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Looking Back: More than medicine: A commitment to community health

Centennial, Health

How Kresge’s Health Program evolved over 100 years from making capital challenge grants to championing community-led solutions

The sniffles, the sneezing, the coughing, the headaches – we’ve all come down with a cold. Research on this common condition was the purpose of the Kresge Foundation’s very first medical grant, awarded in 1941 to the University of Michigan.

Health has been one of Kresge’s major fields of interest since the foundation’s earliest years, with the principal emphasis being on supporting medical research and scientific equipment. Grants varied in size from a few thousand to several million dollars for projects spanning in purpose from writing medical textbooks to constructing a medical research center.

While grants typically were awarded to existing institutions, in 1948 the foundation established the Kresge Eye Institute in Detroit to provide clinical care for patients living in poverty and to conduct ophthalmological research and education. Kresge continued to fund the institute until it was made part of Wayne State University in 1968.

The national landscape is dotted with medical and research buildings that still stand today as a result of more than 80 years of Kresge’s capital challenge grant funding.

But hospitals and laboratories are just one of many essential elements that enable communities to be well. That’s why the foundation decided to address the other contributing factors that influence our health, including our race, income, where we live, the food we eat and the air we breathe.

Going upstream

In 2007, as the foundation was transitioning from a capital challenge grant maker to a more strategic, values-driven funder focused on advancing opportunity for people with low incomes, Kresge created a new Health program with the intention of improving community health and reducing health disparities by addressing the “upstream” factors of health.

A grantmaking program that concentrated on grants to medical and health care facilities was simply too narrow to address root causes of poor health. Decades of structural inequities and racism had left people of color and people with low incomes with low-quality housing, polluted air, limited access to healthy food and a lack of other resources that are necessary for people to thrive.

David Fukuzawa
Former Kresge Health Program Managing Director David Fukuzawa

“Certainly, no community could be healthy without good hospitals, but we argued that poor health was more largely attributed to unhealthy conditions, such as lack of access to healthy food, safe physical activity, housing and exposure to pollution, rather than individual behavior or lack of health care,” said David Fukuzawa, who served as managing director of the Health Program from its inception until his retirement in 2019.

This new Health Program would “seek to reduce health disparities through innovative, place-based strategies that explore the intersection between health, environment and community economic development,” Fukuzawa wrote in December 2007.

The idea that our health was affected by much more than access to medical care was somewhat unique at the time. Kresge was joining a space occupied by only a few other national funders that shared a similar perspective.

“It’s been said that your zip code matters more than your doctor. But when you take a closer look at that statement, what does that mean? It means that the neighborhood you live in, your physical and social environment, is what influences your health. It was very clear that when you look at the reason we have differences in our health, it ultimately comes down to segregation. Segregation is a sign not only of separation, it’s a sign of disinvestment, and disinvestment is the problem. We must invest in everyone,” Fukuzawa continued.

“The intersection of health with community economic development would prove to be one of the hallmarks of Kresge’s approach to health. Kresge, with its programs in Detroit and other cities, arts and culture, environment and social investments, can bring a full palette of tools and resources to the table to support the health of low-wealth communities,” Fukuzawa said.

Photo gallery: Health Program investments over the years

Strong partnerships between government and community are necessary to achieve meaningful community-led change. While leadership has been woven into the Health Program’s work for many years, two initiatives, Emerging Leaders in Public Health and PHEARLESS (Public Health Regenerative Leadership Synergy) made it a specific focus.
Fresh, Local & Equitable (FreshLo) sought to improve access to healthy food, ignite entrepreneurship, spur economic development and integrate arts, culture and community-engaged design to spark neighborhood revitalization in cities around the country. The initiative built on and enhanced existing community assets and strengths, and uplifted community leaders to ensure that development is led by and for its residents.
With FreshLo, The Kresge Foundation was the first national funder to intentionally integrate food, art and community to drive equitable neighborhood revitalization. Launched in 2015, FreshLo provided $8.4 million in grant funding, as well as technical assistance and learning opportunities, to 23 organizations from around the country.
Equitable Food Oriented Development, or EFOD, is a community-anchored development strategy centering Black, Indigenous and people of color food and agriculture projects and enterprises as vehicles for shared power, cultural expression and community asset building. EFOD is growing from a small peer group to a grassroots movement seeking to build community power and bring deep, long-lasting change to the social, health, and economic conditions of local communities. Photo courtesy of Oakland Bloom.
People living near ports and freight facilities experience high levels of air pollution. Moving Forward Network is a national network of community-based organizations, researchers, and advocates focused on reducing diesel emissions at several major port and freight facilities across the U.S.
The Climate Change, Health & Equity initiative seeks to mobilize equitable climate action by community-based advocates, health care institutions, and public health practitioners in ways that benefit low-wealth communities and communities of color, reducing their climate-related health risks. Photo courtesy of WEACT.
In the Bay Area, the BUILD Health Challenge Healthy Havenscourt Collaborative works to reduce Havenscourt’s asthma rates, focusing on upstream policies regarding unhealthy housing conditions and toxic stress. Launched in 2015, BUILD supports communities in their efforts to address health disparities caused by systemic or social inequities and advance health equity. To date, the BUILD funding collaborative has invested more than $30 million to support 74 multi-sector, community-driven partnerships around the country. Photo courtesy of BUILD Health Challenge.
An early Health Program grant was to the Trust for Public Land, for a $2 million public-private initiative to redesign and rebuild parks and playgrounds in Newark, NJ.

