Q. We aren’t sure whether to pursue a Capacity-Building Grant or an Implementation Grant. What’s the difference?
A. Capacity-Building Grants are most appropriate for organizations that have an interest in addressing social determinants of health, but have yet to develop their strategies or partnerships. These grants can provide up to $50,000 for a maximum of 12 months. Grant funds can support staff time, focus groups, community convening, facilitators, training, consultants, travel, conferences and related expenses. By the end of the grant period, organizations will be expected to have developed a clear strategy for addressing one or more social determinants of health; demonstrate a clear understanding of how their work fits within the social determinants framework; have developed partnerships with other organizations (where necessary), with clearly defined roles and responsibilities for each partner; and be prepared to seek more substantial funding to implement their strategy.
Implementation Grants are most appropriate for organizations that have already fully developed their strategies to improve community health using a social determinants approach; have clearly defined the roles and responsibilities of each partner (collaborations are generally preferred to stand-alone efforts); can articulate how they plan to evaluate the community impact their project would achieve; can articulate their strategy to fully fund and sustain the initiative; and identify the community need for the program and community assets that will be mobilized to ensure its success. Implementation Grants can be funded for periods up to 36 months. While we have never set an explicit limit on the amount of funds that can be requested, previous KPCF awards have averaged between $160,000 to $200,000. For the full range of awards, please view the KPCF grant history.
Q. Can you give an example of what you mean by an “upstream” approach to prevention?
A. One of the Implementation projects that we funded in 2008 was the Village Gardens program led by Janus Youth Programs. Working in partnership with the Housing Authority of Portland, Portland Farmers Market and many other organizations, Janus helped St. John’s residents build and start three 2,500 sq. ft. community gardens. These gardens not only provided fresh, culturally-appropriate produce in a neighborhood that had been devoid of such products, but also served as a nexus for cross-cultural communication, intergenerational cooperation, and decreased crime and vandalism. Inspired by these outcomes, Janus expanded the Village Gardens program to the New Columbia and Tamaracks affordable housing communities. The gardens quickly became a central community resource for the dozens of different racial, ethnic, immigrant and refugee groups represented in these developments.
The Gardens have also served as a micro-enterprise development opportunity for youth, who now grow, sell and donate more than 4,000 pounds of organic produce per year. Most of these youth have significantly improved their grades, and several have earned scholarships to be the first in their families to attend college. In 2008, Village Gardens approached the Kaiser Permanente Community Fund to expand this program by establishing a chicken farm on a one acre plot of land donated by Sauvie Island Organics. Program participants had identified developing a protein source as the next step in meeting residents’ needs, and had developed a plan in cooperation with OSU Extension and other partners to meet this need. KPCF’s two-year, $196,599 grant will deepen the benefits the program is able to generate. While on the surface, Village Gardens may appear to be primarily about one component of healthy community life – access to nutritious food – the program improves lives in many other ways. According to resident surveys, 90% of teen participants and 88% of adult participants report feeling safer in their communities due to the program; 100% of teens and 89% of adults said that they learned how to resolve conflicts non-violently; 91% of all gardeners reported sharing food with neighbors; 93% felt more involved in their neighborhood; and 67% reported making a new friend from a different culture. These bonds of trust, connection, opportunity and safety, which represent some of the social determinants of health, help create a community that is more self-sufficient, and more likely to grow a healthier generation of children.
An example of a Capacity-Building Grant we funded in 2008 is the Regional Safe Housing Initiative of the Community Alliance of Tenants. Substandard housing - a social determinant of health - can lead to adverse health outcomes, including asthma (through exposure to mold, mildew and vermin), injury (through crumbling infrastructure or malfunctioning appliances) and more mundane conditions such as rashes, colds and infections, which can compromise one’s ability to maintain work or school attendance. Results from the 2002 American Housing Survey found that 7% of respondents in the Portland area reported moderate to severe problems in their housing. CAT requested a $50,000 capacity-building grant to allow them to develop leadership and advocacy skills among low-income renters to help them convince landlords and city officials to improve substandard conditions in rental units. The grant also allows CAT to develop or deepen partnerships with other organizations concerned with the health impacts of substandard housing, especially in Clackamas and Washington Counties, where CAT has not historically had a strong presence.
Q. The Fund’s focus is on the social determinants of health. Will you also consider funding programs that provide direct health services to disadvantaged populations?
A. We appreciate the value of direct medical services in mitigating the health effects of adverse social conditions. However, the Kaiser Permanente Community Fund is more interested in addressing the conditions that contribute to excess illness and injury than we are in supporting projects that treat adverse effects after they occur. As the Institute of Medicine has noted, “Interventions to improve access to medical care and reduce behavioral risk have only limited potential for success if the larger societal and economic context in which people live is not improved.”
Q. Are colleges and universities eligible to apply for funds from the Kaiser Permanente Community Fund?
A. Academic institutions can contribute a wealth of expertise and resources to the development, implementation and evaluation of projects designed to address the social determinants of health disparities. Historically, however, the balance of power between academic institutions and the communities in which they work has been skewed toward the interests of the academic partners. In recent years, a number of private funders and public health professionals have sought to correct this imbalance by supporting programs in which the needs, assets and methodologies are defined by the community, rather than a university faculty member. Such an approach is more likely to yield results that are culturally relevant to the community, and whose benefits can be sustained. In order to help ensure that the community is an equal partner in proposed projects, the Kaiser Permanente Community Fund will welcome proposals from community-university partnerships provided that the proposal is submitted by a community-based organization, rather than the academic institution.
