In a nation that is increasingly divided, finding common ground is more important than ever. Health may be that opportunity to bring people together for a shared purpose.

When asked in a focus group how they would spend $100 to create health in their community, African-American women who registered Democrat and white Republican women all agreed on solutions down to the percentage point: One-third would be spent on healthcare (housing and health centers), while two-thirds would be spent on a combination of access to healthy food (25 percent), affordable housing (19 percent), affordable childcare (14 percent) and the balance on transportation and utilities.

Rebecca Onie“Across race, gender, socioeconomic status, political party and geography, there was startling alignment around what voters understood was necessary to be healthy,” said Rebecca Onie, co-founder and CEO Emerita of Health Leads, which commissioned this polling. “It signaled the opportunity to marshal a new conversation in this country recognizing that we may be divided on healthcare, [but] we are in fact unified on health.”

This growing alignment led Onie and Rocco Perla, Health Lead’s former president, to co-found The Health Initiative (THI). They aim to elevate the conversation about delivering care based on social determinants.

“How do we begin to chart a course for increased investments in what we know and agree drives health?” said Onie. “The work of The Health Initiative is the next extension of that.”

Health Leads: Connecting Patients to Community Resources

Onie has been driving conversations about social and environmental factors of health and mobilizing communities for two decades. She co-founded the social enterprise Health Leads while she was a college student at Harvard after working as an intern in the housing unit of Greater Boston Legal Services. Onie encountered typical housing-related issues, such as code violations and evictions, but would often find the people she spoke with were dealing with underlying health problems.

“It felt like we were intervening so far downstream in the lives of these families,” she said.

With the permission of Boston City Hospital Chair of Pediatrics Dr. Barry Zuckerberg, Onie spent six months talking to nurses, doctors and others at Boston Medical Center asking what they would provide to patients if they had unlimited resources. Many admitted they knew there were other factors (lack of food, safe housing, etc.) affecting, for example, a child with an ear infection, but their hands were tied.

“Health Leads’ work was really around how you operationalize integrated social needs into care delivery,” Onie said. In other words, creating a system where a doctor could prescribe healthy food and navigate patients to this resource.

In 20 years, Health Leads has evolved — with New Profit’s support — from a direct service model to providing tools, platforms, data and analytics to health systems. Some of this evolution was driven by the Affordable Care Act’s model of rewarding good health outcomes.

“There was a diverse set of actors across the healthcare system whether it was payers, providers, VC firms, red state, blue state, purple state, secretaries of health and human services that increasingly recognized the impact of social needs on care delivery,” Onie said.

How to Make an Impact

With this collective focus on social determinants, there is greater opportunity for donors to invest in systemic change.

Philanthropy continues to put a focus on health. In 2017, giving to health organizations increased by 7.3 percent to $38.27 billion, according to the Giving USA 2018 report, but Onie said these dollars are often spent on the “next program, the next model,” instead of a set of levers that will enable sustained impact over time.

“For the greatest impact, one of the most essential features is that there is alignment among the donor community and a shared commitment,” Onie said.

Removing this fragmentation and asking the right questions will illuminate the power of shared beliefs. It’s then that the real problem solving can begin.

“There’s a profound opportunity in the context of health to be able to nurture, elevate, cultivate, communicate [and] bring people together around these admittedly shared beliefs and with that as the foundation, then begin the work of solving difficult problems,” Onie said.