Health foundations play a critical role in funding and supporting health related initiatives and causes in the United States. While it's difficult to determine an exact number of health focused foundations due to the various types of organizations that could fall under this category, it's estimated that there are over 4,000 such foundations in our country. These foundations collectively give out billions of dollars in grants and funding each year to support a range of health related causes, from medical research to programs that increase health care access to broad sweeping public health initiatives. While larger foundations tend to give out tens or even hundreds of millions of dollars each year, smaller foundations also play an important role in providing funding to smaller-scale programs and organizations. Collectively, foundations help us begin to test or support programs or efforts that may not be funded through traditional mechanisms.
Foundations come in different types, each with its own unique characteristics and ways of operating. One of the primary distinctions is between private foundations and public foundations. Having the pleasure of running a foundation that was both at different points in time, the distinction matters. Private foundations have more restrictions on their operations and tax benefits, while public foundations have more flexibility in their operations and grants. Another distinction is between operating foundations and grantmaking foundations. Operating foundations carry out their own charitable programs and invest aligned with their priorities, while grantmaking foundations mainly focus on giving grants to other organizations to advance those organization’s and their work. Finally, foundations can differ by their focus area, such as education, the environment, or health, and by their geographic scope. These differences reflect the diverse range of approaches and priorities within the philanthropic sector that are both a blessing and a curse to advancing health.
I remember the first grant I ever received. It was small, something like $25,000 dollars, but I still recall my huge sigh of relief after seeing the note alerting me to the award. While $25,000 doesn’t seem like a lot, I used it to host a series of meetings and wrote a series of reports that offered direction for the mental health field on research priorities. This was way back in 2009, and you can still fid papers from the event online! This little grant was the boost I needed as a junior faculty, and led to many more grants of a much larger size. If you’ve ever applied for funding, you know how amazing it is to receive those resources and be able to do what you actually want or need to do. Sometimes funding is the catalyst for change.
We have an amazing health foundation community here in the US. They are committed to seeing us advance health in this nation, and we need them as the problems we are facing are massive and just not getting any better. I think that this moment is one where our foundations can step up in a major way. How?
Take more risk: I have worked with numerous foundations, and have found that many of them are relatively risk adverse. It could be for a variety of reasons, e.g. the board, fear of public backlash, and these are all legitimate except they are increasingly hard to defend when you see our health trending in the wrong direction. Encouraging the health foundation community to take more risks with its investments can be a challenge, but there are several strategies that could be leveraged. One approach is to shift the focus from short-term outcomes to long-term impact. By looking beyond immediate results, foundations can take more calculated risks that have the potential to drive significant change over time. Additionally, foundations can collaborate more closely with other stakeholders, such as other foundations or philanthropic leaders, government agencies, health care systems or providers, and community organizations, to pool resources and expertise and spread the risk and increase the likelihood for impact. Another angle is to prioritize innovation and experimentation, supporting new and untested ideas that have the potential to yield breakthrough results. This to me is the golden egg for foundations and where risk may pay off the most.
Have data driven leadership: Data driven leadership is essential for a foundation as it helps ensure that the precious charitable resources are being used in the most effective and impactful way possible. By analyzing and interpreting data, foundations can gain insights into the most pressing needs and challenges facing the communities and causes they serve, as well as identify the most promising strategies for addressing these issues. This information can then be used to guide decision-making around funding priorities, grantmaking strategies, and program evaluations, ensuring that resources are directed towards initiatives that are most likely to achieve measurable results. Moreover, data driven leadership can help foundations demonstrate their impact to stakeholders and donors, promoting accountability and transparency, and ultimately strengthening the overall effectiveness of the philanthropic sector. Data driven leadership is the antidote to a belief based mindset, which often makes investment decisions purely on a personal whim.
One other note on sharing lessons learned. Health foundations should leverage their position as a trusted institution to promote awareness and education around critical health issues. By leveraging their data and investing in public health campaigns and initiatives that raise awareness of specific health concerns, foundations can help drive positive behavior change and ultimately improve health outcomes. Foundations must take advantage of this enviable leadership platform and share out their work and findings (good and bad) through media, op-eds, and other modalities that can reach the public.
Take advantage of the moment: Employing the above two strategies better positions foundations to be relevant and take advantage of critical moments. COVID-19 was one of those, a moment where everyone could relate to mental health, what it was and how important it is. To take better advantage of unique moments, health foundations need to be proactive and flexible in their approach. One way to do this is to build strategic partnerships with other organizations and stakeholders that have expertise in specific areas. Some foundations are staffed with content experts that can leverage their experience and help, others are not. Through the right kind of partnership, foundations can respond quickly and effectively to emerging issues and crises, leveraging their collective knowledge and resources to achieve maximum impact.
In addition, foundations can set aside resources to prioritize funding for research and development, allowing them to stay ahead of emerging trends and identify opportunities for intervention before they become widespread problems. This can involve supporting innovative ideas and technologies that have the potential to address unmet health needs and improve health outcomes. Of note, this approach benefits from a complementary investment in data infrastructure to help.
While its wildly unpopular to say to some, there’s also the option of spending down a foundation’s endowment to take advantage of the moment and achieve maximum impact. There’s a lot to be said about having more financial resources to help advance a cause, and sometimes the amounts we invest aren’t sufficient to have the intended impact. If the goal of many of our health foundations is to improve health, it seems that we should do all we can to aggressively achieve that goal.
Push and challenge the field: Finally, our health foundation community should be pushing and challenging our field. From investing in novel strategies to supporting transformative policy, foundations should be out in front as a leader. One way to do this is to adopt a culture of failing fast, failing smart. Challenging longstanding structures, cultures, and beliefs means that we are going to have to try a lot of new things at once. Some of these will stick, while others will simple fail. Foundations should push the field, in large part through its own investments, to go big and try radical things.
To support this innovation acceleration, foundations should rapidly invest in research and evaluation for these new and bold ideas. This also means funding rigorous evaluation studies and supporting the development of best practices and guidelines that can be used to guide decision-making within the field for future investments. leaders, and policy makers.
I love what our foundation friends do every day to help our communities. Thank you! It matters, and could matter so much more if we follow some of steps I have outlined above. Now is not the time for hesitation or small steps. It's an opportune moment to be bold with our policies, programs, and investments. While some foundations have already adopted this approach, it's important to consider what could be achieved if more followed suit. By being audacious in our actions and embracing innovative solutions, we can unlock a new era of health and well-being for our country. Foundations have the power to make a significant difference and impact millions of lives. Let's take this moment to push the boundaries of what is possible and create a healthier future for all.
I appreciate this - especially the encouragement for foundations to embrace risk. Foundation funding is an excellent option for challenging the status quo and too often ends up reinforcing it.
I recently met with a small health foundation program officer and discussed “innovative and outside the box” non-clinical mental health supports in schools by integrating more nature connection. She sighed and said, “I love this. And I wouldn’t use the phrases innovative or outside-the-box to describe our board...”
Disappointing. She didn’t give me a hard “no”; instead she suggested I would need to nest the request within the confines of physical well-being (per their funding areas) instead of leading with the increasingly robust case for nature’s protective powers for mental health.
Thanks for holding this conversation.