Tag Archives: nonprofit quarterly

The following is a transcript of the video above, from our webinar on “Remaking the Economy: Information, the Media, and Economic Justice.” View the full webinar here.

Darryl Holliday: I think one thing I’m hearing from all of us—and I hear this even beyond this group, I think there’s a network forming—is that we’re talking about journalism as community-building. You know, we use journalism as a tool but we’re organizers; we’re educators; we’re facilitators; we’re on-demand investigators. I’m thinking about Outlier in particular.  

I’m not big on the whole “save journalism” rhetoric. I think there are a lot of parts of it that don’t need to be saved. But this broadening of the field and how we talk about journalism—who can be one?—I think that’s what’s going to save journalism. 

So when we talk about the ecosystem, I think acknowledging that journalism is not just this ivory tower bestowing accurate records of the draft of history upon the public is one of the first steps. We’re a part of our ecosystem. We’re one piece of this thriving network that has challenges. And we have a responsibility to engage with the people who are doing the work of finding solutions. 

I’m not sure I answered the question exactly, but I think what we’re talking about is redefining or reframing what journalism looks like in this time when the entity is in crisis. It’s falling apart over here, and it’s like a phoenix on this other side. It’s growing, it’s evolving, and changing. 

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

“I believe that no white woman reared in the South—or perhaps anywhere in this racist country—can find freedom as a woman until she deals in her own consciousness with the question of race.”

—Anne Braden, A Letter to Southern White Women, 1972

How are people like me—white women—complicit with white supremacy? That is one of the disquieting questions that more than 1,000 white women across the country have wrestled with as participants in one of the more than 40 rounds of the training and support series, Finding Freedom: White Women Taking On White Supremacy. This five-part workshop is unique in its sharp focus on anti-racism organizing directed exclusively at US white women—not just a caucus, coaching, or schooling space—but as a place to build the back bench required for white women to take on the often-risky work of fighting racism in their own spheres of influence—whether at work, worship, volunteering, socializing, or family gatherings.

Co-designers and facilitators Evangeline Weiss and Kari Points started Finding Freedom in 2016, convinced that well-meaning white women were too often entering BIPOC-led spaces in ways that were disrespectful, presumptuous, and ill-informed.

Indeed, for decades, leaders of color—ranging from James Baldwin and Malcolm X to present-day author/activists Charlene Carruthers, Rev. Angel Kyodo Williams, and Darnell L. Moore, to name a few—have called on white Americans to step up and dismantle white supremacy in their own communities. As the late Nobel Prize-winning author Toni Morrison put it back in a 1993 interview, “my feeling is that white people have a very, very serious problem, and they should start thinking about what they can do about it. Take me out of it.”

In their work, Weiss and Points have sought to take these calls to action to heart. Begun as in-person weekend retreats in Durham, North Carolina, in the past two years, with the COVID-19 pandemic, Finding Freedom has morphed into a virtual experience for 40 white women of all ages, locales, and backgrounds for five weekly two-and-a-half hour sessions. “Our first online workshop debuted on May 19, 2020,” recalled Points, “and George Floyd was murdered six days later. His murder and the uprising that followed were the main reason for our subsequent growth.”

Weiss and Points see Finding Freedom as an early step in a long journey. “It’s not about figuring out you’re a racist and stopping there.” First, it’s about understanding how patriarchy and homophobia are intricately intertwined with racism, how white women are complicit in upholding these structures, and how white women—if they are to be effective in their antiracism work—must convince other white women in their lives to act courageously in their own spheres of influence. Certainly, white women have a role to play in multiracial spaces, flanking leaders of color, pulling back when appropriate, and building relationships grounded in respect. But, most importantly, white women have their own work in their own spaces to do. And this takes practice.

Finding Freedom is undergirded by these five beliefs and values:

1. Liberatory mutual aid. An anthesis to charity models, mutual aid is about sharing resources to support each other, understanding our interdependence, and firmly believing that we benefit individually when everyone has all the resources that are needed. “This work is not about saving anyone else,” explains Weiss. “I’m trying to save my own integrity and spirit…. I can only be free when racism is dead and gone.”
2. Community. White women can’t do effective antiracism work in isolation. “We need a community that has our backs—that will support and inspire us to keep going. You can’t be the only one in your workplace, boardroom, worship space, book club, family gathering, neighborhood platform.”
3. Somatics. Finding Freedom is not just an intellectual or emotional experience. Somatics—the study and practice of being attuned to the body—is central to the Finding Freedom experience. Our bodies hold information, memory, wisdom, and trauma. And that knowledge is critical to recognizing, reacting, acting, and healing. As North Carolina community organizer Sendolo Diaminah remarked last year to NPQ, “Our bodies aren’t just vehicles that take us to meetings. Our hopes, our fears, our dreams live in our bodies. And if we want to actually build a new and a bigger ‘we,’ that means being present to the emotions.” Weiss and Points share this philosophy, so a part of each of the five sessions is spent on examining how our bodies react when we encounter/participate in/survive racism.
4. Ancestors. We build upon our ancestors, whether kin or not, noble or flawed. Look to the late Anne Braden of Louisville, Kentucky, an early white ally of the southern civil rights movement, and build on her positive example as a staunch supporter of the Student Nonviolent Coordinating Committee (SNCC) in the South, certainly. But white women must also understand where we came from and how our ancestors fit into our nation’s racist history. “They’re my people,” says Points. “If I’m going to figure out what type of ancestor I will be, I need to know who my ancestors were. The past is as messy as the present.”
5. Differences. White women—differentiated by age, class, religion, gender orientation, and geography—show up differently when it comes to their experiences and perspectives on white supremacy and its dependence on patriarchy and misogyny. Queer women occupy a critical place in Finding Freedom—both Weiss and Points are queer, as are a generous proportion of participants. The recruiting material is clear: “We warmly welcome lesbian, queer, gender-nonconforming, non-binary, and trans workshop participants, as well as mixed-race or white-presenting people who are interested in exploring the intersection of white womanhood and white supremacy.”

Co-founders Weiss and Points contend that the differences among the participants—class, geography, sexual identity, formal education, religion and more—are “enormously generative, opening up conversations, ideas, conflicts, and questions that wouldn’t surface in a more homogenous group. But they also note that queer women and genderqueers are at the forefront of anti-racism work in this country and that is not a coincidence. “Being a queer and a dyke means that we have some emotional distance from the intersection of patriarchy and white supremacy…and that gives us the room to ask some very pointed questions that are grounded in decades of our feminist community, analysis, and organizing.”

Finding Freedom’s five sessions incorporate these frameworks. The first session sets the stage, building community and accountability through the activation of “high-five buddies” and pods. The second session engulfs participants in the intersecting oppressions of racism, misogyny, and patriarchy. Participants are asked to grapple with hard questions, such as: What do we have in common with Carolyn Bryant, the 21-year-old white woman from Money, Mississippi who condemned 14-year-old Emmett Till to a violent death? How have we supported the trope of fragile white womanhood needing protection from the Black male predator? What can be learned from this legacy?

The third session is about collusion and how white women use their whiteness and privilege to step away from hard conversations. In many venues, white men make the rules and white women enforce—as nurses, teachers, human resource (HR) professionals, nonprofit workers, and leaders. What are the gaps between our professed values and how we show up as white women?

Session four is about resistance and begins with a focus on participants’ shame as white women who continue to perpetuate white supremacy. Shame immobilizes us and we must push through. Session five is about taking actions in those white spaces where we are welcomed and trusted and in which we need to take bigger risks for racial justice.

But this series of workshops is just the beginning for Finding Freedom. Though their long-term impact remains to be determined, Weiss and Points point to anecdotal evidence of alumni running for office and starting anti-racist organizations, the continued growth of their mailing list and Mighty Networks, sustainability of the pods and High Five Buddy connections a year or more afterwards, and robust sign-ups for refresher workshops. Plus, Finding Freedom has successfully raised significant funds from participants to continue the work—clearly a sign of alumni’s desire for the work to deepen and continue.

Weiss and Points are expanding on the work, providing different doors to enter this community. Seventeen alumni have graduated from a 38-hour “train the trainer” program and are now offering the series on their own to their own networks of white women across the country. Points is planning a new series for white women to wrestle with their genealogy and its relationship to white supremacy. Weiss is planning a set of workshops focusing on white women and Judaism, and on anti-Semitism and anti-racist spaces. Both are planning to delve more deeply into the unique role of class in this country and that “it is not just one more ‘ism’ but something that deeply informs our ‘whiteness’.” And both are offering a Finding Freedom 2.0 beginning in February 2022 called the YES lab, also known as “where perfectionism goes to die” for alumni to debrief and practice this work in their own white women’s spaces.

Weiss and Points are not seeking to build an organization nor a nonprofit beholden to foundations. Rather, they envision a movement for white women to resist white supremacy; patriarchy; and yes, capitalism, at all the possible tables where white women sit. “We’re part of the broad river that is the anti-racism movement. We’re a tributary…. We’re bringing Anne Braden’s legacy forward,” enthuses Weiss.

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

What would it take for the nonprofit sector to live up to its potential to advance systemic social change?

