Disrupting Patterns in Who We Fund and Listen To

At RWJF, we’re confronting the ways our funding has favored larger, more powerful organizations over community leaders and advocates closest to the issues.

When everyone has a say in decisions that affect their lives, we can create a society where every community flourishes. Philanthropy has a unique responsibility to advance this vision, especially at a time when policies threaten basic health protections and exclude community voices. With tremendous resources, philanthropy influences not just who receives funding, but also who drives these decisions and whose perspectives count. 

At RWJF, our ongoing Truth, Repair, and Transformation (TRT) process takes a critical look at our history, going beyond narrating our successes to acknowledging where we fell short.  We previously shared lessons about the origins of our wealth from Johnson & Johnson, the pharmaceutical and health products company. Now, we’re focusing on what we funded—and didn’t fund—through a few of our signature grantmaking initiatives. 

Our review of independent evaluations, financial data, and historical records suggests that RWJF prioritized input from well-established, powerful partners in our decisions, approaches, and grantmaking, more than input from organizations representing the people most acutely affected by unfair systems, such as people with low incomes and people of color. To build a future where health is no longer a privilege, but a right, we must change this.

What We Learned

As part of RWJF’s TRT work, we took a close look at how the Foundation defined problems, selected partners, distributed resources, and decided which solutions to pursue—and which not to pursue. Here are some of the patterns we found:

1. We provided significantly more money to large, influential organizations, including universities, research institutions, and large national organizations, than to organizations closest to harm, such as community-based organizations, grassroots advocates, and Indigenous-led organizations. Across four signature initiative programs between 1985 and 2024 that received more than $2 billion in funding, we gave nearly two-thirds of grant dollars to universities, research institutes, and large national organizations, while community-based organizations and grassroots advocates received approximately 15% and Indigenous-led organizations received less than 1%.
2. RWJF’s closer relationships with these institutions gave them outsized influence over our strategy and approaches. As a result, we were more likely to support grantmaking and use our voice to support policy, healthcare, and business decisions that preserved these organizations’ power and influence, rather than challenging how those decisions caused harm. Too often, we overlooked the input of communities directly experiencing health inequities.
3. Many of our grants focused on changing individuals’ health behavior, rather than addressing the laws, narratives, policies, and corporate and institutional practices that put and keep people at risk of poor health. We failed to adequately name and work toward government and corporate accountability for their roles in causing or exacerbating health inequities, ultimately limiting our impact on improving health. 

Our long-term tobacco control and childhood obesity funding initiatives illustrate ways that our priorities and alignment with powerful interests diminished our impact.

Tobacco Control (approximately $600 million from 1991 to 2009): RWJF’s commercial tobacco control funding heavily supported programs run by large national organizations and medical associations, including those with professional relationships with Johnson & Johnson executives connected to RWJF. We gave far less funding and decision-making power to community groups representing people harmed by the tobacco industry. RWJF framed tobacco use as a problem of individual choice and addiction, rather than a public health crisis manufactured by Big Tobacco and reinforced by the political, economic, and institutional interests that protected it.

These funding choices also shaped national policy priorities. For example, RWJF funded powerful organizations that helped negotiate the 2009 Family Smoking Prevention and Tobacco Control Act, which gave FDA the authority to regulate the manufacture, distribution, and marketing of tobacco products. Although the Act banned most flavored cigarettes, it did not ban menthol products, despite evidence that tobacco companies heavily marketed menthol cigarettes to Black communities. RWJF’s largest tobacco grantee received $99 million in funding, and they and other grantees played a large role in advocating for the legislation. In contrast, the National African American Tobacco Prevention Network advocated for an immediate menthol ban—a position that RWJF did not support. Today, roughly three in four Black smokers continue to use menthol cigarettes: If a menthol ban were enacted now, it could save as many 654,000 lives over 40 years, including 255,000 Black Americans.

RWJF’s focus on individual behavior change and medical smoking cessation approaches also aligned with the interests of the pharmaceutical and insurance companies. Though supporting smoking cessation helped many people, we failed to acknowledge that there was also a financial benefit at play, as Johnson & Johnson was a major producer of nicotine replacement products such as the nicotine patch during this period. Moreover, RWJF did not directly confront the role of tobacco companies in fueling addiction through concentrated advertising and supply in low-income and Black and brown communities.

Childhood Obesity (approximately $1 billion from 2007 to 2024): RWJF’s childhood obesity work intended to help improve conditions that shape diet and physical activity. We gave far less grant funding to community-based and -led organizations, even though people most directly affected are best positioned to drive change in their communities. Instead, most of our funding went to universities, research institutes, medical associations, and communications companies. RWJF’s own board included trustees with industry ties: An RWJF board member simultaneously served on the Pepsi Bottling Company board and had connections to two of the largest recipients of RWJF’s childhood obesity grants who received a total of $154 million.

Our approach to working with food and beverage companies involved voluntary partnerships, including corporate self-monitoring and business incentives. We continued these strategies even though our own funded evaluations showed no evidence that they produced meaningful changes in public health outcomes. At the same time, RWJF avoided seeking stronger government regulation or legal liability to hold food and beverage companies accountable for the harms they were causing with unhealthy food. Our strategy shifted the burden to communities to make healthier choices without publicly stating how unhealthy, processed foods were heavily marketed to them and made abundantly available, while fresh, healthy foods were prohibitively expensive and often inaccessible. While RWJF funded research on the targeted marketing of harmful foods to communities of color, we did not change our strategies to support efforts to hold companies accountable. For example, we did not provide substantial funding to build the power of communities to challenge the food industry’s practices that made healthy food a privilege available based on economic resources.

Over the almost two decades that the foundation took on childhood obesity, the rates of childhood obesity in the United States did not decrease. The Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (CDC NHAMES) data show that obesity rates have increased for Black and Hispanic children, while remaining roughly the same for White children.

What Comes Next?

When philanthropy privileges insiders while sidelining and underfunding community voices, we reinforce inequities. Our responsibility now is to act on these lessons by changing how we work. Going forward, we will focus on increasing our accountability to people and communities facing the greatest inequities. Here are the steps we’re taking: 

• Listening and Learning: In August 2026, we began a series of listening sessions to inform our next steps and gather thoughts about what meaningful change will require of us. We will continue to engage the TRT Wisdom Council, an external advisory group, to guide us and help to hold us accountable, and evaluate and be transparent about whether our work as a philanthropy is more equitable. In this way, we are shifting whose expertise and input we prioritize and working to ensure community interests drive our next steps.
• Changing How We Fund and Grant: We have started to track how much of our funding supports health justice and community power-building efforts, which we have historically under-resourced. Our goal is to shift the balance towards funding more groups that work through these approaches.
• Transforming How We Work: We are working to build mechanisms of accountability into our work going forward. This means prioritizing equity in each decision we make, whether it’s around funding, staffing, evaluation, or operations. Even with the best intentions, we know we’ll make missteps in the future. That’s why we’re putting systems in place to identify harms and course-correct more quickly.

We all have a responsibility to recognize and interrupt harmful institutional patterns so that health equity and justice prevail. We will be successful if we see a measurable change in who we listen to and trust, who has the power to define solutions, and ultimately, whether communities facing the greatest adversities are healthier. We must commit ourselves to shifting power, confronting systems—not just symptoms—and following the leadership of communities who have too often been excluded. That is how we begin to earn trust and move closer to a more just and equitable future.

About the Authors

Fiona Kanagasingam is vice president, chief Equity and Culture officer.

Maisha Simmons is associate vice president, Equity and Culture.