So Long, Stay Well: What Did Risa Lavizzo-Mourey Achieve at the Robert Wood Johnson Foundation?

photo: rwjf

photo: rwjf

Being an outstanding foundation president is much harder than it looks. At the end of the day, success in these jobs is all about having impact, ideally in some new and important way, and quite a few CEOs finish up their tenures with middling records. Maybe they didn’t have any big ideas. Or maybe they did place major bets, but the wrong ones. Or maybe their promising plans foundered on the shoals of poor execution—or worse, got derailed by internal dissent from board and staff. A lot can go wrong.

All of which is why it’s worth looking back at Risa Lavizzo-Mourey’s 14 years atop the Robert Wood Johnson Foundation as her tenure comes to a close. Everything went right. In fact, it’s hard to think of a more successful top foundation head than Lavizzo-Mourey in recent decades. Under her leadership, the nation’s fourth-largest grantmaker, one exclusively focused on health in the U.S., scored major successes that improved the lives of millions of people.

“Risa has been the most important person in public health philanthropy in a generation,” Darren Walker told me. “She was a really great leader.” Many others in the sector would agree with that assessment.  

But what, exactly, did Lavizzo-Mourey do? And how did she do it? Here's a look at a few of the ingredients of her success. 

Perfect Timing

To succeed in philanthropy, it helps to be working in the right area at the right time. The windows of opportunity to drive big change tend to open and close, and funders often have limited control over these cycles (as much as they might like to think otherwise). Lavizzo-Mourey’s timing couldn’t have been better. When she came to RWJF in 2003, a new and broader conversation about American health was underway. Eric Schlosser’s investigative look at how we eat, Fast Food Nation, was a runaway bestseller—as was Michael Pollan’s The Omnivore’s Dilemma a few years later—underscoring rising public and elite concern over America’s unhealthy eating habits and its corporate-controlled food systems. In the public health world, more alarms were sounding about the devastating long-term impact of soaring obesity rates.

Health policy debates were also heating up in Washington, after a period of quiescence that followed the Clinton administration’s failed effort at reform in the mid-1990s. President Bush had signed a landmark bill in late 2003 to improve prescription drug coverage under Medicare—a measure that only scratched the surface of dealing with the deeper dysfunctionality of a U.S. healthcare system that left millions uninsured even as costs marched rapidly upward. President Obama entered office determined to pursue the Holy Grail of U.S. social policy that had eluded Clinton—universal health coverage—instigating a chain of events that’s still unfolding today.

In short, Lavizzo-Mourey’s tenure at RWJF coincided with one of the most eventful periods in the history of public health—one that presented opportunities that she and the foundation deftly seized at every turn.

A Big Idea

One way that Lavizzo-Mourey exploited these opportunities, and helped create new ones, was by throwing the full weight of RWJF behind a big idea in tune with the times—namely, that creating a healthier society requires looking upstream, beyond traditional issues of medical care, to address the social and economic factors that influence health. The foundation now talks about this approach under the rubric of a “culture of health,” the umbrella frame that Lavizzo-Mourey rolled out in a 2014 speech that called for a sweeping effort to create "healthy places and healthy practices," making changes that touched many parts of American life.

RWJF's new thinking along these lines started percolating right after Lavizzo-Mourey took over, as she led the foundation to focus on the rise of childhood obesity, developing work that became a $500 million national initiative launched in 2007 to reverse this trend. (The foundation has since put another half-billion dollars behind this work.) While obesity in childhood correlates with a range of negative health outcomes, it was impossible to look at this problem without recognizing that better medical care was unlikely to have much impact. Instead, the solutions lay in changing what kids ate, how active they were, and more. Which is exactly what RWJF sought to do with ambitious and far-flung grantmaking on childhood obesity. Today, after years of upward growth, obesity rates have flattened, and for the youngest children, have declined.

