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Excerpted from No More Status Quo: A Proven Framework to Change the Way We Change the World by Heather Hiscox © 2023 (forthcoming). Reprinted with permission.

This excerpt comes from my forthcoming book, No More Status Quo: A Proven Framework to Change the Way We Change the World, and is aimed at addressing common feelings of disillusionment within the nonprofit sector. The book tackles hard questions about whether passionately created programs really transform lives, or why nonprofits so often jump to solutions and waste resources, often without a process to guide their decision making. All of this is written with an eye toward creating tools to illuminate better paths forward. In this section, I take a look at empathy—and how to connect with others authentically, a critical component of so much social sector work.

NPQ readers can sign up to receive notifications when the book is ready for pre-order and to receive a copy of the first chapter here.

Empathy is complex, and there are several very important elements to consider when you are thinking about how you might understand another person’s perspective.

It is a myth that you can, through conversation or by mimicking another person’s experience, truly understand what it is to be them. We often hear about “walking in someone else’s shoes,” but I question if this is really possible. I like the idea that many share about how we need to “remove our own shoes before trying on another’s,” but I think there is tension and significant uncertainty within empathy that must be explored.

In an excellent article called “Stop Bastardizing Design with False Empathy,” Ovetta Sampson, VP head of design machine learning and responsible artificial intelligence at Capital One, says, “As a Black woman in America, I can tell you that few people in the world can know what it’s like to ‘walk in my shoes.’ And if you think that the result of empathy in design is all about you trying to really understand what another person is going through while leaving you unchanged[,] then you are an empathy offender.”

In the article, she goes deep into the many forms of empathy and how empathy transforms us. Sampson discusses the work of Daniel Goleman, who coined and defined the term “emotional intelligence,” and the three levels of empathy.

The first level is cognitive/intellectual empathy. This is the empathy most folks are familiar with and mistakenly refer to when talking about empathy in human-centered design. Cognitive or intellectual empathy occurs when we know what others feel and what they think. If you think about this in terms of the design process, this happens in the story telling phase, [t]he “what we heard” phase of our design research shares. In this phase, designers talk to people, write down what they said and share photos and quotes to communicate what they heard. A lot of folks stop here and expect this to build empathy.

The second level of empathy is emotional empathy. Sampson writes, “This is when you feel physically along with the other person, or feel what they feel, as though their emotions were contagious. Empaths famously have this ability. But research shows though we’re neurologically wired to have emotional empathy, that instinct can fade over time.” […]

The third level of empathy is compassion empathy, or empathetic concern. This is the level of empathy that moves you to action, as you not only understand what someone is facing and how they feel, but you want to try to do something about it. You can listen and not be motivated to do anything, or you can listen, and it lights a fire under you to be better, learn more, and cocreate. […]

While our positionalities can limit walking in someone else’s shoes, you can and should try to experience something similar to what stakeholders might be experiencing. Not in
an attempt to convince yourself that you have achieved full understanding, but to create a deeper connection between what you hear and what you do to support that person. For example, when the financial collapse that was caused by COVID-19 hit the United States, more people than ever before had to navigate government websites, bureaucracies, and delays to apply for unemployment benefits and loans. Some said that, for the first time, it exposed many wealthier Americans to the painfully frustrating and demoralizing experiences that many community members have endured to gain access to government benefits.

If you cannot or have not experienced exactly what someone is experiencing, like applying for government benefits, you can still connect with the feelings of confusion and powerlessness. Maybe consider how you felt when you got your first loan from a financial institution, when you filled out your first job application, last did your own taxes, or maybe filed for divorce. You probably weren’t sure whom to talk to, what questions to ask, what information to include and where, and you probably had some apprehension about the outcome. While the experiences and instances are different, the emotions are similar in many ways. You can add layers of imagination to this exercise if you envision that the only paperwork you can find is not in your first language and think of how you might solve the problem of finding support from someone to help you. Maybe consider what you might do if you had another significant barrier, such as lacking a social security number or ID. What do you do then? One response could be just thinking, “Yes, filling out paperwork can be confusing,” and another could be to connect the dots of the emotions embedded in other people’s experiences with something that was challenging, confusing, infuriating, and defeating for you.

Connecting empathetically is about opening your mind and embracing complexity. At its root, empathy is about understanding that your perspective is just your own and that you are providing space for another person’s experience and their truth to live alongside your own. To be successful empathetically, you are not only connecting to a feeling within you that is the same as or similar to the feeling of another person, but also detaching and untangling your own emotions and experiences from theirs. When you connect with stakeholders, you will hear stories, ideas, justifications, experiences, and explanations that might be very different from your own, and you must be open to challenging your own immediate judgments and assumptions. Without acknowledging this attachment-detachment dance, you might listen to the experience of another, unintentionally compare it to your own, form judgment, and potentially dismiss, undervalue, or even develop contempt for that person. Sadly, this happens every day, and we are all guilty.

I experienced a gift when I first started doing this work that totally shifted my thinking about empathy. I was coaching a multiday event with an organization, and there was a woman on a team who seemed really grumpy about having to be part of the training. She appeared distracted, short-tempered, and easily frustrated. My brain immediately went to judgment. I made the assumption that she was pulling back from the work.
I judged that she was not participating in the ways I thought she should to really demonstrate commitment to the process. As the training continued, I decided to check in with her, so during a break, I strategically lined up next to her at the snack table and asked her how she was doing.

