An alignment mechanism is an action or set of actions that helps medical, social, and public health systems operate in more integrated and coordinated ways, ultimately leading to improved health and health equity for a defined population group of interest. We view systems alignment as a deliberate process to coordinate the work of multiple independent systems and sectors, including the development of shared priorities and goals, shared governance and decision-making, shared financing and resource allocation, and shared data and information. See for example this article. S4A has studied a variety of novel approaches for aligning systems using rigorous scientific methods to determine their impact on health and health equity. But unfortunately, many promising ideas for systems alignment have yet to be rigorously studied.

The S4A program is interested in aligning delivery systems and/or financing systems that operate within the three broad domains of medical care, public health and social services. Delivery systems include the organizations, people, information, and materials used to deliver services. Financing systems include the revenue sources, payment mechanisms, and flow of funds needed to deliver services.

Every program, service, or intervention is implemented through a delivery system. A delivery system is the constellation of organizations, people, policies, and resources that allow the program to be implemented for members of the target population. Similarly, a financing system is the constellation of financial resources, funding mechanisms, funders, and payment policies that support implementation of a program or service. Applicants should articulate clearly how they define the delivery and/or financing systems to be aligned through their proposed research.

We define the social services sector to include any organization, program or service that works to address fundamental human needs in the community and promote social well-being. This sector includes organizations and programs that provide education, housing, income support, employment assistance, diversity and inclusion initiatives, food assistance, transportation, child and youth development, recreation and physical activity, legal assistance, disability support services, violence prevention, arts and cultural programming, criminal justice and juvenile justice services, and community and economic development.

We define the medical care sector to include any organization, program, or service that helps individuals obtain access to clinical services that prevent, treat, or manage diseases and injuries, including services for physical health conditions, mental health conditions, substance abuse, and developmental disabilities. This sector includes the providers, purchasers, insurers, and payers of these services as well as the suppliers of associated products and technologies, such as pharmaceutical products and health information technologies.

We define the public health sector to include any organization, program or activity that works to create the conditions in which people can live healthy lives, including activities to prevent disease and injury and promote health for the population at large. They include governmental public health agencies working at local, state, and federal levels, as well as nongovernmental organizations that contribute to the performance of core public health functions. A defining feature of public health systems is their focus on actions designed to protect and improve health at a population level rather than purely at an individual level through delivery of personal health services.  Public health systems implement activities to protect populations from communicable diseases, to prevent chronic disease risks and injuries, to promote healthy behaviors, and to reduce environmental health risks in the air, water, food, and built environment.

The S4A program funds rigorous scientific studies that are designed to evaluate the impact of initiatives that align medical, social, and public health systems. This 2025 call for proposals (CFP) will provide funding for a new cohort of research studies to produce new, actionable evidence for aligning across the three systems to address systemic racism.

Each study funded under this CFP must (1) identify a specific form of systemic racism that limits health and well-being for affected populations; (2) be led by a community-based organization with a research partner; and (3) investigate a novel systems alignment strategy for solving the problem that engages relevant representatives from medical care, public health, and social services systems. The systems alignment strategy to be studied must engage all three types of systems that comprise the health and social ecosystem in American communities—medical care, public health, and social services. For definitions and examples of systemic racism and potential solutions, please read this review article. Read the full CFP for more information about this specific funding opportunity.

S4A studies novel SA interventions using rigorous scientific methods to evaluate their potential to improve health outcomes for populations that experience health inequities. Examples include: (a) multisector governance models that distribute decision-making power and authority more equitably across medical, social, and public health systems; (b) new financing models that pool funding across medical, social, and public health systems and target these resources to the services and supports needed in historically marginalized communities; (c) multisector data collection and data-sharing models, such as social health information exchanges that seek to improve the identification of unmet health and social needs in historically marginalized communities and to assist these communities in accessing services that address unmet needs; and (d) new staffing and workforce models, such as including community health workers, peer support workers, and cross-trained health and social service professionals to strengthen coordination across health and social service systems. More information about previously funded S4A studies can be found here.

Studies must evaluate proposed solutions that engage all three types of systems implicated in the S4A research agenda: 1) medical care; 2) public health; and 3) social services.

The S4A program focuses on building evidence about system alignment strategies that are successful in advancing health equity in American communities. We recognize that promising ideas for system alignment can come from many sources, including settings and experiences outside the U.S. As such, we encourage applications that utilize ideas, evidence, and inspiration from international settings to let that inform their work within the U.S. 

We also recognize that the opportunities and challenges encountered in aligning medical, social, and public health systems within the U.S. may be very different from the issues faced in other countries due to unique historical and contemporary developments in policy, politics, economics, institutions, culture, and society. Similarly, the forms of structural racism and inequity that have become embedded within U.S. health and social systems derive from historical and contemporary developments that are specific to U.S. contexts and cultures and may not reflect the situations found in international contexts. As such, system alignment strategies that are successful in international settings may not work the same way in American communities, or may need to be adapted for unique American systems, contexts, and community needs. 