Along the way in this fight, Lavizzo-Mourey made herself, and RWJF, the most important advocates in America for addressing the social determinants of health. While this idea had long ago gained traction in other advanced countries, it didn’t really stick in the U.S. until RWJF embraced it in an “intense and strategic way,” as Walker described the foundation’s near-messianic approach.

“It is almost impossible to overstate the influence that Risa and her team at RWJF have had on public health philanthropy,” said Rip Rapson, who’s the CEO of the Kresge Foundation, another big health funder and frequent collaborator with RWJF. “Risa has skillfully and patiently evolved Robert Wood Johnson’s longstanding focus on healthcare and public health into a more multidimensional approach centered on wellness, looking upstream to identify and address determinants of disparate health outcomes in low-income communities.” The result, he said, was that they’ve “forever changed the conversation in favor of a recognition of the multiplicity of factors at play in poor health outcomes.”

New Partnerships

The Robert Wood Johnson Foundation has over $10 billion in assets and paid out nearly $350 million in grants in a recent year. Despite these resources, Lavizzo-Mourey was always acutely aware of the limits to the foundation’s hard power to make change and determined to make the most of its soft power. “We’re mostly a sector that works by influence,” she told me. “We don’t make products or services, like business. We’re not government, with the ability to regulate… The way of making change is to influence others.”

When Lavizzo-Mourey came to RWJF, this foundation—like so many others—tended to work with a narrow swath of partners within the nonprofit sector and, to a lesser extent, government. “We didn’t interact at all with the business sector,” she told me.

This insularity wasn’t going to cut it as RWJF looked to address the deeper drivers of poor health in America. “It became clear that a problem as complex as child obesity would require working across sectors,” she said. As that initiative progressed, the foundation cultivated new kinds of partners, including those in business, setting a pattern of collaborating with “strange bedfellows” that would continue during Lavizzo-Mourey’s entire tenure at RWJF. She believes strongly that a key to improving health is to convince other sectors, like education, that doing so would also advance their own missions. “We look for opportunities to find the overlap or the sweet spot.”

One highlight of the foundation’s collaborative approach in recent years was its work with America’s top food and beverage corporations to reduce the calories in its products. RWJF also brought together diverse stakeholders to improve health through other big projects, like its Aligning Forces for Quality program, which backed 16 community coalitions to improve local healthcare systems. Efforts like this, it should be noted, were underway well before “collective impact” became a hot idea in the philanthrosphere. Advancing what Lavizzo-Mourey calls a "systems approach" to change is another area where RWJF has been a leader in recent years. 

As a foundation chief with both an M.D. and an MBA, Lavizzo-Mourey had a strong background for thinking across sectors. Maybe more importantly, she had the low ego and collaborative style needed to succeed in this work. “She presents herself as unassuming,” Darren Walker said. “But she’s actually confident about her ability. She’s also not one to seek credit. She’s happy to let the issues speak for themselves.”

Integrated Strategies

I’ve often described RWJF as the “mothership” of health philanthropy, by which I mean that it’s not just the biggest funder in this space; it’s also one that does everything, pulling all available levers to make change, including backing sophisticated research and data projects, public policy development, marketing and public education campaigns, and community-based work on the ground.

Not many foundations are good at playing all these different kinds of positions—or have the resources to do so. But under Lavizzo-Mourey’s leadership, RWJF excelled at working across multiple fronts, often shifting gears as the terrain changed on an issue. “Foundations have to be increasingly nimble and able to respond to changes in the environment with adjustments in their strategies,” she told me.

Consider all the ways that RWJF worked to advance the Affordable Care Act over the years. First, long before legislation was debated in Congress, the foundation sought to legitimize the overall idea of universal access. RWJF’s efforts in this regard went back many years, but Lavizzo-Mourey stepped up this push in a big way—and at a critical moment. “The notion of a universal right to health was a radical idea,” recalled Walker. “And she was a drum major for the idea that every American should have health coverage.” It wasn’t just her voice, by any means. RWJF bankrolled a wide range of nonprofits advancing both data-driven and story-driven cases for the ACA.

