Civic Engagement Is a Social Determinant of Health

Eileen Salinsky, Program Advisor, Grantmakers In Health

Over the last two decades, health funders have embraced public policy engagement as a high-yield strategy to advance their missions. Most health funders believe that systemic change is needed to achieve a just, equitable, and healthy society and such change requires meaningful reforms across multiple public policy domains, including health care, housing, education, employment, criminal justice, environmental protections, and economic development.

Fair and constructive policy advancements fundamentally depend on a healthy democracy. Two intersecting and interdependent systems comprise democracy in the United States:

• a political system of representative government, which includes the legislative, executive, and judicial branches at the federal, state, and local levels; and
• a collective system of self-governance, which includes how individuals interact with each other and their political system through many forms of civic engagement.

Philanthropic interest in and support for efforts that strengthen democracy have grown in recent years. Both the Funders’ Committee for Civic Participation (FCCP) and Philanthropy for Active Civic Engagement (PACE) have seen their memberships expand beyond foundations that have traditionally identified as “democracy funders” to include issue-oriented funders that recognize that an open, fair, and inclusive democracy is foundational to their strategic goals. Grantmakers In Health (GIH) has similarly observed growing attention to civic engagement within the field of health philanthropy.

In order to explore investments in civic engagement by health funders, GIH conducted interviews with representatives of 14 foundations that are currently GIH Funding Partners (i.e., philanthropic organizations that support GIH’s work). Interview respondents represent a convenience sample of health funders who are actively engaged in supporting civic engagement efforts. These foundations may not be representative of the wider field of health philanthropy, nor do they constitute a comprehensive list of health funders that support civic engagement efforts.

In selecting organizations to interview, GIH was intentional in choosing funders with diverse characteristics in terms of asset size, geographic focus (i.e., foundations operating at national, state, and local levels), geographic location, and tax status (i.e., private foundations and public charities). While most respondent foundations have organizational missions focused on health, some have missions that are more broadly framed.

This article summarizes the key themes that emerged from these interviews exploring why and how health funders are investing in civic engagement. The examples provided are illustrative and do not fully describe the work supported by any of the foundations referenced or their grantees.

What is civic engagement?

PACE defines civic engagement as “helping people be active participants in building and strengthening their communities, whether defined as a place or a shared identity or interest.” This inclusive definition reflects a spectrum of ways people can participate in their communities—including both public- and private-sector interactions—such as voting, advocating for policy change, joining social and religious groups, volunteering, and donating to charities. Similarly, FCCP defines civic engagement as “the collection of nonpartisan ideas, activities, and field building interventions that serve to promote reform in the areas of social attitudes and behaviors, public policy, and politics.” This definition more explicitly recognizes that policy-oriented reforms are necessary to strengthen and protect the civic infrastructure.

Relatively few of the foundations represented in this scan of the field have adopted a formal definition of civic engagement and individual perspectives regarding this definition varied. Most respondents held a broad conceptualization of civic engagement similar to the PACE and FCCP definitions. However, respondents typically reported that the civic engagement work of their foundations emphasizes increasing participation and power in democratic processes and prioritizes communities of color, low-income populations, and other groups that have been historically marginalized and disenfranchised. For some respondents the term civic engagement was closely associated with encouraging electoral participation, such as through voter registration or engagement efforts. Others employed a broader frame to include efforts directed at increasing communications with and accountability for elected officials, improving interactions with government agencies, supporting grassroots mobilization, promoting community organizing, and advancing structural reforms to protect and modernize democratic processes.

