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Isabelle Moses: I had the pleasure and the pain, the suffering, of writing “A Journey from White Space to Pro-Black Space,” which, I have to say, some of my experience of working on this piece was that it was really, as much as it has my name on the byline, it really felt like a very strongly collaborative effort both with colleagues of Faith in Action but also with the editing team at NPQ. I think having an accountability partner and a coach, and somebody who was really able to help me move past some ideas that were kind of nascent but not quite fully emergent and help me name those things was so valuable. And then I had probably 10 pages of mishmash, and Steve Dubb was able to turn it into something coherent which didn’t take my voice away. So, I was really impressed. I was like, oh, I still hear myself in this, but you’ve turned it into something that, like, I couldn’t necessarily do on my own. So, I just really want to shout out the partnership, because I really feel like Cyndi, your vision of having writers who are not traditionally seeing ourselves as writers be able to express our ideas in this way really required that type of extra support. And so, I just want to really appreciate that.

I will also say I had some impostor syndrome around, like, can I tell this story? Our organization is not perfect, and we still have so much more work to do. And can we share something that’s in process, knowing that we haven’t gotten to the promised land yet? And we’re still not at the promised land and, in fact, shortly after this article came out, or around the time that it was in publication, we were putting on this very, very stressful event in Washington, DC and all hell broke loose. Even though it went ultimately really well, there was some real hurt that happened within our staff team because of the stress of trying to put on a big event. We haven’t seen each other in two years, middle of a pandemic, and it just was a reminder how much more work we still have to do to kind of overcome some of the ingrained practices that we fall back on when we’re in crisis, urgency, under deep stress. And I was like, oh, when we figure out how to do something like this and don’t cause each other harm, we will have really figured it out. So, we still have more work to do, but I think it’s okay to celebrate the progress, even if we know that we’re not all the way where we want to be.

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

Lisa   

Where’s Miles? I thought he said he could be here at six.  

Damon  

He said he got held up, but he’s on his way now.   

Lisa   

Weird. He’s always on time.  

Damon   

Yeah.   

(To Miles) Whoa, what’s up with you?  

Miles   

You will not believe the day I just had.   

Lisa   

Today was that implicit bias training with that care center, right?  

Miles   

Oh, yeah. 

Damon 

What happened?  

Miles   

So you know how I got called in after an incident with the head nun?  

Lisa   

Yep. Good old Sister Maureen.  

Miles   

Right. So, I get there, and the entire management team is there. All white, mostly graying. And right next to them is the new head of HR who called me. This young Black woman. 

Damon   

Poor woman.  

Miles   

It gets worse. So, I’m taking this rapid COVID test, and I’m waiting for my results when all of a sudden, this blur of black and white goes rushing past me and out the door! It was Sister Maureen running out the door in full habit. She decided to do an Irish goodbye to the implicit bias training.  

Damon   

Wow. It’s the flying habit that really seals it. 

Lisa   

How symbolic. She couldn’t break her habit. 

Miles   

She was 75. She was retiring in two weeks. She was just like, “Oh, I’m too old for this. If I haven’t changed now, how am I supposed to change in two weeks?” It’s like retirement is home base and she’s trying to slide in before she gets tagged out? 

Lisa   

Right. It’s like she’s trying to get home safe before the rest of the world wakes up to white mediocrity and raises the standard. 

Miles   

Exactly. Why change when the end is in sight? 

Damon   

The fact that she literally ran out the door! That kind of panic is spreading now. White people are learning that people of color are raising the standard. And they don’t even know how to begin to meet it. 

Lisa   

Oh my god, that reminds me of this interview I had last year. They kept calling me back in for interview after interview. And each time they called in more and more members of the hiring team and board. But my fourth interview, I was sitting in front of a panel of 10 people.  

Miles   

Whoa.  

Lisa   

Yeah. And then finally, at the end of the day, they said, “We don’t understand. Can you just tell us, are you practical or are you visionary? We just don’t understand how you can do it all.” And I just said sorry, guys, you’re just gonna have to accept that I’m just really damn good.  

Damon   

Good response. Did you get the job?  

Lisa   

No. But at that point, I was like, fuck y’all, you know? But the fact that they made me jump through all those hoops and I still didn’t get the job—because what? They couldn’t make sense of the fact that I didn’t fit into their paradigm? Because I could do all these things and they couldn’t understand it? 

