Focus on Philanthropy

As our nation increasingly focuses on building a value-based health care system, there is a renewed appreciation for the value of prevention. In order to improve the health of communities, there is a need to move upstream beyond clinical care and invest in actions that result in a healthy population. Historically, public health has been grounded in prevention and improving community health. The Duke Endowment has partnered with other foundations to leverage, enhance, and expand on this scope of work.

For the past several years, the Endowment’s health care program area supported efforts in Western and Eastern North Carolina that brought together hospitals and local health departments to create and strengthen regional and county community health needs assessments and improvement plans. In response to the Healthy NC 2020 objective to increase physical activity and nutrition, the Endowment launched Healthy People Healthy Carolinas, an initiative to establish communitybased coalitions to implement a collective impact model supporting physical activity and nutrition [1]. The coalitions offer health systems and health departments the opportunity to work with non-traditional partners such as child care, schools, business, churches, and local government to advance policy and evidence-based and evidence-informed interventions to reduce chronic disease and obesity. These coalitions have successfully advanced local policy changes within private and public organizations. They have implemented interventions and built infrastructure such as walking trails that create opportunities for residents to make a healthy choice where they live, work, play, and pray. Most community health improvement plans have a shared objective of reducing chronic disease and obesity. Whenever possible, the coalitions are intentional about supporting instead of duplicating local efforts to improve public health.

Many North Carolina philanthropic organizations are funding activities that strengthen both public health and community health, and we are working together to align our efforts when possible. One example is the joint funding to support the Division of Public Health and North Carolina Institute of Medicine (NCIOM) Healthy NC 2030 Task Force. The task force’s report recognized the shift to population health and was intentional in calling out structural racism and disparities. The goals selected expanded the focus beyond clinical care to include other factors that profoundly impact health [2].

As the health care industry is innovating, acquiring knowledge, and advancing reimbursement models that demonstrate the ability to improve health and decrease costs, philanthropic organizations are shifting their strategies to support efforts that promote equitable improvements in health. The Endowment’s health care program area seeks to be an innovative partner that accelerates reform by creating, testing, scaling, and sustaining effective models of care. This focus includes identifying and testing alternative models that expand access for vulnerable populations and organizing communities to support population health and promote healthy lifestyles. This includes creating opportunities in communities to advance positive health behaviors and address social determinants.

Philanthropy can play an important role by acting as a venture capitalist, supporting efforts to innovate and test alternative care models. Grant

funding creates a unique opportunity to try new approaches so that we can learn and share what works. As we increasingly shift to value-based models, learning within the health care sector allows best practices to become the new standard of care. Philanthropy has the unique ability to take risks by investing in and understanding innovative approaches and accelerate the adoption, spread, and sustainability of models that equitably improve health and contribute to the advancement of public health.

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