Several of the foundations included in this scan have explicitly identified concepts related to civic engagement in their strategic plans, although they may utilize different terminology to describe these goals. Strategic priorities often refer to building community power, lifting community voices, and activating community members. For example:

• Vitalyst Health Foundation has identified “civic health” as one of five major strategic goals, seeking to “build resident, community, and civic leadership; connect empowered voices to influence policies; and promote fair processes in civic institutions.”
• The California Endowment has identified “people power” as one of three bold ideas for the coming decade with the goal of “developing young and adult leaders to work intergenerationally to raise up the voice of marginalized communities and promote greater civic activism as essential building blocks for an inclusive, equitably prosperous state.”
• Health Forward Foundation’s three purpose areas and platform strategies focus on people, power, and place. To build power, Health Forward seeks to “strengthen organizational capacity, leadership, and civic engagement with the following strategies: to advance capacity building, leadership development, and connectedness; to advance participation in democracy; and to enhance community-initiated engagement.”

More work is needed to develop a clearer consensus in the field on definitions related to civic engagement and community power building and how these concepts intersect with and support each other.

Why fund civic engagement?

The link between civic engagement and health status is well-established, but causal relationships are complex. A growing evidence base indicates that increased levels of civic engagement are associated with improved health status. The Health & Democracy Index developed by Healthy Democracy Healthy People shows that states with more inclusive voting policies and greater levels of civic participation are healthier. However, the causal nature of this relationship between civic engagement and health is not fully understood. Some studies suggest that civic engagement and health are mutually reinforcing. Healthier people are more likely to be engaged in civic activities. Civic engagement, in turn, appears to improve the health of participating individuals by increasing agency and social cohesion and may also improve the community conditions that influence population health.

Health funders are increasingly beginning to recognize that investments in civic engagement are not only helpful, but necessary, to achieve health-related objectives. Although many of the foundations participating in this scan have supported civic engagement for several years, both the strategic importance of this work and the level of resources invested in related grants have increased. Most of the funders participating in this scan devote a significant portion of their grantmaking to civic engagement, typically ranging between 10 to 30 percent of total funding. Respondents generally expect levels of support to remain stable or increase in the future.

A commitment to health equity was cited by numerous respondents as a primary driver in their organization’s decision to increase investments in and attention to civic engagement. Community power building is essential to dismantling the structural racism that disenfranchises and marginalizes people of color.  A few respondents noted that while early investments in civic engagement were primarily viewed as a means to advance health promoting policies, such as Medicaid expansion, this thinking has evolved to recognize civic engagement as an inherently valuable goal. The intrinsic value of civic engagement lies in the collective agency people gain by exerting power to influence the conditions that shape their lives.

How can health funders support civic engagement?

As described by FCCP, funders can pursue a wide range of strategies to promote civic engagement and strengthen the civic infrastructure. Civic engagement activities most commonly cited by health funders participating in this scan include community organizing, leadership development, voter engagement, census support, and redistricting advocacy. These activities are supported through program grants, as well as general operating support for power building organizations and technical assistance.

Community Organizing

In the Power Moves toolkit, the National Center for Responsive Philanthropy defines community organizing as:

A process of building relationships, leadership and power, typically among marginalized communities, and bringing that power and collective voice to bear on the issues that affect those communities by engaging with relevant decision-makers. The issues raised, solutions identified, and strategies developed to achieve those solutions all are defined and acted on by the leaders themselves, often with help from professional organizers.

This definition centers affected constituencies as the agents of change, rather than paid advocates or lobbyists who represent community interests.

Organizing and base building are pivotal to community power building efforts. Groups that facilitate organizing and base building frequently partner with other organizations in the broader power building ecosystem, such as organizations that specialize in research, policy advocacy, and legal support; focus on communications, messaging, and polling; or employ arts, culture shifting, and narrative change strategies. These activities are most effective when conducted in service to the priorities and change strategies that emerge through community organizing.

