Now in its fourth year, the Anthology series attempts to offer an unvarnished and in-depth analysis of The Robert Wood Johnson Foundation's activities as seen by both insiders and outsiders. Complementing our Annual Report, special reports, Advances, and Grant Results Reports, the series is one of the ways that we provide an accounting of our programmatic activities to the health field, philanthropy, and the general public. This year's Anthology contains ten chapters, the first two of which offer insights from senior staff members into the way the Foundation operates.

In chapter 1, Michael McGinnis, a senior vice-president of the Foundation, and I examine the dramatic shift that took place in 1999 when the Foundation moved from a predominant focus on health care services to one giving equal importance to behavioral and social health. We analyze the reasons for the shift, discuss the major reorganization that accompanied it, and explore the implications for future programming.

Except for a six-year period ending in the early 1990s, Frank Karel has directed The Robert Wood Johnson Foundation's communications unit since its inception in 1973. In chapter 2, he takes a personal and candid look at the Foundation's communications program, tracing its development from the first newspaper accounts announcing the Foundation's creation through its recent use of the Internet. In the bargain, he makes a strong case for strategic communications as an integral part of any foundation's activities.

The next six chapters examine a broad spectrum of Foundation-supported programs. In chapter 3, Sharon Begley, a senior editor at Newsweek, and Ruby Hearn, a senior vice president of the Foundation, chronicle the approaches the Foundation has adopted to improve children's health. Among other things, the authors note that the Foundation has moved from funding demonstration programs designed to spark support from the federal government to supporting large community coalitions.

In chapter 4, Janet Firshein, a journalist specializing in health care, and Lewis Sandy, executive vice president of The Robert Wood Johnson Foundation, take a similarly long perspective. They relate how the Foundation's approach to managed care has changed over the years-from supporting nonprofit group health plans in the 1970s to funding an accrediting agency to develop quality of care standards in the 1980s to encouraging health maintenance organizations to serve chronically ill individuals in the 1990s.

Chapter 5, by Joseph Alper, a journalist who writes about health, and Rosemary Gibson, a senior program officer at the Foundation, examines a series of programs aimed at improving the care of poor older Americans. They find that integrating both the services themselves (acute, chronic, and supportive) and the financing of those services by Medicare and Medicaid is a challenge, and document the ways in which Foundation-funded programs have attempted to foster such integration.

Under the Workers' Compensation Health Initiative, the Foundation funds research into ways to improve the workers' compensation system. In chapter 6, Allard Dembe and Jay Himmelstein, the co- directors of the initiative, summarize the key findings from this research, especially research on ways to integrate the traditional health care system and the workers' compensation system, thus providing what is known as 24-hour coverage. The authors suggest ways in which findings from the initiative can be applied in making workers' compensation more responsive to both injured workers and employers.

In chapter 7, journalist Digby Diehl, describes Sound Partners for Community Health, a partnership with the Benton Foundation in which local public radio stations collaborate with service organizations in their community to provide more and better coverage of health issues. Unlike many programs featured in the Anthology series, Sound Partners is a small initiative that is designed not to affect national policy but to increase awareness and improve health in local communities.

Chapters 8 and 9 look back at two areas that the Foundation championed in the 1970s and 1980s. In chapter 8, Marguerite Holloway, a contributing editor of Scientific American, recounts how the Foundation's efforts stimulated and helped shape the development of regional perinatal care networks to identify and care for low-birthweight babies. Although these networks took off in the 1980s, competition among hospitals for neonatal intensive care units and the rise of managed care in the 1990s undermined the idea of regional services.

During the 1970s and 1980s, the Foundation worked to strengthen public health dentistry. In chapter 9, Paul Brodeur reviews the range of programs the Foundation supported to improve the nation's oral health. Although the Foundation did not actively support dentistry in the 1990s, oral health has re-emerged as an area of interest, and new Foundation programs are under development.

This year's Anthology concludes with an examination of partnerships among national foundations, complementing a chapter that appeared in last year's Anthology on partnerships between The Robert Wood Johnson Foundation and local foundations.

In chapter 10, using Robert Wood Johnson Foundation collaborations as their starting point, Stephen Isaacs and John Rodgers, both from Health Policy Associates, find that, despite rhetoric to the contrary, national foundations do not often enter into collaborations with one another, and that when they do, the partnerships are difficult to maintain. The authors offer suggestions for improving the likelihood of successful partnerships.

As I wrote in the foreword to an earlier Anthology, any single volume will provide only a partial view of what The Robert Wood Johnson Foundation does, but over the years a more complete picture will emerge. That picture is now beginning to take shape, and we are beginning to gain insights from the Anthology series. In the editors' introduction that follows, Stephen Isaacs and James Knickman offer ten grantmaking insights from the first four volumes. We expect more to emerge in the coming years.

 

Princeton, New Jersey August 2000

Steven A. Schroeder President The Robert Wood Johnson Foundation