A question frequently asked of anybody who works at a foundation is: How do you decide how to spend the money? The challenge of picking and choosing from among so many potentially worthy initiatives is ever present in philanthropy and obviously of great interest to potential grantees. This chapter of the Anthology offers a candid look at how the Robert Wood Johnson Foundation went about deciding to devote a substantial part of its annual grantmaking budget to the problem of substance abuse.
The decision to make grants that would attempt to "reduce the harm caused by tobacco, alcohol, and illegal drugs" was a significant departure for the Foundation. For its first 15 years, the Foundation focused more on improving health care (particularly access to medical services) than on tackling determinants of health. Adoption of the substance abuse goal was a first step toward addressing both the health and health care aspects of the Foundation's mission.
This chapter describes the staff and board processes that led to shaping and adopting the substance abuse goal, and assesses the consequences over the next six years of adopting that goal. The author, Robert Hughes, who was at the time a vice president of the Foundation, was actively involved in the planning process that took place in 1990 and 1991.