A 1993 article in the Journal of the American Medical Association by J. Michael McGinnis and William Foege estimated that more than 40 percent of all deaths in the United States could be attributed to behavior-related causes. For example, the authors attributed 400,000 deaths in 1990 to tobacco, 300,000 to diet and activity patterns, and 100,000 to alcohol. This widely cited article served to wake up many in the health field to the fact that medical care alone cannot always ensure better health, nor is it a dominant determinant of health status. It was among the factors that led the Foundation to reconsider its priorities and, in 1999, to make an important change in its focus.
This chapter offers a detailed examination of why and how the Foundation moved from an approach focusing largely on improving health care services to one that gives equal importance to addressing the behavioral and social causes of poor health. It explores the ramifications of this shift, including the largest-ever reorganization of the Foundation's staff into two groups, one focused on health care, the other on health. Additionally, it lays out a blueprint for a grantmaking program that is currently being developed by the health group.