She told me it was her first day back from maternity leave. It was the first time she had left her infant in childcare, and she was in pain because she needed to pump breast milk and was trying to find a way to do that in the rapid flow of the workshop. She was feeling very mixed emotions: excitement about being back with her colleagues but also tremendous sadness and anxiety about being away from her baby. This interaction stopped me in my tracks, and I have never forgotten the shame I felt at that moment as a fellow mother who has felt those very same feelings. I was so ashamed that my judgment had created a story about and for this woman when I was totally uninformed.

Just as we all are biased, we all need to do internal work before we can be positioned for optimal connection fueled by empathy. We must acknowledge that what we think we know about a person from what we see on the outside might be in no way connected to what is really going on with a person on the inside. There are many times when the joyful person I have shown to others masked pain, sadness, and grief, and I think this has been true at some point for most of us.

We must also do the work involved in experiencing the shame, disappointment, and discomfort we might feel when we misstep, as this is an essential piece of self-empathy and self-awareness, which are key to connecting empathetically with others. I felt awful and was so angry with myself after I had wrongfully judged this new mother, but I sat with and processed those feelings, and the experience imprinted a powerful lesson I will never forget. None of us is perfect empathetically, but when we do the work to hone our empathy skills, not only will our potential solutions and organizations be elevated, but we will also be transformed.

Copyright:

Hiscox, Heather. No More Status Quo: A Proven Framework to Change the Way We Change the World, pp. 152-156 © 2023 (forthcoming). Reprinted with permission.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

Join us on October 20^th for a webinar addressing the themes of this article. Co-author Cathy Dang will be joined by Ingrid Benedict and Isabel Sousa-Rodriguez. Register here.

Much has been written about the wave of incoming BIPOC leadership at nonprofits and about how philanthropy needs to better support these leaders. Yet, we continue to hear that BIPOC nonprofit leaders feel under-supported and overwhelmed in their new positions. Clearly, something isn’t working.

While the general sentiment is that funders want BIPOC leaders to succeed, especially leaders who come from the communities they serve, stories continue to emerge about how these leaders have been set up to fail. Incoming BIPOC leaders often face impatience from staff to quickly get up and running, sometimes while cleaning up an organization’s inherited financial or programmatic woes. Often an organization’s first leader of color, they are frequently expected to reverse a long history of entrenched racism while serving a majority-white board. Leaders try to accomplish these Herculean tasks with little time to settle into their roles and often with meager support, especially from anxious funders.

Many experts have offered sound—but insufficient—ideas for how philanthropy can do better: provide more flexible money, build longer on ramps for transition, and embrace succession planning and transition as normal parts of an organization’s life cycle—to name a few.

We believe the problem is deeper. Poor funder behavior during transitions—whether it’s pulling back support, micro-managing, or prescribing unhelpful “best practices”—is rampant in the philanthropic sector. This behavior leaves nonprofits, especially nonprofits run by BIPOC leaders, confused, weakened, and vulnerable. It jeopardizes organizations’ visions, needs, and critical work to uplift communities.

As a former nonprofit executive director who faced these challenges and a funder who works alongside grantees during such struggles, we’ve seen and experienced harmful philanthropic behavior firsthand. Funders need to fundamentally reimagine how they think about leadership transitions to make such occurrences more equitable, supportive, and transformative for organizations.

Funders must honestly explore and shift the impact of white-dominant power structures that define what leaders look like, how organizations are structured, and who holds power. Philanthropy holds a set of harmful assumptions that show up throughout the transition process in ways that are both painfully obvious and dangerously subtle.

Who’s on deck? In the private sector, we celebrate succession planning. Leaders are expected to leave, and organizations invest time and energy in building leadership teams. But in the nonprofit world, funders have an overreliance on individual leaders. We celebrate and uplift them, and our relationships and leadership investments often stop at the C-suite. When leaders depart an organization, often no one is ready to step up and replace them because the executive pipeline has been neglected. This situation can lead to funder panic. In the worst cases, organizations fold because of a perceived inability to move forward, leaving gaping holes for underserved communities.

Boards as experts: The dominant narrative around best transition practices is that boards should take the lead. Funders reinforce this model through words and action, happily paying for consultants to work with boards on the transition process but rarely providing support for a more inclusive process where community members and staff share decision-making and input. Sometimes, communities and staff are asked for their input, but in superficial fashion—ultimately, the board will make the decision, often in opposition to community feedback. Without any real decision-making power for the community, when there isn’t alignment between the board and a community, the board’s preferences will always win. These dynamics may disenfranchise community members and devalue their perspectives. The outcome is often the hiring of a leader of color who meets the needs of the board but not of the community. While boards are legally charged with making hiring decisions, there are other stakeholders whose buy-in is critical to organizational transition and whose experience with the community’s culture and needs are often deeper than the board’s. These stakeholders should have a real say in the choice of leadership.

Hierarchy produces the best leaders: Many funders assume that one structure—usually a rigid hierarchy—fits all organizations and that hierarchical organizations are most efficient in their decision-making, but that doesn’t apply to all organizations and doesn’t develop long-term community leadership. This assumption means that organizations do not feel empowered to determine their own leadership structures to best fit their work. It also results in organizational structures that often burn out individual leaders, who hold the weight of so many decisions on their shoulders. Alternative leadership structures include co-directorship, collectives, or a leadership body led by community members—models that should be considered.

New leaders have the skill sets funders favor: When there is a vacancy at the top of an organization, philanthropy values leaders with traditional skills sets and a track record of executive experience in financial management and strategic planning. Funders also tend to trust leaders who can speak their elite language, with the use of philanthropy-friendly vocabulary and an emphasis on the written word. But this perspective does not consider the needs of an organization or community. Finding a leader whose culture, lived experience, and values match that of an organization’s community base is vital. Even if a person does not fit the traditional leadership mold, they might be best positioned to carry out an organization’s mission.

