Change can't wait: how to collaborate for health equity

 

 

Health equity means ensuring that everyone, regardless of their background or circumstances, has a fair and just opportunity to be as healthy as possible. This requires addressing the social determinants of health—the conditions in which people are born, grow, live, work, and age. For funders, coming together to invest in communities is not just a moral imperative but a strategic one. By pooling resources and focusing on the root causes of health disparities, we can create sustainable change that uplifts entire communities. Investing in health equity means fostering environments where everyone can thrive, ultimately leading to a healthier, more prosperous society for all.

1. If you’re a grantmaker out there or working with other grant makers, you can add an emphasis on racial health equity into your existing work regardless of what the structures you are in are, or examine the readiness of other people with power in those structures to talk directly about race.
2. I think it’s really important to view health as holistic, and you have to treat it that way. If you don’t, you’re contributing to disparities.
3. We encourage you to think about engaging in both policy and practice at the same time. 

Let’s talk about health equity so that we can set the board for everyone. What is health equity and how did it become so important for the Stupski Foundation? 

Dan: Before getting into health equity, let's frame our general perspective in health. We think health is everything. Without your health, you’ve got nothing. Yet, in America, somehow we pigeonholed this word health into a weird medicalized system with fancy words like provider and payer and more acronyms than you can fit in a can of Spaghettios. 

We’ve segregated that system from stuff that actually promotes wellbeing. That’s supportive relationships, nutritious food, economic security, housing stability, and environmental safety. We’ve decided these two systems can’t talk to each other. The medical and social service systems don’t talk to each other, leaving the individual in the middle to try and sort it all out while they’re sick. Each of these have their own set of hoops and administrative burdens to jump through if you actually need assistance…

"What is health equity? It’s when everybody has a fair and a just opportunity to achieve their optimal wellbeing. It doesn’t exist, it’s a destination. Getting there requires addressing the root causes and barriers that prevent people of color from achieving good health outcomes."

Dan Tuttle, Director of Health
Stupski Foundation

At the Stupski Foundation, we lack the money to fix the entire set of root causes, fix the effects of the Bay Area’s extreme economic inequality, or fix hundreds of years of forced slavery and oppression of Black people. We can advance towards racial health equity by adding it as a lens to our work, so that we can focus on permanently changing the healthcare system to better serve the needs of people of color and bring in those promises, and change systems for good.

Expanding our grantmaking beyond the purely clinical in recognition that health is holistic and achieving good health outcomes requires a broader set of family supports.

There’s no one solution,  I don’t think there’s any one foundation that could fix all of the health issues and inequities within their community. It takes all of these different partners coming together and collaborating to change. If it could have been fixed with a grant, we all would’ve done that long ago. 

Dan: When I was first brought in, in 2016, I was a consultant. I was preparing materials for staff to go and advocate to board members and donors for different types of investments. What the research showed was there was an extraordinary potential to change life outcomes through better interventions in the first 1000 days. Our board wasn’t ready to explicitly talk about race, but I knew it was an important lens to be able to bring into our work. 

That drew on a consultation with a lot of community partners in the Bay Area…we pulled together the research which was locally grounded and all of the data, and proposed that a new issue area be created for the Foundation. I recommended we make grants to speed the pediatric transformation. Improving well child checks for kids who are insured by Medicaid. Medicaid in the Bay predominantly serves people of color. It was a way to stick within institutionalized non-racial language by focusing on Medicaid, and the financial incentives there to operationalize as a health equity strategy. 

In 2021, the goal was to staff up with people on the program team who can bring different and more expansive views into our health work to share the power, funds, and resources.

La Roux: In the Bay Area, we work in serious illness and early brain development with a racial health equity lens. I worked in public health for almost 20 years, and I focused on chronic disease conditions like tobacco control and diabetes. For me the through line has always been, how do these affect historically oppressed and marginalized communities across race and ethnicity? How do root causes and social determinants of health drive the inequities we see? I consider health holistically, that is inclusive of mind, body, and spirit. It’s situated in a context of where we live, work, and play.

Early brain development and serious illness care are vastly different topics, but both contain disparate outcomes that can be seen when race is stratified. Stupski understands the importance of equity work, and has ensured that the program teams have the autonomy to create and implement our strategies without the approval of our board, which is a fake philanthropic rule we’ve broken.

I went about building a community resilience portfolio, which supports organizations that are supporting children and families in a more holistic way…How do we authentically engage our partners in community? I did this by reaching out to other funder partners, sharing that same vision, listening, and sharing ideas about other organizations that I could be considering for funding.

What came out of those conversations is what represents the community resilience portfolio:

• Improving black maternal health outcomes
• Spaces for early education
• Community health and wellbeing 

"Because of the autonomy and flexibility we have as an organization, we are able to offer funding to support what our grantee partners tell us will lead to impact. We have limited resources and we want those resources to be used in a way that is most impactful for our grantee partners based on what they tell us and not what we think is best for them."