Damon   

If you were just one, just visionary, just practical, you probably would have gotten the job.  

Lisa   

Exactly. When the people in charge have such a small frame, no real change ever happens.  

Miles   

And now people of color are bursting open the frames and letting the light in, and they are literally running for the hills!  

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

Over the years, in our roles as staff at Community Wealth Partners, we’ve spoken and worked with hundreds of Black, Indigenous, and other BIPOC nonprofit leaders. They’ve consistently told us that current capacity-building approaches often miss the mark—or worse, contribute to inequities in the sector.

But they’ve also shown us what it looks like—and what impact is possible—when they get the capacity-building support they need. Below, we share their insights, alongside direct quotes from focus groups and interviews we’ve facilitated on behalf of funders who want to support BIPOC-led organizations.

National data reinforce the urgent need to shift capacity-building practice. A 2022 Nonprofit Finance Fund survey shows that compared to BIPOC-led nonprofits, white-led nonprofits received more unrestricted funds (15 percent more), more federal funding (14 percent), and more corporate funding (13 percent more). Meanwhile, more BIPOC leaders bring lived experience representative of the communities they serve than white leaders (39 percent more). Although funders are increasingly trying to support these nonprofits and deepen their own focus on racial equity, a Center for Effective Philanthropy survey shows that one third of interviewed nonprofit leaders said funder actions on racial equity didn’t match their rhetoric.

It’s time to act. It’s time to adopt capacity-building approaches that leaders of color say will actually help. Below are three basic principles to guide these efforts.

Principle 1: There’s no one right way for nonprofits to be effective. Capacity building is about supporting nonprofits to choose and invest in how they want to change. 

Listen to what people say their needs are. —Nonprofit Leader

Traditional capacity building often prioritizes a narrow vision of what an effective nonprofit looks like. In an NPQ article from 2019, Sarah EchoHawk emphasizes this issue in relation to Native nonprofits, arguing that forcing nonprofits to adhere to preconceived standards of success turns capacity building into a colonialist practice. As Kathleen Enright, the former head of Grantmakers for Effective Organizations, observed years ago, that vision often rewards nonprofits “most skilled at navigating the thicket of hurdles, requirements and processes put in place by philanthropy,” which disadvantages smaller, BIPOC-led organizations.

This traditional approach is reinforced by white dominant cultural norms of perfectionism (e.g., focusing on perceived inadequacies) and paternalism (e.g., assessing and defining the “weaknesses” for capacity-building support). For example, traditional capacity assessments tend to focus on deficits and reinforce the assumption that an organization needs to be strong in all areas. This assumption isn’t always realistic or helpful. There are alternative ways to think about assessments as tools that lift up different perspectives from internal and external stakeholders and help guide conversation within a nonprofit about where they want to focus their time.

Capacity building should be about resourcing nonprofits so they have the time, networks, and skills they need so they can focus on delivering their mission.

When we conduct capacity assessments, we guard against assessments becoming a punitive tool in a few ways, with the aim of designing them to provide grounding for helpful discussions with funders and nonprofits about opportunities to provide meaningful support. First, the results for individual organizations are shared only with the organizations themselves; funders see aggregate data but not individual reports. Second, we encourage nonprofits to view the assessment and the results as a tool for conversation. The findings can help illuminate where there might be differences in perspective about an organization’s strengths and challenges as well as the types of capacity support that could be most helpful. They are not intended to dictate where an organization focuses its capacity-building efforts. Many nonprofits have shared that the assessments have been a helpful tool for conversations with staff and board and have helped them make decisions about where to invest in strengthening capacity.

The bottom line is, nuance, not a one-size-fits-all approach, is required in supporting nonprofit capacity. Sometimes, the most valuable thing for a nonprofit might be building their current strengths while finding ways to outsource or collaborate around areas of need. Capacity building should be about resourcing nonprofits so they have the time, networks, and skills they need so they can focus on delivering their mission.

Principle 2: Capacity is built through unrestricted funding paired with long-term, tailored supports.

Stop inviting me to trainings. Most of the time we can do the training better. I hear that a lot of leaders go to trainings only because they are tied to funding. Give investments to Black and Brown leaders and trust them. —Nonprofit Leader

First and foremost, capacity is built through unrestricted funding. When organizations have full power to decide how to spend funds, they can invest in their priorities. There’s also data showing the power of pairing unrestricted grants with designated capacity-building grants.

