Evaluating the Kaiser Permanente Community Fund's Social Determinants of Health Portfolio

Abstract

Keywords: Social determinants of health, logic models, equity, Pacific NorthwestIntroductionHealth begins where we live, work, learn and play - long before any clinical intervention is required to treat disease or injury.- Northwest Health FoundationThe concept of the social determinants of health (SDOH) has been widely embraced within the public health community. Research over the past two decades repeatedly demonstrates the relationship between poor health outcomes and socioeconomic factors such as poor housing, unsafe work environments, poor education, social exclusion, poverty, racism, and structural inequity (Krieger, 1994; Marmot & Wilkinson, 1999; Williams, Costa, Odunlami, & Mohammed, 2008; Commission on the Social Determinants of Health, 2008; Centers for Disease Control and Prevention, 2011). Despite this evidence, few community-based health foundations have taken the opportunity to invest in the social determinants of health.Addressing the social determinants of health is a challenge for two reasons. One is that societal conditions have evolved over generations; as a result, problems such as poverty, racism, and social exclusion cannot be mitigated, much less solved, through short-term investments. The second challenge is the long lag time between changes in social determinants and corresponding health outcomes. This delay means that scalable best practices are still largely theoretical (Bramba et al., 2010).BackgroundIn late 2004, Kaiser Permanente Northwest established the Kaiser Permanente Community Fund within the Northwest Health Foundation (NWHF) with a $28 million gift. In 2006, the fund advisors took the bold and strategic step of investing in improvements to the social determinants of health. In order to improve the impact of the fund, key leaders at the NWHF and Kaiser Permanente Northwest made a commitment to continuous learning based on their own experiences and those of community partners. As part of this commitment, NWHF commissioned the Center for Community Health and Evaluation (CCHE), part of Group Health Research Institute in Seattle, Wash., to retrospectively evaluate the first five years of the fund's grantmaking (2005-2009).In this article we present an overview of the Kaiser Permanente Community Fund's SDOH initiative and its theory of change. We then introduce the frameworks and methods we used to conduct our evaluation. In the findings section we summarize the accomplishments of the initiative and grantee success factors. We conclude the article by imparting the lessons learned during and from the evaluation. We believe these lessons will be helpful to other foundations and funders interested in interventions and initiatives focused on social determinants of health.Development of the InitiativeThe fund is based at the Northwest Health Foundation in Portland, Ore. In 2005, the fund invited and funded proposals to advance health equity and promote cultural competency in health care. Although some of the fund's 2005 grantees were already addressing social determinants, the following year, the fund's advisory board and NWHF staffmade a commitment to focus grantmaking on social determinants of health. They believed this refined strategy offered the greatest opportunity to improve community health. A survey of the local philanthropic landscape revealed a significant gap in upstream community health initiatives. The fund focused on determinants as diverse as economic opportunity, public safety, civic engagement, and early education as avenues for long-term health improvements.The fund is governed by an advisory board comprised of six representatives of different constituencies within the Kaiser Permanente system and five representatives from the broader community. Community representatives have worked in a variety of areas, including housing, economic development, public health, and advocacy for social equity. Advisors and NWHF staffjointly develop requests for proposals, outreach strategies, and criteria for selecting proposals that are most likely to achieve sustained community impact. …