Addressing Root Causes and Immediate Needs

Our framework organizes projects of different durations and focuses, so every effort contributes to larger goals, advancing systemic change over time. This work balances long-term commitments addressing the root causes of historical problems with urgent short-term needs. Advancing system change can be complex and requires the consideration of many factors.

Conditions of Systems Change

We are guided by the “inverted triangle” framework, which defines systems change as “shifting the conditions that hold the problems in place.” To advance systemic change in society, various work must be well-orchestrated to engage conditions including mental models, policies, practices and resource flows. Our framework considers each condition individually, and as part of a greater whole— coordinating efforts to address conditions as needed.



Government, institutional and organizational rules, regulations, and priorities that guide the entity's own and others' actions.


Espoused activities of institutions, coalitions, networks, and other entities targeted to improving social and environmental progress. Also, within the entity, the procedures, guidelines, or informal shared habits that comprise their work.


How money, people, knowledge, information, and other assets such as infrastructure are allocated and distributed.


Quality of connections and communication occurring among actors in the system, especially among those with differing histories and viewpoints.


The distribution of decision-making power, authority, and both formal and informal influence among individuals and organizations.


Habits of thought—deeply held beliefs and assumptions and taken-for-granted ways of operating that influence how we think, what we do, and how we talk.


Informed by The Water of Systems Change,
written by John Kania, Mark Kramer and Peter Senge.
Working on and Within Systems

Wagner Foundation makes investments in organizations working at the systems level, whether they address many of the conditions of systems change or focus on a specific challenge within a system. We summarize this as “working on and within systems.” How we engage with a system is guided by our grantee partners, as we seek opportunities to align efforts across our partners and focus areas. We originally came to understand these two framings of systems change through our health equity work described below.

Health Equity

Wagner Foundation has been a longtime supporter of Partners In Health (PIH), which addresses global health inequities by accompanying local governments and investing in local health systems. PIH’s holistic approach consists of the “5 S’s”: staff, stuff, space, systems, and social support. Strengthening a health network requires long-term planning on the systems level while engaging many discrete or short-term challenges specific to individual communities.

Through this relationship, the Foundation became aware of the operational needs of health systems and how they relate to social drivers that impact a community’s wellbeing. As a leader in this work, PIH inspired a new generation of organizations that engage health systems in a manner specific to different geographies while, at the same time, share knowledge, collaborate and advocate together.

Through this relationship, the Foundation has become more aware of the needs both within the health system, but also of other social drivers that impact a community’s wellbeing. As a leader in this work, PIH has inspired a new generation of organizations working towards health systems strengthening in other geographies that come together for knowledge sharing, advocacy efforts and beyond.

Gender & Health Equity

The inadequacy of existing global health systems was made explicit throughout the COVID-19 pandemic. Women, who make up 70% of the global health workforce, are under-invested in and undervalued, representing only 25% of global health leadership. Wagner Foundation partnered with Women in Global Health (WGH) to support efforts confronting the multiple conditions of systems change affecting gender equity within health systems. In September 2020, together with WGH, the Foundation co-hosted a summit with Foreign Policy during the UN General Assembly. The summit stressed that the failure to address the circumstances of an overwhelming majority of health workers undermined global health security and the advancement of global health equity. As a result of the summit, over 40 + global institutions and governments made commitments and pledges to further gender parity in global health security during the pandemic and for the future.

Focus Areas

Wagner Foundation focuses on supporting partners at the intersection of Health Equity and Economic Prosperity, particularly as work pertains to historically disenfranchised or geographically isolated communities.

Our selection of these focus areas reflects our vision of a just and robust community and an understanding and consideration of additional social drivers that impact overall wellbeing.

We recognize that the advancement of our vision is linked to Cultural Transformation, which may incorporate funding artists and arts organizations, advocacy, and knowledge sharing & communications


Our selection of these focus areas reflects our vision of a just and robust community and an understanding and consideration of additional social drivers that impact overall wellbeing.