The Robert Wood Johnson Foundation, which began operating as a national foundation in 1972 with a bequest from former Johnson & Johnson chairman Gen. Robert Wood Johnson valued at $1.2 billion, has grown into the nation’s fifthlargest foundation, with assets of approximately $8 billion. It distributes nearly half a billion dollars annually, primarily in the form of grants to organizations carrying out demonstration projects, providing education and training, conducting communications activities, doing research, carrying out evaluations, and giving technical assistance.

To attain its mission of improving the health and health care of all Americans and reach its goals of (1) ensuring that all Americans have access to basic health care at a reasonable cost; (2) improving care and support for people with chronic health conditions; (3) promoting healthy communities and life styles; and (4) reducing the personal, social, and economic harm caused by substance abuse (tobacco, alcohol, and illicit drugs), the 245-person Foundation staff works along two parallel tracks.

One track focuses on improving health care (that is, medical services and coverage), with teams of staff members developing and funding programs on health insurance, management of specific illnesses, support services for people with chronic conditions, end-of-life care, and disadvantaged populations.

The other track focuses on improving health, with particular attention to the nonmedical factors that influence health. Teams of staff members develop and fund programs in these areas: alcohol and illegal drugs, tobacco, population health sciences, health and behavior, and community health.

The staff’s recommendations for funding are transmitted to the board of trustees, which meets four times a year.

Sixty-eight percent of the Foundation’s grant money goes to national programs that are carried out in numerous sites throughout the nation and managed by national program offices. Thirty-two percent goes to ad hoc programs, which are generally research, conferences, or demonstration projects carried out a single site.

At any given time, the Foundation manages roughly 2,500 grants. Just keeping track of this many projects—much less drawing lessons from them— is a mammoth undertaking. As Steven Schroeder observes in his Foreword to this Anthology, the Foundation has developed a number of ways to learn from its grants and grantees and to share information with the field and the public. One of them is the Anthology, in which we, as the series’ editors, try to present a clear, unvarnished, and readable look at a range of Foundation programs. To do this, we recruit outstanding (often award-winning) journalists, program evaluators, national program officials, and Foundation staff members to write chapters. In addition, we attempt to demystify the world of philanthropy, at least as practiced by The Robert Wood Johnson Foundation, by asking staff members to reflect on why and how important decisions were made and priorities were determined.

This year’s volume of the Anthology contains chapters on a variety of Foundation activities. It begins, in Section One, with an interview of Steven Schroeder by writer Renie Schapiro, in which the outgoing president and CEO reflects on the Foundation and, more generally, on health and health care since he became president in 1990.

It continues with three chapters in Section Two, “Improving Health Care,” that examine the health care system and how to improve access to, and the quality of, health care. In Chapter Two, writer Carolyn Newbergh examines the Health Tracking initiative, a large-scale effort to understand the effect of market forces on access, quality, and cost. In Chapter Three, journalist and program evaluator Irene M. Wielawski writes about the Practice Sights initiative, a ten-state demonstration program to encourage health professionals to practice in underserved rural areas. Since the 1990s, the Foundation has made a major effort to improve the care seriously ill people receive toward the end of their lives; in Chapter Four, journalist Ethan Bronner analyzes the Foundation’s strategies and investments to stimulate interest in and build this field.

In Section Three, “Improving Health,” the Anthology explores how the Foundation has attempted to improve health by reducing smoking and alcohol abuse. In Chapter Five, author Digby Diehl looks at the National Center for Tobacco-Free Kids and its involvement in settlement negotiations with the tobacco companies. In Chapter Six, C. Tracy Orleans, a senior program officer and senior scientist at The Robert Wood Johnson Foundation, and journalist Joseph Alper combine to examine the Foundation’s efforts to make tobacco cessation a part of normal medical practice. In Chapter Seven, author Paul Brodeur takes a close look at a single site in a national endeavor: the Fighting Back and Healthy Nations programs of Gallup, New Mexico. He tells the story of Gallup’s efforts to fight alcohol abuse among Native Americans coming to town from the surrounding reservations.

The two chapters in Section Four look at programs designed to strengthen human capacity. In Chapter Eight, David C. Colby, a senior program officer at the Foundation, takes a retrospective look at its investments intended to interest social scientists in health policy and to increase their ability to conduct health policy analysis. In Chapter Nine, writer Paul Mantell describes another kind of program, The Robert Wood Johnson Community Health Leadership Program, that honors local leaders who have made a difference in their communities.

In this Anthology, as in previous volumes, we examine a major communications effort. In the single chapter of Section Five, journalist Susan B. Garland analyzes a major communications campaign that supported the work of the Covering Kids program to get families to sign up their children for health insurance coverage under a new program established by the federal government.

The Anthology concludes with a look back at a program the Foundation supported many years ago. In Section Six (and the final chapter), journalist Sharon Begley examines the “swing-bed program” (formally named the Rural Hospital Program of Extended Care Services), funded initially by the Foundation in 1981, in which rural hospitals converted some of their beds for use by patients needing long-term nursing care.

We sometimes refer to the Anthology as a public accounting of the Foundation’s programmatic activities. We hope the series continues to serve as a public accounting and, as such, to be useful to those trying to improve health and health care as well as those attempting to understand the sometimes mysterious world of philanthropy.

San Francisco Princeton, New Jersey August 2002

Stephen L. Isaacs James R. Knickman Editors