Seeking an Equitable Healthcare System, a Major Funder Backs Grassroots Power-Building

The U.S. healthcare system has many flaws, from its lack of accessibility to its obscene price tag—and health funders are pursuing a range of strategies in their efforts to improve it.

The Robert Wood Johnson Foundation is the largest philanthropy in the country devoted exclusively to health, and has long worked to support equity in healthcare, from investing in early childhood development to addressing social determinants of health.

RWJF is far-reaching, and notably works to widen the scope of how we improve our health and healthcare, not shying away from power-building in pursuit of policy change. In the latest example of such work, the foundation recently launched the Voices for Health Justice Project to help state- and community-based organizations around the country grow health justice from the ground up.

RWJF was created by the son of the first president of pharmaceutical giant Johnson & Johnson. Robert Wood Johnson II worked in many areas of the company, and became president himself in 1932. He had rheumatic fever as a child and struggled with related health problems throughout his life, which may be part of why he devoted his philanthropy to improving healthcare. As he put it, “There is no area of social responsibility more important than the care of the sick and the injured, and I think it best to confine my foundation to the area of healing.”

RWJF has remained true to its founder’s vision, working to build what it calls a “culture of health” in the United States. As IP has reported over the years, the foundation has backed a galaxy of related causes, including support for healthcare workers, health journalism, relief for communities hit hard by COVID-19 and anti-poverty efforts, to name just a few.

The foundation’s new initiative, the Voices for Health Justice Project, will provide $9 million to support local and state organizations working to promote health equity. The project isn’t an attempt to apply Band Aids to the many cracks in the health system; instead, it is aiming for system transformation, as the announcement makes clear: “Each of these 25 projects emphasizes building the power of people at the grassroots level to demand and win health system policy change at the national, state and local level.”

Andrea Ducas, RWJF senior program officer, expanded on this goal. “I work with a team of individuals at the foundation that is really focused on healthcare systems transformation,” she said. “That is, having the healthcare system, the public health system and social services working together in a way that meets the needs of people in a meaningful way. One component of pushing us in that direction is advocacy—actually pursuing policy change. We have found that is most reflective of what people care about when folks closest to issues are the ones setting the agenda and doing the advocacy.”

Supporting community leaders

RWJF is providing the funding for the Voices for Health Justice Project, and three national organizations, Community Catalyst, Community Change and the Center for Budget and Policy Priorities are working together to implement it.

Since it was founded 20 years ago, Community Catalyst, the lead group on the project, has been supporting community-based efforts to make health systems more accountable to local needs.

“The hallmark of [the Voices for Health Justice] program is very connected to the Community Catalyst vision,” said Emily Stewart, Community Catalyst’s executive director. That vision, she said, “Embraces that community members and community leaders are the ones who have the best idea of what needs to change in the health system, and that if you give them more resources and support so they can both leverage and build power to pursue policy ideas, we will see much more progress toward health equity.”

As examples of innovations that grew out of local needs, Stewart cites community health workers and doulas. “These were roles that were born out of communities, in particular, Black and brown communities, to meet the needs of those communities,” she said. Too often, she adds, such innovations are underfunded and under-resourced. Community health workers, for example, seldom get a fair wage, and weren’t prioritized for PPE in the pandemic.

For the Voices project, Community Catalyst worked with Community Change and the Center for Budget and Policy Priorities to select 25 community and statewide organizations in 24 states across the country. Grantees include organizations “working in and with Black and brown communities, immigrants, LGBTQ+ people, people with disabilities, and low-income and rural communities often overlooked by policymakers and failed by the health system,” states the press release.

Some of the grantees are working to expand and/or protect access to Medicaid coverage; others are pushing their states to provide health coverage regardless of immigration status, and still others are promoting access to alternative healthcare providers, like community health workers and doulas.

The goal of the Voices project is to “narrow health inequities through a racial justice framework,” Stewart said. She points to SPACEs in Action, a grantee working to reduce inequities in Black women’s maternal health and infant mortality rates in Washington, D.C. CASA, a Maryland-based grantee, will provide primary and preventive care insurance for people who are ineligible for coverage under the Affordable Care Act. (See the complete list of grantees here).

For RWJF, this work is a natural extension of what they’ve been doing for years. “We have supported consumer-driven advocacy efforts for a long time,” Andrea Ducas said. “Through this work, we wanted to push ourselves to reach deeper and to do more community-centered work, and to anchor that work in issues we know are most meaningful to people.”

Toward a more equitable system

RWJF takes a broad view of healthcare, but it’s also been a major player in national policy. For example, the foundation supported analysis, technical assistance and advocacy for the Affordable Care Act and its implementation, and Ducas says it continues to do so at both the state and national level, with the goal of “maximizing its potential, especially with respect to health equity.”

With new leadership in Washington, will the Voices for Health Justice Project help lay the groundwork for a more comprehensive national health program? That isn’t the goal, according to Ducas and Stewart, who emphasize the project’s local and state focus. But both agree that the project will provide information that could have a national impact.

“We’re going to learn a lot with this program,” Stewart said. “I think people care about making the health system more equitable, getting us much more quickly on the path toward a just and fair health system. I think we are going to learn a lot from this program that will inform policy in a much bigger way, including at the national level.”

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