Earlier this year, we named Risa Lavizzo-Mourey, head of the Robert Wood Johnson Foundation, as one of the 15 most powerful women in philanthropy, and for obvious reasons: She's laser focused on the top domestic issue of our time (healthcare), commands big resources (RWJF spends nearly $450 million a year), and is not afraid of the political combat needed to have impact (unlike other foundation presidents we can think of).
But here's another reason Lavizzo-Mourey is a big deal: She's calling for a fundamental change in American culture and laying out a plan to make that happen. The broad details are in a remarkable 4,000-word speech she gave in Aspen in late June.
Bold values-based visions are not so common in foundation land, where leaders can be skittish about saying their values out loud and getting anywhere near the dreaded realm of "ideology." Instead, funders more often talk about goals, strategies, and outcomes in an anodyne drone shorn of any real normative content.
Of course, most foundations do have strongly held values and, yes, ideologies, whether they want to publicly admit it or not. (See my recent article on Hewlett.) And the ones that are most effective, I think, are those that start with core value propositions and then figure out the rest from there.
Lavizzo-Mourey gets all that. She gets that a big foundation needs a strong moral compass and clear set of values to achieve change. And what she's doing to chart RWJF's next phase stands as a model of philanthropic leadership.
Here are three things she's done:
Lavizzo-Mourey's big idea, which RWJF has been working on for a while, is to create a new "culture of health" in the United States. This is a brilliant conceptual centerpiece for the foundation because a culture is made up of a set of values and norms. And if you want to change a culture, you need to think at a deep level about what motivates and structures human behavior. Thinking this way is more likely to get at the root of the challenge you're tackling than the technocratic approaches so often favored by funders.
What would a culture of health look like? Lavizzo-Mourey imagines an America where having a healthy weight, eating right, and being active are ingrained norms, along with a full embrace of the still-controversial idea that all people should have health coverage. She imagines workplaces where you don't sit on your butt all day, communities where most kids walk to school, and a broader redesign of all physical environments to encourage physical movement. And, more ambitiously, she imagines a far greater blending of the spheres of health and education, which she sees as deeply interlinked.
Needless to say, all this is a far cry from where we are today, with people jockeying for the closest possible parking space at super markets where they fill their carts with garbage to take home to fat kids who play video games all afternoon and get chauffered to school every morning while our medical establishment looks the other way because it's too busy fighting a high-tech war on disease to promote the healthy living that might actually make a dent in epidemics like diabetes. Step one to escaping this toxic situation is fleshing out an alternate reality, and Lavizzo-Mourey has.
In her speech, she cites environmentalism as an example of how American culture can change, and how it has changed. Forty years ago, recycling anything was very rare. Now it's standard practice. Yes, there are policies that mandate and facilitate recycling, but more important is the shift in norms that's occurred. There are plenty of other examples Lavizzo-Mourey could have cited, such as shifts on race and gender.
Set Super Ambitious Goals
Setting modest goals is always tempting because they're tangible and achievable. But that's not what foundations with billions of dollars should be doing, and Lavizzo-Mourey has some big ideas about what a culture of health could look like in practice by 2024.
First, every American child would be a healthy weight and we'd conquer the childhood obesity epidemic.
Second, universal coverage wouldn't just be taken for granted, as is the case in every other advanced country, but all Americans would also know what benefits are available and make the most of them.
Third, we'd be well along in the shift toward "healthy places and healthy practices," which includes everything from encouraging more physical activity in the workplace and getting more kids walking to school and playing outside to changing food offerings and how people eat.
Believe a Revolution is Possible
It's not just that Lavizzo-Mourey set out ambitious goals, it's that she expressed total conviction that we can achieve this new culture of health, pointing to many trends and developments already paving the way to a different future. She said:
it's rare to recognize a moment of great change while you are living it. But here we are, quite aware that we are standing on the threshold of a new era. Big data. Biometrics. Crowd sourcing. Social entrepreneurship. It's all changing everything at lightning speed. The famous science fiction writer William Gibson said: “The future is already here. It's just not evenly distributed.” And that is true when it comes to a Culture of Health.
And, of course, it is true, with myriad big and small things going on right now to upend how we behave individually with regard to health and how institutions operate. Lavizzo-Mourey sees RWJF's job as accelerating all that to the point of a full-fledged revolution that topples the status quo.
RWJF is hardly alone in its thinking, we should note. Other big health funders, like Kresge, are thinking along the same lines, which makes a revolution that much more likely.
Am I going overboard here? Maybe, and we'll see how the actual grantmaking plays out. But keep in mind that RWJF is already well along in fleshing out its thinking about a culture of health and pushing for its big goals.
It announced a $500 million push on childhood obesity seven years ago and, of course, has played a huge role in the drive toward universal coverage, not just through work that helped enact the Affordable Care Act, but even more ambitious grantmaking to get people informed about the law and signed up. Meanwhile, RWJF has funded an endless array of projects to help change how Americans eat and their level of physical activity.
So this is no ten-year pipedream Lavizzo-Mourey is peddling. It's a plan, and it's already in motion.