The Foundation of Equity

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What can be done to effectively address racial health inequities? This question came to me, oddly enough, when I was watching an episode of the tv show Grey’s Anatomy. In the show, Dr. Jackson Avery, played by Jesse Williams, decided to leave the medical profession and take over his family’s foundation to “reallocate every penny that we have to equity in medicine.” The audience of this episode, all 4.9 million people who watched it when it aired and the millions who saw it on demand, were receiving the message that all issues with inequity in medicine could be fixed if one man would just put enough money towards addressing the problem.

As one of the evaluators on two different foundation-funded projects designed to address racial inequities in the healthcare system, this plotline resonated with me and made me think. While there seems to be a narrative that it would be simple to fix health inequities if only enough money were put towards this goal, either from the government or private entities like foundations, I feel like my work has given me insight into the many moving parts involved in these efforts. With this blog, I wanted to reflect on the variety of ways that stakeholders, including foundations, non-profit organizations, and evaluators, are working to try and improve health equity.

Foundations, and the funding they provide, are critical to our current non-profit infrastructure. The two projects ICH is evaluating are both designed to address systemic racism in healthcare across the United States. One is focused on building power in communities in order to increase equity through policy action. The other is focused on elevating the voices of community members in order to impact their local healthcare systems. Funding is an important element of what the foundation is contributing towards these goals, as this money makes space for people to dedicate their time and energy to the work. It is also worth noting other important roles that foundations can play, in addition to providing funding. Foundations can work in partnership with grantee organizations, and their decisions about grant structure shape that working relationship as well as the ways that grantees implement projects. Foundations are also well-positioned to connect grantees to resources like up-to-date research and capacity-building opportunities that can aid grantees in using their funding most effectively. In fact, a report by Coffman et al. on a foundation-funded project tested the hypothesis that grantee work would be more successful if the foundation were less involved, and found that funders “can play an important and visible role in advocacy effects,” though they argue for the importance of centering communities[1].

Thinking of communities, funding for health equity becomes particularly impactful when it is provided to those with on-the-ground expertise who can do the work to bring about change.  In the programs we’re evaluating, grantee organizations are engaged in a huge variety of activities designed to lead to a more equitable health system. Some examples include pushing for more transparency from a healthcare system, working to ensure that information shared with the public in done in the multiple languages their communities speak, training and supporting doulas to ensure better birth outcomes, advocating for policies to reduce the costs of prescriptions, and much more. Each of the grassroots and community-based organizations that are involved in these projects have devoted effort to learning from their communities about which issues are more important to target and what achievable goals will have the most impact on their lives. They are able to put their funds to good use and advocate for meaningful change by taking their lead from communities. No single approach is the best approach, as health equity is such a complex issue that it requires a breadth of approaches designed to fit each local problem.

As evaluators, we aim to incorporate information from multiple perspectives to understand the impact of all of the different things that our partners are doing, and offer insights about effective ways to do this work. That means we’re learning from the work grantee organizations are doing to identify successes and recommendations for furthering health equity in different settings – and we’re also trying to understand how foundations can best support the work of those organizations. If the work of all these stakeholders is important, it’s also important to understand how best to work together.

I hope that as an evaluator, I can help bring some understanding to the big picture question – what can be done to effectively address health inequities? Even though we’re early in our evaluation, I have some ideas, starting with what foundations can do. Providing sufficient money to support the people doing work in their communities is essential. It’s also important to support innovative approaches and be willing to try new things and put in the effort to understand how well different approaches are working. And it is important to build networks, so that successful work and ideas can be shared broadly, and those with the ability can support capacity building for those who need it. I look forward to the opportunity to learn more through our ongoing evaluations.

The main idea that I want to share is that all of these pieces are part of the work of addressing large-scale, systemic challenges. It’s important to recognize the breadth of the challenge so that we can best position ourselves to do this work in partnership with others, bringing our skills into conversation with others. Perhaps assuming that one individual has the ability to change everything by themselves is the sort of thing that works well on television, but doesn’t work so well in the real world.

[1] 2021. Coffman, Julia, Gigi Barsoum, Albertina Lopez, and Mariah Brothe Gantz. Adovcacy that Builds Power: Transforming Policies and Systems for Health and Raial Equity. Center for Evaluation Innovation, pg. 39.

Amanda Robinson, PhD

Research and Evaluation Project Manager