In the 30 years I’ve been part of this sector, that question has been a constant. Critics often focus on the sector’s size—a huge asset that could be leveraged for more significant change. In the US alone, the nonprofit sector raised $471 billion in donor revenues last year for 1.3 million organizations employing 12 million people. Changemakers themselves often feel like Sisyphus, pushing a boulder uphill, only to see it roll back down.

Everyone seems to have their pet answer. More diverse boards. More equitable funding. Reforming human resources. Or evaluation. Or leadership.

It’s time to acknowledge that there is not one silver bullet that will lead to our potential. What is needed is structural change in every aspect of nonprofit work. And the time for that change is right now.

What’s Been Tried

The quest to enhance nonprofit results is not new. Below are just a few reforms I have witnessed.

Enhancing board effectiveness:  The baseline for boards is the seemingly official list of roles and responsibilities (few of which are actually law, just “best” practice). Governance reforms like governance as leadership and policy governance have recently been joined by new models to flatten organizations with distributed leadership (e.g., holacracy and sociocracy), as well as others built around circles, committees, roles, and/or community engagement.

Better fundraising: “Not enough results” is often equated with “not enough money.” For years, those tasked with raising money have been steeped in donor-centered fundraising, assisted by software programs that turn people into acronyms like LYBUNTs (gave Last Year But Unfortunately Not This year).

Social entrepreneurship: The trend toward social entrepreneurship also comes from the search for sustainable funds. Before social enterprise there was the “run like a business” trend—a trope that continues to tout the benefits of business approaches.

Foundation-favored reforms: Foundations are often the source of organizational reforms. Decades ago, it was metrics and logic models—requiring “evidence” that short term funding of one nonprofit would somehow make a dent in addressing large-scale social problems. Around the same time, foundations began requiring collaboration as a condition for getting funded, the precursor to the collective impact and impact philanthropy movements.

Bang for the buck: Even accounting has not been immune to fads. The drive to hold organizations to a standardized (and very low) ratio of indirect funds compared to direct program funds, has now seen the pendulum swing, where the very people who sought to limit investment in overhead have confessed they were mistaken.

That mea culpa is sadly all too rare. More often, when these experiments fail to create the intended improvement in communities, those failed efforts live on, with many of them eventually canonized as “best practice.”

Why These Fixes Haven’t Worked

Albert Einstein famously noted, “No problem can be solved from the same level of consciousness that created it.” And yet that is exactly what we keep doing: generating new things to do, without changing the assumptions—our level of consciousness—behind all that doing.

What, then, are the assumptions at the heart of all these reforms?

1. Organizations at the center: Perhaps the foremost assumption is that organizations are the unit of primary importance. In the beginning, “charity” was the realm of individual churches and private philanthropists. Each of those efforts was owned by its founding philanthropist or religious order, just as modern-day programs are owned by a nonprofit, a social entrepreneur, a church, or a government department. That translates into legal fiduciary duties of care and loyalty—not to the community, but to the organization.

That primacy of individual organizations is a huge barrier to creating equitable, healthy communities. Over 40 years ago, Frances Fox Piven and Richard A. Cloward summarized this in their seminal work, Poor People’s Movements. They observed that too often organizations actually undermine the social movements they were founded to support, “abandoning their oppositional politics…becoming increasingly subservient to those on whom they depend.”¹

2. Imitating the cause of social problems: Many day-to-day nonprofit functions have been adopted from places of power and privilege. For example, strategic planning originated in the military before being adopted by the business world, and then by nonprofits. This leads to win/lose, zero-sum strategies aimed at short-term goals—the opposite of what is needed to create change.

Modeled after the work of the early philanthropists, who modeled their own efforts on religious charity, modern-day social programs emphasize alleviating the suffering of one deserving person or group at a time, rather than the kinds of transformative change that might threaten the standing of powerful individuals and groups.

Accounting, human resources, and other seemingly invisible functions we take for granted as “just the way it’s done” have been copied and pasted directly from the business world. These business origins emphasize sustaining the capacity of the organization rather than sustaining the community, fostering a culture of competition rather than cooperation.

It is therefore not just how groups raise money or how work is done “out there” in the community that stops change from happening. It is that internal work, grounded in the profit mandate, in military strategy, and in religious ideas of deservedness, that stops us before we even get out the door. From there, when nonprofit leaders take university classes in nonprofit management or engage in other capacity building interventions, those leaders are then taught these “best practices” as “the right way” to do their work.

When the tools used by social change groups are lifted wholesale from the very institutions that have caused so much injustice in the first place, then even those seemingly mundane internal functions end up perpetuating the very conditions those groups are seeking to change.

