Over the past decade, large foundations have spent millions of dollars on programs to address factors beyond the healthcare system that affect the health and well-being of people in poor neighborhoods, the San Jose Mercury News reports.

In January, for example, the Los Angeles-based California Endowment pledged to spend $1 billion by 2020 through its Building Healthy Communities initiative to address so-called social factors such as poor schools, a lack of employment options, and unsafe housing in fourteen low-income communities. Similarly, the Robert Wood Johnson Foundation has awarded $23 million since 2005 to Playworks, an Oakland-based nonprofit that works to increase physical activity in its network of schools.

Foundations aren't alone in the effort to reduce health disparities, however. The healthcare reform law enacted last year includes $145 million to bolster effective strategies for improving quality-of-life issues in low-income neighborhoods.

According to Frank Staggers, chair of the Ethnic Health Institute at Alta Bates Summit Medical Center, health leaders need to move beyond focusing only on the medical model and pay more attention to the social aspects of health. "[W]here you live, what kind of education you have, what food stores are available to you, where you can walk, all of these things have a bearing on your health and your welfare," said Staggers.

"The solution to the chronic disease epidemic is not in more clinical medicine," said Anthony Iton, senior vice president of the Building Healthy Communities initiative. "That has been a failed solution that has driven up costs. The solution is in how we engineer our environment — looking at how we design our communities, or workplaces, and in how we educate our young people."