As 2008 draws to a close, organisations, just like individuals, should take a moment to reflect on the challenges and accomplishments of the year that is ending, and prepare for the one ahead. I’d like to do that, in this final column of an eventful year, by revisiting a few of the things I’ve written and reported on.

• In July, I wrote about Atlantic’s support for the Health Care for America Now campaign – a $10 million grant, one of the largest foundation grants ever for an advocacy initiative – to press the Presidential candidates to commit themselves to comprehensive health insurance reform in 2009. I’m happy to report that, despite the grave financial crisis he is faced with – or perhaps because of it, since health care costs are a significant factor in the economy’s structural weaknesses, and insecurity about health coverage looms greater than ever as companies cut costs and more Americans face unemployment – President-elect Obama has endorsed HCAN’s statement of principles and given every sign that health care will be a major priority of his administration.For up-to-the-minute information on this critical effort to repair the most gaping hole in the U.S. social safety net, visit HCAN’s website.

• On September 11, during the Service Nation summit, I wrote about Atlantic’s long history of support for citizen service, and the growing movement of younger people to give back to their communities and their country through participation in programmes like Teach for America, Public Allies and City Year – not to mention the contributions made by older adults in programmes like Experience Corps and ReServe. President-elect Obama has designated Martin Luther King, Jr. Day, on the eve of his inauguration, as a day of national service, and we are joining with other funders to make sure the country rises to that opportunity – and to the increased avenues for citizen service and engagement that the new administration is likely to propose. For some further thoughts on this subject, particularly as it applies to older adults, take a look at the closing remarks I made at the Encore Careers summit of Purpose Prize recipients earlier this month.

• In October, I wrote about the vital role played by nurses in improving health care for the underserved. I’m happy to report that this month in Cape Town, Atlantic announced a commitment of R70-million over four years to elevate nursing education and uplift the quality of healthcare delivery in South Africa. Four major grants and three “seed” grants will be made to a total of seven universities – the biggest single commitment of funds for nursing academia in South Africa from a single private funder. From 2009 to the end of 2012, the universities will use the awards to improve the health of South Africans by transforming nursing education, research, clinical care and specialties, and to advance current and future generations of nurses to the highest levels of doctoral study and beyond. More specifically, this investment will improve many areas of nursing specialisation, including maternal and child health, community health, and critical care nursing. The four institutions receiving major awards of between R16- and R17-million are the Departments of Nursing at the Tshwane University of Technology, the University of Fort Hare, the University of Free State, and the University of the Western Cape. Seed grants of R1-million each are being awarded to three additional universities: North West University, Stellenbosch University and the University of KwaZulu-Natal. The grants were awarded through the University-based Nursing Education South Africa (UNEDSA) programme, managed by Inyathelo – The South African Institute for Advancement, a non-profit trust that promotes philanthropy and strengthens the NGO sector and institutions such as universities. “Through this programme, South African nursing will compete internationally, attract the best candidates for the profession and encourage nurses who have moved abroad to return to the country,” said Barbara Hogan, South Africa’s new Health Minister.

• Also in October, I wrote about the early signs of impact on the work of Atlantic and its grantees as a result of the developing global financial crisis. As the year ends, the warning signs have turned to alarms in many communities in which Atlantic works. On the one hand, there are indications that the response of government in several places has sparked growing activism by affected communities. In my October column, I wrote about the success of older protesters in the Republic of Ireland in forcing the government to back down from its plan to end free medical care for those over 70; just last week, 60,000 students, teachers and parents took to the streets in Dublin to protest educationbudget cuts. On the other hand, the rippling effects of the budget crisis may cripple the capacity of many Atlantic grantees to carry out their work – most ironically, at a time when organisational strength could lead to real changes in public policy. The fraud perpetrated by Bernard Madoff has caused two of our colleague foundations, JEHT and Picower, to close their doors next month, and many shared grantees in the human rights, democracy and youth fields face gaps in their budgets from several hundred thousand to over a million dollars, as these foundations are unable to meet their existing commitments – all of this happening at a time when other foundation, individual, government and corporate donations are falling off, along with declining endowments. Atlantic cannot possibly cover all these shortfalls, but we will work with all our grantees to find ways to preserve as much capacity as possible in this difficult time. This will call on all of us to determine what is most important and to be as creative, innovative and tough as we can manage. Weathering the financial crisis in the smartest way will be an urgent priority in 2009.

