Key Points

With place-based philanthropy, a foundation provides extensive, long-term support for a comprehensive mix of programs within specific communities, with the expectation that this will produce benefits at a communitywide level. One of the key questions in designing a place-based initiative is how much the foundation will control local decision-making.

In some initiatives, the foundation dictates the issues that community groups must address and/or the nature of the planning process that will be used to develop solutions. This sometimes produces ineffective or irrelevant solutions. In contrast, other initiatives allow local groups considerable discretion in naming the issues and choosing the solutions, but the resulting strategies can suffer from a lack of cohesion and rigor. We propose that this distinction between foundation-driven and community-driven approaches is a polarity that needs to be actively managed in order to produce positive and sustained impacts.

Healthy Places North Carolina, funded by the Kate B. Reynolds Charitable Trust, began with a highly community-driven orientation, experienced the limitations and complications, and then shifted to a more focused approach. While still supporting locally developed solutions, the Trust prioritized health equity, limited the set of issues for which it would offer funding, and emphasized systems change as a key element in the solutions it would fund.

While this pivot was essential to the observed successes, the initiative would not have succeeded if the Trust had begun where it ended up. Neither the foundation-driven approach nor the community-driven approach is “good” in an absolute sense. Instead, foundations should make an informed choice as to the best place to begin, and then rely on warning signs to determine when it is time to adjust in order to take the work to the next level and avoid the pitfalls associated with the initial model.

Open Access