It is important to note that these functions are not broken. They are doing exactly what they were built to do. They are simply the wrong tools for the job. Reforming a hammer because it does a lousy job of opening a wine bottle cannot turn that hammer into a corkscrew. In a paper published in the Academy of Management, Dr. Steven Kerr described this phenomenon as “The Folly of Rewarding A, While Hoping for B.”² Enough said.

3. Fixing what is wrong vs. creating what is right: One final reason nonprofit and philanthropic reforms have failed to create meaningful change is because they are aimed at fixing what is perceived as the problem, rather than creating what is possible. To create structures and systems that will lead to change, the focus must reach beyond problem-solving; what is required is a social change ecosystem where means reflect desired end results.

What Will Work

Progressive social change happens when people make decisions and take collective action about the issues in their own lives. The following explores what some nonprofit systems might look like if they were rooted in values of equity, relationship, trust, enoughness, and possibility.

Organizational structure and leadership: If social change organizations reflected the world we want to see, relationships within organizations would resemble communities and natural ecosystems—networks of mutual support committed to a shared vision and shared values. This is how social movements organize—and when they succeed that is the heart of their success. Organizational “walls” would be porous, fostering an open flow of ideas, people, and resources from outside those “walls.”

People from affected communities would be seen as leaders of their own change, with organizations actively helping to develop those leaders. Power and decision-making would be centered in those community leaders, with organizational staff taking a support role. Where required by law or regulation, boards would see themselves as a support to all those individuals—not as leaders.

Planning and program design: To create a more equitable, humane future, community members would determine goals and plans for their communities. The planning process itself would be mindful of privilege, patriarchy, colonialism, and racism that are often present in planning processes—including decisions about who is invited to whose table, and who facilitates the conversation. That planning would be future-focused, aimed at dramatic, visionary results as an achievable goal. From there, programs would be designed by community members, building on their existing strengths, and assisted by organizational staff only as needed.

Evaluation as learning: If evaluation aligned with the world we want to see, those reflections would be shared across the community and throughout whole fields of work—learnings from one food bank shared with all food banks everywhere, for example. Because humans learn through stories, learning and evaluation would center stories of the relationships that created the change, seeing quantitative data as just one way to illustrate those stories. That learning would therefore be a powerful, open-source, shared effort, funded commensurate with its importance.

Communication and engagement: To support community members in their change efforts, the goal of communication would be to build collective strength towards accomplishing the community’s goals. Those activities would emphasize all that we can accomplish together as allies, that none of us can accomplish on our own, instead of the marketing mandate to differentiate and compete.

Accounting and accountability: With this emphasis on co-creating change, an organization’s foremost accountability and stewardship would be to the people the nonprofit supports.³  Duties of care and loyalty, if still legally aimed at care for and loyalty to the organization, would be interpreted as possible only if the organization is upholding its primary accountability to the community.

Human resources and compensation: Similarly, the work of human resources would be to live up to its name—providing the resources humans need to be their best. Creating conditions for employees’ success would include compensation that reflects the value of that work. Such compensation would be adequate for employees to not worry about finances, freeing staff to be at their best both at work and at home.⁴

Resourcing and funding systems: Lastly, the one place everyone seems to focus their reform efforts—resources. If an organization’s vision and values include people being valued for who they are rather than their monetary wealth, resourcing social change must reflect those values. Those efforts—rooted in sharing, relationship, equity, and trust—would reflect the stone-soup spirit of collective enoughness,⁵ that together we have everything we need. In-kind resources and volunteers would therefore be valued more than cash, as those in-kind gifts are the actual resources that are needed.

Most importantly, valuing people and community over money would mean a significant shift in the role of foundations. Rather than self-appointed arbiters of what change deserves support, the role of foundations would be to ensure that there are adequate funds to accomplish what communities determine they need. Expecting community groups with expertise in literacy or homelessness to also acquire expertise in fundraising, when foundations’ raison d’être is money, is one more example of the folly of rewarding A when what we want is B.

The Time is Now

In The Way Out: How to Overcome Toxic Polarization, Columbia University professor Peter Coleman notes, “Studies have shown that enduring patterns often become more susceptible to change after some type of major shock destabilizes them.” Between COVID, George Floyd’s murder, the climate crisis, and the January 6^th insurrection, destabilizing shocks are evident everywhere we turn.

If ever there were a time when the nonprofit sector was ripe for transformation, it is now. And that transformation will start by asking and answering different questions about every aspect of our work.

Begin by asking the following questions:

1) What actually creates change?

Nonprofits often pretend that they know how to, for example, end hunger and poverty, ensure literacy, and create social justice. However, given that those problems are still with us, we would be wise to heed Einstein’s suggestion and change the assumptions that guide the work of social change. This will require replacing the role of “expert” with a spirit of humility and approaches rooted in inquiry, listening, and learning.