• At the same time, as I wrote about last month, 2009 will be a year of great opportunities presented by a new administration in Washington. There have also been changes of government in South Africa and the Republic of Ireland, as well as the restoration of a functioning partnership in shared government between Unionist and Nationalist parties, and all of these present opportunities for fresh approaches to advocacy on health, human rights, disadvantaged youth and ageing. In the U.S., where President-elect Obama’s cabinet and White House staff is now taking shape, we congratulate our partners in the Atlantic-supported middle schools Elev8 programme, New Mexico Governor Bill Richardson, designated as Secretary of Commerce, and Chicago public schools CEO Arne Duncan, also joining the cabinet as Secretary of Education. With pride, we note the appointment Atlantic board member, National Council of La Raza Vice-President Cecilia Muñoz, as White House Director of Intergovernmental Affairs. John Podesta, President of Atlantic grantee the Center for American Progress, co-chairs the transition team, and his CAP deputy, Melody Barnes, will assume a key White House staff position as Director of the Domestic Policy Council. Another grantee, American Constitution Society Executive Director Lisa Brown, will become White House Staff Secretary, and grantee, Nobelist and President of Memorial Sloan-Kettering Cancer Center Harold Varmus has been tapped as a co-chair of the Council of Advisors on Science and Technology. At its meeting earlier this month, the Atlantic board, recognising the historic moment at hand, approved a proposal to commit $20 million to support of the new President’s economic recovery plan and related opportunities. After a holiday break and rest, we will return on January 5 with renewed energy and commitment to work with our grantees and funding partners to make the most of them.

From all of us at Atlantic, our very best wishes for a 2009 in which the moral arc of the universe bends more sharply toward justice.

Gara LaMarche
gara@atlanticphilanthropies.org

In the United States, we are about to engage in a potentially historic debate about long-overdue reform of our inadequate health care system, and big change may be on the way. That is exactly what we need because our current system is failing the very young and very old and everyone in between, including adolescents, a group we (mistakenly) don’t often associate with major health problems, much less as a priority in health reform.

How our system fails to deliver the best possible care to 42 million adolescents in the U.S., ages 10 to 19, is the subject of an illuminating and timely report released today by the respected Institute of Medicine (IOM) and National Research Council. Funded by Atlantic, this report, "Adolescent Health Services: Missing Opportunities", was not cobbled together in a hurry to influence the new administration and Congress, but rather was in the works for more than two years and reflects a comprehensive review by an expert panel of all of the significant research evidence available. The contributors to this report were motivated by the desire to see our health care system invest in the nation’s future by ensuring that adolescents get the best care possible. Not surprisingly, the report finds the U.S. health care system woefully lacking for adolescents, and while it focuses on shortcomings related to young people, the report’s findings are relevant to the broader health reform debate and deserve our full attention.

When it comes to how the system treats young people, the specifics of the indictment are clear. At least five million adolescents lack health coverage of any kind. The care they receive for chronic illnesses, such as asthma, depression and diabetes, is often ineffective, and preventive care is nearly non-existent. At the heart of the problem is the dearth of well-trained health professionals who understand the particular needs of young adults, a lack of thoughtful co-ordination of care, and gaping chasms in private and public insurance programmes, which block millions of adolescents from consistent access to coverage and care. For instance, when many young people turn 18, they are dropped from their parents’ plans or public programmes, but they frequently cannot find affordable plans for themselves, so they go without health insurance. Add to this mix the fact that adolescents experience tough physical and emotional challenges during the transition to adulthood, sometimes take risks they should not, and often justifiably feel that health care professionals don’t understand them. The results are at times dramatic, even deadly, especially for young people from low-income families and communities of colour, who are the least likely to have access to coverage and care.

• More than one-third of the adolescents who need treatment and care for depression, drug abuse and other behavioural problems don’t get any, leaving them vulnerable to suicide and accidents – two of the leading causes of adolescent death
• Adolescents use emergency rooms for routine care more than members of any other age group, resulting in very expensive, sporadic and woefully ineffective care
• Millions of adolescents with untreated chronic conditions suffer needlessly, sometimes fatally.