Transitions are “problems” that need a fast fix: Funders who support transitions usually emphasize the selection process as a “solution” rather than seeing succession planning and transition as a natural part of an organizational lifecycle. Instead of supporting a specific transition, funders should make consistent investments over time and include succession planning as part of their thinking on organizational strengthening. Focusing solely on the moment of transition deprives organizations of capacity development, making them less likely to succeed in the long run.

These assumptions and mindsets lead to misguided and harmful attitudes and actions. It’s time for funders to fundamentally change the way they approach transitions by centering organizations and communities. Here’s a helpful place to start:

• Ask questions: The most valuable thing you can do as a funder is to ask your grantees questions—before, during, and after a transition. This includes questions about succession planning, capacity-building outside the C-suite, community engagement during the hiring process, and how the leadership structure might evolve. All these questions signal that funders are open to listening and thinking outside the box. One of the most critical questions is what kind of support the organization needs during transition. Nonprofits may request that funders cover expenses like coaching or consultants, staff retreats, facilitated meetings of outgoing and incoming executive directors, trainings, health insurance and placement support for the outgoing ED, translations, interpretations, and even food costs for group trainings. Funding requests will vary based on organizations’ needs and complexity. Transition budget requests can be expansive, and funders should be open to all supports that an organization requires.

• Reconsider your timeline: Patience and an extended timeline are vital for successful transitions. Organizations should design transition processes that embrace the values and voices of the communities they serve—and funders need to bolster these efforts. Deeply inclusive transitions that build buy-in take time but ultimately lead to better and stronger nonprofits. Organizations must be supported before the outgoing leader leaves. The new leader requires time and support to settle into their role and build the resources they need to succeed.
• Think beyond the ED: Invest in the whole organization and its mission, not just the executive director. That means meeting with people working at different levels and in different departments and supporting their professional trajectories. This could include something as simple as inviting people in diverse roles to funder-hosted events to help them network and spotlight their work. This approach builds the capacity of the entire organization and ensures more continuity during transitions. It can also create a leadership pipeline that increases the likelihood of promotion from within when an ED leaves.
• Embrace discomfort: Transitions may result in leaders whom the community trusts but with whom donors aren’t comfortable. Sometimes, a new leader comes in with an approach that differs from that of a prior leader, causing internal tension. Discomfort is important. There is always tension with new leadership, and everyone—board, funders, staff, and community—needs to be ready for it. Funders must be prepared to extend new leaders patience and grace as they settle into their roles and sometimes make important changes. Stumbles and surprises will happen as an incoming executive director digs in. Funders must be comfortable with these unpredictable rhythms.
• Have their back: Help organizations prepare for transitions by offering every option for building a pipeline of leaders, organizational development, and transition support. A nonprofit should not worry about funding cuts in the middle of a transition; reassure the organization that funding will continue even if challenges arise. Most importantly: have honest conversations with the organization about what it needs throughout the transition process and offer information about what other organizations in similar circumstances have done.
• Look in the mirror: By nature, leadership changes are messy, non-linear, and uncomfortable processes. Funders should channel this discomfort to examine their own behaviors and consider: What do I need to change? How can I change and partner with grantees in a different way?

Sometimes, despite the best efforts of everyone involved, new leadership does not work out. Though disappointing, this need not be disruptive. An organization may require different kinds of leaders at different points in its evolution, leading to several transitions over the course of a decade. But if funders invest in the whole of an organization and its mission, these changes will feel like normal developments rather than scary surprises that jeopardize a nonprofit’s future.

Transitions are a healthy part of an organization’s evolution. It’s time that funders start acting that way by talking about and preparing for transitions alongside staff and community. This involves continual commitment to an organization’s mission and impact—and making that commitment clear through ongoing engagement and trusting dialogue.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

This is the fourth installment of a five-part series, Reclaiming Control: The History and Future of Choice in Our Health, examining how healthcare in the US has been built on the principle of imposing control over body, mind, and expression. However, that legacy stands alongside another: that of organizers, healers, and care workers reclaiming control over health at both the individual and systems levels. Published in five monthly installments from July to November 2022, this series aims to spark imagination amongst NPQ’s readers and healthcare practitioners by speaking to both histories, combining research with examples of health liberation efforts.

 In their new book, Inflamed, doctors Rupa Marya and Raj Patel explore how colonialism makes us sick while also shaping our core beliefs about how healthcare providers should make us better. For example, Lakota elders in the book describe the forces that led to widespread prevalence of diabetes in their communities: colonizers arrived and dammed a river that traditionally fertilized a rich river valley where nutritious food and medicinal plants utilized by local peoples grew. As this ecosystem was erased, and as the impacts of erasure and assimilation took hold, the Lakota became less active and were forced to rely on the food and medicine of their oppressors, rather than their ancestors. Marya and Patel point out that skeletal evidence backs up these claims, showing a marked difference in Indigenous remains excavated before and after European invasion. However, they also point out a paradox that comes with this data, writing:

If you find yourself more convinced by studying skeletal remains than by listening to the oral histories of Indigenous people, you’re a participant in a colonial system of organizing truth. Reconstructing history through bones misses much that oral histories capture. Yet, in a colonial world, stories passed down by Indigenous elders cannot be considered true until they are validated by the empires that colonized them.

