Goal: 

To improve the health of Californians by funding interventions that positively influence health through approaches related to employment.

Objectives:

• Better understand the links between economic conditions, work and health, and their effects on employees, employers and the community.
• Demonstrate the relationships between work and health for employees, potential employees, employers and the larger community.
• Influence corporate and government policymakers to improve working conditions for individuals in California.
• Establish a self-sustaining network of researchers and practitioners to advance the work and health agenda. 

Accomplishments:

• Articulation of and dissemination of links between work and health. TCWF’s decision to make work and health one of its initial areas of emphasis was a very strong statement about the value that it attaches to work as a critical ingredient of health promotion. The significance of connections between work and health have been underscored and reinforced through TCWF communications and countless activities of this Initiative, including hundreds of presentations and publications. Target audiences have included the general public, health specialists, people in the job training and employment services world, philanthropy and specialist groups across the work and health continuum. 
• Provision of services to a total of 30,326 individuals. The two direct service programs reached a significant number of Californians providing many with enhanced skills that increase their opportunities to attain higher salaried jobs with benefits and other interventions that maintained mental health during a period of unemployment.
• Demonstrated relationships between work and health. The two service programs (CIOF and WNJ) were themselves demonstrations of programs connecting work and health. Considering health as an important factor in reemployment was a new and compelling dimension for the employment agencies delivering the program. The relationship was probably less compelling for CIOF sites and clients because health was a very long-term outcome not directly measured through this intervention. The salience of the connection between work and health was probably higher for CIOF program managers who were aware of the goals of the Initiative than for clients who used technology for many reasons unrelated to health.
• Collaboration with other funders to undertake activities building a field of work and health. TCWF worked with both The Rockefeller Foundation and The California Endowment to sponsor a conference featuring research and programs to build a field of work and health.

Challenges:

• Communication about work and health. Work and health is not a defined field that brings with it boundaries, definitions and clear-cut images. As a consequence, communicating about work and health was difficult.
• Short-term versus long-term impact on health. A portion of the difficulty in communicating about work and health stems from some interventions, such as CIOF, that can only be expected to have a long-term impact on health by influencing the educational and employment opportunities of those whom the program has benefited. Despite a significant science base, there are different points of view on whether education, training, and economic development are considered legitimate health interventions.
• Distinctiveness of the Initiative’s programs. The program elements of the Work and Health Initiative are each very distinct. There was some ambiguity over the course of the Initiative as to whether the Work and Health Initiative should strive to achieve coherence or whether it should simply be considered four programs under one title. Although some energy was expended toward creating some coherence and contributing to a developing field of work and health, the legacy of the WHI may rest primarily in its individual programs.
• Front-ended commitments of initiative-style grantmaking. The up-front commitment of most initiative dollars made it difficult to be responsive to new conditions and opportunities or to shift course mid-stream. Complicating this particular Initiative, program officers were also hired after the Initiative was designed and all major Initiative support grants had been committed. Nonetheless, for the most part, program officers were able to establish effective working relationships with existing Grantees and take full ownership of the Initiative, its processes and outcomes.
• Business involvement. It was assumed that the private sector would be involved in some portions of this Initiative. Because there was no explicit role or strategy for involving businesses, this did not happen.

Lessons Learned: 

• Creating social change is daunting and timing is everything. In each of the four programs, creating and sustaining change was identified as a challenge. This is best exemplified in the HIPP in which excellent, well-utilized information was written into legislation to expand health insurance coverage and then resulted in many bills that were dead on arrival. The most successful effort at change has been through the CIOF network whose development coincided with increasing public concern about the digital divide. Even unsuccessful attempts at change are important because they keep issues alive when forces are not aligned to create major change. However, the timing of issues is a major factor to consider when social change is the desired outcome.
• Grants are most effective when their purpose is very close to an organization’s mission. Conversely, grants that stretch an organization’s mission have a higher than average likelihood of being flawed or failing. Although this appears obvious, initiative-style grantmaking serves as a carrot for many organizations to stretch their organizational boundaries to apply for a grant. Many of the problems and failures in the Work and Health Initiative can be traced to the inappropriate fit between organizations and the projects they took on. When an organization is stretching outside its mission, technical assistance is often a critical ingredient in helping the Grantee successfully accomplish the stretch.
• Roles of program coordinators are complex. Three of the programs had program coordinators whose grant purpose included coordinating other Grantees. Although the technical expertise that the coordinators brought to Grantees was very significant, the relationship between program coordinators, evaluators, and Foundation staff was complex and required ongoing monitoring. Roles and responsibilities had to be continually discussed and negotiated.
• There was a tradeoff between statewide coordination and site-specific needs. Each program coordination team had dual roles that included statewide coordination and technical assistance to sites. Their technical assistance strengths were tailored to what the statewide initiative and local sites might need. Limitations stemmed from the coordination team’s inability to provide site-specific technical assistance that could have improved program performance such as board development, strategic planning and staff training. A brokering model of providing technical assistance that gives sites discretion to select their own technical assistance providers might have been more effective, but then the statewide program coordination function would have been lost.
• Diversity is an extraordinarily important dimension in work and health. In all of our programs, the diversity of the California population was an important factor that shaped programs, influenced delivery methods and affected results. 
• Role and experience of TCWF staff is important. Managing an Initiative with four distinct programs and goals has its benefits and challenges. The diversity of programs and Grantees led to a rich and challenging experience for the Initiative and for program officers. Though Foundation staff had programmatic incentives to identify cross-program themes within the Initiative, Grantees within each of the distinct programs had no easily identifiable incentive to do so. This emerged as a challenge to creating an Initiative-wide community of learners and partners.