• The Colorado Health Foundation funds a wide variety of community organizing efforts. One of the foundation’s current funding opportunities, Advancing Advocacy and Justice with Communities of Color, aims to build power in the advocacy ecosystem with organizations that are most critical and closest to the communities for whom health is furthest from reach. It will support both long-term movement-building and the ability of advocacy groups to act when high-leverage opportunities to bring about change arise.
• The Robert Wood Johnson Foundation has a history of supporting community organizing and this work has been bolstered by a $90 million investment in Building Community Power to Advance Health Equity. The initiative includes three major strategies: (1) local base building to help grow capacities of local organizations that organize and advocate for low-income and Black, Indigenous, and People of Color (BIPOC) community members with a focus on youth and the South, (2) housing justice to build power among low-income renters of color to combat the effects of systemic racism in housing policy that fosters residential segregation and continues to drive health disparities, and (3) birth justice to support historically underfunded organizations championing Black, Indigenous, and other birthing people of color. The foundation has also funded analytic work to build the evidence base related to community organizing strategies. For example, Lead Local was a collaborative research project which brought together well-respected local power-building leaders in the fields of community organizing, advocacy, and research to explore how community power can catalyze, create, and sustain conditions for healthy communities.
• The Horizon Foundation supports a variety of community power building efforts, including People Acting Together in Howard (PATH), a broad-based community power organization rooted in Howard County, Maryland’s neighborhoods and congregations. Horizon has provided operating funding for many years so that PATH could support its local organizers and work to build power and organizational capacity, and pass policies related to traditional health issues like diabetes and obesity prevention, and social determinants like wealth attainment, housing, and education.

Leadership Development

Community organizing is closely tied to leadership development, as these activities depend on community leaders who can cultivate strong relationships with other community members and mobilize broader support for and participation in organizing efforts. Leadership development builds the knowledge, skills, confidence, and network of community leaders to support their agency and enhance their effectiveness.

• The California Endowment has invested more than $1 billion over a decade to develop an adult and youth organizing ecosystem in 14 communities and statewide that builds power and advances health and racial equity. Youth-oriented leadership development plays an important role in these efforts to build a youth power infrastructure. The foundation has emphasized leadership development of boys and men of color, in part because they are significantly overrepresented in the prison system and significantly underrepresented in institutions of higher education. For example, the foundation has partnered with Power California to support and train youth leaders to develop, coordinate, and align narrative and cultural strategies to close youth detention centers. As youth activists grew more prominent, they became critical contributors to California’s health equity landscape, including an understanding of how trauma and healing were intertwined with organizing work; social media as an essential organizing component; the importance of infrastructure for expanding and sustaining power; and the creation of a new generation of social justice leaders of color.
• The Episcopal Health Foundation recently awarded $5.3 million in new investments to fund a variety of projects in rural and urban areas of Texas focused on youth leadership development, community organizing, and faith-based efforts that concentrate on health-focused community work. These investments included $520,000 to Young Invincibles to train young adults to become community leaders through the Young Advocate Program, which educates them on policy strategies and advocacy to increase health insurance coverage among young Texans.
• The Greater Clark Foundation in Kentucky focuses its work on changing the community norms that influence community governance and civic participation. In 2016, the foundation partnered with the Harwood Institute for Public Innovation on a three-year, $500,000 initiative to encourage people to think and act differently about both what is possible in their community and how they can be agents for change. Community members stepped forward to participate in a “public innovators” program. Small business owners, retirees, high school students, educators, public officials, health care providers, nonprofit leaders, clergy, artisans, and others completed a 2.5-day immersive training and joined teams to tackle community priorities over time. Ongoing support, coaching, and convening facilitated collaboration and engagement. The foundation also provided mini grants that helped the public innovators and other community members implement their ideas for change.  The initiative yielded fruit quickly, including the emergence of new leaders and new mindsets.

Voter Engagement

Voting is perhaps the primary and most visible expression of active participation in democracy. Voters participate in elections to choose representatives for government at federal, state, and local levels and to decide ballot initiatives in some states and localities. Although voter participation has trended upward in recent years, approximately one-third of eligible voters did not vote in the 2020 presidential election. Structural barriers, such as onerous voter registration requirements, inflexible voting hours, long lines in polling locations, and cynicism about government depress voter turnout. Because communities of color, young people, and low-income Americans are disproportionately burdened by structural barriers and frequently marginalized in political decisionmaking, voter participation rates are often lower for these populations.   

