Back to top

The California Endowment Reports Out on Community Feedback, Next Steps for Building Healthy Communities Initiative

Friday, September 29, 2017

The California Endowment recently released an open letter to A, B, C, as well as their Community Feedback Report on the Building Healthy Communities initiative. Please see the letter, full report and executive summary below. 


Open Letter to… Colleagues, Friends, Partners, and Grantees of Building Healthy Communities,

We Heard You…

A little more than a year ago, we released our five-year report on the impact, progress, lessons, and mistakes of our Building Healthy Communities (BHC) campaign. We named the report “The Power Grid” in acknowledgement of the extraordinary role we have seen community and civic voices, advocacy, and activism—or “People Power”—play in advancing our healthy communities agenda across our state and in the 14 BHC sites.

Your partnership support of BHC, your specific feedback, and the broader national and historic challenges of health equity and health justice remind us how important this undertaking continues to be. At this very moment, we are watching as federal efforts to “repeal and replace” the Affordable Care Act shift toward efforts to undermine its implementation. We see simultaneously vibrant and troubling discussions about race, immigration, inclusion, and exclusion in our national discourse. We see the scientific and research basis about the social determinants of health continue to grow with each passing year. When we consider these factors, we see that addressing health inequity through meaningful and inclusive community participation must be center stage for our nation and our state. This is the core work of our shared vision for BHC.

We have found ourselves in the middle of the exact fight we need to be in.

This note is intended to provide a TCE leadership summary on three fronts: First, our collective read on the community feedback interviews we conducted to gain a better sense of what community partners think about the BHC journey and the response to our five-year assessment report (full report and executive summary now available). Second, the implications of that feedback as we begin to engage our Board of Directors in the coming months about the future of BHC through 2021 and beyond. Finally, our thoughts about how the political dynamics in Washington, DC influence our thinking and planning for the future of BHC.

The Community Feedback Report

Some of you participated in the more than 175 interviews and focus groups conducted across the state this past year by consultant Frank Farrow and the team assembled by the Center for Social Policy. The report is attached for your review, along with a separate Executive Summary, and you will see how wide-ranging and rich the feedback is. Let us share three key reactions in 2 response. The first is a heartfelt thank you for taking the time to participate in the feedback conversations, as well as the candor and thoughtfulness that came through. Some of the feedback was tough for us to hear and take in, but it is rich and valued nonetheless. The second is an appreciation to Frank Farrow, Cheryl Rogers, and their team for providing the safe space where this degree of candid exchange could take place. We are aware of the power dynamics that can exist between funder and grantee, and we appreciate the extra effort required to ensure honest feedback.

Finally, prior to offering our thoughts about the various themes that arose from the interviews and focus groups, here is our overarching takeaway from what you shared about the BHC journey thus far:

“Building Healthy Communities has brought significant value and impact in the fights for health equity and health justice in our communities and across our state, and we need to continue this work and this journey. We have contributed to a new narrative for community health—we appreciate the emphasis on inclusion, justice, and equity, and we have seen real policy and systems improvements in several key areas. But in order for us to optimize the potential impact of Building Healthy Communities, TCE must do better on certain fronts. We need more humility from TCE, and less arrogance; we need more true partnership, and less top-down; we need more input into decisions, and not merely communications about decisions that have been made; we need more of an emphasis from TCE on building our capacity to lead change, and less ‘doing and directing’ from TCE staff. Finally, we need a combination of stronger alignment of efforts, improved communications about efforts, and more private sector resources rallying to the vision of BHC. So, stay in the fight—we want to own BHC, and this is how we’d like to see you raise your game.”

With this message to us in mind, the following section represents how we are categorizing the feedback for action and response on the items where we must do better:

  1. Partner Better: Improve communication and improve inclusive decision-making on key strategies, and reduce the degree of top-down foundation direction.
  2. Build Better: Focus more on resident, youth, and community infrastructure and leadership capacity for the purposes of power-building, uplifting community voices, advocacy, and activism—all through a racial and justice lens.
  3. Learn Better: Be more intentional about creating spaces for shared and joint learning, impact, and lessons learned—both within TCE and in the partnership space with grantees.
  4. Connect Better: Alignment is critical to the success of BHC; TCE must improve internal organizational collaboration, alignment must improve between TCE and community partners, and the nexus of local and statewide advocacy must be better defined and connected. 3
  5. Leverage Better: We have done a commendable job leveraging public resources through policy and system changes, but we need to be more attentive to partnerships that expand private-sector and other philanthropic funding to achieve the vision and goals of BHC.

