Private Foundations

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PRIVATE FOUNDATIONS

The search for ways to improve the health of the public has been a salient goal of private foundations since their emergence as important American social institutions in the early 1900s. In 2000 there were approximately 50,000 private foundations in the United States, with assets of some $450 billion and awarded grants of $27.6 billion. Their share of total voluntary giving, however, was just above 14 percent of the $190 billion contributed by Americans that year—making foundations relatively modest participants in the annual flow of the country's philanthropic dollars. The major share (85%) came from individual charitable gifts and bequests.

Foundation giving, however, tends to be quite different from giving for general charity. The bulk of charitable dollars are devoted to the operational budgets of the churches, rescue squads, shelters, and other local agencies that depend on these funds. In economic terms, charitable dollars are largely consumption dollars. In contrast, foundation dollars are usually targeted on investment spending. They help grantee institutions explore and adopt better ways to do their work, test new ideas, and engage colleges and universities in related research and training. Activities of this type build the future capacity of foundation grantees. In this way foundations have become the largest single source of private investment capital dedicated to the progress of America's helping institutions. The record of foundation giving in public health illustrates their utility over time as publicbenefit investment institutions.

Throughout most of the past century, foundations—especially Rockefeller philanthropies—have been in the forefront of infectious disease control. In combination, the Rockefeller Sanitary Commission, the Rockefeller Institute for Medical Research, the International Health Board, and the Rockefeller Foundation itself, promoted community sanitation practices and conducted laboratory research leading to the control of such scourges as hookworm, malaria, and yellow fever. Foundations were also involved in the development of the key agents (streptomycin, isoniazid) that brought tuberculosis under control. The advent of HIV (human immunodeficiency virus) infection as a major health problem has also engaged the attention and funding of many foundations. For example, the Robert Wood Johnson Foundation underwrote a series of model communitywide HIV-prevention programs.

HIV is a preventable condition calling for public education and therapeutic counseling to produce changes in population and individual behaviors. Similarly, dependence on psychoactive substances, including alcohol, requires behavioral interventions that challenge public health. The Christopher D. Smithers Foundation and the Hanley Family Foundation have worked intensively on this issue, as has the Robert Wood Johnson Foundation.

As the country enters a new century, public health surveillance has produced evidence of a changing pattern of disease—away from contagious and infectious assaults and toward chronic conditions with high levels of prevalence, mortality, and morbidity. Virtually all of these conditions(e.g., heart disease, cancer) are associated with long-term lifestyle patterns and related environmental factors that call for new and vigorous public health interventions, particularly in the areas of tobacco use and physical activity. Through state and federal agencies, particularly the Centers for Disease Control and Prevention, the public health community is addressing these issues. The Robert Wood Johnson Foundation has initiated several programs to stimulate greater private-sector participation. For example, the American Cancer Society has been a major partner in its work with states.

Over the years, foundations have provided considerable leadership to the progress of children's and family services. The Laura Spelman Rockefeller Memorial helped establish communitywide parenting education initiatives. At about the same time, the Commonwealth Fund founded child guidance clinics and funded related training in psychiatric social work, and in the 1990s it created a model form of well-child care under its Healthy Steps initiative, which brings professionals in child development into frontline pediatric practice. Many other foundations are interested in the early developmental experience of children and their transition to adolescence. Among these are the Annenberg Foundation, the Carnegie Corporation, the Charles Stewart Mott Foundation, the David and Lucile Packard Foundation, the Ewing Marion Kauffman Foundation, and the Foundation for Child Development. In concert with these and other foundations, the Robert Wood Johnson Foundation has launched initiatives to improve county-level maternal and child-care systems, establish school-based health centers, assure the completion of immunization schedules, and to institute nurse-home visiting for first-time single mothers. Also, the Johnson Foundation has partnered with other grantmakers to build statewide health and social support services for low-income families. In terms of their investments in public health, concern for the health and well-being of America's children has been a long-standing and major theme of foundation philanthropy.

Improvements in the organization and staffing of public health was accelerated in the 1920s under grants from the Commonwealth Fund to establish a twelve-state series of model county health departments. Operating standards for these projects were developed in cooperation with the American Public Health Association and were widely instituted throughout the country. Professional education for the field became solidly established in 1916 with the founding of the Johns Hopkins School of Hygiene and Public Health under grants from the Rockefeller Foundation. Johns Hopkins formed the prototype school for the establishment by Rockefeller of 22 additional schools in 17 countries.

To assure that education would remain rooted in practice, the W.K. Kellogg Foundation funded an initiative to build formal partnerships between schools of public health, health departments, and community health service agencies. More recently, to address the learning needs of in-service public health staff at both the state and local levels, the W.K. Kellogg Foundation and the Robert Wood Johnson Foundation have formed a joint funding program called Turning Points. In addition, working with the National Governors' Association, the Robert Wood Johnson Foundation is funding a program to accelerate the development of the leadership capacity of state health officers as policymakers, administrators, and advocates for the health of the public.

Finally, public health has great needs for ascertaining the determinants of health and the health and functional status of defined communities. Epidemiology is thus one of the basic disciplines in this field, and this science of measurement has been strengthened through the grantmaking activity of the Milbank Memorial Fund.

Terrence Keenan