8

The Roles of Foundations

Foundations have supported efforts in preventing and treating obesity. In the final panel of the workshop, four foundation representatives—Marion Standish, vice president for enterprise programs at The California Endowment; Monica Hobbs Vinluan, senior program officer at the Robert Wood Johnson Foundation; Barbara Picower, president of The JPB Foundation; and David Fukuzawa of The Kresge Foundation (who also spoke about treatment challenges; see Chapter 6)—reflected on the lessons they have learned from past investments and their plans for future investments.

CREATING A MOVEMENT

Standish began by saying that everyone working on childhood obesity—whether lawyers, scientists, researchers, or social workers—is passionate about the issue. She suggested that strengthening obesity prevention and treatment as part of a broader social movement focused on health equity would propel the issue forward. She observed that grassroots movements around the country are taking on issues related to obesity, from school nutrition to safe streets and access to healthy foods. If these groups forged a broader narrative together, she asserted, they could create a tent large enough to include multiple new constituencies. A much larger narrative around this work would, of necessity, encompass prevention, health, the food system, and other basic societal systems that underlie the work of diverse advocates. “If we began to see ourselves more as a social movement than as a set of diverse activities, research projects, and interventions,” she said, “we would be ever more powerful.”

Standish argued that this larger social movement could organize itself around obesity, food, physical activity, the built environment, conservation, animal rights, or other issues, but that the most powerful force within all those movements is health. She believes, for example, that the current food system has proven itself to be “a profound failure” in its central mission, which is to produce and sustain the health and well-being of society.

According to Standish, social movements have several defining characteristics. First, they need a vision and a framework for their work. “We have that,” Standish said. “We just need to call it out.” They also need an authentic base of people at the grassroots level who are engaged in meaningful ways; they need to be there for the long haul; they need a vision for governance; and they need to be networked with other movements. Finally, they need to be able to scale. “We have so many evidence-based good ideas,” Standish said, but “scale is a challenge.”

FINDING THE INTERSECTIONS BETWEEN SOCIETAL FACTORS AND OUTCOMES

Vinluan agreed that bringing disparate movements together to advance work on child obesity is “the key to our future.” The Robert Wood Johnson Foundation has been a leader in the work on obesity, she noted, investing a billion dollars in the issue over 10 years. In the process, the foundation has learned some important lessons, said Vinluan. It has gained a better understanding of how health and well-being are linked to education, income, zip code, race, and ethnicity. According to Vinluan, while the declining rates of obesity—in particular for young children—have been gratifying, “we’re

not making the progress that we need to be making” if disparities continue to widen.

Vinluan explained that the foundation has also learned about different strategies and how to link them to what works in communities and states. When young children experience poverty, hunger, family violence, or substance abuse, they are more likely to drop out of school, end up in prison, or become addicted to drugs, she observed. She asserted that the intersections between these societal factors and negative outcomes provide opportunities to weave together strategies for making greater progress.

Vinluan noted that the foundation has been investing in a number of different strategies that take advantage of these intersections. Its Culture of Health Prize not only rewards communities for their accomplishments but also uncovers successful approaches that can be shared. Vinluan explained that the foundation has been investing in communities that make child obesity prevention a priority above all else. “That is their primary strategy,” she said, “whether they articulate it like that or whether there are several movements that are giving voice to different aspects of the child obesity movement.” She noted that successful communities have also been implementing a wide range of strategies with multiple sectors. “To build a culture of health,” she suggested, “we need lots of component pieces in place. We need to make sure that health is a shared value. We need to make sure that we’re fostering cross-sector collaboration. And we need to create healthier communities while at the same time integrating our health services and systems. . . . Health is very much connected around the conditions of social, emotional, and physical health. How do we try to identify strategies and solutions that combine all of those efforts?”

The Robert Wood Johnson Foundation is going to continue this work, Vinluan said, focusing on schools, early care environments, homes, and communities. The work will be connected to efforts to identify tools and strategies that can help communities and families address the trauma and toxic stress that are present in many communities across the United States. “That’s where we’re going,” Vinluan said, “and I invite you all to join us in this journey.”

ATTACKING POVERTY

According to Picower, The JPB Foundation considers poverty to be the biggest problem in the United States. “People find nice ways to talk about poverty,” she said. “They call it inequality or lack of social mobility. But when push comes to shove, it’s that people are living really poorly. They don’t have enough money to feed themselves. And when they do feed themselves, the food that is generally available to people who are making

$2.00 a day with a family of four is fattening food. It’s chips. It’s snacks. It’s potatoes. It’s nothing that’s good for them.”

Picower reported that the foundation has been working to identify and lower the barriers to escaping poverty. Obesity is one such barrier, she asserted. “If we can get young people to grow up at normal weight,” she suggested, “then they will have a chance of crossing that street and having a more successful life.”

One program the foundation has been funding is the Harlem Children’s Zone, which includes a project known as Healthy Harlem. Picower explained that the program’s components include nutrition, cooking, physical activity, and sports, with opportunities for parents to become involved as well. An evaluation of the program found promising and statistically significant results, Picower reported, saying, “We’re really proud of that.” The foundation has also been funding the scale-up of the YMCA’s Diabetes Prevention Program for adults (see Chapter 6) and working to translate it for young people.

Obesity is not going to go away, said Picower. She emphasized that foundations will need to remain involved and cannot succumb to issue fatigue. The problem does not belong to any one group in the United States, she said. Rather, “this is an American problem, and we have to work together to solve the problem.”

FOSTERING A CULTURE OF HEALTH

Funders can bring a values-driven or a mission-driven point of view to social issues, observed Fukuzawa. Because they are not constrained by government, he suggested, they can speak on behalf of or in support of communities that have been marginalized, and they can take the long view. As a result, he asserted, foundations can be, and have been, the progenitors of long-term social movements. The Kellogg Foundation has funded experiments and important advances in local, equitable, and sustainable foods for decades, he observed, arguing that the food movement today would be significantly different “were it not for [that foundation’s] early investments.”

His foundation is also “fixed on the culture of health,” Fukuzawa explained. He described it as a community development foundation that includes a health program. But, he noted, health is clearly a central theme in community development. In fact, he suggested, it is a critical integrating factor in transit, housing, economic development, workforce development, and other aspects of community development. As an example, he pointed to the many places where health care institutions have become the foundation for community development and better health. As other examples, he cited the work of the Partnership for a Healthier America on affordable

housing and the effects of the Moving to Opportunity demonstration on health, including obesity.

One thing foundations can do besides supporting programs, Fukuzawa suggested, is to fund leveraged investments that improve health. In this way, he argued, they can help induce other funders, both public and private, to invest in socially beneficial community programs, such as the new accountable communities for health.

REASONS FOR HOPE

At the end of his summary of the workshop’s themes (see Chapter 1), Bill Purcell cited the work of foundations as one reason “not just to be hopeful but to be optimistic.” He said, “This country has a large number of people, many in this room, who understand what needs to be done and increasingly are closer to knowing how to do it. For that reason, I’m optimistic, hopeful, and encouraged.”

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