Fall 2001

As the Urban Health Initiative heads into its final four years of implementation, the five local campaigns in Baltimore, Detroit, Oakland, Philadelphia and Richmond are in the midst of a metamorphosis. After a reaffirmation or tweaking of goals and strategies based on opportunities, challenges and other realities encountered during the previous few years, the campaigns are gearing up to secure the systems changes necessary to fully implement their strategies.

Because of the UHI's challenge to take strategies to scale (that is, improve youth health and safety statistics throughout the metropolitan area), campaign strategies are extraordinarily ambitious. For example, the City of Philadelphia's Investment Strategy, led by the Safe and Sound Campaign and unveiled by Mayor John Street, seeks an increase in funding of $150 million over the next three years to support a citywide expansion of services to 100,000 children.

Last year campaigns were charged with developing systems change plans that identify and lay out the policy changes and funding streams vital to the implementation of their strategies.

Implementing these plans will put the local sites in more of a "campaign mode" than they have been in years past. What will the local campaigns look like in the next few years? What new challenges can be expected, and how might they be poised to address them? Below some of those involved in the UHI provide some insight into these vital questions.

Flexible fund seeking

Otis Johnson, dean of the College of Liberal Arts and Social Sciences at Savannah State University, is a member of the UHI's National Advisory Committee. As a former public official and leader of a variety of systems change efforts, Johnson has experience with issues the UHI campaigns will face in the next few years.

"The campaigns will have to be very entrepreneurial and strategic with regard to fund-seeking and sustainability," he says. "Private and public sources change all the time as priorities, personnel and circumstances change. Plans will have to be flexible enough to take advantage of unforeseen opportunities and give up on sources that are no longer feasible."

Dr. Johnson says one of the biggest temptations campaigns will face is "mission-drift" as they pursue funding that might be available, but not exactly right for the campaign's established goals. "One thing that feeds mission-drift is categorical funding," he says. "Campaigns need to resist chasing easy, 'fad' funding. The smart ones won't chase all sources; they'll be strategic and stay true to their mission."

Naomi Post, executive director of Philadelphia Safe and Sound, agrees on the need for flexibility. "For example, because of the problems faced by our city's school district, we are concerned that certain discretionary federal money could be shifted to schools rather than youth development," she says. "We'll be aggressive in our research, monitor dollars and alter the plan as opportunities and challenges arise."

Good analytic work will be a critical, ongoing activity, says Cindy Curreri, UHI national program deputy director. "The five UHI campaigns will need to understand public budgets, not only what is currently spent on children's' issues but also other possible targets of shifted or new dollars," she says. "They need to understand the timing of decisions and processes, that is, what can be done by legislation, by administrative fiat or other means. Really, it calls for a political plan, to secure financial and other public policy changes."

Not only will the local campaigns be targeting funding to carry out their strategies, they will also need sources to replace operational costs phased out by the Robert Wood Johnson Foundation. "Our operating costs will come from a single or very few sources in an effort to maintain the level of RWJ's current support," says Hathaway Ferebee, executive director of Baltimore's Safe and Sound Campaign. "We will attempt to secure another financial sponsor to prevent the campaign's fiscal and human resources from being diluted or placing a misplaced focus on our own fundraising. We will maintain our position as a time-limited campaign that provides resources rather than competes with our partners for scare resources."

Strong community support

Dr. Johnson notes that campaigns will need to retain and demonstrate broad-based community support, both public and private. "Having such support will be key to attracting and maintaining funding support," he says. "As budgets change and tighten, public funders especially will need to see strong community support."

A related need, according to Dr. Johnson, is strong and very visible leadership within the business community. "When business leaders advocate for these types of changes, it makes a difference because they are not normally seen as bleeding hearts," he says.

For the UHI campaigns, the "community" from which they need support can mean the entire state. It's likely that every campaign will need at least some legislative and/or fiscal support from the state legislature. "Finding like-minded organizations throughout the state will be a priority for us," says Post. "So will the Pennsylvania governor's race. Will we have a 'children's governor'? There are no guarantees, so we want to get on the radar screen of all candidates and get them committed."

Ferebee agrees. "We are developing a communications plan to more broadly communicate and engage the public," she says. "We will have to organize and support positive action at not only the individual, group and city levels, but the regional and state levels as well."

An adjunct to the need for strong community support is the need for effective leadership development by the UHI and the local campaigns. "Members of boards and staff come and go, but the effort is only as strong as the board and staff," notes Johnson. Current and emerging leaders who buy into the UHI goals and strategies will help ensure the effort continues beyond the 10-year commitment of the Robert Wood Johnson Foundation.

Moving the bureaucracy

Perhaps the most difficult issue UHI campaigns will face in the coming years is getting bureaucracies to embrace and implement policy changes. "It's one thing to change a law or policy; it's another thing to get it carried out," says Curreri. "The campaigns will have to be vigilant."

"To institutionalize change, we need to work at levels lower than agency heads," says Post. "What we're really doing is changing the culture in children services to reach an understanding of how prevention can complement treatment and intervention. Our goal after completion of our investment strategy is to assure that there are people within the systems who will own the strategies after we're gone."

Ferebee agrees, adding, "This change in culture is also occurring in Baltimore where agencies have worked to create the strategies. The challenges are for the agencies to stay the course, and for the community at large to support these changes and give the agencies the time it takes to change to a prevention focus."

Good data

All the local UHI campaigns have invested a lot of resources into the gathering of data. This will only continue in the years ahead.

"You can have great public relations, but you need data to articulate your goals and objectives and to demonstrate results," says Johnson. "Data speak volumes. Citizens are more sophisticated in evaluating efforts such as these. They don't want to hear promises, but to see what is delivered."