This tenet applies not only to our society writ large, but also to healthcare professionals. As physicians, the authors grapple with their own training, pointing out that modern clinical professionals are taught to be “biomedical technicians” rather than healers. Inevitably, they fall short when root causes of poor health, from structural racism to food insecurity, present themselves.

The COVID-19 pandemic and the national uprisings on race that took place in summer 2020 further exposed the shortcomings of our current paradigm for training, recruiting, and deploying healthcare workers. Coverage of the harrowing experiences that healthcare workers endured over the past two and a half years highlights not only the trauma that the pandemic inflicted on such workers as they cared for surges of critically ill patients with limited supplies and equipment; it also shows the stress caused by underpayment and overwork, divisive, politically driven policy shifts, and the disproportionate morbidity and mortality burden that low-income and BIPOC communities face. BIPOC healthcare workers, as well as frontline support staff, home care workers, and service staff, all of whom are deprioritized within the medical hierarchy, experienced additional layers of threat: racism and xenophobia inside and outside of their institutions and a compounded mental health toll. Since the pandemic began, 20 percent of healthcare workers in the US have quit their jobs, and healthcare labor shortages are now a major challenge for the sector.

Healthcare staff’s feelings of powerless in the face of broader societal forces, however, are not unique to the pandemic. Almost two decades ago, as an undergraduate patient advocate, I experienced this dynamic up close. At clinics in East and West Baltimore, I had the opportunity to partner with individuals and families who presented not just with individual health issues like asthma and lead poisoning, but also with social issues: a crumbling rowhome with asbestos dust; limited fresh food options in the neighborhood; a bureaucratic social services system quick to judge Black and Brown families. Many of the clinics I worked in had one social worker for every 5,000 patients, presenting an impossible capacity challenge—even when medical staff asked about patients’ life situations and referred patients to social work or our advocacy program to identify helpful resources. While not all the clinics’ physicians, nurses, or medical staff felt obliged to address the impacts of social forces on their patients’ lives, most did—but they had limited training, resources, and time to do so.

In the first few articles of this series, we covered the political history of our healthcare system and the role that organizers and healers play in imagining what the future could hold. But what role will healthcare workers have in that future? As actors who benefit from the existing healthcare system while facing harsh challenges within it, healthcare professionals hold a specific positional power and can play a unique role. Even for those of us that have faced trauma inside healthcare institutions, or who have reason to distrust the system as a whole, healthcare workers can still act as trusted messengers and crucial lifelines during the uncertainty of seeking care for ourselves or loved ones.

Bringing Training into the 21^st Century

Much of medical education’s current pillars—the separation of public health and medicine, a focus on treatment rather than prevention—can be traced to a 1910 report prepared by Abraham Flexner. In an effort to standardize curricula across medical schools, the report prioritized a biomedical care model that excludes social and environmental factors. It reinforced a healthcare model, including a paternalistic doctor-patient complex, adopted by institutions that only white males could access. That prioritization also led to the closure of many historically Black medical colleges.

What would it look like to reimagine the tenets of healthcare education through a host of lenses, voices, and teachers who take a more holistic, healer-rooted approach? Many training programs are now adding anti-racism frameworks and a focus on health equity to their classrooms. The Institute for Healing Medicine and Justice, launched in 2020 by a community of medical and graduate students at the Joint Medical Program of UCSF School of Medicine and UC Berkeley School of Public Health, envisions a “new medicine” that centers healing, community, and justice. They seek to bridge their own educational experiences with multidimensional healing paradigms that have long been promoted by women, people of color, disability activists, queer organizers, and healers across cultures.

With a community of more than 3,000 people representing 300 institutions, the institute focuses on establishing a new, ground-up praxis for medicine, consisting of interdisciplinary research working groups, community healing gatherings, a justice hub, and a peer-reviewed publication. Along with the Othering and Belonging Institute and the Center for Race and Gender at UC Berkeley, the group published Toward the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research, and Practice, which traces the history of white supremacy and racism in healthcare training. The publication also points out that epigenetics, the study of how the environment can alter gene expression, promises to deepen understanding of how racism—and not race—impacts health outcomes. The also launched the Freedom School for Intersectional Medicine and Health Justice, a community organizing effort led by Bernie Lim and Nicole Carvajal, both women of color in the Joint Program. The Freedom School re-imagines medical praxis and creates community for women of color in medicine, offering a community organizing model, an alternative syllabus populated by critical studies frameworks, and a fellowship for people interested in intersectional healing, medicine, and/or public health initiatives.

Power Outside the Exam Room

One additional effect of the Flexner recommendations was that advocacy training is largely absent from clinical curricula. While this has started to shift in the past 20 years, such training is still rarely seen in clinical classrooms, and when included, it varies from program to program: some programs focus on social determinants of health policy, while others focus more on advocacy to ensure the healthcare profession’s viability as a whole. This lack of training contributes to missed opportunities for the sizable healthcare workforce— trusted experts with a front row view of the challenges involved in improving patients’ health—to leverage their collective power to enact change.

People Power Health, which trains health professionals in community organizing skills in order to set them up to redress power and resource inequities, aims to agitate healthcare workers to co-create just systems for communities, caregivers, and clinicians alike via trainings and fellowships targeted at different sections of the healthcare worker ecosystem, including clinicians interested in health justice, immunization professionals, climate health organizers, healthcare professionals focused on civic engagement and voting, and more.