When it comes to how you support designated capacity-building opportunities, one-off trainings certainly have their place but should not be the primary way to strengthen capacity. Instead, capacity-building opportunities need to be sustained over the long term. BIPOC leaders also point to the value of relationship building (connecting with and learning from peers) and individualized support (such as coaching or programs tailored to the needs of a subset of grantees).

The Southern Reconstruction Fund provides what they have coined as restorative capital to organizations and leaders that are transforming their communities, thereby helping strengthen the resilience of the American South. As the fund’s website says, “Traditional philanthropy starts and stops. Restorative Capital walks alongside communities as they rise to health, wealth, and prosperity.” The fund makes philanthropic and equity-based investments in communities of color as they decide for themselves the goals they will pursue and the mix of financial mechanisms (philanthropic grants, program-related investments, loans, etc.) that will best help them achieve their goals.

“For too long philanthropy has rewarded those amongst us who tell the worst stories about our communities the best. We have to realize that Black communities in the South do not have a human capital problem, but we do have a capitalization problem,” said Dr. Dorian O. Burton, managing partner and CEO of the Fund. “These racialized barriers to capital are a result of centuries of racist behaviors and bad policies that continue to be extractive and exclude Black communities from markets, investment, and self-determined community wealth and health. Philanthropy makes decisions about communities often absent this historical context and frames communities as ‘problems’ or having problems that need to be solved.”

Principle 3: Capacity building requires change not only at the individual and organizational level, but also in the ecosystem as a whole.

There is a notion that capacity building needs to happen for people and organizations, but I personally don’t like the term. I would prefer to use “cultural transformation.” If we’re talking about supporting organizations and individuals, we have to think about how we are going to change the systems that have oppressed us. —Nonprofit Leader

Current capacity building often focuses on individuals and organizations as the units of change. Those are critical, yet we know sustainable change relies on the strength of an ecosystem. Capacity building that focuses only on individuals and organizations fails to address the broader ecosystem of funders, service providers, community groups, movement leaders, government, businesses, networks, and groups not formalized into 501c3s.

In Southeast Michigan, a network of local partners came together to create a new definition of capacity building—one that emphasizes the connectivity between individuals and organizations in the nonprofit sector and that also recognizes the racial, social, and economic barriers nonprofits face. In 2019, these partners came together to launch a hub for nonprofits called Co.act Detroit. Co.act’s mission is to accelerate collaborative action among nonprofits and community organizations in Southeast Michigan. The hub works to leverage capacity supports that already exist and fill the gaps that remain so that nonprofits have access to a broad range of services to support their capacity. Since its launch, Co.act has become an essential resource for nonprofits, a trusted partner to intermediaries and a convener of cross-sector partners. Through equitable grantmaking, collaborative networks and expanding nonprofit access to innovative resources Co.act Detroit is addressing systemic barriers that impeded nonprofit success and equitable outcomes for communities.

The ability to help strengthen the collective capacity of organizations within an ecosystem relies on having access to intermediary organizations with the knowledge, skills, and capacity to provide the services organizations need. When the Kresge Foundation designed a program to help develop leadership capacity through a racial equity lens among its grantees, the program included an explicit focus on the intermediary organizations that provide leadership development services to nonprofits. In addition to providing funding, training, and peer support to grantees, Kresge’s Fostering Urban Equitable Leadership (FUEL) program also provides funding and peer support to a set of service providers. Investing in the capacity of these providers has led to outcomes such as 1) increased effectiveness and efficiency of service delivery, 2) strengthened capacity of capacity builders, and 3) greater collaboration and coordination among service providers.

“Being in work that is fee-for-service or grant dependent means that you’re often isolated,” said Jessica Vazquez Torres of Crossroads Antiracism and Training. “The FUEL program provided a place of collaboration, learning, and camaraderie across a set of shared commitments to notions of equity from organizations that normally would compete with each other for the same RFPs or who would be passing each other because we exist in this parallel world.”

Funders’ actions can also impact the strength of an ecosystem. One way that funders can contribute to a strong nonprofit ecosystem is by convening grantees to learn from and support one another. In capacity-building cohorts we have facilitated, time and again grantees find tremendous value in being able to connect with and learn from their peers. Busy nonprofit leaders don’t always have the time to prioritize networking, and the structures and supports funders provide for peer connection are often appreciated.