The severe consequences of such gaps in care are made clear by the case of Marcus Campbell, pictured above, a young athlete who suffered for years from untreated asthma. He is one of three students featured in a video documentary released with the report. Marcus’s untreated asthma prevented him from playing sports and compelled him to visit emergency rooms nearly 15 times a year for the treatment of severe asthma attacks. “When I really had a bad attack,” said Marcus, “they would keep me in the emergency room for maybe 8 or 9 hours… But when I would leave the hospital, I knew I was going to be back.” Marcus knew he would return to the ER because he had no access to regular care and emergency health professionals never taught him how to manage his illness. That is, until tragedy struck. One night, Marcus’s 10 year-old brother, also severely asthmatic, died of an attack. After this completely preventable and devastating loss, the family was finally educated about how to avoid triggers that can lead to acute, deadly attacks. Now, Marcus is doing much better and is able to hit the basketball court with near abandon, and he even coaches youth basketball in his community.

Unfortunately, Marcus, his brother and other adolescents are not the only ones to suffer from gaps in coverage and a lack of high-quality care for chronic illness. More than 13 million people age 65 and over have three or more chronic conditions, and they too face similar challenges related to a lack of quality care, gaps in coverage, and a dearth of physicians trained to care for the special needs of older adults.

Clearly, our health care system is not delivering affordable, quality coverage for all. Overall, Americans are paying too much money for too little health care. Nearly 50 million Americans have no health coverage, and very few of those who have coverage get consistently top-notch care based on medical evidence, especially those people with one or more chronic illnesses. Both the systems for financing and the delivery of care in the U.S. are broken and need to be fixed, and that is why Atlantic is supporting Health Care for America Now (HCAN), a coalition of hundreds of advocacy organisations working to ensure that the new administration and Congress craft, pass and sign legislation in support of quality, affordable health care for all in the U.S. Furthermore, to address the health needs of adolescents through innovative approaches, Atlantic is supporting the Elev8 initiative in up to four states, which is working to provide comprehensive school-based health care to middle school youth. There is much that our elected officials can learn from the leaders of the Elev8 projects as they craft solutions aimed at ensuring that young people in their communities have access to quality health care.

These efforts and today’s new report from the IOM underscore the need to act on health care system reform and to do so both boldly and thoughtfully, accommodating the needs of everyone: young and old; blacks, Hispanics and whites; women and men; the disabled, chronically ill and healthy. In a recent conversation with Atlantic staff, the report’s authors acknowledged that many of the problems that adolescents face around access to quality care are similar to the problems that other groups face, including older adults. As members of President-elect Obama’s team and the new Congress prepare to fix the U.S. health care system, I recommend that they add the IOM’s report to their end-of-year reading lists and watch the accompanying DVD with their families. As a nation, we can do much better, and perhaps this time we will.

Coda

It is bittersweet that this report is sensitively dedicated to Debra Delgado, the programme executive in Atlantic’s Disadvantaged Children & Youth Programme who shepherded this project until her death a year ago at age 50 from cancer. Debra’s commitment to the health of young people was deeply felt and drove her to work on this and many other projects. Debra was one of the first in our office to pin a picture of Barack Obama on her bulletin board, and when we think of how this report may contribute to improvements in our health care system under President Obama, we can see Debra’s big smile in our mind’s eye. To read the full dedication to Debra, please click on this link.

Gara LaMarche
gara@atlanticphilanthropies.org

Links to organisations mentioned in this column:

• The National Academies
• Institute of Medicine
• National Research Council
• Health Care for America Now
• Elev8

The transition from apartheid to the new South Africa is rightfully viewed as one of the major advances in human history toward equality and democracy. But as I have written here before, many problems still exist: the South African government became an object of ridicule, and many lives were lost, with former President Mbeki’s denial of the relationship between HIV and AIDS; xenophobic violence erupted this summer against Zimbabwean refugees fleeing from President Mugabe’s reign of terror; lesbian and gay South Africans, particularly those in rural areas, are often victims of “corrective rape” or other forms of violence and intolerance despite the acknowledgement of the South African courts and Parliament that they have the right to marry; and the economic divide between those who live in comfort and most people in South Africa is widening.

Since 2002, The Atlantic Philanthropies has supported efforts in South Africa to address a number of these issues. I want to share today a less well-known example of injustice with its roots in apartheid – the plight of South Africa’s rural poor, including the unjust and unlawful evictions of nearly one million farm dwellers in the decade after South Africa adopted its new constitution in 1994. Incredibly, the widespread problem of farm dweller evictions was almost invisible until a group of sixteen NGOs in South Africa banded together with support from Atlantic to tell the story of evicted farm dwellers.

