A TROUBLING REPORT CARD
If you asked people—both experts and rank-and-file Americans—to grade health care in this country, an overwhelming percentage would hand out a D. The system is not quite failing, but it is barely passing. This is particularly troublesome given our nation’s resources.

We have an enormous and growing gap between the public’s expectations of the health care system and the quality of the care being delivered. For many people the gap is simply intolerable. Intolerable in the care they personally receive. Intolerable in the care their loved ones receive. Intolerable in terms of the growing number of uninsured. Intolerable in the rising cost of care. Intolerable in the occurrence of medical errors. Intolerable in the seeming inability of Medicare to provide for seniors. Intolerable when loved ones die in pain, alone, without the comfort and care they need.

And what about Americans’ actual health? We are barraged by news stories—confirmed by our own personal observations—that Americans are increasingly and alarmingly reaping the undesirable rewards of sedentary and overindulgent lifestyles. We are overweight. Too many of us still smoke. We drink too much. We exercise too little or not at all. We indulge in a panoply of risky behaviors.

These system problems and these personal behavior choices are like two massive freight trains speeding toward each other, and we may not be able to deal in any kind of just and humane way with the aftermath of their seemingly inevitable crash. Our challenge is to try to prevent that train wreck.

THE FOUR PORTFOLIOS
Our four goals focus on access to care, chronic conditions, community health, and substance abuse. All of them include elements that address both system change and personal behavior. They can be pursued in various ways. Most recently, we have implemented a new defining framework through which our grantmaking will operate. It is a formal construct that acknowledges the different grantmaking techniques and styles employed at the Foundation, and helps us harness these varied approaches more effectively and hold ourselves even more accountable for the private funds of which we are stewards for the public’s benefit. That construct clusters our investments into portfolios. Going forward, the Foundation’s grantmaking will fall into the following portfolios:

Targeted—Achieving specific improvements, in specified time frames, in nine issue areas: health care coverage, quality care, disparities in care, end-of-life care, nursing, tobacco control, addiction prevention and treatment, childhood obesity, and public health. A majority of our grantmaking is in this portfolio.

Vulnerable Populations—Identifying and fostering new and effective ways to deliver services at the community level to our most vulnerable populations, in efforts such as Faith in Action and our Local Initiative Funding Partners Program.

Human Capital—Improving the quality of the workforce and developing the leadership essential to improving health and health care. Many long-standing training programs—such as Robert Wood Johnson Clinical Scholars, Robert Wood Johnson Health & Society Scholars, and Robert Wood Johnson Health Policy Fellowships—are in this portfolio.

Pioneer—Seeking innovative, breakthrough ideas and approaches that may change the fields of health and health care.

The problems we face are national in scope, so even with our significant financial and human resources, we need to become more astute in identifying problems, defining time horizons and levels of investment, and holding ourselves accountable for accomplishing the objectives that we and our grantees set out to achieve. Our goal is to make a difference in your lifetime, and this framework will help us do that.