Giving Compass' Take:

• This case study explores how the Empire Health Foundation is working to address obesity in Spokane, Washington. 

• How can founders learn from this effort? What are the health needs of rural communities near you?

• Learn about rural LGBTQ giving.

From its headquarters in Spokane, Washington, Empire Health Foundation (EHF) serves seven counties with a combined population of more than 650,000 people. Roughly three-quarters of the population live in Spokane County, but drive just 10 minutes in any direction from that urban center, and you’ll find yourself deep in rural America.

Out among the rolling hills of farmland in Adams County, or up in the forests and mountains of Pend Oreille County, the area’s rural population drops from Spokane’s 200-per-square-mile to only five to 20 people per square mile. Agriculture, forestry and manufacturing are economic cornerstones, but unemployment ranges among counties from 3.7 percent (below the national average) to as high as 8.1 percent in some counties. Poverty ranges from 12.5 percent ( just above the national average of 12.3) to nearly 26 percent.

More than 138,000 people make their home in the rural reaches of EHF’s service area, including 14 Native American tribes on three reservations — the Spokane Tribe of Indians, Kalispel Tribe of Indians and Confederated Tribes of the Colville Reservation. The tribes have reservation land, but tribal members live throughout the region in both rural and urban locations.

EHF is a relatively new player in the region, created in 2008 from the sale of a nonprofit hospital system — and it’s the only private, rural health funder dedicated to this part of the state. At its first strategic planning retreat, the founding board of trustees named obesity prevention, mental health, and access to care as foundation priorities.

Initially, the foundation functioned like a traditional grantmaker, but with the implementation of the Affordable Care Act in 2010, the focus shifted to a more upstream approach aimed at influencing policies and systems to impact measurable improvements in health for the region’s most vulnerable citizens. The EHF board recognized the importance of being innovative, risk-taking and opportunistic, and today supports an approach to philanthropy that bears a closer resemblance to a venture capital enterprise than a traditional grantmaking foundation.

“Our board realized that if we tied ourselves to something too specific, our money would no longer be flexible, and we wouldn’t be able to respond to things like this sweeping legislation or other shifts in the landscape,” says Brian Myers, vice president of programs.

With $75.9 million in assets, EHF’s grantmaking from endowment averages $3.75 million annually. That annual average is a drop in the bucket when compared to the weighty task of achieving the foundation’s mission of investing in ideas and organizations that improve access to care, education, research, public policy and wellness to result in a measurably healthier region. Consequently, EHF has deployed staff to identify new revenue streams for the region, resulting in an additional $68 million in grantmaking funds — some of which have been reallocated to help grantees attract an additional $250,000 if federal and state funding.

“We are 100 percent entrepreneurial and opportunistic,” explains Myers. “We have a lot of flexibility within our focus areas around what we want to try to accomplish. We find a gap in the system, look for opportunities that arise and then create a strategy to address it. This has led us to some very large things.”

Those “large things” include the creation of regional programs such as a school-based obesity prevention initiative and the launch of several affiliate organizations that draw multiple players together to tackle thorny regional challenges. In many ways, EHF serves the role of regional ideation hub and incubator, creating and nurturing new structures and networks with the goal that they will eventually function independently.