The California Endowment Had a $1 Billion Plan. Then It Threw Out Its Playbook

In Long Beach, Calif., the mayor told foundation executives to stop rabble-rousing. In Fresno, city officials tried to block bus ads chronicling stark inequities between the city’s north and south. In Sacramento, a community board that was advising the foundation’s local organizing hub voted to dissolve itself in protest.

Welcome to the California Endowment’s Building Healthy Communities project, a decade-long, $1 billion experiment in community-led change.

When the foundation launched the effort in 2010, it had a clear vision: Invest about $100 million per year over 10 years to improve health in 14 communities across the state, rooted in the idea that policy change is key to tackling entrenched health disparities.

What came next was anything but simple. The initiative’s early years were marked by tensions between the foundation’s vision and community priorities, ultimately leading to a dramatic pivot — spearheaded by grantees, nonprofit partners on the ground, and the foundation’s middle managers — in support of community-led organizing and “power-building.” Those same advocates have argued that the initiative was by and large a success, laying the groundwork for a major shift in community organizing in California with ripple effects for causes beyond health. This all happened despite the discord — or perhaps in part, because of it.

“Democratic solutions are, by definition, messy, meaning that communities will organize and they’ll push back against power, including philanthropy,” said Anthony Iton, former senior vice president at the California Endowment and one of the initiative’s primary architects. “We expected it to get messy.”

The foundation’s receptiveness to change and ability to let go of some control produced results. In the end, the initiative contributed to over 1,200 policy changes across the state, according to the endowment. Among the policy actions spurred by the organizers: local measures to secure safe drinking water, reform disciplinary policies in schools, and create health care coverage for undocumented residents, as well as statewide policies barring young teenagers from being tried in adult court and increasing voter registration rolls.

Over a period of 10 years, the foundation spent around $1.75 billion, supporting hundreds of grantees across the 14 communities. This translated to roughly $1,700 per resident in the targeted areas. Available data from the Philanthropic Initiative for Racial Equity shows it’s likely that the California Endowment gave more dollars to local organizing than any other grant maker nationwide between 2009 and 2012.

Still, the path toward those policy victories was at times rocky, and often veered in directions that the foundation didn’t originally expect. “When you fund a bunch of organizers, they start organizing against you,” said Jennifer Chheang, a former program officer at the California Endowment, who acted as a go-between for the foundation and its Building Healthy Communities partners in Long Beach.

High Poverty, Low Health Insurance

In 2010, the swine flu pandemic had just infected over 60 million Americans, the iPad and Instagram debuted, and the Tea Party held its first convention. It was also the year that then-president Barack Obama signed the Affordable Care Act into law, a move that helped inform the endowment’s thinking about the future of health in California.

That year, even as the Great Recession eased, California’s poverty rate increased for the fourth year in a row and nearly one-fifth of the state’s residents lacked health insurance. Those disparities compelled the California Endowment, the state’s largest private health foundation, to direct some of its over $3.5 billion in assets toward tackling the root causes of health inequality — including access to safe schools, preventative care, and housing — in the state’s most under-resourced zip codes.

The 14 places included immigrant communities, rural outposts, and urban centers, where Californians contend with shorter lifespans and worse health outcomes than other residents across the state.

The foundation had ambitious goals. It focused initially on increasing health-insurance enrollment and school attendance and reducing childhood obesity rates as well as on health-related policy changes at the state and local levels. Building campaigns to advance health and equality was also a persistent priority for the foundation, which earlier this month took home the Communication Network’s prestigious Clarence B. Jones Impact Award for its #Health4All campaign, which aimed to improve insurance access for undocumented Californians.

Yet, the initiative’s early years were marred by tensions between the foundation’s often top-down vision and the realities for organizers on the ground.

“The original plan was like a grad student term paper,” said James Suazo, executive director of Long Beach Forward, a community organization that grew out of Building Healthy Communities. He recalled a five-year convening after the initiative’s launch when a group of endowment officials admitted to “overcooking the dish” and mapping out far “too much of what it was going to look like before actually bringing it out into the community” to see what would work in practice.

“At the end of the day, when a foundation is coming in and saying, ‘We’re going to make this investment,’ it’s still the foundation’s investment,” said Suazo. “It’s still their priorities, right?”

Disconnects and Growing Pains

In Long Beach, “there was a lot of turmoil and tension” over issues like immigrant rights and community safety, considered imperative to local organizers but not to the foundation, says Suazo, “because the endowment said, ‘Well, that doesn’t connect to health in the same way, so that’s not a priority.’”

