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Foundation History

Rural hospital construction

From the late 1920s through the 1940s, the Fund supported the construction of rural hospitals meeting high standards of care, and in doing so laid the way for the federal Hill-Burton Act, which in 1946 initiated a program of hospital construction and improvement.

The Commonwealth Fund has its origins in the philanthropic efforts of the Harkness family. Stephen V. Harkness began his career in New York State’s Finger Lakes region at age 15 as an apprentice harnessmaker. Harkness eventually settled in Ohio and became a successful businessman. He invested early with Rockefeller, Andrews & Flagler in the petroleum refining business and provided funds at a critical moment in the history of the fledgling Standard Oil Company.

Stephen’s wife, Anna Harkness, had a strong civic spirit and believed in encouraging all forms of self-help. In the years following her husband’s death in 1888, she moved her family to New York City where she gave liberally to religious and welfare organizations, and to the city's major cultural institutions.

In 1918, Anna Harkness founded the Commonwealth Fund with the mandate that it should “do something for the welfare of mankind.” Among the first women to establish a foundation, Anna initially endowed the foundation with a gift of nearly $10 million. The Fund’s first president was her son, Edward Stephen Harkness, who was committed to building a responsive and socially concerned philanthropy and who, over the years, gave generously to the Fund’s endowment.

As a first step, Edward hired a staff of talented and experienced people, led by General Director Barry C. Smith. Harkness and Smith led that staff to rethink old ways, experiment with fresh ideas, and take chances, a path encouraged to this day by the Fund’s board of directors.

Through additional gifts and bequests between 1918 and 1959, the Harkness family’s total contribution to the Fund’s endowment amounted to more than $53 million. Edward Harkness died in 1940 and his estate and that of his wife Mary were bequeathed to the Fund upon her death in 1950. With these bequests, the foundation’s endowment amounted to $99 million, or approximately $852 million in today’s dollars.

Throughout its history and in keeping with its donors’ intent, the Commonwealth Fund has sought to be a catalyst for change by identifying promising practices and contributing to solutions that could help the United States achieve a high-performance health system. The Fund’s role has been to establish a base of scientific evidence on what works, mobilize talented people to transform health care organizations, and collaborate with organizations that share its concerns.

The Fund’s work has always focused particularly on the challenges vulnerable populations face in receiving high-quality, safe, compassionate, coordinated, and efficiently delivered care. The foundation’s communications efforts have enabled it to share knowledge and experience and reach influential audiences able to push forward the necessary agenda for achieving a high-performance health system. As an independent, nonpartisan organization, the foundation has aimed to help develop common ground from which policymakers across the political spectrum can lead the nation toward a health care system that assures its residents have long, healthy, and productive lives.

History of Fund Work

The Commonwealth Fund’s work in the 1920s led to the development of the field of child guidance and contributed to the emergence of progressive public health departments in communities around the country. From the late 1920s through the 1940s, the Fund supported the construction of rural hospitals meeting high standards of care, and in doing so laid the way for the federal Hill-Burton Act, which in 1946 initiated a program of hospital construction and improvement. Always mindful of the long-term payoff of investments in people, the Fund launched in 1925 an international program — initially called the Commonwealth Fund Fellowships, later changed to the Harkness Fellowships — bringing young professionals from the United Kingdom, Australia, New Zealand, and other English-speaking countries to the United States for extended study and travel.

Following World War II, the Fund supported the development of new medical schools in the United States, with the aim of addressing doctor shortages and the needs of communities lacking health care services. In the 1960s and early 1970s, the Fund continued to contribute to the movement to bring health care to underserved communities, including troubled urban areas. Following a period of encouraging improved medical school curricula in the late 1970s, the foundation played a major role in the 1980s in stimulating the patient-centered care movement and bringing attention to the problems facing elderly Americans, as well as the challenges confronting the nation's academic health centers. The Fund also maintained its early interest in youth development in this period by helping stimulate organized youth mentoring programs.

Since 1995, the Fund has concentrated its efforts on helping to address health care coverage and access issues, improving the quality and efficiency of health care, and slowing the growth of health care costs. The foundation underwrote a considerable part of the research underlying the development of the reforms in the Patient Protection and Affordable Care Act of 2010, and reports of its Commission on a High Performance Health System (1995–2013) helped inform the debate leading up to this landmark legislation. Since 1995, the Fund also has been a leading philanthropic voice promoting modernization of Medicare, developing new payment methods encouraging better and more efficient health care delivery, and delivery models featuring better primary care and care coordination. In all of this work, the foundation has placed a particular emphasis on meeting the needs of vulnerable populations.

The Fund refocused its historic international activity in 1997 with the creation of an international program in health policy and practice, the aim of which is to bring the international experience to bear on the U.S. health care reform debate and to promote exchanges that stimulate health system improvements in economically advanced countries. As a result, the earlier international fellowship program was transformed into the Harkness Fellowships in Health Care Policy and Practice (expanded to include key Western European countries), and the program features an annual ministerial-level international symposium in Washington, D.C.