For all of these reasons, we anticipate that is unlikely that the S4A program will support a system alignment study that is implemented exclusively outside of the U.S., because the findings from such a study will be unlikely to be immediately generalizable, translatable, and usable in U.S. communities – at least not without subsequent study to support adaptation and testing within the U.S.  Nevertheless, if you believe that your international study idea would produce evidence that is immediately translatable and useable within U.S. contexts, then we encourage you to contact the S4A National Program Office in advance of submitting your application to discuss your ideas and receive additional guidance.  

Active collaboration is required to define and refine the proposed SA intervention, to develop appropriate research strategies for pilot testing, and to develop the written research proposal narrative, budget, and budget narrative for submission to this CFP. The CBO-research partnership should ensure an equitable division of responsibilities, effort, and resources among the CBO applicant organization, the research partner, and other project collaborators in carrying out the proposed pilot study.

For resources on meaningful partnerships, see the NAM Consortium, CTSA tools from Tufts, and CPIC (also available on the applicant resource page). For current and recent S4A grantees with successful partnerships, see our current and past grantees.

This CFP is not appropriate for applicants who primarily seek funding to implement their proposed solution. Because S4A is a research program, grantees are expected to use all or most of their grant funding to carry out the research study, rather than to implement the proposed solution. Applicants who propose to use part of their grant funding to support implementation may be at a competitive disadvantage relative to other applicants, for several reasons: (1) these applicants will have fewer resources available to carry out a scientifically rigorous research study; (2) these applicants will have greater difficulty demonstrating the feasibility of their proposed solution, because implementation will depend upon receipt of grant funding; and (3) these applicants will have greater difficulty demonstrating the sustainability of the proposed solution beyond the end of the grant period. 

Applications must be submitted through the RWJF online system by June 4, 2025 at 3:00pm ET. Late applications will not be permitted. You will be required to register at MYRWJF at https://my.rwjf.org before you begin the application process.

This CFP requires a community-based organization (CBO) to be the lead applicant. CBOs include nonprofit organizations (501c3), local and state government agencies, and tribal organizations for the purpose of this CFP. Research institutions such as universities and contract research organizations are not eligible to serve as lead applicant organizations for this CFP, although they may serve as fiscal sponsors or research partners for eligible applicant organizations.

Applicant organizations must be based in the United States or its territories. Awards will be made to organizations, not to individuals. Multi-organizational consortia are encouraged to apply if a single eligible organization is designated as the primary applicant responsible for maintaining consortium agreements with other participating organizations.

The eligibility requirements that apply to the applicant organization do not necessarily apply to partner organizations, subcontractors, and other collaborators. However, subcontracts or partner relationships with for-profit entities or entities based outside the United States may require additional financial and/or legal due diligence.

If you require a fiscal sponsor, they will not be required to meet the eligibility requirements stated on page 10 of the funding opportunity brochure. However, preference will be given to applicants that are either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code and are not private foundations or Type III supporting organizations. RWJF may require additional documentation.

Yes, an organization may submit more than one proposal as long as each proposal submitted is distinct in terms of both project and research team.

Yes, previously or currently funded RWJF grantees are eligible to apply for this funding opportunity, but the proposed project must be different from previously funded work.

Applications will be reviewed by a review panel that includes members of the S4A National Advisory Committee, S4A staff, Robert Wood Johnson Foundation staff, and System Alignment Innovation Hub staff. See the CFP for the specific review criteria.

The lead applicant organization must be a community-based organization that is actively engaged in serving communities that experience systemic racism. The CBO that applies as the lead applicant organization must work in partnership with an experienced research team that will help to design and carry out the pilot research activities associated with the proposed project. Active collaboration between the CBO applicant organizations and their research partners must occur prior to applying and should ensure an equitable division of responsibilities, effort, and resources among the CBO applicant organization, the research partner, and other project collaborators in carrying out the proposed pilot study.

We are also looking for research teams from diverse health and social service fields that have expertise in the three broad types of delivery and financing systems implicated in the S4A research agenda: (1) medical care; (2) public health; and (3) social and community services and supports. Because S4A is a research program, all applicants should ensure their team includes individuals with relevant expertise in scientific research design, data analysis methodologies, and scientific publication. Partnerships should also include individuals with knowledge of communities that experience forms of systemic racism, individuals with practical experience with leading systems change, and individuals with expertise in approaches for dismantling structural racism. We encourage applicants to include individuals with lived experience related to systemic racism as key members of the partnership.

Yes, interested applicants may apply for other RWJF grants. You must actively submit to other opportunities in which you are interested as proposals declined by S4A will not automatically be considered by other programs.