Foundations can support a wide range of nonpartisan election-related activities to educate voters and increase voter engagement and participation. While federal law places some restrictions on private foundations seeking to earmark funds for voter registration, philanthropy can play an important role in encouraging people to vote. Integrated voter engagement (IVE) is one of the most effective ways to increase voter turnout. By integrating voter engagement with ongoing issue advocacy and community organizing, these efforts build long-term engagement in democratic processes beyond sporadic participation in isolated election cycles.

• The REACH Healthcare Foundation and Health Forward Foundation, in partnership with the Kansas Health Foundation, launched a $2.6 million Integrated Voter Engagement Initiative in 2017 to help community-based organizations incorporate IVE into their health equity work. Grantees pursued a variety of strategies to increase voter education, registration, and turn-out; support local volunteer engagement and organizing; promote leadership development; and sustain health equity issue advocacy and organizing.
• Voter engagement is an important component of the Foundation for a Healthy St. Petersburg’s broader commitment to building community power in Pinellas County, Florida. The foundation’s mission is to close the health equity gap by focusing on race equity. Fundamental to the foundation’s work is the belief that solutions must be centered on lived experience and prioritize collaboration that starts with, is owned by, and sustained by community. In addition to elevating community voice in the foundation’s own decisionmaking, the foundation also seeks to build community connections with elected officials and other systems-level leaders. In 2018, the foundation funded a Civic Health Study to explore civic engagement levels, political participation, and perceptions of trust and cohesion in the community. The foundation funds efforts focused on increasing voter engagement, such as the Get Out the Vote project, led by Women Talk Black and the Dr. Carter G. Woodson African American Museum, which  harnesses the power of Black women’s voices, increases Black women’s participation in leading efforts to engage in their communities, and drives changes in voting behavior.
• The Langeloth Foundation awarded $20 million in civic engagement and participation grants in 2020, drawing down over 20 percent of its $88 million endowment. Funds both provided rapid response grants to support in-the-moment needs and significantly increased investments in civic participation to achieve long-term structural changes through an actively engaged electorate. A significant proportion of this funding was granted to two collaborative funds, the State Infrastructure Fund and the Heartland Fund, both of which were existing grantees of the foundation, had a focus on voters of color, brought extensive experience, and were positioned to re-grant support to organizations working to increase voter participation and protect voting rights across the country. The foundation’s rationale for making such a significant and, in some ways, novel investment in civic engagement was premised on four major beliefs: (1) the investments were a clear reflection of the organization’s commitment to support equity, justice, and opportunity for all people; (2) the need for this support was urgent; (3) philanthropic assets can and should be put to use in times of crisis; and (4) the foundation’s efforts could serve as a model for other funders considering the need for bold actions. The foundation has continued its support for civic engagement with a $10 million investment in 2021, including grants to Vot-ER which works to integrate voter registration into the health care delivery system and the Voto Latino Foundation which is dedicated to registering Latinx voters and encouraging civic participation.

Census Support

The decennial census has profound implications for the health and vitality of communities across the country. Results influence allocation of public sector resources in programs like Medicaid and the Supplemental Nutrition Assistance Program (SNAP); dictate reapportionment of political representation at the federal, state, and local levels; and inform a host of private sector planning and investment decisions. Certain “hard to count” populations, such as young children, communities of color, low-income households, and people living in rural communities, are particularly at risk for being undercounted. These populations can be hard to count for a wide variety of reasons, including frequent changes in address, reluctance to participate due to distrust of government and concerns about data confidentiality, as well as barriers related to language, literacy, and lack of internet access.

A growing number of health funders have recognized the importance of a fair and accurate census for the advancement of population health goals, supported a broad range of activities to “get out the count” in the 2020 census, and are already planning for the 2030 census.