Q. Can you give an example of what you mean by an “upstream” approach to prevention?
A. One of the Implementation projects that we funded in 2008 was the Village Gardens program led by Janus Youth Programs. Working in partnership with the Housing Authority of Portland, Portland Farmers Market and many other organizations, Janus helped St. John’s residents build and start three 2,500 sq. ft. community gardens. These gardens not only provided fresh, culturally-appropriate produce in a neighborhood that had been devoid of such products, but also served as a nexus for cross-cultural communication, intergenerational cooperation, and decreased crime and vandalism. Inspired by these outcomes, Janus expanded the Village Gardens program to the New Columbia and Tamaracks affordable housing communities. The gardens quickly became a central community resource for the dozens of different racial, ethnic, immigrant and refugee groups represented in these developments.
The Gardens have also served as a micro-enterprise development opportunity for youth, who now grow, sell and donate more than 4,000 pounds of organic produce per year. Most of these youth have significantly improved their grades, and several have earned scholarships to be the first in their families to attend college. In 2008, Village Gardens approached the Kaiser Permanente Community Fund to expand this program by establishing a chicken farm on a one acre plot of land donated by Sauvie Island Organics. Program participants had identified developing a protein source as the next step in meeting residents’ needs, and had developed a plan in cooperation with OSU Extension and other partners to meet this need. KPCF’s two-year, $196,599 grant will deepen the benefits the program is able to generate. While on the surface, Village Gardens may appear to be primarily about one component of healthy community life – access to nutritious food – the program improves lives in many other ways. According to resident surveys, 90% of teen participants and 88% of adult participants report feeling safer in their communities due to the program; 100% of teens and 89% of adults said that they learned how to resolve conflicts non-violently; 91% of all gardeners reported sharing food with neighbors; 93% felt more involved in their neighborhood; and 67% reported making a new friend from a different culture. These bonds of trust, connection, opportunity and safety, which represent some of the social determinants of health, help create a community that is more self-sufficient, and more likely to grow a healthier generation of children.
An example of a Capacity-Building Grant we funded in 2008 is the Regional Safe Housing Initiative of the Community Alliance of Tenants. Substandard housing - a social determinant of health - can lead to adverse health outcomes, including asthma (through exposure to mold, mildew and vermin), injury (through crumbling infrastructure or malfunctioning appliances) and more mundane conditions such as rashes, colds and infections, which can compromise one’s ability to maintain work or school attendance. Results from the 2002 American Housing Survey found that 7% of respondents in the Portland area reported moderate to severe problems in their housing. CAT requested a $50,000 capacity-building grant to allow them to develop leadership and advocacy skills among low-income renters to help them convince landlords and city officials to improve substandard conditions in rental units. The grant also allows CAT to develop or deepen partnerships with other organizations concerned with the health impacts of substandard housing, especially in Clackamas and Washington Counties, where CAT has not historically had a strong presence.
Q. The Fund’s focus is on the social determinants of health. Will you also consider funding programs that provide direct health services to disadvantaged populations?
A. We appreciate the value of direct medical services in mitigating the health effects of adverse social conditions. However, the Kaiser Permanente Community Fund is more interested in addressing the conditions that contribute to excess illness and injury than we are in supporting projects that treat adverse effects after they occur. As the Institute of Medicine has noted, “Interventions to improve access to medical care and reduce behavioral risk have only limited potential for success if the larger societal and economic context in which people live is not improved.”
Q. Are colleges and universities eligible to apply for funds from the Kaiser Permanente Community Fund?
A. Academic institutions can contribute a wealth of expertise and resources to the development, implementation and evaluation of projects designed to address the social determinants of health disparities. Historically, however, the balance of power between academic institutions and the communities in which they work has been skewed toward the interests of the academic partners. In recent years, a number of private funders and public health professionals have sought to correct this imbalance by supporting programs in which the needs, assets and methodologies are defined by the community, rather than a university faculty member. Such an approach is more likely to yield results that are culturally relevant to the community, and whose benefits can be sustained. In order to help ensure that the community is an equal partner in proposed projects, the Kaiser Permanente Community Fund will welcome proposals from community-university partnerships provided that the proposal is submitted by a community-based organization, rather than the academic institution.
Q. Where can I learn more about the social determinants framework of health promotion?
A. Many advocacy and professional associations, as well as independent public health researchers, have published texts explaining the social determinants of health framework, and suggesting strategies to address these determinants.
They include:
- Social Determinants of Health, by Michael Marmot and Richard Wilkinson, Oxford University Press, 1999. As pioneers in the field, Marmot and Wilkinson have demonstrated that the health status of populations correlates strongly with differences in socio-economic status and the accumulation of advantages or disadvantages experienced during the life course.
- Read an excerpt from this landmark work for free at Amazon.com.
- Dr. Marmot led the UN Commission on Social Determinants of Health. You can read their final report, “Closing the Gap in a Generation: Health Equity Through Action on Social Determinants of Health” here.
- Read an article published by Marmot and colleagues in JAMA, “Disease and Disadvantage in the United States and England.”
- The Community Guide to Preventive Services summarizes what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease. The Task Force on Community Preventive Services makes recommendations for the use of various interventions based on the evidence gathered in rigorous scientific reviews of published studies. The Community Guide has reviewed several strategies to address the social determinants of health, and has made their findings available at their web site.
- Policy Link is a national research and action institute advancing economic and social equity. Much of their work supports community-based efforts to improve conditions that influence health. One excellent resource they’ve published is Why Place Matters: Building a Movement for Healthy Communities, which provides specific examples of such initiatives.
- The Robert Wood Johnson Foundation’s Commission to Build a Healthier America recently released its recommendations titled “Beyond Health Care: New Directions to a Healthier America.” You can access the full report or its executive summary here.
- The Institute of Medicine – In 2001, the IOM published “Health and Behavior: The Interplay of Biological, Psychological and Societal Influences,” which examined the complex ways that the social environment affects the health status of communities. You can read a summary of this report here.