Pedja Stojicic, executive lead of People Power Health and a physician by training, shares the role that a power-building community for healthcare professionals can play in moving physicians from an individualistic, passive mindset to one of collective action:

Right now, many [medical residency programs] are thinking about health equity tracks…. But what is still problematic is its [just] awareness generation. Medical education itself is organized in such a way that is focused on individuals. The fact that [participants in People Power Health programs] often need us to see their colleagues as a sense of solidarity … in pursuit of change … is mind blowing. These are the facts of the system: a session outside of it can bring solidarity, hope, etc.

A collectivist approach may also enable healthcare professionals to move beyond defensiveness about their role in a system that often causes harm and to leverage their power beyond the context of an individual patient. Sam Gonzales, a member of the People Power Health core team, points out the value of the relational organizing on which the organization is focusing. Such organizing can be built upon to identify institutional or policy-level campaigns that members want to engage in—an antidote to “project proliferation,” in which healthcare trainees identify an initiative they want to engage patients or community members in, but without first building rooted relationships. “When I was in high school, I had a cancer diagnosis, and that helped me to see some of the health inequities that were in the Mexican health system…. and when I went into medical school, I saw that it was more than just a drug or a treatment that was involved,” shares Gonzales. “Racism, classism, poverty. That is how I came to politics, policy … to organizing. And then … wow, to meet other professionals who are working on these topics was incredible.”

Significant work remains to be done if we are to shift the healthcare system’s core pedagogy. These efforts, however, point to a small but growing movement that is underway, spearheaded by a growing number of healthcare professionals who refuse to accept the status quo. Often lifted up as heroes, healthcare staff are in reality humans frequently tasked with doing challenging jobs in a system with a long history of harm—and are increasingly also challenged to examine their own agency within that system. These models provide an emerging vision of how these individuals—charged with caring for the rest of us—can move from healthcare to healing.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

Earlier this month, several media articles announced the launch of Love, a new health tech startup. The company claims to “act as a Kickstarter for clinical trials, crowdsourcing ideas and cash to run pharma-grade studies on the health effects of natural products—for instance, the power of turmeric to manage diabetes.”

The company, which has already raised $7.5 million in venture capital, bills itself as “people-powered pharma” that will use a decentralized autonomous organization (DAO), or a blockchain-enabled mechanism frequently used in the cryptocurrency universe to enable collective decision-making and participatory resource allocation to projects. Love claims that through this approach, it will address key barriers to adopting alternative medicine and/or modalities. For example, due to skepticism and low prioritization of these approaches in the US healthcare system, we lack data about them, and there is little financial incentive to invest in them. The company will also launch a storefront that sells supplements, vitamins, and other items.

A “litepaper” on the company’s website describes Love’s core assumption, namely, that most wellness practices have no empirical foundation: “Millions have found alternative medicine paths on places like Reddit, Facebook groups, or local communities. However, these communities lack financial means, or a pedestal, to stand on. More importantly, their beliefs are just stories; the things they claim heal them have no clinical data to back them. And, clinical data requires trials, which requires money.” Love’s newly named CEO, Ryan Breslow, echoes this sentiment, sharing, “Some people say homeopathy is a bunch of wackos, and many people say it really works. Our goal is to put an end to the age-old debate.”

Even after accounting for the broad generalizations in these statements, I was astounded at the wellspring of frustration, confusion, intrigue, and disillusionment that the new company’s announcement set off in me. As a long-time student of the ancestral healing practices of communities of color around the world—and, as an Indian American who has sought out my own healing within a whitewashed wellness industry that frequently appropriates then commodifies aspects of my own cultural background—I struggle with the complexities of companies like Love. A public health researcher, I believe in science and am skeptical of “magical cures.” I have also experienced the positive impact that building a healing practice, including meditation and energy work, has had on my health.

On the one hand, many elements of Love’s business (at least at surface value) seem to warrant excitement: acknowledging that the US healthcare system is not working; cultivating greater awareness of and investments in healing efforts that have not historically been funded in the US; democratizing health definitions and decision-making—something I deeply believe in.

On the other hand, Love’s efforts could also reinforce existing economic, racial, and health inequities that healers and wisdom keepers in Black and Brown communities already deal with, while also ignoring the structural forces that gave rise to our current healthcare and wellness industries. Much of the mainstream discourse on healing in the United States is shaped by white, affluent business owners and influencers—people who perhaps were indeed introduced to plant medicine or meditation through a Reddit thread. But for others, the entry point into traditional healing may be a daily ritual with family members or intuition gleaned from qualitative data passed down through generations.

Without democratic ways for those communities to lift up the healing practices they believe in and benefit from, and without mechanisms to ensure that companies like Love are accountable to traditional healers, we run the risk of recreating old patterns. One starting point is to interrogate the history and assumptions embedded within the US healthcare and wellness industries, as well as the financial systems that undergird them.

First, how did the idea of “alternative medicine” (or “wellness” or “healing”) come to be in the US? A limited few in our country have historically exercised power over what counts as data, as an evidence-based solution, and therefore as acceptable medicine.

Second, in what ways does commodification distort healing practices, through cherry-picking an element from its full context and selling it as a quick fix? Ancestral healing philosophies are often integrative and non-linear and leave room for multiple perspectives – a challenging fit for Western societies that seek a definitive yes/no answer.

Third, who stands to profit financially from greater openness around and adoption of these healing efforts? In the case of the growing legal marijuana market, white business owners and investors reap large profits from new ventures while communities of color, already carrying the persecution burden of racist drug policies, are blocked from accessing resources.

What Is Alternative Medicine Anyway?

In Who is Wellness For?, Fariha Roisin, a Bangladeshi Muslim, recounts her recognition that the “customs, practices, and even food of her native culture that had once made her different—everything from ashwagandha to prayer—were now being homogenized and marketed for good health, often at a premium by white people to white people.”

