5 Questions for...Harvey V. Fineberg, President, Gordon and Betty Moore Foundation

Established in 2000 by Intel co-founder Gordon Moore and his wife, Betty, the Gordon and Betty Moore Foundation holds assets of $6.56 billion and in 2013 was the ninth largest U.S. foundation by asset size and tenth in total giving. With a focus on "[tackling] large, important issues at a scale where it can achieve significant and measurable impacts," the foundation's main program areas include science, environmental conservation, patient care, and the San Francisco Bay Area.

Harvey V. Fineberg, M.D., Ph.D., joined the foundation as president in January 2015. Prior to that, he served as president of the Institute of Medicine (2002-14) and as provost of Harvard University (1997-2001), following thirteen years as dean of the university's School of Public Health. A co-founder and former president of the Society for Medical Decision Making, Fineberg has served as a consultant to the World Health Organization and serves on the boards of the Carnegie Endowment for International Peace (which he chairs), the William and Flora Hewlett Foundation, and the China Medical Board.

PND spoke with Fineberg via email about the foundation's approach to grantmaking in the areas of environmental conservation, scientific research, and patient care.

Philanthropy News Digest: As Gordon and Betty Moore, you, and foundation staff have made clear over the years, the Moore Foundation supports fundamental scientific research and embraces experimentation in its grantmaking. Are those two things ever in conflict? And how do you and your colleagues find the proper balance between them?

Harvey Fineberg: Our support for fundamental research enables scientific breakthroughs. We embrace a systematic or "scientific" approach in all of our grantmaking, whether in basic research, environmental conservation, patient care, or at home in the Bay Area.

The systematic approach in grantmaking means that we rely on evidence and investigation, focus on long-term goals, and place a premium on defining measurable outcomes. We develop clear hypotheses that guide our investments. Along the way we continually test our assumptions, challenge our thinking, and, as necessary, adjust our course in pursuit of those outcomes.

In our grantmaking, we are prepared to aim high; we like to identify a path to success, and we are willing to fail in pursuit of a worthy goal. We know that accomplishing big things can take time, and we are investing for the long term.

PND: From your vantage point, does the foundation's focus on evidence make it an outlier in the philanthropic world?

HF: Gordon Moore has encouraged us to "swing for the fences." As we aim to tackle complex, important problems, we understand the world may change in profoundly important ways that we cannot predict. We work diligently to drive change to a certain scale or scope and understand there are times we may fall short. When things don't go according to plan — for better or worse — the most important thing we can do is learn from that experience and try to improve the next time.

PND: The foundation has chosen not to invest in efforts to address global climate change directly. Yet many of the land, marine, and freshwater ecosystems the foundation is working to conserve are directly affected by both the causes and effects of climate change. Is conservation enough to save critical ecosystems on a planet that seems to be warming rapidly?

HF: Arguably, the threat of climate change affects everything. It is undoubtedly one of the most important challenges of our time. The question for any foundation, including ours, is how to focus and apply your resources, and that means making choices about what you do and what you do not do. A foundation can try to influence the world in many ways: you can focus on problems, people, institutions, or causes. In general, we choose to focus on solving big problems. We often invest in human capital and institutions, but with the larger goal of achieving a better outcome in solving one or more problems. We are a problem-driven, rather than a cause-based, organization.

Our conservation program seeks to redress the degradation of ecosystems and to secure biodiversity. As the world's leading private funder of Amazon conservation, for example, we have likely contributed to greater carbon sequestration than many others working directly on climate issues. In our case, that result was incidental rather than a prime motive.

PND: In addition to directing 40 percent of its grant dollars — about $100 million annually — to basic science, the Moore Foundation, in partnership with the Science Philanthropy Alliance, is encouraging other funders to support scientific research. Why is it important for philanthropy to support basic research?

HF: Progress in society depends on basic research. While the opportunities for discovery have never been greater, commitment to and funding for science — from government, industry, and philanthropy — fall far short of what is needed to accelerate progress. As a nation, we must invent in research if we wish to remain in the forefront of fields such as super-computing, cybersecurity, space exploration, energy, and health care.

An unprecedented amount of wealth is accumulating in private hands. The Science Philanthropy Alliance, which we helped establish, recognizes that private funders and philanthropies have access to the kind of flexible dollars needed for early discovery and basic research and is designed to advise and inspire those who are so inclined to support that research. Private funders and the philanthropic sector have the opportunity to invest in riskier endeavors than many government agencies are able to tolerate. We can deploy resources more quickly, select topics with higher risk (and commensurately higher gain), and feel comfortable with investments that are long-term in nature. Private philanthropy will never be able to replace the scale of government funding, but it can serve as society's venture capital.

PND: The U.S. health sector is a complex $3 trillion industry in the throes of change as a result, in part, of the implementation of the Affordable Care Act. Some would argue that change is not happening fast enough. How can the philanthropic sector, and the Moore Foundation more specifically, help accelerate the change?

HF: The U.S. healthcare system is going through a period of substantial change, some of it for the better. There are a variety of external pressures, some a consequence of the Affordable Care Act, others the result of changing population demographics and technological advancements.

The health sector is vast, and for those of us in philanthropy, it is important to focus our efforts if we wish to make an impact. As a foundation able to invest $40 million a year in patient care-related efforts, we recognize that it is not feasible for us to take on comprehensive systems change.

Yet, with focus, we can make a positive difference. We aim to improve the experience and outcomes of patient care, and there are many ways to do this. With the advice of key healthcare experts and our own examination of the field and what others are doing, we identified serious illness and end-of-life care as areas ripe for action.

End-of-life care affects everyone, be it as a patient or a family member. Unfortunately, in too many situations, a patient's preferences are not known, let alone honored. That is not good for health care. It is not good for society.

The IOM report Dying in America; new payment reforms from the Centers for Medicare and Medicaid Services; and Being Mortal, a best-selling book from Atul Gawande, M.D., are all signals of growing readiness for change within the field. We believe that with strategically focused investments, we can help accelerate the momentum of change on this critical issue.

— Kyoko Uchida