In addition to fostering connection among grantees, funders can connect and coordinate with one another to help strengthen the ecosystem. Coming together to share strategies and plans can illuminate which areas in an ecosystem are well supported and where there are gaps. Being aware of one another’s timelines and processes might surface opportunities to streamline grant application and reporting requirements, thereby minimizing the fundraising burden on grantees so they have more time to focus on their missions.

What Can Philanthropy Do?

The philanthropic sector is awash with recommendations for practice. At Community Wealth Partners, we have created our own resources including an equitable capacity building field guide and a set of five recommendations for leadership programs.

How might foundations shift their capacity-building practices? It starts with a willingness to shift power.

But fundamentally, there is no data problem. Most people in the field know what should be done. Even so, debate continues on whether to trust nonprofits with unrestricted funding—or wait until smaller organizations are “ready.”

The results are evident: leaders burn out, harmful public policies continue to become law, and inequities are deepening. A sea change in philanthropic practice is overdue.

How might foundations shift their capacity-building practices? It starts with a willingness to shift power. Philanthropic leaders can begin to shift power by asking the nonprofits they support what they think and then changing practice to match what the nonprofits they survey say they need.

Of course, it is not enough for philanthropy to survey nonprofits. Foundations should also survey themselves. Here are three sets of starter questions:

• What level of investment is our foundation making in nonprofits’ capacity? Is that sufficient for the outcomes they hope to achieve? Is the level of investment equitable between our white-led and BIPOC-led grantees?
• How else is our foundation supporting BIPOC-led organizations? In what ways are we providing helpful support to them? How might our funding practices present barriers to BIPOC-led organizations? What changes should we consider?
• Do grantees receive multi-year, unrestricted funding? If no, why not? If yes, what share of our grants budget does this represent, and is that enough? What justifications are used to provide restricted support rather than unrestricted?

A New Way Forward 

What’s possible when you fund and trust BIPOC leaders and capacity builders to do their work the ways they know it needs to be done?

 —Nonprofit Leader

If philanthropy wants to contribute to thriving, equitable communities, there need to be changes in who receives funding and how funding flows.

BIPOC-led organizations are more likely to be proximate to the communities they serve and have deep, trusting relationships with community members. As a result, they’re more likely to be able to drive change in communities and should receive more support from funders.

Nonprofits pushing for long-term, systemic changes need long-term, flexible support. Offer multiyear, unrestricted grants. Funders must support opportunities for connection, peer support, and collaboration. And, most importantly, they must give nonprofits the type of support they say they need.

Carla Taylor, Megan Coolidge, and Lauri Valerio are vice president, senior consultant, and affiliate consultant, respectively at Community Wealth Partners. Collectively, they have worked with dozens of funders to design and deliver capacity-building programs for hundreds of nonprofit organizations. The authors are grateful to Maria A. Fernandez for review and feedback on this article.

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

This is the third 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 practitioners by speaking to both histories, combining research with examples of health liberation efforts.

Imagine with me, for a moment, that when you feel physically, emotionally, or spiritually unwell, your first stop is a nourishing, natural space. It envelops you in warmth and the familiar scents of the herbs, that possibly your grandmother grew. The healers that greet you deeply understand your social history because the structure of their work allows ample time for listening. They, alongside you and members of your community, have built deep relationships through participatory workshops that have enabled all to have a direct say in the services and traditions that are offered. The guidance offered in this space reflects collective understanding of the costs to health imposed by oppressive systems, and harnesses expertise in the practices and rituals your ancestors relied on to survive. Bodies and identities of all kinds are accepted, nourished, and encouraged to play—rather than restricted or controlled.

Across the country, our current healthcare system addresses sickness with sterile clinic rooms, excruciating wait times, rushed visits, overworked staff, and discriminatory systems.

This is a dream, unfortunately, and far from reality. Across the country, our current healthcare system addresses sickness with sterile clinic rooms, excruciating wait times, rushed visits, overworked staff, and discriminatory systems. In the first two articles of this series—Reclaiming Control: The History and Future of Choice in Our Health—we delved into how the legacies of white supremacy, profit maximization, and patriarchy have shaped our existing healthcare system. We examined how many organizers and movements are wading into what appears like the nightmare of transforming a system that is massive and technically complicated. This installment in the series turns to—another set of actors: those seeking to actualize dreams by building alternative models centered in collective visions for healing.

