In seeking to improve the health outcomes of people in underserved communities, philanthropy’s results have, in general, been disappointing: Socioeconomic and racial injustices run so deep in these communities that strong barriers to change extend well beyond the health care system. It has become clear that only with deep, long-term investment from government and foundations can these communities hope to make meaningful progress in improving their residents’ health and well-being.

This kind of deep, long-term investment was what The California Endowment (TCE) had in mind when it launched its Building Healthy Communities (BHC) initiative in 2010, with the intention of investing $1.75 billion in 14 Californian communities over a span of 10 years. Starting from the idea that health disparities have underlying causes rooted in broader social and economic conditions, the foundation set four goals that it believed would lead to more equitable health outcomes:

  • Provide a “health home” for all children in which they could count on consistent primary care
  • Reverse the childhood obesity epidemic
  • Increase school attendance
  • Reduce youth violence

However, while the foundation was clear that BHC should not be a traditional “top-down” initiative—driven by foundation staff and professional consultants—and the theories of change developed to inform implementation reflected commitments to building community power and supporting community organizing—when BHC began it was still caught up in the traditional philanthropic model. TCE had set the initiative’s specific goals, and as quickly became clear, the foundation did not really cede control to the communities themselves: “Collaboration” meant funding professional advocacy groups, system leaders, and large service providers to seek input from the communities, mobilize community-member support, and advocate for increased and better-coordinated services. Most importantly, the initiative was focused on the policy-related goal of health equity, not greater community power.

Community grantees and residents had seen this model before and knew its faults. They told TCE that the initiative would be more successful if communities set their own goals and priorities, from the bottom up; it would work better if TCE made support of local community organizing groups its top priority, helped them build resident and community capacity, and strongly supported the recruitment and training of community leaders.

TCE listened. It deprioritized “grass-top” organizations and stepped back from driving the agenda. Led by local community organizers, BHC became a grassroots effort to build power for racial justice. At the foundation, this shift reflected the realization that building community power was not only an important means to an end but also an end in itself.

During its decade-long journey through Building Healthy Communities, TCE learned many lessons that continue to inform its approach to grantmaking and social change advocacy.

Read the full article about healthy communities by Tia Martinez at Stanford Social Innovation Review.