• The New York Community Trust served as the administrative home of the New York State Census Equity Fund, a statewide collaborative of funders launched to support a fair, accurate, and complete count throughout New York. With nearly 40 supporting funders and more than $3 million in resources, the fund distributed monies equitably across the state, with the aim of ensuring that the hardest-to-count populations were reached. The initial round of grantmaking began with larger organizations that could lay the groundwork for get out the count efforts, while subsequent rounds were increasingly targeted towards small, grassroots organizations using a regional approach based on emerging data about where response rates were lagging. In addition to grantmaking, the fund played other important roles to support Census 2020, including providing census education and awareness for both funders and grantees; building partnerships to coordinate with other key stakeholders; and engaging in advocacy efforts to support a fair and accurate count.
• The Missouri Foundation for Health invested in a Missouri Counts: 2020 Census campaign to support a fair and accurate census in the state. The foundation developed resources (including fact sheets, research, and data), produced messaging and social media toolkits to facilitate communications, and provided grants to partner organizations to encourage participation in hard to count communities. For example, the foundation awarded $35,000 to Refugee and Immigrant Services & Education (RAISE) to educate community members about the census, organize promotion events, and assist in census completion, with a focus on the limited English-speaking refugee and immigrant population and other hard-to-count communities in Noel, Missouri.
• The REACH Healthcare Foundation led efforts to establish a Metro Kansas City Census Equity Fund to support local education and outreach efforts aimed at ensuring full participation in the 2020 Census. Funded by a coalition of Kansas City area public and private foundations and managed by the Greater Kansas City Community Foundation, the fund’s grantmaking prioritized educating groups and residents about the purpose and benefits of census data and its importance to families, businesses and neighborhoods; partnering with grassroots leaders to engage residents in hard-to-count areas; and mobilizing populations that are at risk of being undercounted due to culture, language, age and other factors. In addition to increasing census participation, the fund also created opportunities for new funders to explore civic engagement funding, learn more about the civic infrastructure, and collaborate with their peers in the region.

Redistricting Advocacy

After each decennial census, new U.S. congressional and state legislative district lines are drawn in a process known as redistricting. This redistricting process is a critical opportunity to ensure equitable political representation and address systemic inequities. Gerrymandering (i.e., when boundaries are drawn with the intention of influencing who will get elected) erodes democracy and deliberately dilutes the power of communities of color that are often targeted in the creation of unfair district maps. Philanthropic resources help to promote community-centered redistricting by supporting public education and robust community input, providing technical resources related to map drawing and analyses, advancing advocacy for fair and transparent processes, and funding litigation to challenge unfair district maps.

• The Vitalyst Health Foundation raised the visibility of redistricting activities in Arizona at both the state and local levels and promoted community input through communication efforts, such as a publication and podcast explaining redistricting and why it matters. The foundation also provided grant support to One Arizona which cultivated a coalition of organizations to educate community members about the redistricting process, increase participation in public hearings, submit public comments, inform media articles, and host training sessions. The coalition was successful in securing additional public hearings in locations that were accessible to communities of color, holding private meetings with officials from the state’s redistricting commission, and influencing mapping decisions based on comments, testimony, and feedback.
• Health Forward Foundation promoted fair redistricting by providing testimony to legislative redistricting committees. Health Forward advocated against the proposed congressional map that dilutes the voting power and representation of racially diverse communities by splitting Wyandotte County, Kansas into two districts. Despite opposition from Health Forward and others, the map passed, withstood a veto by the governor, and is being litigated. The foundation has publicly stated its support for equitably drawing district lines to ensure that racially diverse communities and communities with similar characteristics have representation in elected offices.

General Operating Support

As the preceding examples suggest, organizations involved in supporting civic engagement often rely on a combination of strategies to advance their work. In order to truly center community needs and priorities, civic engagement and power building organizations require flexibility to build institutional knowledge, sustain staff capacity, direct resources where they are most needed, and adapt tactics to changing dynamics. The fluid, locally driven nature of this work makes general operating support particularly valuable to power building organizations.

