health choices at nearly every turn, and that can be especially true in poorer neighborhoods. Junk food and booze is available everywhere, but just try getting fresh produce. The television beckons, but good luck finding a nice green lawn to play soccer on. In a great many places, cars are the only way to get from point A to point B.
Improving community health requires programs and policies that ensure the places where people live, work, learn and recreate support good health. This holistic view includes everything from land use and transportation to public safety and local food systems as important contributors to good health.
It may sound daunting for health philanthropy to take on such big issues in society, far removed from the immediate realm of medicine. But quite apart from common sense, a growing body of data suggests that this larger focus is all-important.
Kresge says that some 70 percent of a population’s health is affected by physical, social and economic environments. David Fukuzawa, managing director of the health program says:
Addressing things like access to affordable, healthy food, housing and transit are especially critical for low-income communities, which have higher rates of chronic diseases, such as diabetes and obesity. We believe that path toward better health for these communities lies in improving the overall environments.
Are philanthropic dollars for health care really best spent promoting public transportation or bike paths or parks or local food coops? I guess we'll see, because lots more funding is now going in exactly that direction, which Kresge calls "Developing Healthy Places."
To be sure, though, Kresge is not betting all its chips on fighting upstream causes. Like any good counter-insurgency operation, it will also directly engage the enemy, but in a smarter way: By getting a range of players—hospitals, community organizations, government agencies—to work more closely together to create more cohesive strategies to improve health.
Too often, in the current health system, people only go to the doctor when they get sick, and then find themselves in a fragmented and rapacious fee-for-service system that is more interested in running up the meter than ensuring better healthcare outcomes over the long-term.
Kresge, like other big health funders such as RWJF, wants that to change. It wants players from different sectors to work at keeping people healthy to begin with, and then ensuring that when they do get sick, health systems work with them in a holistic, cost-effective way to help get better—and stay better.
Kresge has been a supporter of a big funder collaborative along these lines called BUILD Health, that we've written about in the past. But lots of other efforts are also happening, and Kresge wants to speed things along. Hence the title of the second pillar of its retooled healthcare program: "Accelerating Community-Centered Approaches to Health."
It's cool stuff, and pretty radical: Kresge wants to both change how Americans live and overhaul how a $3 trillion health system operates.
As for how it will execute this vision with day-to-day grantmaking, and distribute funds, the foundation does a good job of spelling out those details on its website.