Public Health Partnership With Pew Makes Critical Progress


Shaping a healthier nation

Robert Wood Johnson Foundation's partnerships with Pew aim at a common goal of healthier communities. © iStockphoto

When a new building is constructed or roadway developed or factory built, it often has health effects that ripple through the surrounding community. But how to measure that? 

In 2009, the Robert Wood Johnson Foundation—the nation’s largest philanthropy dedicated solely to health—wanted to see if a process called health impact assessments, known as HIAs, could help provide policymakers with the information they needed to make good decisions about the impact of projects on the public’s health. HIAs, conducted by a collaboration of researchers, government officials, and decision-makers, evaluate a project’s full impact on the surrounding community’s health. Recognizing a shared interest in improving public health through the use of strong, evidence-based programs, the Princeton, New Jersey-based foundation turned to Pew to help determine whether HIAs were as effective as they appeared to be. Known as the Health Impact Project, the collaboration, which has recently expanded, also laid the groundwork for other partnerships designed
to improve the nation’s health.

“Back in 2009, HIA was one of the few concrete tools for bringing health considerations into the decisions of other sectors outside of health care,” says Pew’s Rebecca Morley, who directs the Health Impact Project. “RWJF wanted to test the tool, ensure its rigor, and scale it to multiple sectors.” The project was able to confirm that HIAs were indeed a rigorous tool that could improve public health, and it also began to support assessments around the nation. Since the collaboration began, the number of HIAs conducted in the United States has increased from about 60 to approximately 400, over 100 of which were funded by RWJF.

Many of the early assessments focused on the health impacts of decisions relating to the built environment—such as transportation infrastructure, city planning, and housing developments. The assessments considered how the project—be it a new road, a mixed-use development, or updates to a senior housing complex—would affect the overall health of people living in the area. For example, a new development might result in more traffic and pollution, which could harm current residents, but might also bring needed affordable housing units or a new supermarket that could provide fresh fruits and vegetables to an underserved population.

Last year a far-reaching HIA by the Department of Housing and Urban Development looking at locations around the country concluded that the quality, affordability, location, and community of public housing for seniors and disabled families all have an impact on residents’ physical and mental health by reducing illnesses, injuries, and stress. Another recent HIA, of the light rail system in St. Paul, Minnesota, drew lines to community health in a different way by examining a series of land-use changes for a new transportation system connecting the Twin Cities. The project proposed running the system through low-income and immigrant communities where many businesses are on the ground floor of buildings that have apartments above. The HIA revealed that existing zoning regulations would have effectively prohibited such businesses from being allowed to continue with implementation of the new transport system. The finding, which would not have otherwise come to light, led local authorities to change the zoning laws, preserving the mom-and-pop shops—some of which sold fresh produce and ethnic foods—as well as the community’s diversity.

In 2017, the Health Impact Project will use the framework of a health assessment to tackle a national public health concern. Motivated by the crisis of lead-poisoned water in Flint, Michigan, the project will examine how the toxin can affect communities—through water, housing, and soil—and deliver concrete, comprehensive, and definitive recommendations for protecting citizens from the damaging effects of this heavy metal.

“We viewed HIAs as having great promise in exploring the multiple determinants of health—the notion that health is produced more by your physical and social environmental factors than by health care,” says Pamela Russo, RWJF’s senior program officer for the Health Impact Project, noting that with “a lot of depth in government work and government affairs, [Pew] can take advocacy further than we can.”

 Robert Wood Johnson also turned to Pew when confronting another significant national health concern: childhood obesity.

By 2010, obesity among children had nearly tripled in three decades, with corresponding increases in Type 2 diabetes and other related illnesses. But another statistic also attracted RWJF’s attention—most children consume more than 50 percent of their daily calories at school. Determined to advance what the foundation calls a “culture of health” in the U.S., RWJF worked with Pew to develop the Kids’ Safe and Healthful Foods Project, which focuses directly on what’s served in school cafeterias around the country.

“The Robert Wood Johnson Foundation has been critical to accelerating the progress made in child nutrition,” says Jessica Donze Black, who until recently directed the project at Pew. “Its emphasis on backing this work through a partnership built on solid research and programmatic and policy support changed the dynamic.”

Using a variety of approaches, including HIAs, economic analyses, scientific polling, and advocacy, the project team worked to increase awareness and ensure the adoption of healthier standards for meals and snacks in schools mandated through the 2010 Healthy, Hunger-Free Kids Act. Implementation of these standards—the first updates in 30 years— began in 2012 and means that today over 30 million young people are receiving more fruits, vegetables, and whole grain-rich selections, with lower amounts of sodium and trans fats every day.

“We recognized that the most important approach to making change around childhood nutrition in communities was through policy,” says Jasmine Hall Ratliff, program officer at RWJF. “Pew led a great effort around collaborative and coordinated work, from farm to school folks, to hunger folks, to nutrition folks, to funders themselves who had an interest in this work.”

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Most recently, RWJF has begun working with the Pew-MacArthur Results First Initiative, which helps state and local policymakers apply an innovative approach to evidence-based policymaking, including a customizable cost-benefit model, to their policy and budget choices. RWJF’s support will expand the Results First Initiative to encompass state health care programs.

The 5-year-old partnership between Pew and the Chicago-based John D. and Catherine T. MacArthur Foundation has worked in 22 states to help them identify programs that are most likely to produce positive outcomes for their residents and make the most of limited taxpayer dollars.

For example, in New Mexico, Results First helped the state assess the costs and benefits of its programs in early education, child welfare, and adult criminal justice. Since completing the analysis in September 2012, New Mexico has directed $104 million into evidence-based programs shown to deliver high returns. The majority of the funds have been dedicated to child welfare and early education programs, including pre-K, early literacy, improvements to early childhood programs, and evidence-based home visiting.

States eager to embrace the Results First approach have been especially interested in evaluating health policies, as medical care absorbs an increasingly large portion of their budgets, and RWJF’s involvement will help to make this happen. “We want to help states make wise, evidence-based decisions with their scarce resources,” says Kerry Anne McGeary, senior program officer at RWJF. “A major part of the outcome we hope to achieve is improved population health, well-being, and equity. We recognize we won’t achieve equity unless there are evidence-based funding decisions—which is something Results First does well.”

Susan Urahn, Pew’s executive vice president and chief program officer, says the strong collaboration with the Robert Wood Johnson Foundation has served both organizations well, allowing projects to be more effective—and have a more transformative impact on improving public policy—than could be possible working independently.

“Strong strategic partnerships like those with our colleagues at Robert Wood Johnson are like force multipliers,” she says. “We are grateful and delighted to have partners like RWJF who share a commitment to research-based policy that truly improves the lives of people throughout the country.”

For more information about philanthropic partnerships at Pew, please contact Senior Vice President Sally O’Brien at 202-540-6226 or sobrien@pewtrusts.org.