Setting Our Sights on Systems Change

Don Schwarz, Robert Wood Johnson Foundation

Last year, the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America called for a broad range of sectors—including community development, public health, health care, education, transportation, urban planning, business, and others—to work together to create healthier communities. The Commission’s call for this level of collaboration was groundbreaking, and its recommendations are critical to achieving RWJF’s central aim: to build a Culture of Health that enables all of us to live longer, healthier, and more productive lives.

We’re exploring the question, how can we best stimulate the big, broad-scale changes and “seismic shift” to integrate health-improving strategies into communities urged by the Commission?

We’re not alone in asking. A growing number of community revitalization initiatives have been launched by some of the nation’s most innovative funders, with two general schools of thought on the way forward: long-term, placed-based “replication” models and “systems change” approaches to creating impact on a broad scale. To learn more, download the new working paper Pathways to System Change: The Design of Multisite, Cross-Sector Initiatives.

Replication and System Change Chart: Benefits and Challenges

The first approach is to fund a specific project, program, or set of services to address a complex problem in a single neighborhood or community through locally tailored activities. Often, such an initiative is intended to test whether resources deployed in a single place is effective in addressing specific challenges. If successful in one place, the intention is to achieve scale through repeated, locally relevant implementation, usually with long-term support. In contrast, systems change focuses on creating policy shifts and changing how public and private dollars flow into communities to promote more equitable outcomes. In other words, a “systems change” approach to helping ex-offenders re-enter society could include changing education, employment, and housing policies that pose obstacles rather creating a program for a small subset of ex-offenders, testing it and copying it elsewhere through replication. Both types of approaches are meaningful, and all funders should carefully consider the advantages and challenges of each. 

To be better informed about how we should spend our grant dollars, RWJF set out to learn from the successes and missteps of initiatives that have pursued cross-sector strategies through both of these approaches. With the Federal Reserve Bank of San Francisco, we hosted a roundtable of experts on the development of multi-site community change initiatives. And we commissioned new research from Mt. Auburn Associates that is being released this week. In looking at that research—along with our own history of support for better policy-making, planning, practice reform, improved knowledge and data resources, and human capital development—we’ve recognized the opportunity that a systems change approach offers a quiet revolution in our work in scaling up community improvements.

What does systems change look like on the ground? In the late 1990s, the city of Philadelphia—where I later served as Health Commissioner and Deputy Mayor for Health and Opportunity—had the second lowest number of supermarkets per capita among major cities in the nation. To tackle the challenge, city, state, and private sector leaders created the Fresh Food Financing Initiative, bringing together the supermarket industry, public health officials, and economic development professionals. Public agencies agreed to provide supportive services (policing, public transport) and financial incentives (through tax concessions or construction subsidies) to assist the private sector in undertaking what would otherwise be rejected as too risky or not profitable. In fewer than 10 years, the Initiative created 70 supermarkets in 27 Pennsylvania counties, increasing access to fresh food, creating jobs, and attracting additional development in low-income neighborhoods by changing the incentives for the supermarket industry. The model demonstrated sustainable business models for grocery stores in distressed communities and has since been implemented nationwide as the federal Healthy Food Financing Initiative. 

This is just one example of systems change. Several others are featured in the new Mt. Auburn Associates report. We see it as a valuable resource for philanthropy—and especially state and local funders—along with public-sector agencies, community development practitioners, financial institutions, and other funders that are seeking to improve communities and the lives of their residents.

Download the new working paper Pathways to System Change: The Design of Multisite, Cross-Sector Initiatives.

Donald Schwarz is a director leading the Robert Wood Johnson Foundation’s efforts to catalyze public demand for healthier people and the places in which they live, learn, work, and play. He oversees the RWJF effort to identify, support, and spread the word about individual and community actions that promote lifelong health for all Americans. Previously, Schwarz served as Deputy Mayor for Health and Opportunity and Health Commissioner for the City of Philadelphia.

The views expressed are not necessarily those of the Federal Reserve Bank of San Francisco or of the Federal Reserve System.

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