For more than two decades, health philanthropy has contributed to efforts to slow or reverse increases in US overweight and obesity rates. Although these trends have proven resistant to change, health funders have invested generously in possible solutions and been open to creative strategies. Working solo, together, and in partnership with government, they have tackled this complex issue that has major implications for Americans’ health-care expenditures, lifespans, and quality of life.
This collection of articles, produced for Grantmakers In Health and supported by the Colorado Health Foundation, explores the latest thinking from health funders, researchers, and advocates on healthy eating and active living (HEAL) and healthy communities.
In this supplement to Stanford Social Innovation Review, Grantmakers In Health is pleased to present a snapshot of the latest thinking from health funders, researchers, and advocates on healthy eating and active living (HEAL) and healthy communities. Grantmakers In Health (GIH) is a philanthropic affinity organization that informs and advises health foundations, corporate giving programs, and other funders, providing opportunities for them to share their knowledge and experience. We are a voice for the funding community and a contributor to its effectiveness, with the goal of achieving better health through better philanthropy.
The articles that follow offer a sample of the experiences and perspectives from leading local, state, and national organizations that address ways to improve HEAL. Drawing on their expertise, these authors reflect on their past and current work, offer lessons for the field, and suggest next steps to create healthier communities that help reduce obesity and its associated chronic illnesses.
HEAL is such a broad field that we could not possibly cover all topics within it, but it should be clear from our selection that reducing obesity is a long-term goal and will require many years of sustained investment and attention to achieve transformative impact. We expect the nature and focus of this work to evolve as the field becomes increasingly adept at developing and recognizing effective interventions.
Our Commitment to HEAL
GIH’s work on HEAL derives its urgency from decades of research showing a correlation between obesity and a higher incidence of numerous diseases, including diabetes, cardiovascular disease, and cancer. Research has also made clear that obesity is a social phenomenon—not just a matter of individual behavior—with contributing factors that include changes in the physical environment that reduce opportunities to walk or exercise safely; limited access to healthy foods, especially in low-income communities; and increased availability of inexpensive, heavily advertised, high-calorie foods. These same factors lead to dramatic differences in overweight and obesity rates by race, ethnicity, and community of residence. Consistently, the highest rates are among adults and children in African-American, Latino, and rural communities.
Since the late 1990s, an increasing number of health foundations have identified HEAL and healthy communities as a strategic priority. In a 2014 GIH review of the field, funders’ perceptions of the value and impact of their HEAL grantmaking were generally quite favorable. There was a sense that real progress was being made toward achieving HEAL goals, but funders also stressed the need for realistic expectations regarding the pace of change.
GIH has been committed to promoting healthy eating and active living for nearly 20 years. Our early programming, like that of many foundations and public health organizations, revolved around the obesity epidemic. More recently, our strategy has shifted, with more attention to understanding HEAL within the framework of the social determinants of health and tackling issues of equity. Thus, our scope has expanded to include larger issues like food production and the effects of violence on physical activity. We have also begun to look at how poverty and childhood trauma are linked to HEAL outcomes. Our HEAL Funder Learning Community, organized in 2017, examines such issues as meaningful community engagement in the policy process, the needs and challenges of rural communities, and working across sectors to better address HEAL equity.
Innovative Approaches to Improving HEAL
Contemporary work in HEAL and healthy communities addresses a wide range of health issues, settings, and systems. For the supplement, we present examples from advocacy, philanthropy, and research that have national relevance and applicability, whatever their original level of implementation.
Using public policy as a lever, some programs focus on changing how and what Americans eat.
- “Public policy is the only lever with which we can create change at the scale necessary to make a substantial difference,” writes Jake Williams, executive director of Healthier Colorado. Instead of simply educating the public about the dangers of sugary drinks, Healthier Colorado helped pass the nation’s second-ever voter-approved tax on sugary drinks, which directed the resulting revenue toward health programs for low-income families.
- Another initiative, Healthy Eating Research (HER), focuses its efforts on sustainable policies, systems, and environmental-change strategies. Among other objectives, HER’s grants have targeted dietary patterns and feeding practices for babies and young children; food environments in schools and childcare settings; and agricultural and nutrition policies, food pricing and economic incentives and disincentives, and food and beverage marketing and promotion.
Other organizations work directly with the food and beverage industries to stimulate change. For some in the HEAL arena, this is a controversial strategy akin to “working with the enemy”; for others, partnering with the companies that contribute to the overweight and obesity epidemic is essential.
- The Partnership for a Healthier America (PHA) uses the power of the private sector to improve food quality and increase physical activity. For example, PHA partnered with six food distributors to help them identify and source a broader supply of “better for you” convenience foods (e.g., protein bars) in order to increase the supply of these foods in low-income areas.