Many people of color see aspects of their culture, which they were ostracized for, coopted by those that did the ostracizing. Such experiences speak to the shifting nature of what is considered healthy and acceptable in our society. The earliest days of our nation’s healthcare system were deeply intertwined with burgeoning white supremacism, resulting in Eurocentric medical definitions and practice. While diverse groups of people engaged in questionable health practices—like leech therapy and bloodletting—there was a particular push to discredit non-western healing traditions, in keeping with medical racism.

The concept of “alternative medicine” today—that is, treatments that the medical establishment deems unorthodox—emerges from this history. Since BIPOC, low-income, LGBTQIA+, women, and nonbinary folks have historically been excluded from the medical establishment, what is considered orthodox leaves quite a lot of ground uncovered. Indeed, in the 18^th and 19^th centuries, even naturopathic doctors, white men who practiced botanic healing and advocated for natural rather than synthetic remedies—a popular approach among patients—were criticized by their allopathic medicine peers.

Interest in healing, wellness, and holistic medicine increased in the 1960s and 1970s, after the first half century’s scientific advancements—and the improvements in life quality that such advancements brought to those who could access care—were coupled with insights into the potential unintended consequences of medical treatments, such as thalidomide, a drug used to treat insomnia that was found to cause severe birth defects. Growing interest in natural healing methods and skepticism of establishment authority served as the launching point for the massive alternative medicine industry we see today. But even today, a limited few control what is “acceptable” when it comes to mainstream health and healing.

Beyond “Science v. Scam”: Commodifying Healing

Embedded within the language of “a bunch of wackos” is deep, long-standing stigma and skepticism regarding the potential of foreign practices to fool and harm white Americans, even though white Americans themselves have for centuries questionably commercialized components of healing practices they are not fully familiar with. For example, the phrase “snake oil”—which refers to exploiting the public by selling an unproven cure—appears to have arisen in conjunction with anti-Chinese sentiment in the 1800s. Chinese migrants working on the Transcontinental Railroad brought with them oil derived from a Chinese water-snake that was used to treat joint pain. They offered this remedy to their fellow laborers. American entrepreneurs like Clark Stanley saw an opportunity to market their own snake oil—but lacking access to the Chinese water-snake, decided to get creative. In 1917, federal investigators found that Stanley’s product contained no actual snake oil. Since then, “snake oil” has become a symbol of fraud—despite the original healing tradition it came from.

Healing practices in communities of color are integrative and multi-faceted. Healers often emphasize that what works for one person might not work for another. The focus may also be on providing physical or mental relief rather than moving the needle on a specific quantitative lab result, as is often the goal of Western medicine. Furthermore, healers typically undergo extensive training and practice-based work before they practice—as do clinicians, they base their recommendations on experience and the specific person in front of them, not blind recommendations.

In a western capitalist context that prioritizes a magic bullet that can be quickly marketed and sold, these nuances are often lost. Taking advantage of the fact that there is still a great deal of variation and unknown when it comes to the body and brain, salespeople in wellness spaces (often white and untrained in healing practices) may cherry pick an element of a broader pedagogy like Ayurvedic or Chinese medicine, divorcing it from its full context and practitioner knowledge.

Take, for example, recent excitement around the use of turmeric to manage diabetes and a number of other conditions. In Ayurvedic medicine, turmeric is viewed as an auspicious herb that helps create overall balance between the three Ayurvedic doshas—a way of understanding different elements in the world and body. Traditionally, in addition to holding spiritual and cultural importance in Indian rituals, it has also been incorporated into dishes to aid in digestion and as an anti-bacterial to protect skin and treat wounds.

This has not gone unnoticed by the American wellness industry. Today, turmeric infused “golden milk” is widely available at coffee shops across the country, and wellness influencers extol the benefits of turmeric capsules to broad audiences. While on the one hand this could be seen as beneficial—exposing people to the potential benefits of something that has long been used by other cultures—it also demonstrates the disconnection of an element from its traditions.

As these turmeric-themed products enter the American market, they invite scrutiny to (appropriately) regulate and prevent any potential harm. Western medicine prioritizes quantitative evidence—clinical studies, for example—over qualitative data, particularly from BIPOC communities. For hundreds of years, turmeric, along with other aspects of Ayurvedic medicine, has been a part of the wellness regimen of millions. Those experiences have created insights about turmeric’s therapeutic potential that has been passed down the generations. But without healers to translate those insights, that information is lost and instead manifests as a quick-fix product.

In turn, this disconnect can reinforce racist and xenophobic narratives about being sold snake oil, particularly when something may not work—while overlooking the industry marketers selling those products in the first place.

Old Modalities, New Markets

At every healthcare conference I have attended in the past year, one of the buzziest conversations has been about the emerging psychedelic treatment space. Like conversations had during the early days of the medical marijuana, then the legal cannabis movement, this conversation is characterized by anticipation about what the future could hold for this new frontier of healthcare, without necessarily grappling with psychedelic substances’ complicated political and colonial history.

Indigenous peoples have long used psychedelic plant medicines in ceremonial, religious, and community rituals. The knowledge and techniques that Indigenous shamans hold is complex—each shaman must understand how to appropriately use psychedelic compounds from psilocybin mushrooms, ayahuasca, and hundreds of other plants for a variety of healing purposes. During the colonial era, European settlers viewed Indigenous healing practices as inferior or barbarian—while simultaneously using their observations of such practices and the extraction of natural resources to advance Western medicine’s development. As colonizers forced assimilation, Indigenous people’s medicinal knowledge base eroded.