To highlight that issue, Atlantic has launched “ What We’ve Learned: Lessons From A Communications Campaign for South Africa’s Rural Poor,” the second publication in its Atlantic Reports series. The report describes the experience of Atlantic and its grantees focuses on using communications to advance human rights; specifically, it highlights the Farm Life in South Africa Project, a campaign Atlantic funded over a number of years to raise awareness of a social injustice and the living conditions of farm workers and the rural poor in South Africa. The report shares lessons from the first phase of the campaign in 2004-2006, which are relevant for funders, nonprofits and advocates around the world interested in using communications to elevate a human rights issue, and describes how the campaign partners are applying those lessons in their ongoing work.

The publication opens with the story of a family, the Skhosanas, interviewed by one of Atlantic’s grantees, Social Surveys Africa:

Until 2001, they survived relatively well on the farm. They had a tap for water; they had firewood. Then the farm was sold to a new owner who wanted the Skhosanas off the land.For two years, they fought eviction. After all, this was the “new” South Africa, and, for the first time, they had rights. But the farm owner shut down their water tap and ordered them to stop gathering wood on his land. Finally, the owner came early one morning when the children were still asleep, broke down the door, and threw the family’s furniture and belongings onto the road. The children were afraid they would have nowhere to sleep. Mr. Skhosana was ill at the time. Mrs. Skhosana says she will never forget the experience of “being thrown out like rubbish”.

Staff members of community organisations had known for years that black farm dwellers, including farmworkers and their families, were being kicked off farm land in post-apartheid South Africa without legal recourse. But without the data to show the scale or impact of the evictions, policy makers paid little attention to the issue. Furthermore, when the Farm Life Project began in 2004, the South African government did not have a clear or integrated rural development programme. The number of commercial farms was dropping throughout the country, resources were scarce in rural community organisations and many evictees did not know they had “tenure” or residency rights and even more didn’t know where to get help.

To demonstrate the breadth and depth of the crisis and help elevate it on the policy agenda, in 2005 Social Surveys and the Nkuzi Development Association developed the National Evictions Survey, the cornerstone of the Farm Life in South Africa Project.

“Atlantic helped initiate the Farm Life in South Africa Project, arising from the work of grantees to combat illegal evictions from farms,” said Gerald Kraak, programme executive for Reconciliation & Human Rights in South Africa. “The foundation funded research to identify the scale of the problem, launched a national education awareness campaign to inform the public about the findings of the study and supported a national advocacy campaign targeting government, with recommendations to prevent ongoing evictions from farms.”

The Project brought together a handful of research, grassroots, legal rights and arts organisations to assess and publicize the current status and living conditions of the nation’s farm dwellers, with Atlantic’s support. The Project explained the predicament of farmworkers and farm dwellers and clarified the impact of the evictions on the stability and well-being of South Africa’s rural communities. Over a number of years, they stimulated a national policy discussion and began addressing the challenges of keeping this issue on the national and social agenda over time.

In addition to the National Evictions Survey, the campaign integrated multiple communications tactics, including commissioning documentary photographs of farm life by photographer Jurgen Schadeberg, publishing them in the book, Voices from the Land, and sharing them in a travelling exhibit which toured both cities and rural areas.

This publication describes the planning and execution of these efforts in 2004-2006, some of which were successful and some not. It also shares lessons from the campaign and describes how partners in the campaign are currently applying the lessons they have learned in their ongoing work, including:

• A coalition can be extremely effective through a multifaceted campaign that integrates many tactics
• A communications campaign must be sustained if it is to produce long-term benefits
• Coordinating a successful communications campaign requires active involvement from participants
• Timing of communications and advocacy efforts is crucial to success
• The communications budget must not only be adequate, but also strategically allocated
• Effective advocacy requires local voices and strong coalitions

The publication concludes by explaining the continuing challenges of responding to rural poverty in South Africa and around the world. It examines potential policy solutions and how funders and nonprofit organisations can influence social change at a systemic level, such as amplifying the voices of the rural poor globally to engage in policy discussions that will impact their lives.

Despite the achievements of this multi-pronged campaign, almost three million black South Africans remain marginalised, living on farms owned mostly by white farmers. But, the future is beginning to look brighter as the policy environment for rural issues in South Africa is improving in the post-Mbeki era.

There are numerous challenges to overcome before South Africa can be the society it has fought so hard to become. But with its progressive constitution and new National Assembly elections this coming April, there is hope that opportunities for change and the advancement of social justice are on the horizon.

Gara LaMarche
gara@atlanticphilanthropies.org

Links to organisations mentioned in this column:

• Farm Life in South Africa Project
• Social Surveys Africa