To ensure that its work reaches the ear of key policy audiences, the Fund expanded its communications program, developed a Washington, D.C. office, and has funded an annual bipartisan retreat for members of Congress who focus on health care issues.

Throughout its history, the Fund has been a value-added grantmaker, employing a professional staff to work closely with grantees in developing and implementing projects and communicating their results to influential audiences. The Fund’s domestic and international health care surveys; its U.S. national, state, and local health care scorecards; and its highly rated website and publications program make the foundation a major information resource for improving health systems, domestically and internationally.

Jean and Harvey Picker

In 1986, Jean and Harvey Picker joined the $15 million assets of the James Picker Foundation with those of the Commonwealth Fund ($200 million at the time). Recognizing the challenges faced by a small foundation, the Pickers chose the Fund as an institution with a common interest in improving health care and a record of effective grantmaking, management, and leadership. The Commonwealth Fund strives to do justice to the philosophy and standards of the Picker family by shaping programs that further the cause of good care and healthy lives for all Americans.

Health Services Improvement Fund

In April 1996, the Fund received a $1.7 million contribution from the Health Services Improvement Fund with a commitment to use these funds to improve health care coverage, access, and quality in the New York City greater metropolitan region.

Frances Cooke Macgregor

In her 2002 bequest to the Fund, Frances Cooke Macgregor gave $3.1 million to the Fund’s endowment to help support projects that aim to reduce medical errors and improve patient safety. A pioneer in the fields of medical sociology and medical anthropology, Ms. Macgregor was an expert on the psychological and sociological effects of facial disfigurement.

Other Donors

While the Commonwealth Fund does not solicit funds, it has received periodic smaller gifts from individuals over the years, including shares of royalties received from books published by former grantees.

Harkness House

The Commonwealth Fund received its historic headquarters building as a bequest in 1951 from the estate of Mary Stillman Harkness, daughter-in-law of the foundation's founder, Anna Harkness. The Fund took occupancy of the building in that year, and has used it as its offices since that time.

Designed by the world-class architect James Gamble Rogers, the building was constructed between 1906 and 1908 as the residence of Edward and Mary Stillman Harkness, and was a gift to them from his mother, Anna Harkness. Much of the business of the Fund was conducted from this building during the period that Edward S. Harkness was president of the Fund, 1918 until his death in 1940.

Known as “Harkness House,” One East 75th Street in New York City received landmark status in 1967. The Landmarks Preservation Commission's designation described the building as “an imposing residence in the style of an Italian Renaissance palazzo . . . outstanding not only for excellence of design and beauty of execution, but also for subtle richness of detail.” Landmarks designation was accorded “because Harkness House has a special character, special historical and aesthetic interest and value as part of the development, heritage and cultural characteristics of New York City.” In a 1987 essay on the building, architecture critic Paul Goldberger described Harkness House as “a notable presence on the cityscape of New York,” and, noting the care that has been given to its maintenance, observed that “the preservation of one of New York’s most distinguished houses can, in and of itself, be a philanthropic gesture that enriches the quality of life for the entire city.”

The donor’s expectation that the Commonwealth Fund would use this distinguished building to advance the foundation’s mission continues to be fulfilled, as the architectural stature and location of the building, along with its effective maintenance, make it a very desirable location for high-level health policy meetings. The building is used both for providing office space for the Fund's staff and for meetings that advance the foundation's work.

The major restoration of the building undertaken by the Fund in the early 1980s helped spark the general move toward improved care of the city’s public spaces and historic buildings on the Upper East Side, which then spread to other neighborhoods. The Fund is pleased to make it possible for those interested in architecture and social history to tour Harkness House, through periodic tours arranged by the Institute of Classical Architecture and Classical America.

The Fund also maintains the Edward S. and Mary S. Harkness Mausoleum, a National Historic Landmark at Woodlawn Cemetery in the Bronx, New York. Begun in 1924, the mausoleum is the result of a long and loyal relationship between the Harknesses and architect James Gamble Rogers, in collaboration with the landscape designer Beatrix Farrand and several accomplished artisans. (Read more about the mausoleum.)

Commonwealth Fund Presidents and General Directors

1918–1940 Edward S. Harkness
1920–1947 Barry C. Smith, General Director
1940–1964 Malcolm P. Aldrich
1964–1975 J. Quigg Newton
1975–1980 Carleton B. Chapman, M.D.
1980–1994 Margaret E. Mahoney
1995–2012 Karen Davis
2013–2022 David Blumenthal, M.D.
2023– Joseph R. Betancourt, M.D.

Centennial Celebration

To celebrate 100 years of our work to improve health care and make it affordable and accessible for all Americans, we launched a website in 2018 that tells the Commonwealth Fund’s story. Explore here.

Rockefeller Archive Center

The Fund makes its historical material available for scholarly research through the Rockefeller Archive Center at