Given this history, many healers of color choose not to engage with capitalist industry, especially financial instruments like venture capital. Prioritizing a collective approach that practices abundance of earth and community, they decide that receiving dollars from an economically extractive system is not in keeping with their principles.

Other healers, however, may recognize the reality of our system and choose to engage with it anyway. Today, as with legalized marijuana, such keepers of traditional medical knowledge risk being shut out of the multi-billion dollar industry that is poised to grow out of ancient medical practices. Even as the stigma around utilizing these modalities lifts, the legacy of past harm persists—as does the predictable outcome that those who stand to profit off this new sector are unlikely to be the communities that first originated it.

This trend is not limited to these two examples—for decades, structural racism and stereotypes have restricted healers of color’s access to capital to fund their own enterprises. Though they seek to bring their knowledge to broader audiences and possess a track record of improving their clients’ health, the prevailing notion that their work is “just stories” blocks them from securing funding and exposure.

Regardless of the fate of companies like Love, there is promise in the idea that significant resources should be invested in community-based healers, experts, shamans, herbalists, doulas, bodyworkers, energy masters, Ayurvedic practitioners, trauma counselors, psychedelic guides, and many others who are bringing their (and their ancestors’) craft to those who seek to heal. Through a nuanced understanding of these practitioners and their craft, and the ways that American wellness and finance intersect with them, we can build the accountability mechanisms necessary to ensure that traditional healing communities are centered in conversation and support.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

In the United States, worker-owned models of commercial enterprise have been practiced for centuries—and have been codified into law over the last several decades. From the many worker cooperatives documented by Jessica Gordon Nembhard in Collective Courage, such as the Freedom Quilting Bee of Alberta, AL, to the large majority employee-owned enterprises that employ tens of thousands, such as Publix Supermarkets and W.L. Gore and Associates, employee ownership has long been among us. For example, Publix started its employee ownership plan shortly after the store’s founding in the 1930s and today has over 200,000 employee-owners, who collectively own about 80 percent of the company.

However, for those of us who have tirelessly fought to bring employee ownership into the mainstream, it seems as if we have come into a “moment.” Once relegated to the niche, if not novel, corners of social movement strategies and wealth management tax schemes, employee ownership as a concept and practice has begun to challenge long-standing dogmas about what business ownership is and who can—and should—have access to it.

The signs of this shift are many. They include the increasing prevalence of bipartisan federal legislation such as the 2018 Main Street Employee Ownership Act and the RISE & SHINE Act (Retirement Improvement and Savings Enhancement to Supplement Healthy Investments for the Nest Egg), which is currently moving through Congress. In the private sector, these signs include the rise of for-profit investment funds like our own and others such as the Fund for Jobs Worth Owning in Massachusetts. In short, the idea that employees should own a stake of the businesses where they work has become increasingly popular.

The Problem

Even so, the expansion of employee ownership models into the far reaches of the US economy is not inevitable, despite such models’ current popularity, COVID’s exposure of the plight of essential workers, and a “silver tsunami” of business transfers from retiring “baby boomer” owners. Indeed, without concerted efforts by both old and new economic actors in both the philanthropic and private sectors, the chance that employee-owned businesses will lead to a paradigm shift in the US economy remains small. Crises create opportunities for change, but they don’t guarantee it.

Moreover, the all-too-common idea that the expansion of employee ownership will inevitably lead to positive and equitable outcomes in communities of color, such as by closing the racial wealth gap, is not only erroneous, but dangerous. Sadly, such blind faith has the potential to leave Black and Brown workers and families even farther behind.

The Solution

Today, the economy is at a crossroads; our decisions will determine if the nation continues down the path of greater inequality and diminished opportunity or chooses something better—an economy in which employees share in the rewards of a business’ success.

The creation of a world in which employee-owned businesses thrive as an economic sector and asset class—while not exacerbating the wealth and ownership gap between white and Black and Brown families—requires doing three fundamental things. Each strategy is detailed below.

1) Reducing the Cost of Capital

For employee-owned businesses to become a significant sector of the US economy, capable of capturing investment from broader capital markets—including public pensions, insurance companies, and private investors—employee ownership advocates must work to reduce the perceived risk of, and thus the cost of capital for investments in, employee ownership.

A firm’s cost of capital reflects both how risky a company or sector is perceived to be by those looking to invest, and the availability of investment capital. Functionally akin to a personal credit score, a firm’s cost of capital determines what type of investment—whether equity, debt, or mezzanine (which, as the word suggests, offers a form of financing between debt and equity, such as a loan that is convertible into company shares)—a company can receive and at what cost. Indeed, significant research shows that the cost of capital is a key determinant of a firm’s long-term success.

The cost of capital becomes even more important if the goal is to expand employee ownership because rapid expansion requires outside investment. Indeed, while certain firms with highly paid workforces or altruistic owners may be able to self-finance and essentially “buy their labor back from their employer” (for example, an accounting firm that employs certified public accountants), the employees of most small businesses that could thrive as employee owned—such as a landscaping company or manufacturing plant—can’t afford to finance the buyout themselves.

There is a work-around for these businesses, but the traditional route requires a patient and oftentimes independently wealthy seller who is willing to delay their own exit by selling the business in tranches to its employees, often over seven to 10 years. For very many business founders, the decision to retire and sell their “baby” after decades of work will be one of the hardest decisions in their lives, and completing such a sell over the course of a seven-to-10-year process is simply not an emotional option, whether or not it is a financial option. This is to say nothing of the regulatory red tape that accompanies most employee-ownership transitions.

