In honor of Wagner Foundation’s 20th anniversary, Founder and President Charlotte Wagner shares lessons from two decades of partnering to build healthier communities and a more just, vibrant world.
Health as a human right, whether in Boston or in Haiti, was and remains my entry point to grantmaking at Wagner Foundation. When I began this work twenty years ago, I viewed health primarily through the lens of access to medical care. What I have since learned is that health is shaped as much by the environments where we live and work, as it is by the healthcare we receive. Public health experts call these nonmedical factors that impact our health the social drivers of health – factors such as income, education, housing, access to healthy food, clean air and water. When our core needs are not met, the impacts on health are measurable creating clear differences in overall wellbeing and life expectancy.
Across the United States, research shows that roughly 80% of health outcomes are shaped by access to these critical social drivers of health. Here in Boston, there is a 23-year gap in life expectancy between Roxbury and Back Bay, two neighborhoods just a few miles apart. These same patterns hold true globally, including in the remote communities where we work in Africa, Latin America and Haiti.
For me, working towards health equity around the world means investing in a future where everyone can live a healthy life, no matter where they live, or what neighborhood conditions they were born into. If we are serious about achieving health equity, we must focus our attention upstream, beyond the four walls of the hospital, to address the root of the social and economic conditions that shape people’s lives. The possibility for health begins long before anyone walks into a clinic.
There is a power imbalance between funders and grantees, which makes it essential to approach grantmaking with humility. When we lead with listening, we’re reminded of how much we don’t know and how much communities already do. Over the years, I’ve learned that meaningful impact begins with asking the right questions and creating space for people to define their own goals and visions.
Some of the most enduring partnerships I’ve been part of started with a simple conversation and a genuine willingness to hear what was truly needed, rather than what I assumed. More often than not, that has meant providing multi-year, general operating support. I can’t overstate the importance of funding the people and infrastructure that make the work possible.
At the same time, when we ask, “What do you need?” our partners sometimes identify specific priorities that fall outside typical funding categories or comfort zones. These moments reinforce why it’s so important to listen with intention — to remain flexible, responsive, and rooted in trust. Our partners have continually taught us to honor lived experience and to recognize that those closest to the challenges are also closest to the solutions.
For some years, we have focused our approach through a systems change lens. It wasn’t until I studied the work of Partners In Health (PIH), and the concepts of social medicine that I truly understood that everything is connected. To change outcomes, we must look beyond the immediate problem in front of us and examine the incentives, relationships, and assumptions that hold it in place.
History helps explain why systems are so hard to change. The conditions we see today are the cumulative result of countless decisions — policies, investments, and omissions — that have shaped communities over generations. Those choices carry weight, creating patterns that feel permanent and paths that are hard to alter. But history also shows that collective action, persistence, and imagination can open new possibilities for what a system can be.
Before PIH, many in the global health community believed delivering HIV and TB treatment in low-income countries was too complex and too costly to succeed. PIH proved the system wrong, demonstrating that the real barriers were Western stigma and the inequitable way global health is financed. Their success showed that treatment could not only work but thrive in resource-limited, rural settings, shifting international funding priorities in the process. Eventually, we saw major bilateral and multilateral funders begin investing directly in community health systems not just outbreak control. PIH’s work revealed that sustainable health outcomes depend on reimagining not just how care is delivered, but how it is valued and resourced.
We focus on sustained investments in health equity, economic wellbeing, and the arts. These are the foundations on which communities thrive, and over time, they transform the structures and norms that determine who has access to opportunity. Systems change doesn’t happen with a single program or grant; it happens when we align our efforts across sectors and stay committed for the long term.
Systems-level change takes time. It’s often invisible before it becomes measurable, and in the early stages it can feel like planting seeds whose growth you may never see. Yet staying the course through shifts in political will, funding fatigue, and moments of doubt is essential if we want to see lasting transformation. When we follow those connections with curiosity and courage, systems can indeed be reimagined.
I genuinely believe that art is essential. Artists are not just storytellers; they’re architects of change. They help communities remember who they are, imagine who they can be, and bridge divides through creativity and empathy. Supporting arts and culture is not ornamental to community wellbeing, it is foundational to it.
Art strengthens the social fabric. Whether through murals that transform public space, publications that preserve memory, or cultural centers that invite dialogue, artists create shared experiences that foster belonging and collective care. Research shows that engagement with the arts enhances emotional wellbeing, reduces social isolation, and strengthens civic trust—the very ingredients of healthy communities.
Art also expands our sense of possibility. Before systems can change, someone must imagine change, and that’s what artists do. They translate complex ideas into forms that words alone cannot reach, inviting us to see old problems in new ways. Experiences of beauty and awe connect us to something larger than ourselves, inspiring empathy, generosity, and action.
When we invest in artists, we invest in the imaginative capacity of our communities. We are supporting essential changemakers who help us reflect on our shared histories, envision a more just future, and find creative pathways toward it.
Lasting social change demands participation from every sector. No single institution—philanthropy, government, business, or civil society—can tackle systemic inequities alone. Real progress comes when we center our shared humanity and recognize that our wellbeing is interconnected.
Shared humanity reminds us that we all have both the responsibility and the power to shape the kind of world we want to live in. Sustainable change cannot happen in a vacuum. It takes community members who understand local needs, nonprofits that innovate on the ground, governments that can scale solutions, and corporations whose decisions shape the economic and environmental conditions of everyday life.
As funders, we see our role as investing in and elevating the solutions of our nonprofit partners—placing trust and authority in those with lived experience who know what works. But we also know that our resources alone are not enough. To meet the scale of today’s challenges, we must coordinate with peer funders, public institutions, and the private sector to multiply impact.
Philanthropy can serve as a connector and translator—lifting up what communities need, helping governments and corporations reimagine how they meet those needs, and fostering a shared sense of purpose. When each sector understands its role in the ecosystem of change, we move closer to a society where opportunity and prosperity are truly shared.
October, 2025
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