In some cases, the endowment came around — ultimately funding the #Health4All campaign and other measures to support undocumented Californians — but in other instances, Long Beach Forward had to turn to other grant makers for support. The city’s mayor at the time, Bob Foster, wasn’t thrilled with the endowment’s incursion either, requesting that senior leadership stop “stirring people up” by encouraging local organizing in ways that he deemed inappropriate for a major foundation, Iton recalled.

Elsewhere, similar disconnects emerged between community priorities and the foundation’s initial focus. In a typical early example, community members sometimes responded to the foundation’s well-intentioned effort to increase the number of nurses in schools by pointing to more pressing local issues — like the number of students unable to make it to school in the first place because of poor transit or housing instability. In Sacramento, the economic fallout from the 2008 recession and the need for well-paying jobs also loomed large in residents’ minds.

“Everything was about work, work, work,” said Kim Williams, hub manager of Sacramento Building Healthy Communities. “The endowment kind of pushed back and said, ‘We understand it. We get it. But this is a health foundation and this initiative isn’t about job creation and workforce development.’”

A year or two into the initiative, the steering committee for Sacramento’s Building Healthy Communities disbanded itself, Williams said, out of frustration over a perceived disconnect between the endowment’s community-centered ideals and the reality of the initiative’s funding structure. The endowment established hubs in each community site as a launchpad for community collaborations, coordination, and priority-setting. But the ultimate decisions around funding came from the foundation itself.

“In their minds, they said, ‘Wait, this is about building power and having a say, and we feel we don’t have a voice. So what’s the point of this steering committee?’” said Williams, who ultimately established a new advisory structure that remains in place today.

Of nine hub managers surveyed in the initiative’s early years, six said they were unable to “comfortably deliver” on the amount of work expected of them, according to a strategic review commissioned by the endowment in 2013. And of 13 program managers surveyed at the time, none said that the breadth of issues they were expected to fund was realistic.

The endowment’s early prescriptions also called for close partnership between local nonprofits and government agencies, a well-intentioned strategy that frequently backfired when community groups found themselves in “forced marriages” with agencies with which they were often in conflict, said Sandra Celedon, president of Fresno Building Healthy Communities.

“We were working with the public health department, but at the same time, they were undercutting safety net programs at the county level for undocumented folks; and our coalition was suing the county for gutting the medically indigent services program,” said Celedon. “How can we be in a room trying to work together and pretending like we’re on the same side?”

Relinquishing Control

Caught in that crossfire were program officers like Chheang. Oftentimes, those officers — essentially middle managers between the endowment and the Building Healthy Communities hubs — found themselves pushing the foundation to take local partners’ concerns to heart.

“The community was organizing us to push our leadership” on issues that mattered to them, said Chheang, with many of those priorities falling well outside the scope of more traditional health funding.

“The foundation’s rhetoric and the genuine intention had been to listen to communities, but the foundation’s behavior was to tell communities what to do,” said Frank Farrow, senior fellow at the Center for the Study of Social Policy, who wrote an outside report on the initiative. “The communities had the sense to say, ‘Wait a minute. That’s not the deal we made. What about all this language of ‘listen to communities’?”

Program officers and other foundation staff “embedded in communities became the pivot point for change because they were facing the community pressure,” Farrow said. “They became advocates for change within the foundation.”

Eventually, by 2016, the endowment did something unusual: it rewrote its playbook for Building Healthy Communities, a decision that changed the course of the initiative.

“We made a lot of mistakes in the early rolling out of Building Healthy Communities, but I asked the board for 10 years. That was the smartest thing I’ve ever done in my philanthropic career, because we really needed 10 years to understand the impact and to realize the impact of what these communities are doing,” Robert Ross told the Chronicle in an interview as he was preparing to depart the foundation ahead of Labor Day: “If it had been a three-year project, it would have failed.”

Instead of prescribing solutions, the endowment decided to support local organizing as a goal in itself. This involved listening more intently to local community needs, even when they didn’t align neatly with statewide priorities or relate directly to health outcomes.

The shift also entailed giving local organizations more leeway over organizing priorities, even if they differed from Building Healthy Communities’ statewide priorities, said John Kim, president of Catalyst California, a nonprofit consultancy that helped the California Endowment identify its original 14 community sites.

“That was a critical turning point for the endowment — and a really courageous move — to be like, ‘Yeah, we put a billion dollars out there, but we’re going to trust that you guys know what you’re doing. We’re going to relinquish some control,’” he said. “That was a big step. And from there, all of a sudden, people just started to really flourish. Not evenly, not at the same level across all 14 sites, but things really did start to move.”

