Building Healthy Communities

Grantee Name

Research Foundation of the City University of New York, Graduate School of Public Health and Health Policy / CUNY School of Public Health

Funding Area

Building Healthy Communities

Publication Date

February 2018

Grant Amount


Grant Date:

June 2016 – December 2016

Poor neighborhoods in Central and East Brooklyn have some of the worst health outcomes in New York City and their hospitals struggle financially to keep their doors open and care for the people they serve.

In response, Governor Cuomo budgeted $700 million in capital funding to stabilize the health care delivery system and increase access to health care services in Central and East Brooklyn. The establishment of a Brooklyn Community Wellness Trust was viewed as a potential complement to the State’s and City’s health care investments in the borough. Modeled after the Massachusetts Prevention and Wellness Trust, the idea was that the Trust would ensure that community-based primary and preventive health care services are meeting neighborhood needs in a way that is grounded in principles of population health. In 2016, NYHealth awarded a planning grant to Research Foundation of the City University of New York (CUNY) to explore the feasibility of and steps needed to establish and support the Trust.

Broadly defined, a Prevention and Wellness Trust is a pool of funds that is raised or allocated to improve population health by supporting community disease prevention interventions. CUNY proposed to undertake an analysis to inform the creation, funding, and implementation of population health activities by the Trust. It set out to identify mechanisms for funding, governing, and selecting focus areas and projects for the Trust; recommend the type of entity that would be best suited to run the Trust; conduct economic modeling to identify the per-person investment that would yield cost savings; and identify potential metrics and data sources to monitor and assess impact and cost-effectiveness of the Trust.

Outcomes and Lessons Learned

  • Conducted interviews with a diverse set of local and national experts and stakeholders, including stakeholders from the Massachusetts Prevention and Wellness Trust.
  • Reviewed existing Brooklyn community health needs assessments; New York City Community Health Profiles of Brooklyn; cost-effectiveness research on prevention intervention and financing structures; and analyses on preventable hospitalizations and emergency room admissions.
  • Produced an analysis that:
    • Described the landscape of East and Central Brooklyn as related to chronic disease burden and preventable hospitalizations and emergency room admissions;
    • Provided an overview of existing and past Wellness Trusts across the nation, including the Massachusetts Prevention and Wellness Trust;
    • Described potential financing strategies, such as blended and braided funding, community benefit funds from nonprofit hospitals, and funding allotment from government agencies; and
    • Gathered stakeholder input to inform top-level recommendations for establishing a Trust, including key organizations to involve and the need for community engagement in the process.

Although the CUNY team did conduct a descriptive analysis, the analysis and report did not include essential elements such as: (1) an estimate of the cost of establishing and supporting the Brooklyn Community Wellness Trust, (2) an in-depth and specific set of actionable steps and recommendations on how to create, fund, and implement the Trust, e.g., delineating which entity would oversee the Trust and concrete strategies for financing, and (3) how the proposed Trust would complement newer investments that had been announced, including Governor Cuomo’s Vital Brooklyn initiative. Because of a misalignment of expectations between NYHealth and CUNY regarding the type of analysis to be conducted and the lack of a set of concrete action steps, the project did not result in a NYHealth-produced report. However, CUNY is preparing a manuscript based on its analysis for submission to a peer-reviewed journal.

CUNY has been an effective prior grantee of the foundation and is a highly reputable organization. There are times, however, when an organization may be well suited for one type of project but not another. In this case, there was a mismatch between the project and the selected grantee. Additionally, unanticipated events, including staff transitions, affected the final outcome of this project. These factors may have worked against the project’s success from the start, to no fault of either organization, but from which it was difficult to recover.

Important lessons were learned. Perhaps the grantee should have been selected using a competitive Request for Proposals rather than through a solicited proposal process. NYHealth should work with grantees at the start of a project to establish clear and mutually shared expectations for analyses and to ensure that the final product and report informs decision-making by policymakers. Frequent check-ins, especially at project milestones, will ensure alignment in expectations and any needed course corrections in real-time.

Co-Funding and Additional Funds Leveraged: N/A