The foundation also supplied its own data and expert analysis to inform the healthcare debate, a role that Lavizzo-Mourey sees as critical to its success. “One of the things that has historically worked well with RWJF is being a resource that all of those groups could cite and rely on, because our information was based on science and unbiased analytics,” she said. Somehow, the foundation pulled off a delicate balancing act in the ACA debate—winning wide trust for its research even though it took a strong view in favor of universal access.

Later, after the ACA was enacted, RWJF played an altogether different role: It heavily financed efforts to get Americans to enroll in the exchanges, especially younger and healthier people, in order to ensure that Obamacare actually worked. The foundation made well over $20 million in grants for public outreach, with much of this money funding Enroll America, the lead national nonprofit doing this work. It has given millions more in grants to study the ACA’s effectiveness and impact, generating research and insights that will be critical if Congress ever does turn to a serious effort to repair the law.

Even before legislation to repeal and replace the ACA failed in Congress last week, Lavizzo-Mourey expressed guarded optimism about the future of the law. “This is not going to be a single debate,” she said. “This is going to be a series of policy questions over a longer period of time than it seems at a moment. These are very difficult policy questions, and we’ve seen there is very little policy consensus over what to do.” Lavizzo-Mourey may be exiting RWJF with her most important accomplishment in jeopardy, but the foundation will remain very much on the case. “We’re preparing ourselves for the long battle and long haul, and the multiple debates.”

Whatever the outcome of these debates, one thing seems clear: Universal coverage is no longer the radical idea it once was. Some Republicans, including President Trump, have now said it should be a goal. That shift is profound, and there’s little doubt that Lavizzo-Mourey and RWJF helped bring it about.  

A Strong Foundation

Whatever a foundation CEO hopes to accomplish, they’re unlikely to get very far if they don’t have their own institution behind them—and make sure it’s operating on all cylinders. Which brings me to another thing that Lavizzo-Mourey did well: She forged RWJF into a stronger foundation.

One of her successes was breaking down the silos that can plague large grantmaking institutions. And she managed that without creating too much internal disruption. As Rip Rapson described it, Lavizzo-Mourey “carefully orchestrated a far more collaborative approach at the foundation. They regularly work across multiple disciplines.”

Darren Walker, who knows what it’s like to wrestle with a large foundation, made a similar point: “She succeeded in building a cohesive culture of collaboration at both the board level and among the staff. Which is very hard to do.”

Silos can feel divisive in organizations, and everyone talks about getting rid of them. What sometimes receives less attention are the benefits of doing so in terms of boosting the impact of institutions. That boost can be especially great when an institution’s mission depends on using different approaches and ensuring they support each other. Under Lavizzo-Mourey’s leadership, RWJF’s various moving parts worked together in new and more effective ways. As any leader of a large nonprofit can attest, that in itself is quite an accomplishment.

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So what’s next for Risa Lavizzo-Mourey? Well, there was an announcement in February that she’ll be taking one of those cushy academic jobs that foundation CEOs often dream about when they’re slogging through the latest round of budgeting or planning yet another board meeting. She’ll be at the University of Pennsylvania, serving as the Penn Integrates Knowledge University Professor.

This is a homecoming of sorts, since Lavizzo-Mourey got her MBA at the Wharton School and worked at Penn for many years, both as a professor and in various leadership positions. Her new position, which was created in 2005 to foster cross-disciplinary approaches to knowledge, certainly sounds like a good fit for someone who is fresh off 14 years of building all kinds of new bridges and connections.

Meanwhile, the fierce debates over health and healthcare in America will go on. It’s a good bet that we’ll hear Risa Lavizzo-Mourey weighing in on these debates, perhaps soon. Let’s hope she also shares her views about foundations and philanthropy. She has a lot to teach the sector.

Read About RWJF's New CEO: Bully Pulpit: Why We May Be Seeing a Lot of This New Foundation President