These organizations, often led by women and nonbinary people of color, offer pathways to health based on a dramatically different set of values and approaches than the traditional medical care complex. Some of them are embedded in the healing justice movement, which was named in 2007 by the Kindred Southern Healing Justice to honor a history of BIPOC, queer, trans, and disabled communities looking to ancestral healing practices in order to address generational trauma from systemic violence. Drawing upon ancestral wisdoms, as well as present-day insights, they choose to center liberation, rest, communal support, autonomy, and more—rather than the medicalization-first approach that dominates in the US.

These models explore systems disruption at multiple levels: individual, institutional, and systemic levels. At the individual level, these entities radically design care around the person, rather than forcing individuals to conform to a predetermined course of care. Founders of and participants in these models also prioritize epistemological diversity, pulling from ways of knowing that exist outside of western, white-dominant spaces. In doing so, they are testing how remedies passed down within cultures for centuries may be particularly effective for addressing conditions related to trauma and stress. They are also acknowledging that, since our mainstream healthcare system emerged from conditions that frequently exploited and denied the rights of oppressed communities, it is useful to understand how those communities practiced healing and well-being.

At the institutional level, these organizations are challenging existing governance and organizational structures for health: many of them, for example, follow cooperative or collective models in which healers and members exercise ownership over the strategy, operations, and revenue generated. In this way, these organizations are not only providing a different approach to healing, they are also creating new organizational structures within which that healing can take place. If one of the major challenges of the existing way that control manifests in the healthcare system is removing choice, then these structures demonstrate what it looks like for people to be actively involved in decision-making about the services, investments, and management that comprise health.

And while these organizations may be most frequently focused at the place-based level, where they can engage communities directly, many of them are also linked at the systems level to movement spaces that are fighting for a number of shifts, from corporate accountability to worker conditions to Black maternal health. These connections can happen on two levels. First, by recognizing that political and social forces directly impact wellness, these organizations often bring this power analysis to their work. And, second, many are also focused on actualizing a healing justice framework—informed by economic, gender, racial, reproductive, and disability justice movements—to ensure the role of healing inside of movement environments.

Alternative Approaches Centering History and Autonomy

Founded in 2014, Harriet’s Apothecary is a collective of healers, health professionals, activists, and others that “self-organizes to center healing, wellness and resilience without relying on the medical industrial complex, while also taking health institutions to task about how they create safer and thriving spaces for BIPOC people.” The group centers a Black, queer, feminist analysis that acknowledges the root causes of marginalization and violence, and prioritizes affordability, accessibility, and honoring all bodies and genders.

The programming and services offered through the organization speak to this specific analysis, spanning a wide variety of formats and objectives. Their healing villages, for example, supports the BIPOC community’s healing from stress and trauma, by offering a broad set of healing offerings ranging from plant-based medicine making to somatics bodywork, thai yoga massage, herbalism, and more. These villages are intended to cater to people who may find other healthcare settings harmful or unsafe.

In addition to these direct services, Harriet’s Apothecary provides political education and leadership training focused on enabling participants to examine the challenges of the traditional medical care system, and to develop storytelling and tools related to indigenous methods of wellness and care. Via community workshops and skillshares, the organization focuses both on movement-building and equipping participants with rituals and practices they can bring back to their own communities, schools, and families.

In Baltimore, the Village of Love and Resistance (VOLAR) was co-created as a self-sustained, cooperative community space for health and wellness. Founded in East Baltimore—where residents and communities have long grappled with historical harms driven by healthcare systems—VOLAR seeks to reclaim land, foster healing, and build a base of community power.

The organization has raised funds to purchase buildings that will be transformed into healing spaces and facilities, including a community wellness center, a small business incubator for Black and Brown-led healing enterprises, and a community organizing academy. To enable reclamation of land in a place where Black and low-income community residents have often faced barriers to property ownership, the organization is using a community investment trust fund model that will provide low-dollar investment opportunities to existing residents, and ensure that they can take part in the redevelopment of their own neighborhood rather than experiencing gentrification.

In addition to co-creating and sustaining community-led spaces for healing, some organizations are also bringing their unique healing systems and frameworks, as a point of discussion, to other places where people of color are grappling with questions related to health. Black Womxn Flourish is a design-for-wellbeing collective that utilizes collaborative, community-led spaces, visioning, and healing-centric experiences to shape the future of Black womxn’s health. In a year-long collaboration with Living Cities, the organization developed and facilitated co-design sessions for the Closing the Gaps network, a gathering of anti-racist organizers convened in collaboration with Living Cities.

