Over the ten years of the Building Healthy Communities initiative (BHC), The California Endowment (TCE) cycled through multiple outcome frameworks as the terrain of the BHC work became more complex. Does that mean that TCE had no idea what we were doing? Or was the repeated swapping of one framework for another, a sign that we became a learning organization that was open to emergence, evolution, and adaption? As the officer charged with stewarding learning and evaluation at TCE, I admit that it may have felt like we floundered. But as we got deeper into BHC, we committed ourselves to being pushed by our communities, humbly listening, admitting our mistakes, changing course, and, most importantly, sharing power. As it turned out, that orientation made all the difference.

By the time the initiative wound down, our partners had forged meaningful relationships and racked up significant policy wins and implementation. We could look at the fourteen sites in California in which we had chosen to do our work—all places with severe structural inequalities and poor health outcomes—and say with pride that the BHC community collaboratives have changed the odds for the millions of people living in those communities. They had made considerable progress toward realizing the goal of  transforming communities into places where children and families can live healthy, safe, and productive lives.[1]

These outcomes would not have been possible had we not been willing to question ourselves on our initial assumptions and hypotheses, to listen and respond to our partners, and to make significant pivots mid-stream. Our determination to avoid rigidity was valuable by itself every day of the initiative, but it is also what allowed us to make an important breakthrough.

Our understanding evolved into the belief that health inequity is fundamentally a failure of democracy. We believe that robust, participatory democracy is good for health, particularly for communities that have been politically and socially marginalized because of structural racism. The approach that flowed from this understanding is, in the words of Senior Vice President Anthony Iton, to focus on “deliberate enhancement of local community power, primarily through intensive community organizing, in order to create greater influence over policymaking by people who are most impacted by health inequity.” This approach contrasts with the still-dominant one of working within the medical model, emphasizing specific diseases, improving health education and literacy, and intensifying medical services. To summarize: We view the building of community power as the means for achieving the goal of health equity. A more powerful community, we believed, could secure policy victories and systems changes.

Our breakthrough was the realization that building community power is a key end in itself, in addition to being a means of gaining leverage in changing policy. People who participate in building community power gain a collective sense of agency—they begin to feel that they have the power to influence the world around them. Gaining confidence in the collective ability of one’s community to define problems, develop solutions, hold officials accountable, and exert control over the conditions shaping one’s life becomes by itself a positive influence on health. It was profound for us to realize that the ability for people to exercise their own power is a critical measure of health and well-being. BHC’s final outcome framework encapsulates this insight: Agency + Belonging = Change (in short, A + B = C).

So what does this mean for philanthropy?

Lynn, Nolan and Warring (2021) call for philanthropy to “release control over organizations and their change strategies while using its unique position, reach, and voice to work in solidarity with community leaders.”[2] This orientation expresses what’s necessary to tap into and support the transformative power of “A + B = C.” Foundations need to “loosen control over both pathways and outcomes; support network building rather than solutions; address systems, not symptoms; focus on transformative over transactional capacity; and align philanthropic power to supplement, not supplant.” [3]

While we entered BHC with a strategic mindset, we closed the initiative with an abiding sense of trust in our community partners to determine the pathways and outcomes that will transform their communities and create themselves, the conditions that will allow them to thrive. That is what it takes for philanthropy to become more strategically resilient and impactful.

I invite you to learn more about the findings and lessons from the decade of BHC evaluation by visiting:  https://www.calendow.org/learning-and-engagement/.

Hanh Cao Yu
Chief Learning Officer, The California Endowment

[1] For details about BHC outcomes, see “Ten Years of Building Community Power to Achieve Health Equity: A Retrospective,” Tom Pyun, 2021, Slides 5-6; and “Toward Health and Racial Equity: Findings and Lessons from Building Health Communities,” Frank Farrow, Cheryl Rogers, Jennifer Henderson-Frakes, Center for the Study of Social Policy, December 2020.

[2]  Lynn, J., Nolan, C., & Waring, P. (2021). Strategy Resilience: Getting Wise About Philanthropic Strategy in a Post-Pandemic World. The Foundation Review, 13(2). https://doi.org/10.9707/1944-5660.1564.

[3]  Ibid