Foundations as a Catalyst for Improved Health Outcomes

(Garth Graham, MD, MPH, is president of the Aetna Foundation, which works to strengthen disease prevention programs, revitalize neighborhoods, support the arts, provide assistance to those in need, and empower the diverse voices that shape our nation.)

Through grants and support for research, foundations are uniquely positioned to serve as catalysts for social change in a way that conventional businesses and other nonprofits are not. We also operate in a space that provides us with the rare opportunity to bring together policy makers, corporations, experts, and community organizations to look holistically at an issue and promote the changes needed to achieve our goals.

As a physician and in my new role as the president of the Aetna Foundation, I am reminded every day of the responsibility my colleagues and I have to improve the health of children and adults and to make our healthcare system more equitable and effective. Over the years, Aetna and the Aetna Foundation have strengthened disease prevention programs, helped revitalize neighborhoods, supported the arts, provided aid to those in need, and listened to the diverse voices that shape our nation.

In addition to promoting racial and ethnic equity in health and promoting integrated and well-coordinated health care, one of our priority areas is fighting obesity. While childhood obesity rates in the U.S. are starting to level off, 5 percent of American children and teens are severely obese, which, according to new information from the American Heart Association, puts them at risk for premature heart disease and type 2 diabetes.

We have worked, for example, to better understand and evaluate how changes in food access and choice affect consumption patterns and health outcomes. We have funded partners who look at different parts of the food supply chain to help us understand how best to influence positive behavior changes related to healthy eating. And through strategic partnerships with a range of organizations, we have been able to gather data about how these programs work.

To that end, we supported a study called SNAP to Health to identify best practices for improving nutritional intake among children who benefit from the Supplemental Nutrition Assistance Program (SNAP). Led by Susan J. Blumenthal, former U.S. assistant surgeon general and now a senior fellow with the New America Foundation, the initiative coordinated efforts to investigate how to strengthen federal food benefits. Among other things, the study recommended strategies for improving nutrition delivered by the program. Proposed changes included financial incentives to encourage the purchase of nutritious food items, restrictions on nutrient-poor food and beverages, more frequent distribution of SNAP benefits, enhanced nutrition education, stricter requirements on retailers to become an approved SNAP retailer, and greater coordination of federal and state programs addressing poverty, food insecurity, and public health.

Project collaborators, including experts in health policy, nutritional epidemiology, agricultural economics, and health communications designed and conducted a survey of stakeholder groups to identify barriers and opportunities for improving nutrition delivered through SNAP. They also conducted the first statistical analysis of National Health and Nutrition Examination Survey data to determine the effects of SNAP on nutrition and obesity in youth between the ages of 4 and 19. Based on these two sets of analyses, SNAP-related policy recommendations for the 2012 Farm Bill were developed. In addition, an interactive Web site that serves as a national forum for public discourse on improving nutrition was created.

We also have turned to innovative community programs to understand how incentives play into food choice, particularly in underserved communities where healthy food options may be difficult to come by. One such example, the Double Up Food Bucks program, which was piloted by the Ann Arbor-based Fair Food Network at five farmers markets in Detroit in 2009 and has since expanded to more than a hundred and fifty food outlets in the state, enables SNAP recipients to shop at participating farmers markets and receive up to $20 for the purchase of Michigan-grown fruits and vegetables.

The opportunity foundations have to improve health and wellness is significant, and the role we play in sharing information, coordinating data collection, and creating innovative partnerships is critical. Every American, like every patient, is part of a collective whole, and it is our goal to improve health outcomes for all of them.

-- Garth Graham