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Narrative Matters

On Being A Grantmaker

PREFACE: Philanthropy is a key but rarely examined element of the health policy community. Investigators, advocates, and policy innovators all look to foundations to support their work. Funding from health-related philanthropies fuels both the careers and the impact of many health services researchers and health policy actors. What is life like for professional philanthropists—the individuals tasked with making the grants that so many seek? We present two takes. Michael Lerner, an innovative free-lance scholar and environmental activist, explores the joys and perils of migrating from grantee to grantor. He offers important observations on the education and evolution of the foundation executive. Roger Hughes, the director of a foundation devoted to community health issues, is instructed by a chronically ill man, "Be sure to tell them about my ideas." This is exactly what Hughes does in his essay, bringing the lives, wit, and complaints of the "customers" of his philanthropy to our attention. Writing more than a report from the front, he reflects on the gap between his world of "30,000 feet up" decision making and the ground-level people whom his work affects.

I was forty-eight when Jenifer died. Born in New York, I had taught political science at Yale and had come to California in 1972 on a sabbatical. In the town where I settled, I met a woman who was directing a school for neurologically handicapped children in Berkeley. She introduced me to a little girl who had been diagnosed as retarded until a nutritional therapist had removed all wheat and dairy from her diet. It turned out she was learning disabled, not retarded. I was astounded that diet could affect consciousness. I resigned from Yale to start a residential school to explore the role of nutrition in the learning and behavior disorders of children.

One day in 1974, after the residential school was up and running, I looked out across the fields at the edge of our town at an old RCA radio transmitting facility nestled among trees on the cliffs overlooking the Pacific. I imagined turning those buildings into a center where we might work at the interface between individual health and earth’s health. With a few friends I was able to lease the site for fifty years. We created Commonweal there, a research institute that focuses on environmental public health, programs for cancer patients, continuing medical education for physicians, and work with at-risk children.

Jenifer Altman had come to Commonweal to participate in our Cancer Help Program, a retreat for cancer patients that I still colead today. These retreats offer cancer patients a week of yoga, meditation, massage, vegetarian diet, art therapy, and support groups. I lead evening sessions on making choices in conventional and alternative cancer therapies, dealing with pain and suffering, and facing death and dying.

Jenifer felt that the Cancer Help Program changed her life and asked if she could come work at Commonweal. While working with our staff, she continued her fight for life. She thrived at Commonweal. Her face, pale when I met her, filled with color. She began to laugh, to dance, to live—for two years longer than she or her physicians had expected.

I sat with Jenifer, as she lay in her bed facing the ocean, through the days and nights of her dying. We had attended the same school in New York, although years apart. One early morning, just before the light, I sang her the strangely beautiful school song: "We go forth unafraid /Strong with love and strong with learning /New worlds will be made /Where we set our beacons burning." It felt true to me that Jenifer and I had set our beacons burning together in this small town.

Philanthropy’s Craft

Top Philanthropy’s Craft Choosing A Niche Conceptual Models, Long... Psychological Perils

 
Being a grantmaker looks easy from the outside. It is not. When I became president of the Jenifer Altman Foundation, I had been asking for grants for twenty years, first to build the school for at-risk children that I cofounded when I came to California and then to build Commonweal. I knew how to ask for grants, but I knew nothing about making them.

The first grantmaker meeting I attended as president of the Jenifer Altman Foundation was a 1992 Environmental Grantmakers Association meeting near Tucson, Arizona. Before this I had only gone to grantmaker meetings occasionally, as an invited "resource person." Attending in this capacity typically is an agonizing experience for a nonprofit representative. It is like being a very hungry man staring at a loaf of bread held just out of reach. You are only allowed there for a few hours to give a talk; you are surrounded by unimaginable resources yet are forbidden by etiquette from approaching anyone about support for your work.

Now, as the president of a small foundation, Imagically had been transported inside the sanctum sanctorum, the charmed circle of philanthropy. Yet I still felt very much an outsider. The scene that first evening, as the grantmakers gathered in loose clusters after dinner under the cool, dark desert sky, reminded me of the court of Louis XIV, except that these gifted courtiers—the professional staff of a hundred foundations—were dressed in blue jeans and Birkenstocks instead of silk and satin. They were invisibly but deeply attuned to the modern kings and queens, dukes and duchesses of the philanthropic world—the presidents and senior staff of the larger foundations, and the family trustees of any and all foundations. By the end of the conference I was in a state of psychological shock. Such an enormous amount of wealth was represented there. The dance around it seemed infinitely complex, so mannered, so nuanced. I did not think I would ever understand this dance, and I was even less sure that I wanted to. My deepest impulse was to take a long shower and get as far away from this gaggle of grantmakers as possible.