La Roux Pendleton, Bay Area Health Program Officer
Stupski Foundation

Sulma: I’ve been blessed to be living on Hawaii Island for the last 25 years, and my background is as an administrator in health, human services, and education…Most of those years I was a grantee, so I was receiving funds from federal, state, and foundation grants. 

Joining the foundation was a unique opportunity to leverage the longtime network of community partners and that experience as a grantee myself. Racial and gender equity is not an added lens–it’s a permanent lens that is on me. 

When I joined the foundation, I spent a lot of time in the community…I had over 150 connections during that first year…When we talk about equity and health equity, there’s racial and gender equity, health outcomes, disparities, depending on the population. We know there’s also infrastructure challenges, such as lack of transportation, our provider workforce on neighbor islands, specialty care access, housing, caregiver capacity, communities where you need to have a couple of jobs to be able to actually live and thrive economically.

Those 150 meetings were a learning journey of meeting with communities and leaders of wisdom who knew better about what is needed and how to close the gaps on disparities for the populations that they’re serving. We are probably one of the most diverse communities in Hawaii, and that requires a skill set to be able to support multiple cultures. We have one grantee for example, who supports 17 different languages and in translation for the communities that they serve. That’s not just language, that’s cultural understanding, nuances, decision making, patterns that happen in the family that impact the individual and their healthcare…The zip code and where one lives is a determining factor of health access and outcomes in Hawaii in addition to your gender and racial identity.

We made a decision to support seven community health centers with a $15 million commitment. Five of them are in rural remote community areas amongst all of our islands and two are in more urban areas. A grant contract does not have to be pages and pages long. We provided funds in a way that was no term, no reporting requirements, you use the funds as you wish in ways that you see as important for your communities. These organizations are all led with over 50% of their board representing patients who receive the services of these organizations. We said can we be in partnership together, in solidarity with you holding hands as you face the challenges of your communities? We would like to stay in a relationship with you. And we’ve been able to do that. 

What are the steps involved? We have a lot of partners that need to do things differently, which means they’re going to have to interact with new organizations and break out of the way they’ve been doing things and break open the box of the same organizations getting grants over and over again.

La Roux, As you were looking in the two counties there in San Francisco and making new connections with a lot of new organizations, how are you breaking that open? Can you operationalize three things people could do to break out of the habit of repeating grants to the same orgs and expecting different outcomes? 

La Roux: I will cold email, I will ask for recommendations, and I will also show up. Being present to me in community is something that I value. It’s part of that authentic community engagement. 

Sulma: In Hawaii, we are only one and a half million, and we are so connected network and relationship wise, so I didn’t cold call folks. I either knew them or had a colleague who had a good relationship and put us in touch so there’s trust transference there. I put the burden on myself to meet the organizations and learn what they’re doing. I haven’t run any RFPs, or asked organizations to provide anything in writing, it’s me asking particular questions to learn about what they’re most excited about and what their challenges are. 

Are we making headway on achieving health equity? What do you want to see really happen in the next year or five years? Are we better off than we were 10 years ago? 

Dan: I am excited about possibilities in California and policy. There’s a thing called CalAIM advancing and improving Medi-Cal. It’s a top to bottom transformation of the Medicaid system in California that has been multiple years in the works and has multiple billions of dollars behind it. We’re working with health systems and organizations and providing social services. It’s an opportunity for our involvement to go much further and be amplified in the context of a massive upheaval and shift in how healthcare delivery is paid for across California. 

La Roux: I’m still in it for the long haul. I have seen a change when I say I used to have battles working at the state public health department that I thought truly understood. Now I’m getting to work in a way where the issues have been identified and we can just resource folks that we know are on the ground doing the work having impact with communities that we know need those resources. 

"The path to justice, that arc is long. We’ve been experiencing systems of oppression for centuries. We are here for a short time. I’m excited that our foundation is closing our doors and leaning into returning resources as soon as possible to communities of wisdom right away. That to me is a pathway toward justice."

Dr. Sulma Gandhi, Hawai’i Health Program Officer
Stupski Foundation

Sulma: We are hopeful crossing our fingers that our Medicaid benefit will soon have home-based palliative care opportunities and that our communities will then be able to provide home-based palliative care so that families can stay at home and receive the care that they deserve.

La Roux has been leading participatory grantmaking in the Bay Area and that inspired me to think about what we could do in Hawaii, especially around early childhood and young families. We’re in partnership with another funder building out a kind of participatory model where families will be involved in decision making for resources that go to their own communities.

Some of the highlights from the conversation include:

1. Resourcing people and organizations
2. Leading with values
3. Collaboration across the network
4. Community feedback informs grant practices

Watch the rest of the recording here.