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What if philanthropy took on structural racism with the dedication it reserves for issues like education or health? It would require seeing structural racism as the problem and the racial disparities and inequities as a manifestation of that problem. After all, as the National Equity Project points out, structural racism has become so normalized, our policies and practices ensure access to opportunity for some and exclude others. How then do funders move from merely embracing a racial equity lens in their philanthropy to truly giving in ways that will help create an equitable society?
In our conversations with clients and others across the sector, we frequently hear hesitation because the kind of work needed to achieve racial equity can, for funders, feel slow, amorphous, hard to measure, even risky. The feedback convinced us of the need for a more accurate understanding of how addressing root causes leads to lasting equitable change on other issues. Our recent research, “Unlocking Social Progress by Addressing Structural Racism,” offers examples of how that happens.
GHDC managed to close the gap and improve treatment completion rates for everyone by focusing on the structural racism in the healthcare system itself. Research suggests that people of color receive lower quality healthcare than whites even when insurance status, income, age, and severity of conditions are comparable. Using the Collaborative as a model, we found that efforts to achieve equitable structural change — groundwater change — often exhibit several critical characteristics. Here is what they looked like for GHDC:
- Building shared analysis: All members of GHDC attended anti-racism workshops that offer a historical analysis of the structural and systematic nature of racism.
- Leverage the expertise of communities: Early on, members participated in a structured storytelling exercise to explore and understand their collective and individual experiences with racism in the healthcare system.
- Bringing in the institutions they seek to transform: GHDC purposefully included a medical institution, Cone Health Cancer Center, as a fellow collaborator alongside the academics and community members. Getting institutional buy-in to the mission was difficult at first.
- Establish trust: Through in-depth discussions, GHDC collectively created norms for collaboration, formalized in a document called the “Full Value Contract,” which all members sign. Critical for a group with people from varied backgrounds, the contract affirms “the belief that every group member has value and by virtue has a right and responsibility to give and receive open and honest feedback.” GHDC also invests time to build relationships among members at every meeting.
- Engage with and learn through conflict: Like any collaboration, especially one that values equitable participation and decision making, GHDC’s work has not been without conflict. To deal with conflict GHDC has something they call “pinch moments” or the practice of not ignoring tensions but examining them as they arise.
- Treat the system: GHDC’s work led to initiatives including health equity training at the institutions, data tracking on care quality disaggregated by patient race in real time, race-specific feedback for treatment providers, and nurse navigators working to improve communication with patients. Mindsets shifted along the way.
- Maintain momentum: Given the baked-in nature of structural racism, it is critical to ensure institutions remain committed and do not revert back to business as usual. Having a community-based partner, like GHDC, question the status quo, drive priorities, monitor progress, and push the institution to do better is the foundation of the work and its success.
Read the full article about ending structural racism by Britt Savage, Cora Daniels, and Peter Kim at The Center for Effective Philanthropy.