A February 2021 article on the Health Affairs Forefront explored the increased emphasis on health equity among philanthropic organizations across the US. The piece, which shared findings from a survey of healthcare grantmakers, reported that more than four out of five foundations had changed or plan to change their health equity programming. Moreover, nearly half of those polled had created new initiatives during the pandemic focused primarily on access to care and racial justice.

For practitioners such as us who have spent our careers working to close gaps in access and opportunity for historically marginalized communities, this is welcome news. There is no question that events over the past three years have catalyzed long-overdue action on equity. From the growth of equity-focused corporate roles—with nearly 80 percent of companies pledging to increase equity budgets—to increased health equity programs and curricula in medical and health professions education, there is clearly momentum building to advance change.

And yet, as philanthropic budgets grow, so, too, does frustration within communities that are best positioned to deploy those resources. Most philanthropic dollars still seem to go toward short-term, deficit-based, and scope-limited projects—charitable donations rather than sustainable investments. Of particular concern is that funding models themselves tend to reinforce the same power dynamics they purportedly seek to dismantle.

That’s why a new approach to healthcare equity funding is desperately needed now to both change the system and model how to change the system.

Redesigning philanthropic health equity funding can itself provide a model for social justice. Our own experience leads us to offer the following recommendations to reshape a more just system of health equity philanthropy.

  • First, Stop Fixing 
    • Too much funding is deficit-focused, meaning that grants are designed to fix. For communities historically wronged, that “fixing” looks like correcting people and cultures. Rather than approaching philanthropy as solution-oriented giving, it’s essential to position our work as assets-based investments in what (and who) is already effectively advancing vibrant and just communities, such as the Black and Brown communities that have generations of experience resisting social injustice. We don’t need to “direct” these communities; indeed, we should follow their lead.
  • Second, Most Needs Are Not Time-Limited Or Narrowly Focused
    • Just as racism has taken centuries to intractably root, infrastructures to dismantle these constructs of bias take time and resources to build. Addressing health equity is long-term work. Disparities in health outcomes—especially the upstream social drivers of health—are embedded in persistent inequities and power structures. While we may be able to offer some short-term supports—such as vaccinations, food, or housing—these outputs only last as long as a particular program and do little to ensure that ownership and implementation is wholly centered in and sustained by the community.
  • Third, Ease Restrictions
    • There was a time when paying a patient’s rent was considered a radical, dubious intervention. Today, health care systems, payers, and practitioners all acknowledge the utility in housing as central to health. Likewise, we’ve seen health care magic happen by underwriting barbers as the trusted messengers of preventive health care information. From providing the overhead to cover salaries to the downstream, often iterative (or on the fly) support of unusual undertakings, grantees need to have the autonomy to be creative. In fact, it’s only with a level of autonomy that people can be truly creative.

Read the full article about health equity philanthropy by Rich Joseph and Makeeba McCreary at Health Affairs.