2) As a nonprofit organization, what might our role be in supporting change (rather than leading change)?

• What efforts are underway among real people in your community? (If you think the answer is “not much,” keep looking. You’ll be amazed at what you find.)
• What do your community members really want? Have you asked them about the future they aspire to live in? Or do you only ask about problems and needs, seeing them as deficits in need of saving?
• What roles are needed to support those efforts, that your organization is capable of filling? How might you leverage your access to people and resources in support of those community-driven efforts (instead of seeking to lead those efforts)?

3) What would alignment look like?

To create what is possible, first cause no harm. Seemingly benign functions like accounting and human resources too often block change. Ask: What ways of doing this task would reflect our community’s dreams for its future?

4) Ask funders to do the same.

In The Revolution Will Not be Funded: Beyond the Non-Profit Industrial Complex, Amara H. Pérez notes, “Foundation funding…not only exhausts us and potentially compromises our radical edge; it also has us persuaded that we cannot do our work without their money and without their systems.” ⁶ While nonprofit leaders often feel powerless in the face of foundations who hold access to funding, anyone has the power to invite a different conversation by asking different questions—the power to set the table, not just wait to be invited to “the” table.

• Nonprofit leaders can decide not to compete, asking funders: “We don’t want to compete. Who else is working on this? Will you fund us all?”
• Nonprofit leaders can decide what compensation is equitable, asking funders: “We intend to pay wages worthy of the work people do. What would it take for you to make that possible—not just for us, but for everyone you fund?”
• Nonprofit leaders can decide to value community members for their own work, asking funders: “We are working closely with our community members as leaders of their own change. How will you ensure we can pay them for their time and expertise?”

These questions assume that community members and the organizations that support them can make their own decisions—that communities, not funders, have the right to design their own futures.

Conclusion

Stepping into our potential to create more visionary change in the world will require significant changes in every aspect of work in the nonprofit arena. And because change happens via collective action by real people, perhaps the most important question we can ask is this:  If it winds up that what must change is us, are we willing to make that change?

1. Frances Fox Piven and Richard A. Cloward, Poor People’s Movements: Why They Succeed, How They Fail. 1977, Vintage Books (Random House), page xxi.

2. Steven Kerr, “On the Folly of Rewarding A, While Hoping for B.” Academy of Management Journal, December 1975. https://www.ou.edu/russell/UGcomp/Kerr.pdf

3. For details about what this might look like for accountability, see Hildy Gottlieb, “The Fact-based Fallacy of Accountability to Donors.” Community-Centric Fundraising, April 26, 2021. https://communitycentricfundraising.org/2021/04/26/the-fact-based-fallacy-of-accountability-to-donors/

4. One of the biggest advocates for a livable minimum wage is Dan Price, CEO of the for-profit company, Gravity Payments. https://www.businessinsider.com/gravity-payments-dan-price-ceo-raise-minimum-wage-revenue-2021-8 Recently the nonprofit Choose 180 has been highlighted for taking the same approach. https://www.seattletimes.com/seattle-news/labor-shortage-or-living-wage-shortage-one-king-county-nonprofit-is-taking-a-different-approach/

5. The term “Collective Enoughness” is explained with examples in this article at Stanford Social Innovation Review: https://ssir.org/articles/entry/creating_a_better_world_means_asking_better_questions.

6. Amara H. Pérez, Sisters in Action for Power, “Between Radical Theory and Community Praxis: Reflections on Organizing and the Non-Profit Industrial Complex.” In The Revolution Will Not Be Funded: Beyond the Non-Profit Industrial Complex, edited by INCITE! Women of Color Against Violence. 2007, South End Press, page 98.

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

“Traditionally, advocacy has been a few people speaking on behalf of others. But…it is also about movement building and power building, grassroots engagement, and community organizing. It is about people being able to create the paths and environments to speak for and advocate for themselves.”

Cesar Aleman, Director, Connecticut Urban Opportunity Collaborative

This past June, three Connecticut community foundations—the Community Foundation for Greater New Haven, the Hartford Foundation for Public Giving, and Fairfield County’s Community Foundation (based in Norwalk), which combined have assets that exceed $2 billion—announced their joint hire of Cesar Aleman to direct a newly-formed Connecticut Urban Opportunity Collaborative (CUOC).

The foundations’ agenda is ambitious. As their press release states, CUOC seeks to coordinate senior staff across the three foundations to “develop collective strategies to dismantle structural racism and advance social and economic mobility; aligning the strategic and programmatic efforts of the three foundations to create an actionable plan that builds on each organization’s individual strengths.”