The sessions were designed to center the wellbeing of Black women leaders who are asked to hold racial equity work for their organizations. They were rooted in a pro-Black vision for the future and sought to answer:

• How might we cultivate life-giving environments where the full promotion of Blackness can flourish?
• How might we integrate healing justice practices into racial equity work that fortifies the minds, bodies, and spirits of Black women?
• How might we protect Black women’s personal and creative agency as they lead transformative work within their communities?

Specifically, the organization used P. Ife Williams’ “creative healing praxis,” which delves into how Black joy and creativity is related to healing relationships. By centering compassion, imagination, and holistic perspectives, the sessions generated both recommendations and creative manifestations of wellbeing.

Figure 1: Artwork from Closing the Gaps sessions

Dream spaces are particularly crucial to organizations that are working to re-envision and create multiple paradigm shifts at once.

Denise Shanté Brown, founder of Black Womxn Flourish, describes the role of imagination in their organization’s work, including the development of Dreaming Flourishing Futures: A Black Womxn’s Manifesto for Designing the Worlds We Must Have to Be Well, to be released this fall: “In 2020, when we felt an ever-present call for audacious leaps of imagination to propel us towards a future in which we are all free, we extended invitations to our community to gather virtually… participants moved through a generative journey of somatic exploration and guided visualizations rooted in Black Imagination, collective collaging, affirmation writing, and the creation of artifacts from a Black womxn’s flourishing future from the chosen years of 2025 to 9262.”

Dream spaces are particularly crucial to organizations that are working to re-envision and create multiple paradigm shifts at once. New Seneca Village is a recently launched initiative that seeks to bring together BIPOC cis, trans and nonbinary leaders and healers via pilot residencies that provide space for healing and reflecting. Ultimately, the effort seeks to secure a large piece of land as well as a $110 million endowment that will enable the transfer of that land to a community-governed, mission-driven land trust. New Seneca Village is intended to center connection to a natural, nurturing environment that enables both social justice leaders and healers to gain some respite from their leadership roles and engage in collective visioning, skills exchange, and as described in the organization’s year one update: “a line in the sand against the ongoing, burnout-inducing nonprofit system, and a bulwark against the potential loss (actual or psychic) of these strong leaders from organizations and movements that survive because of their expertise and dedication”.

The first year of the effort convened leaders and healers from across the country, but rather than focusing on professional purpose and planning for the community, participants instead spent time simply relationship building and “being.” Going forward, an advisory circle as well as those who have been part of the New Seneca Village community to date will also engage in collective visioning to shape the village ecosystem and future direction.

The noise—and size—of the wellness industry can often obscure the importance of models that truly are rooted in community responsiveness and the efforts of practitioners whose work is that of systems change rather than sales.

Ain Bailey, founder of New Seneca Village, shares how healing and imagination are intertwined: “So many women—and I’ve had my own organizational trauma—have this same story…in a nonprofit calling, we’re looking and saying, we could do better; lives could be changed. But then the [traditional] spaces organized around that are so resistance to change and transformation, rather than trying new things in a way that is abundantly resourced and all-in. That then pulls us deeper into work that is not always grounded in our own vision and sovereignty. Instead, let’s adopt an abundance framework and live into that as much as possible, because that is the baseline state of this planet. How do we practice that?”

Visioning Into the Future

One challenge that exists alongside these alternative models—that are deeply rooted in ancestral practices which enable BIPOC communities to thrive—is the proliferation of a commoditized wellness industry that often appropriates those practices and packages them for white, upper-class audiences. The noise—and size—of the wellness industry can often obscure the importance of models that truly are rooted in community responsiveness and the efforts of practitioners whose work is that of systems change rather than sales.

Another challenge is that models that prioritize community responsiveness require an enormous amount of investment and effort from their founders and communities. Because they are designed to present alternatives to a massive set of systems, those who are engaged in them carry the burden of identifying how the work is supported, funded, and grown. As they do so, they frequently face significant skepticism and resistance to the viability of their visions. Furthermore, many of those who can seek care within these alternative spaces may still have to interface with the traditional medical care system, whether for their own wellness or in the role of a caregiver. In these cases, the distinctions between a healing space and a medical industry space can be jarring.

