| As part of GIH’s ongoing work to support new conversion foundations, we invited Susan Zepeda, founding President and CEO of Foundation for a Healthy Kentucky, to share insights and advice on starting a health foundation. |
Creating real change—whether in health, education, or broader social issues—takes time. We often point to watershed moments in a movement’s history as if they were a bolt from the blue. But, most frequently, years of hard work, planning, and organizing preceded that “overnight success.” Building a health foundation that effectively meets community needs and creates lasting improvements in population health does not happen overnight either.
Almost twenty years ago, after a career in public health, I was offered the opportunity to bring my passion for population health improvement to philanthropy. Since then, I have had the unique privilege of leading two new health foundations—one in California, and one in Kentucky. Both are dedicated to creating lasting health improvements in the communities they serve. I am pleased to share key learnings from my journey in health philanthropy as the founding CEO of foundations that seek to be agents of change.
Get Your Board on Board
Your board—most likely, of recognized leaders in their respective communities—can be as important as your funds in making change happen. Board members must not only understand the foundation’s mission, but must own it. They must be willing to commit publicly to the work of the foundation. A foundation board also needs to be a cohesive body. Avoid a two-tier board: one tier that is inclusive (in terms of skills sets and demographic and geographic representation), and a second tier that is made up of “three guys in the parking lot before or after the meeting, setting policy.” Beware also the “bobble-head board” who smile and nod, but do not challenge each other or the path you are creating. Commitment and cohesiveness in the board room create a safe place for open dialogue, and side conversations among a small group of members are brought back to the full board.
Build Authentic Relationships
Relationships matter; trust matters. Inclusion and respect are key to building authentic relationships with grantees, community members, and other partners. Regardless of the size of your foundation—the two I led were modest in size—you generally have the greatest impact if you solicit input from community members most impacted by the issues, partner with other funders, and build authentic relationships with effective grantees.
Know where the foundation is headed and state it clearly. As you develop a strategic plan, do not create it in isolation. Let others know what you are doing. Be sure you have included an “environmental scan” in this planning process: What is the state of knowledge and evidence base in the areas you are seeking to influence? Who else is working on the issues your founders focused on, or your board now wants to address? Are they competitors, or potential partners?
Equity Matters
The foundations I served had a commitment to doing our grantmaking through a health equity lens. For us, that has meant breaking down barriers to participation. We developed a more streamlined application process; offered a “boot camp” for those seeking large, complex multiyear grants; and codesigned evaluation strategies after an award, not making the evaluation design part of the application. In addition, we blended convening, training, and funding so grantees and foundation staff could learn together and from each other.
In sharing the equity imperative with our board, I found it helpful to use the three-frame baseball game example: not just boxes of differing heights, but tearing down the wall. Camara Jones’ definition of equity, shared at the 2016 American Public Health Association meeting, offered a “testable” definition of equity as:
- Valuing all individuals and populations equally,
- Recognizing and rectifying historic injustice,
- Allocating resources based on need.
Importantly, equity work needs to move beyond the individual and take a hard look at the ways in which institutions, culture, and policies impede or advance opportunities for all. Anthony Iton of The California Endowment has created a useful framework for moving health equity conversations upstream to the social and environmental factors that shape health outcomes:
Do Not Shy Away from Policy
Engaging in policy is an effective strategy for creating change, so do not be afraid to fund this work. Policy change happens “when preparation meets opportunity.” But, how do you tell you are headed in the right direction? This is where your change theory and evaluation approach can help you identify the intermediate steps from good idea to policy reality.
Health foundations can also influence policy with a “small p”—policy in the private sector that often paves the way for policy change in the public sector. For example, in California, a cohort of health funders agreed to make a “kid-friendly” environment a condition of funding. To get a grant for children’s work from any of these funders, grant recipients had to agree to provide healthy snacks and meals (if food was offered), and to provide opportunities for “large motor activity” if the children were in their care for more than a couple of hours at a time. Grantees also received implementation training to support these new requirements.
In Kentucky, as we worked—and supported grantees’ work—on protecting workers throughout the state from second-hand smoke, we broke advocacy efforts into smaller steps than just “pass/fail” of statewide legislation. We considered hospital, school district, city, and county commitments to clean indoor air as important victory milestones. We also tracked and shared public opinion on the importance of smoke-free workplaces, restaurants, and bars.
Evaluate and Share What You Learn
Test your assumptions. Rigorous evaluation need not be ponderous or costly—a modest 10 percent commitment to evaluation can keep a foundation’s work on track. You will learn whether the work is doing what was intended and if it is having the desired results. The aim of evaluation should be ongoing learning and rapid course correction, so it is important to share what you learn with your board and community partners, cofunders, and grantees in a timely manner.
It is helpful if the evaluator is not your employee. Experienced evaluators from organizations such as the Center for Evaluation Innovation and the Center for Community Health and Evaluation are particularly good at offering a reality check on whether your investment is sufficient to attain the desired outcomes. Finally, be honest—with yourself, your colleagues, your board, your donors. If things are not working as intended, revise, correct, and learn from your experience. And share what you have learned so others who care about this work do not repeat your errors.
Does this seem like a daunting list of suggestions? I hope not. By tapping into the wealth of knowledge of your board, staff, and community partners you can work smarter—and find that your passion for this important work is at least as important as the funds in your portfolio. Si se puede—yes you can!