Absent a seller willing to go through the traditional process, expanding employee ownership in sectors where workers do not earn enough to be able to self-finance requires external investor capital. However, if investors do not understand employee ownership, have little experience of how it works, and are unaware of how conversions to employee ownership can be profitable for the investor at lower risk than traditional investments, then fewer investments will be made, and those that are made will be priced at an inflated cost. As a result, the opportunity to convert many businesses, as baby boomer owners retire, to employee ownership will be missed—resulting in lost jobs, lost local businesses, and a lost opportunity to achieve greater equity.

What can philanthropy do to help de-risk conversions? Three key interventions are to: 1) support and promote research and real-world examples that establish the strong financial performance of employee-owned businesses; 2) invest “catalytic capital”—this can take many forms, including “credit enhancements,” such as loan guarantees or capital grants to provide firms focused on employee ownership with the operational runway to fundraise; and 3) provide early, first-in capital.

2) Requiring a Focus on Racial and Class Equity

The above indicates how to make conversions to employee ownership easier. That is important, but without an explicit commitment to addressing race and class specifically, employee ownership will fail to narrow the racial wealth gap and income inequality. This means that the who of employee ownership matters as much as the what.

Employee ownership can only reduce income and wealth inequality if investments are made in firms that employ both a large number of workers of color and a significant number of low- and moderate-income (LMI) workers.

At the firm where I work, Apis & Heritage Capital Partners, we only care about employee ownership opportunities to the degree that they serve as effective tools in reversing the immoral trends that leave the majority of families in the wealthiest country on earth incapable of handling a $1,000 emergency expense, with trend lines indicating that, absent a change in how the economy functions, Black and Brown families are on track to fall below a median family household net worth of zero in the coming decades.

Employee ownership can be a powerful tool for interrupting this trend. Nonetheless, it is dangerous and erroneous to assume that employee ownership will inherently result in a fair and more equitable economy. Indeed, research shows persistent racial inequality within employee-owned companies. A 2021 Aspen Institute report, for instance, found that the average white employee-owner had a ownership share value of $63,000, while Black and Latinx employee-owners had an average ownership share value of less than $39,000. Now, $39,000 is well above the median Black household wealth of $3,600 or the median Latinx household wealth of $6,600 (2016 figures). Still, no one would claim that a $24,000 gap is equitable.

Moreover, when investment is made in the creation of employee-owned firms absent any goals to reduce the racial wealth gap, outcomes will likely reproduce the same systemic mechanisms that plague the traditional investment community, resulting in underinvestment and predatory investment in Black- and Brown-owned businesses and Black and Brown workforces and communities.

In short, to address systemic inequity while investing sustainably and profitably, it’s vital to demand not just the tracking of impacts, but the institutionalization of goals to reverse these trends.

3) Investing in Ownership Culture and Democratic Practice

Does employee ownership lead to good jobs? It can, but again, not automatically. Employees holding equity in the companies where they work does not guarantee quality jobs. While the alignment of company, worker, and investor interests through governance structures that are accountable to workers as both stakeholders and shareholders—a model that has been institutionalized in Germany—can help, decades of diminishing worker voice and influence coupled with extreme disconnects between company profitability and worker wealth will not be undone overnight. Investment in employee training and education to “think like owners”—internalizing their own fates with that of their business—and management and executive training on worker engagement and investment are key to creating firms where employee ownership doesn’t just mean having a low-quality job with an “enhanced retirement account.”

For these reasons, developing an ownership culture, democratic governance practices, and human-centered human resources are not just “nice to haves” but essential. Nonprofits can help ensure that firms invest in these practices. Our firm, for instance, has partnered with the Democracy at Work Institute to support extensive training to empower workers to engage fully as employee owners and to coach management on how to internalize and build on this culture. This training is designed to cover a variety of topics, including “open book management,” a practice of sharing key company financial information with every employee at the firm; democratic governance, enabling workers to vote for representation on the companies’ boards of directors; and a variety of human-centered human resources practices.

Can Employee Ownership Be Both Profitable and Beneficial for Employees?

One may ask whether investment into matters like an ownership culture pays off. The answer is, it does. A significant body of research—both quantitative and qualitative—shows that engaged workforces have lower turnover and are more productive. This in turn creates companies that are more resilient during economic downturns, even as they grow faster and are more profitable during good times. Indeed, as the pandemic and the newest generation of workers are showing us—better said, reminding us—investment in people is the best way to build a business.

Again, employee ownership models, whether visible or invisible to the broader US economy, will always exist, both through worker cooperatives and companies owned by employee stock ownership plans. However, existence is not the most important question facing employee ownership.

The reality is that employee ownership—if widespread—can be a vital tool for reducing the racial wealth gap. The reason for this is simple: business asset ownership in the United States is presently distributed in an astonishingly unequal manner. Economist Ed Wolff, drawing on data from the Federal Reserve’s 2019 Survey of Consumer Finance, reports that the top one percent own 36.9 percent of all stock (even when accounting for retirement holdings), 54.9 percent of direct stock and mutual fund holdings, and 64.5 percent of business equity. Distributing business equity among all workers through employee acquisitions of strong companies from retiring founders—a strategy that that is commonly called an employee-led buyout—could dramatically change those numbers.

Nonetheless, without intentional and strategic investment by both public and private actors to promote greater race and class equity, employee ownership will fall far short of its potential. That would be a shame because the need to create an economy that is democratic, equitable, sustainable, and resilient has never been more urgent.

This article originally appeared in the Nonprofit Quarterly. See the original article here.