The Urban Health Initiative

From the draft riots of the 1860s to the racial riots of the 1960s, urban violence has signaled major problems in American society. In 1992, Rodney King, an African American, was beaten by Los Angeles police officers after a traffic stop. The beating was recorded on video. The acquittal of the accused police officers triggered a riot in which 55 people were killed, more than 2,000 were injured, and the damage to property was extensive. This riot led to congressional hearings, and it forced government agencies and foundations trying to improve social and economic conditions to re-examine their work in America's cities.

Prior to the Los Angeles riots, the Robert Wood Johnson Foundation had awarded few large grants to improve health in inner cities. A result of the post-1992 re-examination was the development of the Urban Health Initiative, a major effort to improve the health and safety of children living in five medium-size and large cities. What made the Urban Health Initiative unusual was its commitment to improving the health of a significant number of children in the five cities. It was not just a pilot project or a demonstration to test new approaches; rather, the Urban Health Initiative was a program with the ambitious goal of making a positive difference in the cities' health statistics—in effect, undertaking a role usually played by government.

This chapter of the Anthology raises an interesting and important question: how can foundations fund programs of sufficient size to improve the health of a significant number of people living in distressed urban areas? The resources of foundations, after all, pale in comparison to those of government. The Robert Wood Johnson Foundation, the nation's fourth-largest foundation, awards between $400 million and $500 million a year in a $2 trillion health economy. The annual budget of the City of Los Angeles is $6.7 billion.

This question of scale led the Urban Health Initiative to create what it called the denominator exercise, which asks (1) How many kids are in need of help? (the denominator) and (2) What will it take to have an impact on a substantial percentage of those kids? This exercise provides an indication of the size of the effort required to have an impact.