Yet, despite the challenges, these organizations continue to dream—connecting the ancient to the present, co-designing rather than paternalizing, and soothing trauma rather than exacerbating it. Their stories light the way forward to imagine what could be.

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

“We’ve been out front, but we’ve been very careful,” observed Frances Padilla, president of the Universal Health Care Foundation of Connecticut. Padilla was speaking as part of an opening plenary at the annual conference of Grantmakers In Health (GIH). The conference—held this summer in Miami, FL, and online—brought together about 600 participants from over 200 organizations, most of which work in the field of health philanthropy.

On the panel, Padilla and her philanthropic colleagues contended that health philanthropy needed to be less careful and more aggressive in supporting power building in low-income communities and communities of color, both to advance health justice and to resist efforts to dismantle rights to healthcare, with the US Supreme Court’s recent decision in Dobbs v. Jackson that overturned Roe v. Wade looming particularly large.

The panel’s title was “40 Years Together: Focused on the Future.” The “40 years” was in recognition of the fact that GIH hired its first full-time staff person in 1982. Participating on the panel, in addition to Padilla, were GIH president Cara James (who moderated the discussion); Drew Altman, CEO of Kaiser Family Foundation; Dr. Robert Ross, CEO of The California Endowment (TCE); and Qiana Thompson, CEO of Health Forward Foundation, based in Kansas City, MO. In their remarks, panelists empathized the need for the health philanthropy field to focus on addressing economic and racial inequality to achieve better public health outcomes.

What is a Health Conversion Foundation?

A core constituency of GIH, representing roughly half of the association’s funding partners, are health conversion foundations. Indeed, at the opening plenary session, three of the panelists—Padilla, Ross, and Thompson—were CEOs of health conversion foundations. There is some irony in this, since these foundations owe their existence to one cause of the problems that the foundation leaders were calling on their field to address.

As Allen Smart of Philanthropy Rx, along with Doug Easterling and Laura McDuffee of the Wake Forest School of Medicine, detail, health conversions foundations are the direct result of the conversion of nonprofit hospitals, health care systems, and health insurance plans to for-profit ownership or their acquisition by for-profit companies, the same owners and companies that have regularly employed their political and economic power in ways that have increased inequality in healthcare and impeded health justice overall in the United States.

The growth of the health conversion field has been remarkable. According to Health Affairs, as of 1982, there was exactly one health conversion foundation nationwide. By 2014, that number had increased to 228. And by 2018, according to GIH, that number exceeded 300.

How are these foundations created? When a conversion or acquisition takes place, federal law requires that the proceeds be used for some charitable purpose. Typically, Easterling, Smart, and McDuffee explain, “the proceeds from these transactions are transferred into the endowment of a foundation that maintains the general mission of the entity which was sold (that is, improving or advancing the health of the population served by the entity).” For example, TCE, the field’s largest foundation, was formed in 1996, when the nonprofit Blue Cross of California converted to a for-profit firm and acquired the for-profit subsidiary WellPoint Health Networks. Today, TCE has assets in excess of $3 billion. By 2018, the assets of health conversion foundations nationwide approached $40 billion.

While health conversion foundations owe their origins to pernicious commercialization and privatization trends, their growth has resulted in a much larger health philanthropy field. Typically focused on a region or a state, many of the more nationally prominent health conversions foundations, such as TCE, have pushed the field to address social determinants of health, including by offering direct support to local movements for racial and economic justice.

Is health philanthropy resulting in a healthier America? At the GIH [Grantmakers in Health] plenary panel, there was considerable doubt and exploration of this question.

Back in 2017, Taz Hussein and Mariah Collins, writing in Health Affairs, observed that, “The enormous and growing assets of conversion foundations don’t automatically translate into a healthier America, of course. But many make a real effort to address the most important health and wellness needs in their communities.” Hussein and Collins also noted, as did panelists at the GIH conference, that many health conversion foundations have played a major role in supporting advocacy around the creation, preservation, and strengthening of the Affordable Care Act (ACA).

Taking Stock and Learning Lessons

So, to restate the question asked by Hussein and Collins: Is health philanthropy resulting in a healthier America? At the GIH plenary panel, there was considerable doubt and exploration of this question. For her part, Thompson said, “We need to take a step back and ask ourselves. Who are we as a field? Why do we exist as health philanthropy? What is our purpose and view of contemporary conditions?”

