Key Points

· This article describes the trade-offs between the city-level and neighborhood-based approaches in examining the Robert Wood Johnson Foundation’s (RWJF’s) Urban Health Initiative (UHI), an $80 million, 10-year effort to improve the health and safety of young people.

· Eight cities engaged in a two-year planning process; five received funding for an eight-year implementation phase. Plans that engaged in bottom-up activities, but left power and control in the hands of civic, business, social service, and political leaders, were favored. Those who had focused exclusively on neighborhood-based approaches were not funded for implementation.

· RWJF chose a city-level focus because they believed neighborhood-level initiatives lacked the political clout to make sustainable changes in programs, institutions, systems, and policies. Furthermore, poor outcomes for children were not concentrated in a few neighborhoods, but were found in a substantial portion of the city’s communities.

· The UHI sites were successful in bringing existing efforts quickly under their umbrella, strengthening them by bringing added resources, data, technical expertise, and visibility. With citywide focus and leadership, the power between the initiative and local philanthropy was made more balanced. However, the fragmented nature of government service delivery systems at the city level created new obstacles to change in some cases.

· The UHI’s citywide focus meant that some of the important roles that neighborhood comprehensive community initiatives have assumed went unfilled. For instance, attention devoted during planning to cultural norms and values that might influence health and safety outcomes quickly ebbed during implementation.

Open Access