Key Points

Across the globe, foundations grapple with how to tackle complex, cross-sector societal problems. A major effort by the California Health Care Foundation to reduce opioid-related morbidity and mortality, launched just as opioid use was becoming understood as a problem that could reach epidemic proportions, presents an instructive case study of impact.

Starting in 2015, the foundation placed several “big bets” on initiatives aimed at stopping overdose deaths and preventing new addiction. That early investment had dramatic returns, laying the groundwork for scaling pilot projects statewide as hundreds of millions of dollars in government funding became available to address the crisis.

This article, based on review of foundation strategy, data on investments and results, and interviews with foundation staff, partners, and grantees, identifies key strategic elements that contributed to impact: bridging across sectors, resources beyond dollars, and co-creation with grantees. It also highlights lessons learned for foundations working to address this and other complex social issues.

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