Community-Led Change

Among the changes that came after 2016, the foundation began offering longer-term grants — beyond one or two years — and began funding small grassroots organizations as well as youth-focused organizations across the state, all of which were granted more liberty to tailor their organizing more to issues in their local community.

Building Healthy Communities also began achieving significant results across California. In Fresno, years of community organizing culminated in a major win for public spaces, despite those city officials who once tried to stop Building Healthy Communities from advertising on public transit that those living north of Shaw Avenue, the city’s de facto dividing line, had access to over four times more acreage of park space per capita — and lives about two decades longer — than those living in the city’s south.

“We were able to pass a sales tax measure that funds parks, arts, and trails for 30 years,” said Celedon, thanks to community organizing around passing a local sales tax called Measure P. “The mayor opposed it. The City Council opposed it, the police chief, the fire chiefs, the police commission, the fire unions, the taxpayers association, the chamber of commerce, all of them opposed Measure P.”

In the Central Valley, the endowment funded grassroots water-justice organizations led primarily by women, who organized against agribusiness and local governments to secure clean water access. In South Los Angeles, youth organizing groups received support to lead campaigns on school-discipline reform, eventually resulting in significant reductions in suspensions and expulsions.

The endowment also responded to earlier exhortations to focus more on young Californians by ramping up its investment in youth-led campaigns and leadership-development programs. “By its midpoint, BHC clearly and deliberately centered young people as the leaders of real change in California,” said Luis Sanchez, executive director of Power California, a statewide civic engagement organization that grew out of BHC.

Randy Villegas, who first got involved with BHC as a middle school student in Bakersfield, Calif, and later became a youth organizer, saw firsthand how the initiative transformed young people’s relationship with their communities.

“Without the risk of sounding too corny, it was life-changing,” he said. “I was that kid who would always say things like, ‘As soon as I turn 18, I’m leaving Bakersfield, and I’m never coming back because it’s hot in the summers, it smells like cow poop. There’s nothing for young people to do.’”

“Having folks approach me and ask about the issues in your community — How can you solve them? How can we potentially change your community? It was a foreign concept to me,” said Villegas, now a school board member and political science professor who doesn’t live far from his native Bakersfield. “I now care very deeply about the Central Valley, almost more than anything else.”

Ripple Effects

By 2020, 10 years after Building Healthy Communities launched, 4 million more Californians had access to health insurance through their state’s Medicaid program. A landmark overhaul of California’s education funding and accountability system allotted $5 billion more in funding to BHC school districts. Throughout the 2010s, student suspension rates dropped by half across the state, juvenile arrest rates plummeted, and the number of youth-serving organizations ballooned from no more than 15 in 2010 to 171 in 2020.

It’s impossible to attribute any of those changes solely to the California Endowment and its grantees (for example, the Affordable Care Act was a primary driver of increased health-care access during that period). But organizers credit the foundation with helping to fund the groundwork for many of the collaborations and for reframing conversations in ways needed to see those policy changes through.

“It wasn’t a straight line. It wasn’t always perfect. It was a lot of lessons learned along the way,” said Sanchez, but over the initiative’s 10 years, “the institution became stronger — our communities became stronger — and I always say to this day: it had ripple effects across philanthropy.”

Almost four years have passed since Building Healthy Communities ended, but funding local organizing has become a more integral part of the California Endowment’s grant making. Challenging power dynamics between funders and grantees has taken hold throughout the philanthropic world in ways that were far less common when the endowment first launched its initiative 14 years ago.

And many of the relationships and hubs established by the initiative — like Long Beach Forward — remain pillars of organizing across California, albeit less resourced than they might have been a decade ago.

“Our funding has dropped to 50 percent of what we had before. Some of our grantee organizations have dropped significantly. Some are not funded at all anymore,” said Suazo, who noted that in recent years, “it feels like we’re having to defend and recoup a lot of the gains” already made in Long Beach, such as protections for undocumented immigrants and shifting narratives around criminal-justice reform and restorative justice.

Even so, said Suazo, “the reason I can say we’re losing gains is because we made gains in the first place,” adding that the initiative “really was a success, at least for us in Long Beach. It wasn’t without its challenges or its difficulties, but show me a social movement that doesn’t have those challenges too.”

Reporting for this article was underwritten by a Lilly Endowment grant to enhance public understanding of philanthropy. The Chronicle is solely responsible for the content. See more about the Chronicle, the grant, how our foundation-supported journalism works, and our gift-acceptance policy.