Measuring systemic racism in scientifically rigorous and precise ways can be extremely difficult and even impractical in many contexts. This is because many forms of racism operate through complex pathways with multiple contributing factors (e.g. beliefs, values, perceptions, behaviors, habits, institutions, laws, policies, and professional practices) and that involve both historical and contemporary actors, decisions, events, and interactions. Fortunately, it may not be necessary to measure systemic racism precisely in order to successfully develop and test solutions to systemic racism. In other words, it may not be necessary to identify precisely who is exposed to such racism and who is not, or to precisely quantify how much exposure has occurred at a specific place and time. (Think about the analogy to second-hand smoke and the research studies that established the feasibility and effectiveness of clean indoor air policies – many of these studies did not need to measure levels of exposure to second-hand smoke in order to prove that these policies were feasible to implement and were effective at improving health outcomes on a population-wide basis). To be sure, we do need to pursue continued progress in the science of measuring systemic racism, because better measures and data will enable new and better research! But this type of scientific progress in measurement is likely to be beyond the scope of the pilot studies supported by this CFP.

Although measures of systemic racism may not be necessary in a pilot study of a novel SA intervention, it is very important to establish a clear and detailed understanding of the specific form(s) of systemic racism that your proposed SA intervention is designed to address. Using existing knowledge from previously conducted research and insights from lived experience, you should establish key facts such as who is affected by your chosen form(s) of systemic racism, how pervasive this problem is across communities and population groups, and what impact this problem has on health and wellbeing for effected communities. Similarly, you will want to use existing knowledge from research and experience to establish key facts about how your chosen form(s) of systemic racism operate through medical, social, and public health systems and how they affect these systems. This knowledge should directly inform the design of your proposed SA intervention, and it should be reflected in the logic model that you develop for your proposed SA intervention. Your logic model should draw upon this existing knowledge to clearly describe how your proposed SA intervention – if successful – will produce improvements in health and wellbeing for communities that are effected by your chosen form(s) of systemic racism. Make sure to include your logic model and related descriptions in the application that you submit to this CFP, using the proposal narrative template.

Systems for Action will conclude its operations as a RWJF research program in December 2026 and will not release another CFP before then. Pilot studies funded through this CFP are expected to help grantees prepare for and pursue future research opportunities from other funding sources beyond the S4A program.

Make sure to use the Proposal Narrative Template to write your proposal because it contains specific information on what to include and formatting instructions and specifications including maximum page numbers, margin sizes, font sizes, and line spacing. Proposal Narrative Template linked here.

Your organization is not required to use a fiscal sponsor as long as the organization: (1) meets the eligibility criteria to serve as an applicant organization as specified on page 7 of the CFP; and (2) has the necessary administrative and financial capabilities to successfully manage a RWJF grant. If necessary, the applicant organization may utilize the services of a fiscal sponsor to support the project’s financial management and grants management and reporting activities. Research institutions, such as universities and contract research organizations, are not eligible to serve as the applicant organization for this CFP, but they may serve as a fiscal sponsor for an eligible community-based organization (CBO) as defined in the CFP.

You may upload a separate document containing references that are cited in your proposal narrative, so that this reference list does not count against the 10-page proposal narrative limit. Please review the Proposal Narrative Template for additional instructions on how to format your reference citations.

Yes, when you submit your application using the RWJF online system, you will answer several questions, including a question asking about which Special Topic of Interest your application addresses. Note that the three Special Topics of Interest are described on Page 5 of the CFP.

Yes, BUT you will need to specify which ONE of the three Special Topics provides the best fit with your proposed research. Note that the three Special Topics of Interest are described on Page 5 of the CFP.

Yes, you may propose a research study to address other topics, as long as your research focuses on a system alignment strategy that helps medical, social, and public health systems work together to dismantle and disrupt for forms of systemic racism embedded within these systems. For instance, You may propose a novel system alignment intervention that test other ways of helping medical, social, and public health systems work together to address forms systemic racism, such as interventions involving new staffing and workforce training models, new data sharing, data linkage and data dissemination models, or new communication and information-sharing strategies.

Yes, we encourage you to participate in one of our CFP webinars and attend one or more of the weekly CFP Office Hour sessions. You can ask questions and obtain general feedback about your ideas. More information about registering for these sessions can be found here.

Additionally, if you are a community-based organization you can utilize a variety of technical assistance resources and supports available through the S4A System Alignment Innovation Hub. Please reach out early because available assistance opportunities may be limited in the days leading up to the application submission deadline.

