Urban Health Initiative: Working to Ensure the Health and Safety of Children

“This was going to be the biggest deal since Head Start—it was going to transform these places.”—James Knickman, PhD, RWJF

Dates of Program: 1996–2005

Field of Work: Improving child health and safety outcomes in urban America through comprehensive reform of local decision-making and funding systems.

Problem Synopsis: In 1992, the acquittal of four Los Angeles police officers charged in the videotaped beating of Rodney King, a Black motorist stopped after a high-speed car chase, sparked riots. The six days of death and destruction forced institutions across the country, including philanthropies, to reexamine their efforts to address the complex problems of big cities.

The Robert Wood Johnson Foundation concluded that while it had made numerous grants to urban organizations, relatively few had gone to the nation’s largest cities—and those that had were of insufficient size and duration to have an appreciable effect on the huge health challenges confronting major urban centers.

Synopsis of the Work: In response, RWJF launched a 10-year initiative in five cities to define the community’s most pressing child health and safety problems and marshal public and private resources to address them. The aim was to implement new strategies, policies, and funding mechanisms on a scale large enough to change child health and safety statistics citywide.

The five cities—Baltimore; Detroit; Oakland, Calif.; Philadelphia; and Richmond, Va.—took different approaches. However, all worked to expand participation in after-school programs. Improving preschool care, strengthening home visitation programs, and increasing support for youth at risk for violence were among the other strategies.

The program changed how leaders in the five cities thought about children’s health, and gave them new tools for making health-related policies.”—Evaluator Beth Weitzman, PhD

Key Findings/Results

  • An evaluation team from New York University led by Beth Weitzman, PhD, compared outcomes in the five cities against those in nine cities with matching demographics. The researchers based their analysis on site visits, household surveys, and government data on child health and safety.

    They found that the five cities made some measurable gains relative to the comparison cities—but that the gains were small. “Judged by the ambitious expectations of its designers, the impacts of [the program] fall short,” the evaluators wrote in the American Journal of Evaluation. The evaluation won the 2010 award for best evaluation from the American Evaluation Association

    The national program office took a more upbeat view. Headed by former Seattle Mayor Charles Royer, it reported that four of the five cities “either achieved scale in one or more of their strategies, or demonstrated that they were on a trajectory to reach scale within a reasonable period of time.”

    According to the national program office:

    • The sites together leveraged more than $200 million in annual support for their strategies.
    • The four sites on track to reach scale “secured major meaningful system reforms that changed policies” to support site strategies.
    • Four of the five sites “markedly improved the ability of their cities to secure, analyze, and utilize data” in decision-making related to policies and investments that affect children.

“Small but measurable gains—stemming the tide of decline relative to other distressed cities—were a great outcome, given...the depth and breadth of the problems.”—Evaluator Beth Weitzman, PhD

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Report examines 10-year, $63 million program to improve health outcomes for children in 5 major US cities