NONGOVERNMENTAL ORGANIZATIONS, UNITED STATES

Societies and their institutions are commonly divided into three sectors: public or governmental, for-profit or corporate, and nonprofit or independent. This number is sometimes reduced to two— public and private. The public sector includes governmental institutions, while the private includes both for-profit and nonprofit organizations. Institutions within the nonprofit or independent sector are often referred to as nongovernmental organizations (NGOs). This term is somewhat misleading, since it suggests a broader scope—that is, everything outside the governmental sector—than is usually intended. In general, the term refers only to nonprofits and does not include any organizations in the corporate sector.

Broadly speaking, NGOs include charitable organizations such as hospitals, museums, and orchestras; voluntary health agencies such as the American Cancer Society and American Heart Association; foundations or grant-making institutions such as the Robert Wood Johnson Foundation and the Carnegie Endowment for International Peace; social welfare organizations such as the National Association for the Advancement of Colored People and the National Center for Tobacco-Free Kids; and professional and trade organizations such as chambers of commerce and business leagues. Certain types of NGOs are also called voluntary organizations, development agencies, civil society organizations, membership organizations, mutual aid societies, advocacy organizations, and grassroots organizations.

NGOs are committed to addressing social needs and improving the human condition. In addition to this broad mandate, many NGOs share a number of other characteristics. They recruit and engage volunteers for many of their activities and are usually led by volunteer boards; they place mission before profits; and they engage in activities, such as grassroots advocacy campaigns, that would be difficult or impossible for other organizations. By focusing on a specific mission and drawing on the passionate support of local communities and loyal volunteers, NGOs are able to address issues that organizations in other sectors cannot or will not. Perhaps most important, NGOs enjoy a unique independence in their service to the public. Unlike organizations in the public sector, which are often subject to constant political pressure and regulation, and those in the corporate sector, which are beholden to their owners and shareholders, NGOs are accountable primarily to the public's trust.

With the rise of the modern nation state, social development has increasingly been viewed as the responsibility of government. The growth of social democracies and the welfare state during the twentieth century clearly reflects this belief. However, despite massive investment in social programs, governments have never been able to address fully the many needs of their citizens, nor are these needs often met by the corporate sector. NGOs have emerged in large part to bridge the gap between what governments and corporations can do and what society needs or expects.

The unique history and culture of the United States has played an important role in the growth of NGOs and their precursors, which include a range of disparate associations from volunteer fire departments, church groups, and missions to public and voluntary associations. Alexis de Tocqueville, the nineteenth-century French observer of American democracy and customs, was one of the first to comment on the unusual inclination of Americans to volunteer for community-based efforts. What he saw in America was the embodiment of modern longing for a fresh beginning and a fair start for all amid infinite possibilities. Everything American seemed limitless: its space, its resources, its energy, its pioneering spirit. These Americans are curious, he said. There is present an unusual neighbor-helping-neighbor philosophy. No sooner would someone's barn burn down than the entire community would pitch in to raise a new one. This, he said, was uniquely American. It is only since the 1850s, however, that NGOs in the modern sense have emerged and have begun to influence U.S. society on a broad scale. By the year 2000, the nonprofit sector within the United States included more than a million organizations, about 6 percent of all organizations in the country. Together these organizations allocated and dispensed more than $500 billion a year and employed one in fifteen Americans.

Present-day NGOs are often legal corporations with full-time staffs and governing boards and in the United States are categorized by the Internal Revenue Service as 501 (c)(3)s, (c)(4)s, and (c)(6)s. Their organizational structures are more formal and complex, and their operations are more strategic and businesslike. In fact, although NGOs are commonly defined in opposition to government and for-profit organizations, they frequently display characteristics of both. Many NGOs receive support from the government and for-profit corporations, and they often work in collaboration with these groups, each bringing their particular competencies to bear on a common issue. Such collaborations, especially those with the corporate sector, have often led to an increased professionalism and efficiency in NGOs. In fact, many choose to refer to themselves as notfor-profits, rather that nonprofits, indicating that although they are not in the business of making a profit, they are by no means averse to raising more funds for their work. Of course, unlike for-profit corporations, which distribute earnings and dividends to their shareholders, NGOs roll their surplus revenues into ongoing activities or hold them in reserve to cover future needs.

An important subset of NGOs is involved directly in public health issues and education. International NGOs, such as CARE, Oxfam, and Doctors without Borders, often focus on economic development and disaster relief, seeking to address crisis situations and broad infrastructural issues in order to improve the overall health and well-being of a community. Domestic NGOs provide similar services to low-income areas in the United States in addition to deploying resources and manpower during natural disasters. NGOs that focus on educational and occupational issues may indirectly address public health issues by empowering individuals with new skills and competencies, thereby improving their overall standard of living.

Voluntary health agencies (VHAs) are more directly involved in public health issues, often focusing on a particular disease or risk factor. They were among the earliest nongovernmental organizations established in the United States, with several dating back to the beginning of the twentieth century. Some of the larger and more well known VHAs are the American Cancer Society, the American Heart Association, the March of Dimes, the Planned Parenthood Federation of America, the National Easter Seal Society, the American Lung Association, and the Arthritis Foundation. VHAs are involved in a wide variety of activities including research, advocacy, public education, and patient services. Through experience and recruitment, they have acquired broad expertise in the practice of public health and have become critical to the pursuit and achievement of certain public health principles, such as universal access to health care.