In an interview with Aleman shortly after his hire, New Haven radio station WNHH program host Babz Rawls-Ivy expressed her surprise that community foundations would take on promoting racial and economic justice as primary goals. Her implied question: Is this real? Just a half year later, it is too early to say. To learn more, NPQ interviewed Aleman, along with Will Ginsberg, who has led the New Haven foundation for the past 21 years.

A Pre-COVID Shift in Foundation Philosophy

Ginsberg credits his colleague, Jay Williams—former mayor of Youngstown, Ohio, and head of the community foundation in Hartford since 2017—with initiating a cultural change in Connecticut philanthropy. “When Jay Williams became head of the Hartford Foundation, it seemed like an opportunity to have this [justice] conversation in a way that hadn’t really happened before.”

Ginsberg notes that while he and Williams came from very different backgrounds, they share a passion for the pursuit of racial and economic justice, with a focus on urban communities. They also, as it happens, both served for presidents in the exact same role as assistant secretaries of commerce in the Clinton and Obama administrations, respectively. As Ginsberg recalls, “When Jay came to the Hartford foundation, we started having this conversation. And we talked about focusing on the cities. And we created a six-community foundation collaborative.”

The six-foundation group included the three members who now are the foundation members of CUOC, along with smaller foundations in New London, New Britain, and in Waterbury (Connecticut Community Foundation). Ginsberg notes that while the coalition had fewer resources and operated informally, it did make some steps toward developing a common policy agenda and narrative. This included supporting a series of articles in the Connecticut Mirror on urban issues as part of a joint narrative change strategy to lift up cities, where most residents of color in the state live, as vibrant places of possibility rather than “problems” to fix.

Three of the six Connecticut foundations in that initial coalition were also members of a national network, the Community Foundation Opportunity Network (CFON), which Terry Mazany—former president of the Chicago Community Trust—discussed with NPQ in the fall of 2019. As 2019 ended, Mazany and his colleagues were aiming to recruit a cohort of community foundations to create a community of practice within which foundation leaders could deepen their racial and economic justice grantmaking and investment. At the same time, in New Haven, the community foundation adopted its 2020-2024 strategic plan, with a dual focus on opportunity and equity. Then the COVID-19 pandemic hit.

The COVID Accelerator

As Ginsberg observes, the foundation’s work, “changed dramatically as a result of COVID—what we do, what we focused on, our processes, our schedules.” At the same time, “the focus on opportunity and equity did not change.” Ultimately, both in Connecticut and nationally, the COVID-19 pandemic—along with the national racial justice uprising of May and June 2020 in the wake of the murder of George Floyd—acted as an accelerator.

At the national level, CFON launched its NEON (Nexus for Equity + Opportunity Nationwide) cohort program. Foundations within CFON had to apply to join what became a cohort of nine community foundations that aim to be a peer learning community. The three Connecticut foundations that were members of CFON applied as a group and when their application was accepted, the CUOC experiment advanced considerably.

At roughly the same time, the community foundation in New Haven launched its “Stepping Forward” initiative, which dedicates $26 million in foundations resources over three years to COVID relief and recovery and to advancing racial justice. A unique feature of this fund is that $15 million of the fund is borrowed from the foundation’s endowment (the other $11 million is solicited from foundation donors), with the money scheduled to be repaid to the endowment over seven years. Effectively, this raises the foundation’s spending from 5.5 percent of its endowment to roughly 6.25 percent for a 3-year period.

Ginsberg emphasized that the foundation’s board agreed to this shift not only because of the extraordinary needs “but also because we saw an opportunity to make real progress on racial equity because of the protests that emerged last year after George Floyd’s murder and everything else that was going on.” The foundation, he added, saw a chance to invest in “new voices, new energy, new ideas, and a new generation.”  One area that Ginsberg cites where the foundation is applying its approach is its New Haven Equitable Entrepreneurial Ecosystem program, which seeks to “build an equitable entrepreneurial ecosystem designed for historically marginalized entrepreneurs, such as those who identify as Black, Latinx, and women” and is overseen by a council of movement and community development leaders.

Building the Collaborative 

While the concept behind CUOC has a longer trajectory, Aleman was only hired as its first staff member and director in June 2021. A half year in, a lot remains in the idea stage. But some contours are becoming clearer. Aleman notes that the group focuses in two areas: 1) income and wealth, and 2) power and leadership. In terms of levers to create shifts in those areas, Aleman says one area of focus is advocacy. “Because Connecticut is a small state, we have good opportunities to influence and shift advocacy efforts to improve a lot of policy pieces in our cities,” Aleman remarks.