At the beginning, the team first tackled a pervasive and concrete problem affecting thousands of children, particularly in cities: lead poisoning.

In 2008, the Health Program would launch one of Kresge’s first initiatives, Get the Lead Out, aimed at preventing childhood lead poisoning through improving substandard housing.  One grantee, Greensboro Housing Coalition, received a multi-year $300,000 grant, and would later gain national recognition for its pioneering healthy housing efforts and partnerships with health care institutions.

Another early grant in 2008 to the Trust for Public Land, for a $2 million public-private initiative to redesign and rebuild parks and playgrounds in Newark, NJ. The initiative grew out of the community’s response to a widely publicized incidents of gun violence. It would eventually incorporate elements of what is now called community-centered design and placemaking.

Many grants in the first few years also went to community health centers.

The team’s commitment to community-centered approaches really emerged in 2009 with the Safety Net Enhancement Initiative (SNEI). SNEI was a national, place-based initiative designed to demonstrate that community health centers could improve health by collaborating with other sectors to address key social determinants like housing, food and transportation.

“The Safety Net Enhancement Initiative taught us that health systems must go beyond medical care to intervene and invest at the community level and embrace a community-centered versus patient-centered approach,” Fukuzawa said.

Over the next several years, other key initiatives took shape, including Advancing Safe & Healthy Housing, BUILD Health Challenge, Emerging Leaders in Public Health, Fresh, Local & Equitable (FreshLo) and the Moving Forward Network.

While efforts addressed key priorities such as health, economic development, creative placemaking, health leadership and equity, what Kresge’s Health Program didn’t do was define specific projects. That was up to individual communities to decide based on their needs and goals.

“Communities have a sophisticated understanding of the challenges they face, and are uniquely positioned to know what’s needed and what’s possible. They have the expertise and experience to drive locally determined solutions to improve health,” said Stacey Barbas, retired Kresge Health senior program officer.

Former Kresge Program Officer Stacey Barbas

“Over the years, as we continued to learn from our community partners and others in the field, our approach evolved,” Barbas said. “We learned that engaging people and communities means seeing problems and solutions in multiple dimensions. Most importantly, we learned that authentic community engagement is fundamental for sustainable efforts to building healthy equitable communities.”

Today, the Health Program continues to champion community-led solutions through grants, social investments and initiatives, including Advancing Health Equity through Housing, Climate Change Health & Equity, Equitable Food Oriented Development, and PHEARLESS.

Kresge Health Program Managing Director Monica Valdes Lupi

“Working closely with our partners, we want to make sure that low wealth communities across America’s cities have access to locally produced fresh food, safe affordable housing, clean air, safe neighborhoods and economic opportunities,” said Health Program Managing Director Monica Valdes Lupi.

“We want to see the adoption of equitable community-centered food policies, climate resilience policies and strategies, and community-led safety policies. We want more investments in community-centered health infrastructure. We want to see public health leaders forging partnerships with community leaders to advance health equity and well-being,” Valdes Lupi said.

Communities and residents should have the full power to decide what their own community looks like and how it is resourced, Valdes Lupi said.

Communities across the U.S. have the expertise and experience to design solutions that change systems, services and practices to achieve equitable health outcomes. By changing how we invest in communities and trusting in their power and ability, together we can build new systems of health for all of us.