To Make a Meaningful Difference, Look at the Full Scope of the Problem

When a group of foundation officials made a visit to a major American city some years ago, one of the grant makers asked the chief of police what the city’s police department was doing to curb youth violence besides locking up the offenders. The chief proudly described an intensive effort to work with first-time offenders to be sure they wouldn’t get into trouble again.

“It sounds impressive,” the site visitor remarked. “How many kids are in the program?” Beaming, the chief responded, “Seventy-five.”

As a follow-up question, the visitor asked the chief how many youths in the city he thought would potentially qualify for the program. “At least 3,000,” the chief replied. A hush fell over the room. How much of a difference could a program that served 75 youths make in the city’s youth-violence statistics if more than 3,000 of the city’s youths were in need of such a program?

The police chief is hardly alone. This is a problem that foundations and other nonprofits across the country, both large and small, face: a tendency by these organizations, as well as their grantees, to focus on the “numerator,” the number of people served by their programs, without taking into account the “denominator,” the total number of people in the community who actually need the service.

Many foundations today seek to achieve measurable impact in the regions where they are working. That is, they want to make meaningful improvements in the health, education, or broader well-being of the people in a community, a state, or, for national foundations, the nation as a whole. Yet unless a foundation takes into account the total number of people within a region that need help, the scope of the foundation’s effort most likely will not match the scale of the problem—in which case, the impact will be minimal.

Take, for example, a program that sends nurses to visit first-time pregnant teenagers. Doubling the number of young women who receive these services from 100 to 200 is a big deal if there are only 300 first-time pregnant teenagers in the community. But what if there are 3,000?

Determining the denominator enables foundations to understand the level of effort—and resources—that it will take to make a meaningful difference within a region. In many cases, the calculation may indicate that the foundation’s resources alone will not be sufficient and partners will be needed. Even the Bill & Melinda Gates Foundation, with more than $35-billion in assets, collaborates with other donors in its efforts to improve global health.

In some cases, the answer may be to push for the reallocation of some of the resources already in the system. That is what the Robert Wood Johnson Foundation did in its Urban Health Initiative, which was designed to make a measurable difference in the health and safety of children in some of the nation’s major cities.

In that program, the deputy director, Cindy Curreri, developed what she called the “denominator exercise,” which required grantees to:

• Determine exactly how many people in the city needed the health or safety services the nonprofit wanted to provide.
• Calculate the number of children who would have to be reached to make a meaningful dent in that unmet need.
• Calculate how much money, staff, and other resources would be required to achieve that.

As the grantees ran the numbers, it soon became apparent to them that, while sizable, their Robert Wood Johnson Foundation grants alone would not be nearly enough to make a difference, and that ultimately the only way to significantly improve their cities’ child- health statistics would be to make the case for redirecting vast sums of government and private dollars already in the system.

Given the importance of understanding the denominator—the scope of the problem—in any serious effort to achieve meaningful impact, we are frankly somewhat surprised at how rarely the denominator is actually taken into account by foundations and their grantees. Among the reasons this happens:

• Confronting the true scale of the problem could be overwhelming, resulting in discouragement or even paralysis. Foundation board members might feel that if there are, indeed, more than 3,000 young people who need help—far more than the foundation could afford to serve—there is no point in even going down that road.
• Good denominator data on the scale of the problem within a foundation’s region don’t always exist and would be too costly to collect. We would argue, however, that even a rough estimate or extrapolation from other data sources is often sufficient to provide a sense of the order of magnitude of the problem. For purposes of planning a foundation’s strategy, the important point is that there are roughly 3,000 high-risk youths in the community in need of services—not 300 and not 10,000.

n Focusing on the numerator—the number of people who will actually be served under a proposed grant—is easier and safer than focusing on the denominator. Direct services are easy to explain to board members and community leaders, and the foundation can be assured that at least those individuals who are covered under the grant will receive services, while efforts to change the larger system in order to have a larger-scale impact often involve some level of risk.

• Many of us are simply not used to thinking about impact at the population level. Those who have spent time delivering social services—as many foundation staff and board members have—are used to thinking of the number of clients served by an agency as the denominator because that is in line with being asked to indicate the percentage changes in the number of clients served by an agency since its last report.

And those with a clinical background have generally been trained to think in terms of individual patients or clients rather than the population as a whole.

Whatever the reason, the upshot is that as long as foundations and their grantees continue to limit their focus to the numerator and fail to consider what it would take to affect the problem as a whole—the denominator—their impact will fall well short of what it could be.

Stephen Isaacs and Paul Jellinek are the co-principals of Isaacs/Jellinek, a consulting firm that works with foundations and other nonprofits.