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India Philanthropy Report 2019 highlights the ‘Field Approach’ where non-profits, corporates, government and philanthropists have successfully worked towards eradicating malaria and controlling tobacco consumption, and are presently seeking to address sectoral challenges relating to urban sanitation and adolescent empowerment. The report concludes by describing the key themes that emerge from these cases that form the principles of a field approach and calls for Indian philanthropy to take a more ambitious and holistic view towards creating impact at scale.

The following case highlights ways in which philanthropists and other stakeholders have successfully adopted a field approach. The cases are not all funded by philanthropists, but they all demonstrate how the field approach works and how philanthropists could adopt a similar ap- proach to their giving.

Since the early 1990s, the Robert Wood Johnson Foundation (RWJF) has played a vital role in tackling one of the largest causes of preventable death in the US: tobacco use.

The problem: When RWJF began its work in the tobacco control field, the steady progress that had been made against smoking since the mid-1950s (adult rates of smoking had dropped from 42.4% in 1965 to 25.5% in 1990) was slowing down considerably—the adult rate decreased only to 24.7% by 1997. But the smoking rate among high school students was on the rise, surging from 28.3% in 1991 to 36.5% in 1997.

The approach: RWJF knew that in order to get results, it had to influence public behaviours and mindsets at a large scale in a short amount of time. The foundation built on the work and momentum of advocates, researchers, philanthropists, health organisations, federal agencies and NGOs, and adopted strategies that amplified the reach of its message.

• One approach was to fund policy research and advocacy to make permanent structural changes to limit tobacco use. RWJF supported a Tobacco Policy Research and Evaluation Program whose research documented the harmful effects of smoking. This re- search-based evidence, compounded by the findings of existing studies funded by institutions like the American Cancer Society (ACS), formed the crux of RWJF’s advocacy ef- forts. It helped the foundation promote formal statewide and national coalitions to coordinate efforts focusing on policy and systems changes, such as higher tobacco excise taxes, smoke-free indoor air laws, access to cessation treatments and the federal regulation of tobacco. The resulting laws and regulations led to behaviour change and the eventual drop in the adult smoking rate to 19.7% and the rate among high school students to 20% in 2007.

• RWJF also aimed to influence social attitudes and norms. In 1995, it collaborated with the ACS, the American Health Association, the Annie E. Casey Foundation and others to create the Campaign for Tobacco-Free Kids. One of the campaign’s primary objectives was to educate the public and broaden public support to reduce youth tobacco use. To achieve this mission, RWJF supported initiatives to reduce the portrayal of smoking in movies, on television and in mass-market advertising and conducted targeted, evidence-based public awareness campaigns on the perils of smoking. The shift in social norms, though difficult to tangibly capture or attribute to a single initiative, is evidenced in statistics like the increase in the percentage of adults who favoured smoke-free restaurants, from 45% in 1992–1993 to 64% in 2006–2007.

What was achieved: From 1991 to 2009, the foundation invested close to $700 million in its two-pronged approach to tobacco control: helping habitual users quit and preventing tobacco uptake, particularly among children. The foundation and other stakeholders can be credited with policy and behaviour change that resulted in at least 5.3 million fewer people smoking in 2010 and averted more than 60,000 smoking-attributable deaths.

Key success factors:

• Narrative change: In an effort to reach a large audience in a short amount of time, RWJF invested in efforts that amplified the reach of its messages, such as launching a campaign to build awareness around the perils of smoking and to influence social norms and attitudes.
• Data-driven policy advocacy: RWJF supported a tobacco policy research and evaluation programme and used the findings as a core part of its advocacy efforts.
• Strategic funding: The foundation invested in additional research and developing evidence to inform its advocacy efforts and its public awareness campaigns.