Another focus area is narrative change, a topic Aleman is passionate about. “We know there is a dominant narrative, certainly in Connecticut and I think it’s true across the country that often time gets in the way of change, specifically policy change. That’s the narrative around things such as school and achievement.” Aleman calls for reframing the “achievement gap” as the “opportunity gap,” for example. Similarly, he adds, “There is a dominant narrative that locates the problem of poverty on people who are experiencing poverty…People’s perspectives, minds, and ideas around how poverty exists need to change.”

Aleman identifies inclusive economic growth as the “third bucket of work that we are doing.” A lot of this work involves supporting business ownership in BIPOC communities. In New Haven, Ginsberg notes that as part of an unprecedented PILOT (Payment in Lieu of Taxes) agreement with Yale University. Yale is not only providing $135 million in payments to New Haven for services but also committing $5 million to an institution called the Center for Inclusive Growth, which the community foundation has backed and which will be housed at the Yale School of Management under Dean Kerwin Charles. Ginsberg says the foundation has been asked by the city’s mayor “to be part of discussions of how to structure the Center going forward.”

Aleman also emphasizes that CUOC’s existence has helped prod foundations to inspect their individual grant making. In Fairfield County, he explains, “they just went through an entire process to do an internal audit on how they were spending their money.” The audit found that even when funding services for Black and Brown people, “there was not a big population of Black and Brown people in the leadership of those groups.” In Hartford, Aleman noted that the foundation there was focusing its efforts on boosting support for community organizing and engagement.

Aleman adds that as a staff of one, his role largely involves helping the group “think about how to leverage opportunities and resources. It is about coming together with the executive team. Here’s what each of our community foundations is doing. Here’s where we are prioritizing our work. Here’s our framework of common strategies. As we are seeing the alignment across them, here are the places where we see opportunities for aggregate impact.”

Ginsberg also offers a more long-term goal for CUOC, which is to explore the possibility of creating a permanent organization. “Right now, CUOC is a collaborative with a staff of one,” he observes. “If we can show an ability to raise money and impact, we should here think about creating a permanent structure.” This, Ginsberg contends, provides “a different approach to the basic idea of place-based philanthropy.” Right now, Ginsberg notes, each metropolitan area has its own community foundation, with urban and suburban communities together. “If you think about the place that CUOC is focusing on as these spatially disconnected but much in common urban areas—Hartford, New Haven, Bridgeport—all of a sudden you have got a different idea of what place-based can be.”

Ginsberg adds, “That’s my vision for the long-term, that we create a powerful urban-focused placed philanthropy that is funded by donors and funded by our community foundations and funded by national funders too.” Such a collaborative, Ginsberg contends, could really tackle “issues of social and economic mobility, equity, and dismantling racist systems and structures in our cities in new ways.”

But Are Community Foundations Part of the Solution or Part of the Problem?

Echoing the comments of the WNNH radio host, Ginsberg acknowledges that community foundations—which are, after all, funded primarily by local wealthy donors—make for unlikely racial and economic justice advocates. As Ginsberg puts it, “The basic conundrum…that the field has been grappling with for a number of years is, fundamentally, are we part of the problem or are we part of the solution?” Recalling the Occupy movement of a decade ago, Ginsberg notes that at the time a colleague asked him, “Are we part of the 99 percent or are we part of the one percent?” The answer, says Ginsberg, “is both.”

Ginsberg adds that in response, “What we’ve seen in the field—writ large, in the community foundation field, and certainly here in New Haven—is grappling with the question: How do we position ourselves, not just as a reflection of wealth, power and privilege in our community and our society that remains overwhelmingly white but also as an agent of change?” While seven of the foundation’s 11 board members are people of color, that does not change the fact that most donations are from white donors.

One foundation strategy to address this dilemma has been to develop participatory grant programs, which allow community members to decide on grant awards, regardless of the source of the funds. For example, the foundation’s Racial Equity and Community Healing (REACH) program “turned over the program design and the decisions as to grants and awards to a group of local artists, arts patrons, and arts administrators” and made $583,000 in grant awards. Ginsberg says the foundation aims to at least double the amount of dollars going through participatory grantmaking processes in 2022. The foundation has also raised a $2.5 million Black Futures Fund, and is convening a group of Black community leaders to advise it on how the funds should be utilized.