Responding to her own question, Thompson added, “It is time to shake up things. It is time to change some things.” In particular, Thompson called for a greater philanthropic focus on policy and advocacy. Padilla concurred, calling on the field to use foundation resources “to build power.”

“But the thing we have got to learn is we need to take innovation for innovation’s sake off the altar of philanthropy and put power at the center of it.”

Thompson also emphasized that shifting philanthropic resources to build community power meant shifting resources away from other initiatives. “When I think about what is happening, I need to communicate the importance of discontinuing programming this thing to death. Programming is fixing people. People have never been broken. They have never been broken. It’s our systems. It’s our structures that are broken. We cannot program our way to health change and health justice.”

For his part, Ross discussed some of the lessons that resulted from a 10-year program that TCE had led. Called Building Healthy Communities, the effort, which ran from 2010 to 2020, involved $1.5 billion in grants made over 10 years in partnership with 14 California communities. “What we learned,” Ross said, is that “the surest path to community wellness is through a robust, inclusive, participatory democracy.”

Ross added that, “You can get as cute as you want about bold innovation and new killer apps. That stuff is fine … But the thing we have got to learn is we need to take innovation for innovation’s sake off the altar of philanthropy and put power at the center of it. That is what this is about.”

As an example, Ross asked rhetorically, “You saw how long it took us to get to the ACA? That wasn’t a data problem. That was a power issue.” The same dynamic, Ross noted, is behind the struggle over reproductive rights. “This is fundamentally about who can play the democracy game better. Who can rally more folks with organizing and advocacy investments that assert a fully inclusive participatory democracy that centers the experiences of the most marginalized, the most oppressed.”

Success, Ross remarked, “is a long game, not a short game. It’s not a two-year grant strategy.” Ross observed that if TCE’s Building Healthy Communities program had been a three-year initiative, “we would have pulled the plug.” The time horizon, he emphasized, must extend beyond the next election cycle.

Also, the challenges are not merely partisan. To illustrate this, Ross mentioned an attempt just this year to create single-payer healthcare in California, a state with a Democratic governor and where Democrats outnumber Republicans in both houses of the legislature by three-to-one. The bill “died in committee,” he recalled. “In a legislature dominated by progressive Democrats, in a committee run by progressive Democrats, with a governor who campaigned in support of single payer … it couldn’t get out of committee.” He added that even in California the “gap between what we know is best and getting it done is significant.” Health insurance industry opposition was among the drivers of defeat.

Where Are the Levers for Change? 

Perhaps not surprisingly, panelists were less specific when it came to identifying paths for solutions, but James question about where to focus efforts garnered some responses from panelists. Ross, for his part, emphasized “integrated voter engagement with a health lens,” which, for him, meant deep community organizing, not just election-time mobilization. Ross also emphasized the importance of greater engagement with faith communities around health justice issues.

For her part, Thompson said that the foundation she leads in Missouri is “focusing on racial equity and economic just systems. Those are the cross-cutting factors. Not race, but racism, and the fact that folks don’t have access to the assets that they need to be healthy. So those are things we think you need to focus on from a systemic change lens.”

“We need to look at civic engagement as the new super social determinant of health.”

Echoing Ross’ and Thompson’s comments, Padilla in Connecticut said the foundation that she leads is focusing “on strengthening the ecosystem for organizing and building it out. And working with other funders outside of health so that the issues are really issues of justice and they are bound together by a commitment to antiracism.” For his part, Altman noted that the Kaiser Family Foundation is focused on supporting local journalism “as a vehicle to amplifying the voices of … marginalized groups.”

Panelists also responded to a question on how to advance health justice in Republican Party-leaning states. Thompson cautioned against trimming movement goals in the face of opposition. She pointed out that Health Forward, the foundation she leads, serves “two red states,” Missouri and Kansas. She added, “Our allegiance needs to be health and not to politics or partisanship. When we look at the data, which includes the lived experience of our communities, it’s clear that civic engagement—participation in democracy—is the newest social determinant of health … We need to look at civic engagement as the new super social determinant of health.”

Thompson emphasized, “You’ve got to believe you can make a change.” She recalled that in 2020, Health Forward joined over 300 groups in a statewide initiative campaign to expand eligibility for Medicaid coverage. “The faith community was heavily engaged. Grassroots game was tight at that level,” she said. Ultimately, the voter initiative passed with a 53-percent yes vote. “Start from a place of belief. Believe in yourself and believe in your communities,” Thompson implored attendees.

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