But I did not get far. I came first to tolerate the funder meetings, then, to varying degrees, to like them, and finally to depend on them as an integral part of my work. I found my home as a grantmaker in the Consultative Group on Biodiversity (CGBD), in the larger Environmental Grantmakers Association (EGA), and in Grantmakers In Health (GIH). It was in these grantmaker affinity groups that I found the wise and experienced men and women who schooled me in the craft of philanthropy.

Choosing A Niche

Top Philanthropy’s Craft Choosing A Niche Conceptual Models, Long... Psychological Perils

 
Eventually we focused the funding work of the Jenifer Altman Foundation on the intersection of health and the environment. This resulted from my exposure to the shocking new science on endocrine-disrupting chemicals at a meeting of the CGBD. This science is demonstrating that some chemicals may have wide-ranging effects on fetal development at exposure levels far below those of traditional regulatory concern.

My interest in this area was due in part to our Commonweal work with cancer patients and children with learning and behavior disorders. The more I learned about traditional toxicology and the new literature on endocrine-disrupting chemicals, the more concerned I was that environmental contaminants might be contributing to a wide range of chronic illnesses (asthma, birth defects, learning and developmental disabilities, cancers, and so on) that are increasing or are at disturbingly high levels. I deeply felt that we have not put enough research effort into exploring the linkages between environmental contaminants and the epidemic of chronic illness we are experiencing.

Environmental health works at the interface of human, animal, and ecosystem health; as a field of philanthropy, it is quite new. Four years ago I joined with other funders to found the Health and Environmental Funders Network (HEFN) to represent the field. (Philip R. Lee, former assistant secretary of health, is HEFN’s chair.) HEFN is a virtual network that works by e-mail and conference calls; it supplements rather than supplants established groups such as Grantmakers In Health and the Environmental Grantmakers Association.

What I learned through grant making is that you have to know your target areas inside and out. You need to know the science, the industries involved, and the legislative and regulatory issues. You need to know the scholarly work in the field and the public perceptions of the issues. You have to learn which of the nonprofits delivers on their grant commitments and how effectively, and the probable cost-benefit ratio of each grant. You have to know the other grantmakers in the field, their strategies, and who you can do business with. Above all, you have to develop a theory of social change that points you toward key leverage points where a grant can make a difference, and you have to be open to modifying your theory as events prove or disprove the sagacity of your previous bets.

There are many ways in which a grantmaker can address environmental health issues. A foundation can support research, policy initiatives, education, or advocacy. In advocacy, some of us have come to believe that seeking to modify corporate behavior in the marketplace is one of the most effective ways to move toward a cleaner and healthier environment. The HEFN funders have supported an array of campaigns to reduce the use of harmful chemicals in the health care, education, computer, construction, agriculture, and military industries, among others.

For example, six years ago a group of funders and nonprofits, including the Jenifer Altman Foundation and Commonweal, started a campaign called Health Care Without Harm. Its aim is to "green" the health care sector by reducing mercury, dioxin, and other toxicants in the medical waste stream. This has been a highly successful, collaborative campaign that has closed medical waste incinerators at home and around the world, reduced the use of mercury thermometers and other mercury-containing medical devices, and begun to move the industry away from using PVC plastics in medical devices and other industry materials, since PVC is associated with high environmental and health costs. HEFN funders also helped to launch the Keep Antibiotics Working project, which has played a role in reducing antibiotic use in poultry and other livestock factory farms—a key step in keeping antibiotics effective for human use.

