Equity: How It’s Changing Philanthropy

Fourteen years ago, I found myself embarking on a new career path into philanthropy. Healthcare Georgia Foundation was still a new organization, creating an identity for itself in an environment at the time where philanthropic support for healthcare was scarce. My wide-eyed optimism allowed me to learn all that I could about philanthropy. Health Disparities and the Social Determinants of Health were topics being discussed, and, in some circles, even quietly debated and challenged.

It was a time when the health nonprofit sector and public health were using every opportunity to educate and inform the public and community stakeholders about alarming health disparities across Georgia. Atlanta was (and still is) the epicenter of the HIV/AIDS epidemic, and the state ranked 42^nd nationally in health outcomes, according to the United Health Foundation’s America’s Health Rankings Report (2006). Health equity became the focus of discussions on how to improve health outcomes in Georgia.

Healthcare Georgia Foundation welcomed the opportunity to elevate one of its core priorities since its inception – Addressing Health Disparities. The Foundation was one of a few funders in Georgia willing to champion this area within its grantmaking strategies. For example, the prevailing approach in philanthropy at the time was to focus on reducing health inequities by supporting health programs designed to address rising rates of childhood obesity, access to healthcare services, and advocacy. Race and equity were rarely discussed as strategies to combat poor health outcomes.

Today, the question worth asking is what has changed? In 2018, Georgia was ranked 39^th by the United Health Foundation’s America’s Health Rankings Report. Health inequities continue to plague our state with the burden most apparent among people of color, women, children, rural communities, and the poor. The existing healthcare infrastructure is increasingly fragile due to rising healthcare costs,  increasing numbers of uninsured individuals, hospital closures, and an inadequate healthcare workforce tittering on collapse.

According to the 2019 County Health Rankings Report by the Robert Wood Johnson Foundation, 22% of children in Georgia live in poverty; 54% of those children live in households that spend more than half of their income on housing costs; African American women are twice as likely to be a victim of pregnancy related maternal death compared to White women and; 14% of births by African American women are classified as low birth weight regardless of socioeconomic status or educational attainment.

Healthcare has become a political lightening rod in the U.S., and in Georgia, despite persistent poor health outcomes.  Health status and wellness are directly correlated to who you are and where you live. Racial inequities impact on health isn’t a new concept. What is slowly changing, however, is the clarion call to action embraced by the philanthropic sector to take a closer look at how grantmaking strategies need to account for systemic racism that exists in the form of policies that either hinder progress toward equity, support “business as usual” or outright creates roadblocks to allowing equitable access to services or opportunities.

Philanthropy can no longer afford to ignore decades of institutionalized policies intended to limit access and exploit people of color, whether it is the “redlining” housing policies, underfunded public education based on property taxes, banking policies limiting access to business loans, predatory lending practices or denying access to medical treatment in deceptive clinical research studies. All of these factors have contaminated the healthcare ecosystem, limiting the degree to which any one program or initiative can impact reducing health inequities.

Healthcare Georgia Foundation is taking steps toward fully embracing health equity by being more intentional and deliberate in its grantmaking. The recent adoption of a five year strategic plan is designed to reaffirm our mission and uplift a vision that embraces health equity. Our focused vision will allow the Foundation to leverage its resources and position as a thought leader in healthcare and reimagine existing partnerships and create new ones. As a statewide convener, the Foundation can identify and inspire transformational leaders to partner with us on a path toward creating the conditions in communities where the seeds of racial equity can be nurtured through open and honest conversations – where everyone is offered a seat at the equity table. This work will require patience, consistency, collaboration, and long-term dedication.

Our four impact areas – Strengthening Health Nonprofit Organizations, Programs, and Workforce; Promoting Health and Preventing Disease; Expanding Access to Affordable, High Quality and Integrated Healthcare Services; and Addressing Health Disparities – are the cornerstones of our grantmaking that you will see in our future initiatives and programs. These core areas will initially focus on five areas: Chronic Disease; Nonprofit Organizational Capacity Building; Rural Health; Maternal and Infant Health, and Health Equity Leadership. In addition, we are currently investigating several emerging areas related to community  health that include, but are not limited to, behavioral health, policy, transportation, and workforce development.

Changing health outcomes, reducing health inequities, and improving the overall health and wellness of Georgians in underserved communities requires new approaches with our partners and our grantees. We need to move beyond theory into practice as we enhance the equity lens in our funding programs. Embracing health equity honestly will challenge us, cause discomfort, and require a willingness to listen to different voices. The Social Determinants of Health need to be at the centerpiece of the equity table. The voices of our grantees, community stakeholders, and philanthropic colleagues will serve as the truth serum that keeps us focused and grounded so that together, we can create the conditions in Georgia communities where healthy living environments become the norm and not the exception.

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