Looking upstream at the social and economic factors that influence health has been a major theme of grantmaking by top foundations in this space, like Robert Wood Johnson and Kresge. But this framework has also been catching on with more corporate funders, lately.
A case in point: The philanthropic arm of the health insurance company Humana plans to adopt a more upstream approach to guide its grant making in 2018. The Humana Foundation will focus on addressing social determinants of health, like financial stability, food security and social connection, in its quest to reduce chronic health conditions.
Beyond underscoring an ongoing shift in health philanthropy, Humana's move is further evidence of another theme we write about often at IP: The growing sophistication of corporate philanthropy. These funders are less likely to be sleepy outfits that cut checks in the communities where they operate, with few questions asked. Instead, they're thinking harder about how to move the needle in areas they care about—and that also affect their bottom line. Needless to say, the insurance giants that pay medical bills have much to gain from greater population health.
“Increasingly, we’ll be asking ourselves at the Humana Foundation this question: ‘Will our philanthropy have the potential to impact ‘upstream’ social factors—social inequalities—that will result in ‘downstream’ community change, ultimately reducing social inequality and making it easier for more people to achieve their best health?’” said Walter Woods, the foundation’s CEO. “If we can answer ‘yes’ to that question, it means it’s an investment we’ll want to consider.”
As part of this work, the foundation set a goal of improving health by 20 percent by 2020 in the communities where it works, using the U.S. Centers for Disease Control and Prevention’s Healthy Days system as a measurement. The CDC’s tool records the number of physically and mentally healthy and unhealthy days in a 30-day period. Grants fund communities in Tampa Bay, Jacksonville and Broward County, Florida, Louisville, Kentucky, New Orleans and Baton Rouge, Louisiana, Knoxville, Tennessee, and San Antonio.
Humana also plans to consolidate its giving as part of this shift, emphasizing fewer, larger grants with a long-term focus.
“The grants will have a longer-term focus, recognizing that the change the foundation seeks will likely take years to achieve, in partnership with others,” Woods said. “In recent years, we have learned a lot about how larger grants, over a longer period of time, can make the greatest impact for the largest number of people. Combating food insecurity is a great example.”
Within philanthropy, Robert Wood Johnson has been the most important champion of an upstream approach to public health. The foundation first started looking upstream as part of its work to end childhood obesity back in 2007. RWJF’s leadership realized that access to better medical care would do little to curb the problem. Instead, lifestyle changes, like what kids ate or how much they exercised, held more promise.
Since then, RWJF has adopted the upstream approach to its broader work, positioning itself to work toward what it calls a “culture of health.” The foundation considers the social and economic factors that influence health in its grantmaking. The method can sometimes take unexpected directions, like the $2.5 million the funder recently put up to fight social isolation.
The approach has caught on with other funders. The BUILD Health Challenge is a collaborative in its second round of funding for community-led projects that take on the root causes of health problems in low-income neighborhoods. Nineteen communities across a dozen states are participating in the latest round of funding. Projects trace health issues back to sources within communities, like an initiative that funded housing assessments and renovations for families with kids with asthma.
RWJF is one of the funders behind BUILD. The foundation is joined by the Advisory Board Company, the Blue Cross and Blue Shield of North Carolina Foundation, the Colorado Health Foundation, the de Beaumont Foundation, the Episcopal Health Foundation, Interact for Health, the Kresge Foundation, Mid-Iowa Health Foundation, New Jersey Health Initiatives, Telligen Community Initiative and W.K. Kellogg Foundation.
The focus on the social determinants of health is more common in the private foundation world than among corporate funders, but that’s starting to change. The philanthropic arm of Aetna, another health insurance company, also recently shared its plans to move to an upstream approach in its public health grantmaking. The foundation pledged $2 million in grants to 25 community-based nonprofits to promote active living and increase access to healthy foods.
Though a vision of health that includes upstream social and economic factors is still cutting-edge, its embrace by insurance companies like Aetna and Humana points to its growing acceptance and promise. But, as I noted earlier, this development is not so surprising since insurance companies stand to benefit if the upstream approach pans out. A healthier population spells lower costs for insurance providers.