Johnson foundation an enduring force in health care

When the leader of the nation's largest health philanthrophy looks at the world today, she sees great opportunity and growing challenge.

Scientists have more data and can better measure the quality of health treatments, notes Risa Lavizzo-Mourey. But "some of the things we used to look at as gaps" - income disparity and political polarization - "are now more like chasms."

And then there's money. "We are much more cognizant of health-care spending than we've ever been in the time I've been in this," said Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which is based in Princeton. "Everyone seems to agree that we have to get a handle on health care spending. . . . That's going to push innnovation in health-care delivery."

She spoke Thursday to 500 guests - mostly former foundation staffers and researchers who had received grants - at a hotel near the foundation's Route 1 campus (where the cafeteria offers free food, complete with calorie counts and a notation of how much exercise it takes to work off the entrees).

This is how the Robert Wood Johnson Foundation - the nation's third-largest foundation and the biggest that focuses on health care – celebrates its 40th anniversary. With a two-day meeting. One where health policy wonks listen to panel discussions with titles like "Innovation in Challenging Times" and use words like aspirational capital and community of change.

As dry as it might be, this kind of seriousness is characteristic, observers say, of a powerful organization that has changed medical care and public health with its talent for identifying and supporting innovators, willingness to tackle huge problems and emphasis on scientific evaluation. Oh, and a lot of money. Since 1972, the foundation has awarded 574 grants totaling more than $312 million in Philadelphia alone. Organizations in New Jersey have gotten $1.5 billion.

Sue Curry, dean of the University of Iowa's College of Public Health, said the foundation's ability to bring together people who might never have met and encourage them to work together is one of its strengths.

"They're really a catalyst for building the human capital that you need in order to make the kind of transformative changes that they're devoted to," said Curry, who received foundation money to study smoking cessation programs.

The foundation grew from the estate of Robert Wood Johnson 2d, a leader of the family pharmaceutical firm, Johnson & Johnson. He died in 1968 and left most of his estate, in the form of J&J shares, to a foundation in New Brunswick that bore his name. His plans got court approval in 1971, making the new foundation, then worth a mere $1.2 billion, an official entity.

That was 41 years ago. The foundation started giving grants the following year.

It now has $9.1 billion in assets, much less than the Bill and Melinda Gates Foundation but not far behind the Ford Foundation. Lately, it's been giving away about $350 million to $400 million a year.

From the outset, the foundation decided to focus on just a few issues, with long-term goals in mind. It often would pilot new ideas that the government would then pick up.

RWJ was instrumental in creating a more organized emergency response system and the use of the universal 911 emergency number in the 1970s. It took on Big Tobacco and pushed for a different approach to the end of life.

It helped develop a corps of medical scientists equipped to study health policy and the quality of care.

It funded programs to help young mothers and improve care for the chronically ill.

It is now immersed in one of its biggest efforts: a $500 million initiative, announced by Lavizzo-Mourey in 2007, to reverse the childhood obesity epidemic by 2015.

Uwe Reinhardt, a health economist at Princeton University, said he wished the foundation had devoted more attention to the long-term consequences of being uninsured and to comparing other country's approaches with those in the United States, but added that, without it, "we would have a lot less information on a lot of things."

Rebecca Rimel, president and CEO of the Pew Charitable Trusts, lauded the foundation for "decades and decades of providing data and research and policy that has helped huge numbers of citizens. . . . Their impact and their reach has been transformational."

Rimel started her career as an emergency room nurse while the 911 system was being created. "I know just how pivotal this was and how many lives were saved," she said.

In the 1970s, the foundation funded her work on the impact of minor head injuries, which, it turned out, weren't so minor. That was page one news when her paper came out in 1981. Still is, actually. After Rimel joined Pew, the first major grant program she oversaw, to provide health care to the homeless, was conducted with RWJ.

"My lens on the impact and the role of private foundations was really through my experience with Robert Wood Johnson," she said.

Locally, it funded a national initiative led by nurse Mary Naylor and health economist Mark Pauly at the University of Pennsylvania that involved 40 teams studying the impact and quality of nursing care.

Temple University obesity expert Gary Foster used foundation money to learn that Philadelphia schoolchildren were routinely stopping at corner stores and, for an average of $1.07, walking out with 356 calories.

The foundation is targeting care for frequent emergency room users in six cities or regions based on the work of Jeffrey Brenner, founder and executive director of the Camden Coalition of Healthcare Providers. The Food Trust has worked with them to bring fresh food into underserved neighborhoods.

The foundation gave the Health Promotion Council $360,000 to try to improve the quality of food and increase physical activity in Philadelphia after-school programs.

"It's actually informing decisions on a national level," said Marvin Williams, the council's director of health policy. "It's wonderful to contribute to that."

Naylor said the foundation was thinking from the beginning about how the information gathered in the nursing initiative would be put to use. That helps reduce the amount of time from research to implementation.

Ann Klassen, associate dean for research at the Drexel School of Public Health, said the foundation has been good at creating momentum and in making health policy research more scientific. "They really want to know what the impact of their work is and they are very rigorous about using that to modify their plans going forward."