Although it does not focus on a single disease or risk factor, the American Red Cross is viewed by some as an early prototype for the modern voluntary health agency. In October 1863, the International Red Cross and Red Crescent Movement was created in Geneva, Switzerland, to provide nonpartisan care to the wounded and sick in times of war. The American Association of the Red Cross was founded shortly thereafter in 1881. Initially, the organization was led by its president, Clara Barton, and an executive board comprised of eleven members. Shortly after its founding, the Red Cross was called into action to provide aid to the victims of a string of disasters, including war, fires, floods, famine, and hurricanes. To do so, the organization sought out volunteer support and public contributions. Since then, volunteer involvement has been an essential element of its organizational structure. As the organization expanded throughout the country, it began to establish local chapters, creating a model for local involvement that is still used today. Each chapter is responsible for local activities, subject to the policies and regulations of the national organization, and local revenues are generally shared with the parent organization. Over the next two decades, the Red Cross quickly established its place in society, and as the organization entered the twentieth century, its humanitarian efforts were well known and respected among the general public.

The model established by the Red Cross was soon duplicated by a number of other groups established to combat leading causes of death. In 1892, Lawrence F. Flick, a former field hand and tuberculosis patient, founded the Pennsylvania Society for the Prevention of Tuberculosis, the first American association of lay and medical professionals dedicated to the conquest of a single disease. In 1904, a national association was established, which quickly developed wide public support. Americans joined the association by the thousands, boosting the number of local affiliates from 23 in 1904 to 431 in 1910. With their support, the association helped accelerate the decline in mortality from tuberculosis through a variety of public health education efforts. The association also developed an early and innovative fundraising campaign, the Christmas seals program. Over the years, the control of tuberculosis has been so successful that the association has refocused its efforts and is now known as the American Lung Association.

The American Cancer Society was another pioneer in the voluntary health movement. In 1913, fifteen prominent physicians and business leaders gathered in New York City to found the American Society for the Control of Cancer (ASCC). Their mission was to disseminate knowledge concerning the symptoms, treatments, and the prevention of cancer; to investigate conditions under which cancer is found; and to compile statistics in regard thereto. The society soon began to establish chapters throughout the country. For many years, however, the majority of its members were concentrated on the East Coast, and consequently, much of its work was focused there. Then, in 1936, Marjorie G. Illig, an ASCC field representative and chair of the General Federation of Women's Clubs Committee on Public Health, established the Women's Field Army, one of the most successful volunteer recruitment structures ever created. Members of the Field Army donned khaki uniforms, complete with insignia of rank and achievement, and went out into the streets to raise money and help educate the public. Clarence Little, the ASCC's managing director at the time, wrote that, "In 1935 there were fifteen thousand people active in cancer control throughout the United States. At the close of 1938, there were ten times that number." In 1945, the ASCC was reorganized as the American Cancer Society. A year later, New York philanthropist Mary Lasker helped raise over $4 million dollars for the society, $1 million of which was used to establish and fund the Society's research program. In the year 2000, the American Cancer Society was the largest voluntary health agency in the world, with over 18 million volunteers and donors, a staff of eight thousand, and $600 million dollars in annual revenue.

No history of voluntary health agencies would be complete without mentioning the National Foundation for Infantile Paralysis (March of Dimes). In 1938, the foundation began collecting dimes to fund polio research. Seventeen years later, on April 12, 1955, the Salk vaccine became available to the public. Without the foundation's support, this achievement might have been delayed for many years. Indeed, in some ways, the story of the foundation exemplifies the power and possibility of the independent sector: polio was vanquished in large part through the voluntary actions of everyday Americans.

During this period, the foundation was led by Basil O'Connor, a Wall Street lawyer. O'Connor not only directed one of the most successful public health campaigns in history but also reinvigorated the voluntary health movement by applying modern marketing techniques to fundraising and simultaneously inspiring a legion of devoted volunteers to his cause. O'Connor's March of Dimes campaign was enormously successful. In 1938, O'Connor enlisted some of the nation's shrewdest advertising and public relations experts to help develop and implement the inaugural campaign. For weeks, the public was inundated with polio information. Hundreds of thousands of dollars in free advertising was devoted to the cause, and celebrities from Edgar Guest to Walt Disney to Shirley Temple donated their time. The campaign culminated with an on-air appeal from Eddie Cantor, Jack Benny, Bing Crosby, and others, urging listeners to send their dimes to the White House. The public response was enormous. Nearly $2 million was raised during that first campaign and future efforts proved equally successful. Although far more people were affected by cancer and heart disease than polio in 1938, O'Connor was able to capture the public's attention, propelling the National Infantile Paralysis to the forefront of the voluntary health movement.

Since these first organizations came into prominence, many more NGOs have been established. Some are small organizations with only a handful of staff and volunteers. Others operate on a global scale. Whatever the case, NGOs continue to play a critical role in U.S. society. In the future, success will lead to obsolescence for some NGOs, but others will evolve to address unresolved issues and emerging threats, improving the health and wellbeing of the public.

John R. Seffrin

(see also: American Cancer Society; American Heart Association; American Lung Association; American Medical Association; American Public Health Association; Official U.S. Health Agencies )

Bibliography

Carter, R. (1992). The Gentle Legions. New Brunswick, NJ: Transition.

Fernando, J. L., and Heston, A. W., eds. (1997). "Introduction: NGOs Between States, Markets, and Civil Society." Annals of the American Academy of Political and Social Science 554:46–65.

Green, A., and Matthias, A. (1997). Non-Governmental Organizations and Health in Developing Countries. New York: St. Martin's Press.