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Aha Moments on the Road to Building Healthy Communities, Part 1

July 05, 2013

(Robert K. Ross, MD, is president and CEO of the California Endowment. A version of this post appears on the Foundation Center's Transparency Talk blog.)

Headshot_robert_rossWe are now two-plus years into the implementation of the California Endowment's Building Healthy Communities initiative, and I can safely say that it has been the two most exciting years of my career in community and public health.

This is the first of a series of periodic reports we will produce to share our progress, observations, mistakes, and lessons along the way as we support the efforts of community leaders to create healthier environments for young people in distressed and underserved communities.

Building Healthy Communities -- BHC for short -- is a ten-year commitment by our board of directors to a two-pronged strategy. We have "dropped anchor" in fourteen distressed California communities, working in partnership with community leaders to improve the health and life chances of young people. In addition, we are supporting change by funding advocacy, organizational capacity building, and communications related to our key health issues. 

It is our intent to have these place-based and "bigger than place" strategies complement one another -- and for the moving parts to come together and spark a powerful synergy. At the local level, BHC communities are engaging multiple sectors to develop innovative efforts to advance health. As these innovative strategies emerge, we're looking for ways to scale the ideas through policy change and communications at the state and regional levels. By acting on multiple levels with complementary strategies, we expect to make a greater contribution than if we were to work only at the place level or only by supporting advocacy at the state level. This is central to our theory of change. In a sense, it's appropriate to think of BHC as a "place-based plus" community change campaign.

In the spirit of the kind of knowledge sharing that is a central aspect of Glasspockets and Transparency Talk, I will highlight three "aha" moments we've had to date, followed tomorrow by a second post listing key lessons for philanthropy.

Aha Moment #1: The Message Matters

As many of us know, talk about "social determinants" -- the role that poverty, education, and housing play in health status -- tends to cause people's eyes to glaze over. We experienced this communication gap early as local communities strove to decipher our jargon-laden list of ten targeted outcomes and four Big Results. Our communications team, inspired by the engagement of community leaders and residents in the planning process, met this obstacle head-on and created what I believe is one of the first successful "de-codings" of social determinants research: Health Happens Here.

Health_happens_hereIf you put the phrase "Health Happens Here" on a photo of a healthy school lunch, or a bike path, or a father and daughter hugging each other, you immediately communicate the change in norms we are trying to promote. Indeed, we took the message a step further by incorporating it into our internal structures. In looking at our grantmaking, we found that 80 percent of our grants were focused around three areas: neighborhoods, schools, and prevention. That realization led us to create three themes -- Health Happens in Neighborhoods, Health Happens in Schools, and Health Happens with Prevention -- that have become the essential building blocks for our work. In fact, we call them campaigns -- another language choice that communicates our intent as a foundation to use our brand to push for policy reform and systems change. We're also investing in aggressive media strategies -- via television, radio, print, and social media, as well as through partnerships with influential messengers such as First Lady Michelle Obama, Dr. Oz, and Jamie Oliver -- to promote the message. Our hope? A simple, compelling message delivered by popular, influential messengers can shape a new narrative of change.

Aha Moment #2: Trust Young People to Lead

Early in the BHC process, we decided to put young people into leadership roles. Little did I know that the decision to do so would not only impact our community efforts but would impact how we view our work. Young people and adults view health issues differently, and it makes perfect sense to engage young people directly in developing strategies to improve their health. But it wasn't something we had done. Like most adult-focused organizations, we simply didn’t factor young people into our thinking.

Since we've taken this step, we've learned a lot. Young people brought to our attention the scandalous epidemic of suspensions and expulsions in our schools and helped us understand how this issue connects to their health. Young men of color led us to a greater understanding of the role of trauma in the lives of youth growing up in homes and gang-infested neighborhoods plagued by violence and highlighted the critical need for social/emotional health and healing in these communities. We've seen firsthand that young people can be powerful leaders for social change. When they tell their stories through the arts, spoken-word performances, social networking sites, or journalism, they compel action. They are not only about our future; they are leaders for today. And they are helping us evolve into an organization informed by both adult and youth perspectives.

In addition to the numerous youth organizing and development efforts in our BHC sites, I've created a "President's Youth Council" consisting of fourteen youth leaders across the state who meet with me at least twice annually in my role as president and CEO of the California Endowment. In this way, I have the privilege of hearing directly from youth leaders themselves about the progress and struggles of BHC, and about how our foundation can be more responsive to and supportive of their neighborhoods and communities. I believe this represents a fundamental culture change that will influence our work in the years to come.

As of this writing, BHC youth leaders, working in hand-in-hand with the organizations that support them, have begun to rack up a series of policy victories that will check, if not reverse, the epidemic of school suspensions, and they are calling for alternative, common-sense discipline practices, including restorative justice approaches, designed to keep kids in school.

Aha Moment #3: Build Power, Not Just Knowledge and Innovation

Frederick Douglass said that power concedes nothing without demand. The world doesn't change because of the release of new data. It responds when people demand change.

Institutional philanthropy tends to worship at one of two altars: new knowledge and/or innovation. Both are overrated, overhyped, and over-subscribed to by practitioners in our field. It can be argued that the primary value of philanthropy to civic society is its ability to problem-solve at scale. In a perfectly linear, logical, and intellectually driven world, good data and research, and the knowledge derived from them, would be king. But that's not the world we live in. Recently, in a different blog post, I noted that the state legislature in North Carolina effectively banned the use of scientific projections of global warming-induced tidal changes because such projections stand to impede business development in the state. More recently, the NRA-led prohibition against gun-violence research by the Centers for Disease Control was challenged by President Obama after the Sandy Hook school massacre in Connecticut. I wish these were isolated events, but history has shown that good science frequently takes a back seat to political and economic forces, to the detriment of society.

The best public health example of this phenomenon is the eighty-year-plus war against Big Tobacco. The medical and public health communities have known about the detrimental effects of tobacco use since the 1920s, but Big Tobacco had the politicians on its side. Decade after decade, science could make little headway against that power. It wasn't until we discovered the efficacy of grassroots advocacy, in combination with science, that we began to rack up some victories.

Philanthropy also is hopelessly in love with "innovation." In the corporate world, innovation often leads to huge profits -- the iPhone being a classic example. In the social sector, innovation rarely scales on its own merits; there are simply too many powerful political forces in play. Absent a recognition of this fundamental fact, data and innovation by themselves will accomplish little. The battle over school suspensions is a perfect illustration of this point: even though youth leaders and advocacy organizations were able to marshall data that demonstrated the disproportionate impact on African-American and Latino young men of the practice, their efforts only gained traction after they got the attention of politicians in the state legislature.

Through our Building Healthy Communities initiative, we have decided to make a statement: we want to help community leaders and activists secure the power they need to promote healthier places for young people. We want to support people and organizations that think in terms of power and demand change. Because power concedes nothing without demand, and, as Frederick Douglass knew, it never has and never will.

-- Robert K. Ross


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