Conceptual Models, Long Attention Spans

Top Philanthropy’s Craft Choosing A Niche Conceptual Models, Long... Psychological Perils

 
To be effective, grantmakers need some sort of conceptual model to communicate different elements of a theory of social change. I like to imagine the market-based campaigns that many HEFN funders have supported as staves in a barrel. Each stave represents a different industrial-sector campaign, such as Health Care Without Harm or Keep Antibiotics Working. At the base of the barrel are the grassroots organizations dealing with toxics in the workplace and the community. At the top of the barrel are campaigns such as our effort to win the first international treaty to phase out twelve of the most toxic man-made chemicals. The bands that hold the staves of the barrel together are the great ethical principles of our campaigns: citizens’ right to know what chemicals they are exposed to, and the principle that if the preponderance of evidence shows that a chemical may cause extensive harm if released into the environment, it should be regulated with great prudence.

The barrel metaphor helps guide my work; so do my plans to stick to one subject area for the long haul. It is a commonplace that foundations often have short attention spans; the commonplace often is true. I believe it takes a grantmaker at least three years to become competent in a field such as environmental health, and five years to gain some basic mastery of it. I have been in environmental health philanthropy for ten years, but I still have a great deal to learn.

One big problem in philanthropy is that many foundations shift their fields of interest every five years or so. Program officers rarely last longer than that in a field, in any case, because foundation interests shift and because they leave for other jobs. That means that many foundations put aside a subject area just as they begin to achieve some real mastery of it. The short span of philanthropic attention, combined with the profound structural difficulties that foundations have in effectively collaborating with one another, make it easy to understand the skepticism about foundations’ competence in allocating resources that one finds among many experienced nonprofit leaders.

Psychological Perils

Top Philanthropy’s Craft Choosing A Niche Conceptual Models, Long... Psychological Perils

 
The sense of disorientation and alienation that I felt acutely at that first grantmaker meeting in Tucson has faded. But I still find philanthropy to be a psychologically perilous profession. Philanthropy puts you in a particularly transparent power-mediated relationship with other people. The field’s classic urban legend goes like this: A new program officer is taken to lunch by an experienced foundation colleague. The older man tells the newcomer that as long as he remains in philanthropy he will never again have a bad meal or a true friend. Another proverb says that you should not remain in philanthropy more than ten years and that you should have friends from "before" who will tell you when your unearned power has started to erode your integrity. There is wisdom in these admonitions.

Philanthropy is ultimately about providing resources for others to do good work. Most of the pleasure of philanthropy is therefore vicarious. Of course, a gifted and fortunate few people manage to make philanthropy a creative art form all its own. But even they often miss the satisfaction that comes from hands-on work. Some of my friends find great satisfaction in the opportunity to support gifted grantees. They have adapted to the profession in a humble, positive way. Others thrive in unhealthy ways on the power that philanthropy gives them.

My core survival strategy in philanthropy has been to stay moored in my nonprofit work at Commonweal and at the Smith Farm Center for the Healing Arts, where we offer the Cancer Help Program in Washington, D.C. Since I started the Jenifer Altman Foundation, two other friends also asked me—and I agreed—to direct their family foundations. All three of these foundations collaboratively focus on environmental health. They are managed by a very able executive director based in San Francisco, making it possible for me to devote less than a third of my time to philanthropy. That is about right for me.

I continue to live in the small town where Jenifer Altman found me. The heart of my work remains Commonweal’s Cancer Help Program. We recently finished our 112th weeklong retreat. Nine people came from across the country looking for the best way possible to live with and, if necessary, die with cancer. At the end of these weeks, I know I have touched lives. I can’t say that for making a grant. Deciding on the best possible use of resources is deeply useful. But it does not reach my soul.

I admit to feeling a deep paradox in being both a grantor and grantee. When someone contributes to Commonweal, they make it possible for us to continue work that touches the soul. When I make a grant to support someone else’s soul work, I am facilitating what others make possible for me. One would think that I could reach the point of taking as deep a personal pleasure in making possible others’ soul work as I do in engaging in hands-on work myself. But that visceral gratitude, for whatever reason, has eluded me in philanthropy. I am deeply thankful for the opportunity to contribute to environmental health philanthropy. But supporting the work of others feels more like a cherished duty than a source of personal creative joy. The joy, for me, comes from continuing the work we do at Commonweal and Smith Farm that other funders have made possible.

Editor's Notes

 
Michael Lerner, mlerner102{at}aol.com, is president and cofounder of Commonweal, a health and environmental research institute in Bolinas, California, and of the Smith Farm Center for the Healing Arts in Washington, D.C. He is also president of the Jenifer Altman Foundation and the Mitchell Kapor Foundation.

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