Key Points

While a number of observers have offered advice to foundations on how to be more effective with the implementation, evaluation, and adaptation of their strategies, there is little guidance on how foundations should go about designing their strategies.

This study fills that gap by analyzing the strategic thinking of health conversion foundations when they determined how they would address various social determinants of health. Based on interviews conducted with the leaders of 33 foundations across the U.S., we identified four strategic pathways: expanding and improving relevant services, creating more effective systems, changing policy, and encouraging more equitable power structures.

In choosing a strategic pathway, a foundation is determining the type and degree of social change it wants to achieve. This choice should be aligned with the foundation’s mission, values, philosophy, resources, and sphere of influence.

Open Access