Recognizing the value of flexible funding, several of the foundations participating in this scan support civic engagement efforts through general operating support grants.

• The W.K. Kellogg Foundation provides general operating support to a number of organizations working to promote civic engagement. For example, the foundation awarded $525,000 in general operating support to Southern Echo to further the organization’s mission of empowering African Americans and low wealth communities throughout Mississippi and the southern region with the knowledge, skills, and resources needed to impact and demand accountability of the political, education, economic, and environmental systems to address the needs of communities through comprehensive organizing, leadership development, training, and technical assistance programs. Similarly, the foundation provides core operating support to the AAPI Civic Engagement Fund which fosters a culture of civic participation within Asian American and Pacific Islander (AAPI) communities by supporting the growth of AAPI groups as organizational movement and power building leaders that achieve specific policy, systems, and transformational change. The organization re-grants funds to local AAPI groups, advances narrative change through the arts, conducts research to better understand the AAPI electorate, and supports movement building.
• Health Forward Foundation provided general operating support to the Heartland Center for Jobs and Freedom, which creates opportunities for workers to learn and exercise their rights, realize their collective power, and develop the leadership skills necessary to advocate for a racially and economically just society. The organization recently launched a successful campaign in Kansas City, Missouri to secure a Right to Counsel ordinance which ensures income qualifying people will have legal representation in evictions proceedings. Led by people in the community whose lives have been touched by eviction, the campaign advocated for the ordinance which requires the city to pay for legal services, notify people facing eviction of this right, and provide information about how to access this service. The ordinance will take effect this summer and is projected to shield 1000 people from eviction in 2022.

Technical Assistance

In addition to providing project and general operating support grants, funders can also strengthen the civic engagement infrastructure by offering technical assistance to civic engagement organizations. These grassroots organizations are often relatively small in terms of both staff size and operating budgets and may lack access to costly data resources and communications technologies that could facilitate their outreach efforts. For example, commercial voter files are databases that provide publicly available information on individuals’ voter registration and election turnout, as well as information from outside data sources (e.g., consumer data vendors, credit bureaus, and political organizations) that can be used for predictive modeling.

• The Colorado Health Foundation made a voter file available to 24 organizations–including nonprofits, local government agencies, and Complete Count committees– involved in census-related “get out the count” efforts. The foundation covered the costs of data access and provided additional technical assistance to assist organizations in utilizing the tool to develop communications campaigns and conduct outreach activities
• The Horizon Foundation funds equity and organizing consultants to convene and facilitate a community of practice with the foundation’s equity grantees who seek to advocate for policies and practices that dismantle longstanding health barriers and ensure more equitable health outcomes for people of color. Having recently launched its second yearlong community of practice, the group will help elevate the voices of leaders from communities of color and strengthen the abilities and resources of community organizations to advance movements for social change. The first cohort of grantees successfully advocated for adoption of a major equity policy in the local school system to close the educational gap between whites and communities of color. In addition to providing technical assistance resources to support the community of practice’s collaborative efforts, the foundation also provides general operating support to each of the participating organizations to enable their involvement and build organizational capacity.

What are the important lessons learned for funders considering this work?

Interview participants offered reflections and advice to other funders who might be considering support for civic engagement based on their own experiences.

• Let the community lead. The nature of civic engagement requires a bottom-up approach that allows community members to set priorities and determine intervention strategies. Funders need to be willing to listen and respond to community-driven direction. This community-driven orientation takes both time and staff capacity to meaningfully engage with community partners, as well as an openness to cede control in decisionmaking.
• Adopt a long-term time horizon. Investments in civic engagement are unlikely to yield overnight success. Funders should be prepared to invest in civic engagement for the long-term and set expectations for outcomes accordingly. Respondents urged funders to invest in organizations rather than projects. Short-term, transactional funding that mobilizes grassroots support to advance a particular policy objective may result in a policy “win,” but it will not build lasting power within a community. A myopic focus on achieving a policy objective may actually run counter to long-term vision and goals if it inadvertently contributes to community fracturing or undermines democratic norms and values.