We have begun the process of internalizing and understanding these areas of needed improvement, and we will engage our Board of Directors in the coming months about our organizational responses and needed changes.

The community feedback report also features areas of tension where we must be aware of the feedback, but also acknowledge that the concerns defy a simple solution. For example, some participants offered that BHC is in need of a tighter focus for impact, while others mentioned that TCE should be more open to new ideas and efforts generated by community needs. We also continue to hear—particularly from BHC sites—that we should be more attentive to matters of economic development, jobs, housing, gentrification, and displacement. This remains a source of tension for us as a health foundation as it relates to our overall mission— even with our broad definition of health.

We heard that we at TCE should be more humble about taking credit for BHC progress and wins, while others suggested that we be more assertive about touting the impact of BHC. We also heard from some of you that the process of funding decisions should be shared more broadly with community groups, but this is fragile territory for us. The combination of our fiduciary responsibility to the foundation, as well as the potential for conflicts of interest in specific grantmaking decisions, makes this difficult. We prefer to strengthen community participation in BHC strategies that pave the way for funding decisions, but maintain primary responsibility for the grant decisions themselves.

The Even Bigger Fight

While the progress and success of BHC are important to us, we recognize that BHC does not exist in a test tube or petri dish; it exists against a larger civic and political landscape. The emerging political forces out of Washington, DC matter greatly to us all.

At TCE, we are grateful for what we have learned from you—young people, community residents, advocates, and nonprofit leaders—about a new narrative for health. This new narrative is anchored in a core set of themes and values: inclusion, equity, fairness, justice, power, voice, and prevention. What is emanating from Washington, DC right now is a policy agenda that is a clear and present danger to the narrative we have co-created for BHC specifically, and affirmed for California more generally.

In short, we find ourselves in one heck of a fight, and our federal government now appears to be leading an agenda where exclusion trumps inclusion, the needs of the wealthy outweigh the needs of the poor and middle class, and mean-spiritedness overshadows compassion and social justice. Hate groups and white nationalists have surged in recent months and are emboldened. The gains we have all worked for in support of health coverage for all, inclusive policies for 4 immigrant communities, and racial-gender-LGBTQ equity and justice are all at substantial risk. BHC embodies the values of the counter-narrative against Washington, DC.

Our Board of Directors and staff at TCE have learned a lot from you about building civic and political power to advance a much-needed narrative of inclusion and community wellness. The need for California to stand tall and firm against the politics of exclusion has, for us, affirmed the power-building element of BHC. We need more community engagement, not less; we need more civic activism, not less; we need more young people supported and involved, not less; we need to be more audacious about wellness and justice, not less. It is in this vein that our Board, after the November election, approved and announced a $25 million “Fight Fund” to rally in support of those organizations in the middle of this fight.

Steps We Are Taking

The community feedback report is rich and varied, and some of what we heard has implications for longer-range BHC issues of strategy, structure, and partnership. We will continue to examine ways to be responsive to the Community Feedback Report, and we have agreed with our Board of Directors on four action items that we are prepared to implement now and in the months ahead:

  • We are committed to making more multi-year support grants with grantee partners.
  • We have begun the process within TCE of improving internal alignment, coordination, and collaboration on areas of growing momentum for BHC.
  • We will create more opportunities for shared learning, alliance-building, and network development for grantees and partners.
  • We are committed to strengthening community participation in BHC strategies that pave the way for funding decisions, while maintaining primary responsibility for the grant decisions themselves.

We remain proud partners with you in pursuit of BHC’s vision and in the much larger fight for the civic soul of our nation.

Thank you for your leadership and your patience as we continue to learn and grow at TCE.

Zac Guevara
Chair, Board of Directors

Robert K. Ross, M.D.
President and CEO


Funding Issue Area & Geographic Regions
Related Organizations