A conversation with the Robert Wood Johnson Foundation's Health Group on September 23, 2013

Participants

Note: These notes give an overview of the major points made by Dr. Jim Marks.

Since this conversation took place last year, the Robert Wood Johnson Foundation has realigned many staff responsibilities. While the information in these notes is accurate, Dr. Marks has a new portfolio of responsibilities today.

Summary

Good Ventures spoke with Dr. Jim Marks to learn more about the Robert Wood Johnson Foundation’s (RWJF) Health Group. Conversation topics included an overview of the Health Group’s work, its major successes, and how it selects projects to fund.

Overview of Robert Wood Johnson Foundation’s Health Group

The RWJF Health Group works on issues of health by addressing problems outside of the healthcare system, in areas such as public health, agriculture, education, and transportation. For example, addressing child obesity involves improving access to healthy food, creating safe exercise spaces, and changing food marketing tactics that target children, among other things. The notion that areas beyond healthcare have implications for health is a somewhat underdeveloped concept.

There is some disagreement in the US as to whether health is the effect of personal decisions or the effect of social factors. RWJF believes that both are important. For example, in working on the County Health Rankings reports, a US county-level health scoring system based on measures of mortality and morbidity, RWJF found that—in addition to healthcare—both personal health behaviors, and environmental and social factors such as the education level and single parenthood were correlated with mortality and morbidity. Information provided by the health scoring system encouraged counties to address issues outside the realm of healthcare. For example, a county in Michigan learned that their bus lines were a barrier for some low-income women from receiving prenatal care at hospitals in neighboring counties because the buses stopped at the county line.

Five years ago, RWJF formed a commission to develop practical recommendations for improving health in America. The background and expertise of the commission was not limited to health and healthcare.

Generally speaking, RWJF looks for opportunities that are tractable, sustainable, and scalable. RWJF prioritizes vulnerable populations and tends to focus on early childhood, mental health, and populations whose health problems stem, at least in part,  from social circumstances. Policy work and advocacy are important parts of creating lasting, scalable change. Rather than solely funding interventions in multiple communities, RWJF often prefers to leverage its impact by evaluating a policy change, and if it is found effect, supporting efforts to educate for that policy to be adopted more widely.

RWJF reviews existing research to investigate questions such as, “what is the available science on a given topic,” and “what policies have grown out of research, and have these policies had an impact?” It also evaluates the impact of specific policy changes. For example, RWJF’s investigation of tobacco taxes addressed questions such as, “did tax increases lower initiation by youth?”

Currently, RWJF does not grant outside of the US. However, it hopes to learn more about global opportunities that could be usefully applied in the US in the future.

Non-legislative policy work

Roughly 20% of RWJF’s work is on policy change. In particular, the foundation does a lot of work to promote non-legislative policy change.  Changing policy through non-legislative channels often involves facilitating the sharing of information and best practices. Examples of RWJF’s policy-oriented work include:

Major successes

RWJF’s Health Group has had success in areas including:

Selecting projects

Research often informs RWJF’s project selection. Research has led RWJF to the following conclusions:

Before committing to the project on health agency accreditation, RWJF sought a variety of perspectives; investigated the impact of accreditation programs in other social agencies and in the health agencies of particular states (for example, research in North Carolina found that accredited agencies responded more effectively to the flu pandemic); spoke to health officers who suggested that accreditation requirements help protect important programs during budget cuts; and compiled best practices with the CDC as its major partner.

Matching local funders

RWJF has matched funding for projects selected by local funders, such as the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP). In several cases, it worked to scale-up these projects or compile more evidence on their behalf. For example, RWJF funded additional sites for EDIPPP and added an evaluative component to the program.

Service models

RWJF looks for opportunities to fund “service models” such as EDIPPP and Playworks (an elementary school program whose growth RWJF has helped fund) for which it can help strengthen evaluative capabilities, develop sustainable business models, and support efforts to spread the model. Before making a commitment, RWJF investigates questions of funding (e.g. “does this program need a government source of funding?”), scalability (e.g. “can this program be sold as a service to hospitals?”), and management (e.g. “does the program have a board structure with good fiscal management, evaluative capabilities, and strong networks?”).

Miscellaneous considerations

Less successful projects

RWJF has been involved in some projects that did not achieve as much as expected. These include:

RWJF has published evaluations of some of its projects on its website, including its work on tobacco, substance abuse, and end-of-life care. These evaluations discuss the accomplishments, failures, and evolutions of its projects. For example, the evaluation on its work around end-of-life care discusses how the project was initially oriented more toward medical education than policy. After shifting the direction and strategy of the project, RWJF was able to make a larger contribution to the field.

Promising opportunities

Areas of great interest and potential for the future include:

Dr. Marks also recommends funding research around:

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