• Fund trusted organizations that have authentic relationships with the communities you are seeking to support. Locally-based grassroots organizations that have strong, trusted relationships in a community may lack the kinds of capacity that funders traditionally look for in grantees. Multiple respondents noted that trusting relationships are far harder to build than technical or financial capacity and these relationships should be appropriately valued and prioritized when considering potential partners. Given the challenges of building deep relationships with various constituencies within a community, investments in multiple partners will likely be needed. Scan respondents stressed the need to diversify civic engagement funding and support a network of organizations that ensures connections with diverse populations.
• Rethink your perceptions of risk. At its core, community power building seeks to disrupt the status quo. Therefore, funders should expect civic engagement efforts to generate some amount of controversy. Respondents urged health funders to keep these risks in perspective and, more importantly, to consider the far greater risks of disempowered communities and a dysfunctional democracy. Robust civic engagement helps to ensure that elected officials will be responsive to community health needs and priorities. Elevating the voices of historically marginalized communities may change the nature of policy debates, but these efforts are not necessarily divisive. There are opportunities for foundations to foster the conditions and processes that cultivate unlikely alliances, helping strategies be more effective, contributing to social cohesion, and minimizing risks.
• Starting small might be the right first step. For health funders new to supporting civic engagement, modest initial investments may make sense. Although most of the foundations participating in this scan devote significant resources to civic engagement, many grew these investments over time. Easing into this work gives foundation staff and board time to learn more about civic engagement strategies and build trust with grantee partners. Identifying the civic engagement activities and capacity development needs of existing grantees can provide a natural on-ramp for power building efforts.
• Collaborate with other funders. Participation in funder collaboratives, such as the Funders’ Collaborative on Youth Organizing and the Youth Engagement Fund, can be a particularly helpful way to begin funding civic engagement. These collaboratives provide connections to other funders who have extensive expertise and long-standing relationships with power building organizations. Similarly, participation in programming sponsored by GIH, FCCP, PACE, and regional associations of grantmakers can promote a sense of community, expedite the learning curve, and identify opportunities for further collaboration.
• Be clear why you are doing this work. Funders considering investments in civic engagement should be intentional in articulating how this work advances their mission and complements other strategic priorities. Respondents stressed the importance of taking the time to discuss civic engagement with foundation trustees. In-depth deliberations allow board members and foundation management to fully explore the opportunities and risks associated with this work and ensure that everyone has a common understanding of what is being funded and why these investments are necessary for advancing an organizational mission. Funders should recognize that investments in civic engagement support a democratic process, not a particular policy objective, and evaluation efforts should be oriented accordingly. An empowered community may choose to pursue policy directions that funders did not initially envision.

Key questions for health funders exploring whether to initiate or expand funding for civic engagement include: What is the civic health of the communities you serve? Are community members equitably engaged in democratic processes and civic life? How might increased levels of civic engagement influence the distribution of public sector resources, population health outcomes, and health inequities? Is it possible to imagine transformative changes in community health absent a meaningful shift in community power and civic participation?

Acknowledgements

GIH would like to thank the foundation staff that generously shared their time and expertise by participating in this scan of the field, including representatives of The California Endowment, The Colorado Health Foundation, Episcopal Health Foundation, Foundation for a Healthy St. Petersburg, The Greater Clark Foundation, Health Forward Foundation, Horizon Foundation, Robert Wood Johnson Foundation, W.K. Kellogg Foundation, Langeloth Foundation, Missouri Foundation for Health, The New York Community Trust, REACH Healthcare Foundation, and Vitalyst Health Foundation. We sincerely appreciate the contributions of our colleagues at the Funders’ Committee for Civic Participation and Philanthropy for Active Civic Engagement who graciously agreed to review a draft of this article and provided helpful additions and clarification. Special thanks to the Missouri Foundation for Health for providing grant support that enabled GIH to conduct this work.