If you are a community-based organization (rather than a university or research institution), you can utilize a variety of technical assistance resources and supports available through the S4A Systems Alignment Innovation Hub. The Hub may be able to provide assistance and guidance for identifying a suitable research partner for your organization, as well as free technical assistance, consulting, and support through their Community Power Network. Additionally, Johns Hopkins University maintains the Accelerating Collaborations for Evaluation Matching Service which may be able to assist with finding research partners. The S4A program also can discuss general strategies related to finding a research partner during our weekly CFP Office Hour sessions or via email.

As a general strategy, we encourage you to reach out to the universities and research institutions that operate in your region, including institutions that are part of the NIH Clinical and Translational Science Awards (CTSA) program which focuses on community engagement in health research.

Additionally, as stated in the funding opportunity brochure, it is important to note that active collaboration between the CBO applicant organizations and their research partners must occur prior to submitting an application to this CFP. Active collaboration is required to define and refine the proposed SA intervention, to develop appropriate research strategies for pilot testing, and to develop the written research proposal narrative, budget, and budget narrative for submission to this CFP. The CBO-research partnership should ensure an equitable division of responsibilities, effort, and resources among the CBO applicant organization, the research partner, and other project collaborators in carrying out the proposed pilot study.

No, you are not required to allocate 50% of your project’s budget to a subcontract with a research partner. As stated on page 8 of the CFP, the CBO applicant organization may allocate up to 50% of the total project budget to a subcontract with the research partner to support that organization’s contributions to the project. We anticipate that the research partner subcontract will support activities, such as reviewing the existing scientific evidence to inform and refine the proposed SA intervention; preparing research protocols for Institutional Review Board approval; selecting and recruiting research participants; developing and implementing data collection and data management plans; implementing data linkage and data analysis activities; preparing research reports and manuscripts for publication; and identifying and preparing for future funding opportunities for subsequent studies of the SA intervention. We encourage applicants to carefully consider the effort and costs required to implement these types of research activities when developing their proposed budgets and subcontracts.

Systemic racism and structural racism are forms of injustice resulting from historical and contemporary laws, policies, and practices that perpetuate unfair treatment of people from racial and ethnic minority groups and indigenous communities. We use systemic racism and structural racism interchangeably in this CFP. These forms of racism are deeply embedded in the institutions, delivery systems, and financing systems that shape the distribution of power and resources across American society. Examples include: barriers to political participation such as political district gerrymandering, inequities in access to polling locations, and restrictive timeframes and mechanisms for ballot casting; lack of representation on governing boards and decision-making bodies; residential segregation by household race, ethnicity and income; inequities in access to capital and financial resources; maldistribution of health and social resources such as clinics, libraries, parks, teachers, sidewalks, and public transportation; environmental injustices such as exposure to polluting industries, hazardous infrastructure, and climate risks; and inequities in information such as the lack of disaggregated data about health and social needs and program effectiveness for specific racial and ethnic minority populations and indigenous communities. Additional examples include racial patterning in the implementation and enforcement of public policies and administrative practices that require some level of discretionary decision-making, such as law enforcement use of force, incarceration, bail, probation, eviction, expulsion, child protective services actions, child support enforcement, occupational health and safety enforcement, employee recruitment, hiring and training practices, property valuation and tax assessments, medical necessity determinations, medical billing and debt collections, housing voucher acceptance, eligibility determination for Medicaid and other social assistance programs, hospital community benefit activities, and awarding of grants and contracts that fund health and social service programs. 
 
For more detailed definitions, examples, and potential solutions, see this review article. We encourage applicants to study how forms of systemic racism intersect and interact with other forms of marginalization and inequity in American society, such as those related to sexual orientation, gender identity, disability status, socioeconomic status, educational attainment, immigration and refugee status, national origin, language and literacy, religious affiliation, tribal membership, and rurality.

We prioritize community-initiated and community-engaged studies where community representatives play a leading role and work in partnership with an experienced research team that will help to design and carry out the pilot research activities associated with the proposed project. The CBO-research partnership should represent a reciprocal relationship that values community knowledge and scientific knowledge equally in designing systems alignment interventions and in carrying out the research to test these strategies.

S4A is a research program that places a high priority on producing scientifically rigorous and credible evidence. We encourage partnerships between community-based organizations and external research institutions to ensure that your research team has the necessary scientific expertise, systems knowledge, implementation capacity, and community expertise to carry out the proposed research. An external research partner can provide a neutral and independent perspective on the system alignment strategy and can provide protections against some common sources of research bias such as social desirability bias and motivated reasoning bias. Additionally, an external research partner may allow your research study to achieve higher levels of credibility with external audiences, and avoid perceptions of research bias, lack of neutrality, or conflicts of interest. Finally, an external research partner may allow for efficient division of labor by allowing one partner to focus primarily on implementation of the system alignment strategy, while allowing the other partner to focus primarily on implementation of research activities. Of course, all partners should play active and equitable roles in the research design, interpretation of results, and translation of results into actionable strategies for dismantling and disrupting systemic racism.