- Public Health Advocates (PHAdvocates) aspires to find common ground between health advocates and the food and beverage industries but acknowledges that there are times when more adversarial tactics are used by both sides.
School systems, childcare settings, and community parks are key settings for introducing healthier eating opportunities and healthy activities, such as exercise.
- The Healthy Schools Campaign, which once focused on traditional components of the school-based HEAL model such as school meals and physical education policies, explains why it is turning to a broader approach that includes issues like chronic absenteeism and the funding of school-based health services.
- The Physical Activity Research Center at Baylor University provides recommendations about sectors and settings on which continued research is needed, such as rural communities.
Contributions from several place-based foundations reflect a willingness to make sustained investments and a concern for addressing community-defined needs.
- In Colorado, the Colorado Health Foundation funds grantmaking and advocacy focused on increasing children’s physical activity and access to healthy foods. The foundation’s efforts include the creation of the Denver Food Access Task Force, which gave rise to the Colorado Fresh Food Financing Fund and increased access to healthy food for underserved communities and store owners.
- In Maryland, the Horizon Foundation has supported a suite of HEAL initiatives that address school policy, pediatricians’ skill sets, the availability of healthier food and drinks, and increased access to opportunities for physical activity.
- In North Carolina, the Kate B. Reynolds Charitable Trust’s Healthy Places NC initiative supports long-term, community-driven health improvement in several rural counties that identify healthy eating and active living as key focus areas. The foundation invests in playgrounds, walking trails, community gardens, farmers’ markets, and parks.
Accomplishments and Lessons Learned
The experiences described in this supplement address several key points:
- There is effective, bipartisan support for HEAL and healthy communities. For example, through their lobbying and political resources, Healthier Colorado and its partners have generated bipartisan legislative victories on a broad range of issues that influence health, including healthy eating and active living.
- Behavior change is difficult and requires the active involvement of people in communities. The Horizon Foundation found that a focus on reducing sugary drink consumption was more effective than asking people to make too many behavioral changes at the same time. The Kate B. Reynolds Charitable Trust learned that it is essential to pay attention to the voices of the people most affected by poor health outcomes and to build authentic relationships with those communities. The Colorado Health Foundation found that policies and programs generated at the local level were more successful than those that were top-down and statewide.
- Systems change is a critical component of institutionalizing support for HEAL and healthy communities. For the Healthy Schools Campaign, three strands of work were critical: identifying, engaging, and training parents to advocate; building effective policy advocacy campaigns; and creating innovative programs that support sustainable systemic changes. For the Kate B. Reynolds Charitable Trust, interventions at the systems level have changed the context that shapes the way people live. For example, the foundation responsibly built the capacity of grassroots organizations, especially organizations led by people of color, to participate in health campaigns. For the Horizon Foundation, which is a local grantmaker, supporting advocacy and working with state and regional partners has been very important.
- To tackle child obesity, strategies will need to adopt a broader focus that includes children’s physical, social, and emotional health. Healthy Eating Research is turning its attention to the effects of social, political, economic, and familial influences and environments on nutrition, healthy eating, and healthy weight across the course of a life.
- To increase young people’s levels of physical activity, interventions should focus on improvements across multiple sectors. The Physical Activity Research Center at Baylor University calls for concerted action from a variety of interests, including city planners, school officials, and media experts.
- Collaboration with the private sector is a vital part of changing how Americans eat. Partnership for a Healthier America has learned that changing the food culture will require shifts in inventory, pricing, and marketing of food, made in collaboration with the private sector. Their experience suggests that public-private partnerships aimed at helping business diversify and promote better food are the best opportunity for progressing toward sustainable health.
- Public-private partnerships that include the food and beverage industry can identify areas of common ground. For PHAdvocates, one place where health advocates and the food and beverage industry can work together is to ensure that consumers have complete information about the products they purchase.
The programs and initiatives described in this supplement confirm the value of multisector collaborations, innovative policy approaches, and sustained investments in achieving reductions in obesity. The pursuit of healthy eating, active living, and healthy communities is an evolving challenge that constantly opens up new questions and strategies. These new areas include early childhood and maternal interventions, HEAL in health-care settings (e.g., nutrition education for health-care providers, fresh food prescription programs, and hospitals as food sites and food buyers), working with the media to develop effective health messaging, engaging young people—especially young people of color—and effectively using new technologies.
Philanthropy and its partners will continue to play a vital role in developing, testing, and evaluating current and emerging strategies. Their sustained commitment and willingness to invest in a very difficult health challenge are crucial to the nation’s progress.
We thank the Colorado Health Foundation for their sponsorship.