Building for the Long Haul

For his part, Aleman acknowledges that he is an unlikely philanthropic program director. Much of his work has been the fields of community organizing and affordable housing. For much of his life, he also was a true believer in many of the narrative myths he is now seeking to dismantle. “I am somebody who benefited from an opportunity. I come from a low-income background. I am undocumented, I am queer, I am a first-generation student.” Aleman notes that the narrative that hard work reaps success “felt true to me for a very long time.” Aleman adds that it wasn’t until he worked for a private landlord and saw the conditions of tenants first-hand that he realized that “there are a lot of external factors as to whether somebody can escape poverty. I really have dedicated my career to disrupt the narrative in myself and the communities I am a part of.”

As to what degree disrupting those narratives is possible, Aleman maintains a mix of optimism and realism: “I think that we have a real opportunity and community foundations are well positioned to be long-term partners to do some of the work that we are identifying,” he says. Aleman cautions, however, that, “Dismantling structural racism is something that is going to take decades. It has taken decades to cement the racist practices that we have across all sectors. It will take an equal amount of time to dismantle it.”

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

Click here to download this article as it appears in the magazine, with accompanying artwork.

This article is from the Winter 2021 issue of the Nonprofit Quarterly, “We Thrive: Health for Justice, Justice for Health.”

What might healthcare look like if the profit motive were removed from the provision of care altogether? If healthcare were designed as a public service, what possibilities would exist for health equity, health system resilience, and reduced costs? The multiple crises of our current healthcare sector, laid bare by COVID-19, should move us to ask deeper questions about how our investments into the healthcare sector should be employed to maximize the health and well-being of our people and economy.

There are, sadly, few bright spots in a system that has allowed more than one in five hundred Americans to die due to COVID-19.1 Many readers may be surprised to learn that one of the few highlights in healthcare performance during the pandemic comes not from the nation’s richest hospital systems or biggest names in medicine but from the poorly understood and often maligned Veterans Health Administration (VHA).

The VHA—the country’s only fully public, integrated healthcare system—has a lot to tell us about how a national healthcare service for the United States might operate, and not just for its performance amid COVID-19. Indeed, combined with other public healthcare institutions, it could prove to be a critical institution to achieving health justice.

While the new is often fetishized, sometimes the most effective and feasible models are not new; they just need dusting off so that we can see them for what they are. Healthcare as a public service is one such model, and the VHA could help jump-start a revival of this model today.

U.S. Healthcare in Crisis

The COVID-19 pandemic has brutally exposed the weaknesses of the nation’s fragmented, inequitable, and extraordinarily expensive healthcare system. In the early days of the pandemic, as revenue from elective procedures cratered, many health systems furloughed staff, cut their hours, or reduced pay, even as demand for emergency care due to COVID-19 exploded. Many hospitals resorted to rationing care, and some shuttered altogether. Increasingly, we are witnessing the collapse of U.S. healthcare, as multiple crises—including lack of rural hospitals, shortages of physicians, and overpriced treatments—collide.²

Hard though it may be to believe, today healthcare consumes almost one fifth of the entire U.S. economy. This is far more than most other advanced economies, even as health outcomes fail to match this extraordinary expenditure.³ Life expectancy in the United States has been declining for years, and existing health inequities have only been exacerbated by the pandemic. To do better requires changing how the nation finances, administers, and allocates healthcare resources.

The VHA’s pandemic experience provides some valuable lessons. When COVID-19 hit, the VHA, rather than contracting, expanded to meet needs. It opened its doors to accept hundreds of nonveteran patients and sent staff to assist in non-VA hospitals and nursing homes. By September 2021, it had provided nearly a million pieces of personal protective equipment to non-VA facilities and sent personnel to more than fifty states and territories to assist local authorities and health systems.⁴

The department moved swiftly to protect its workers and patients, restricting nonessential visitors at facilities, screening returning soldiers, and offering telehealth options nationwide for both medical and mental health services. It also used its novel tele-ICU (intensive care unit) program to help alleviate the pressure on overtaxed ICUs. VA-run nursing homes fared so well that the VA was asked to take over some state-level Veterans Homes from the private, for-profit companies experiencing crises.⁵

In this time of extraordinary challenges for the healthcare sector, what can this tale of two health systems teach us?

Healthcare as a Public Service

The VHA operates like a Beveridge-style health system. Beveridge, for the uninitiated, refers to the British economist William Henry Beveridge, author of the famed Beveridge Report during World War II that set the foundations for what would in the United Kingdom become that nation’s enormously popular National Health System.⁶

In such a system, both the payer and provider are public: Funding for the VHA, for example, is appropriated by Congress; VHA personnel are salaried public employees; and the hospitals, clinics, and equipment used to serve patients are publicly owned. Like the United Kingdom, Spain, New Zealand, Cuba, Hong Kong, and much of Scandinavia employ this model for virtually their entire healthcare sector.⁷ Rather than seeking to maximize profit and allocate resources based on ability to pay, these systems run like public services.

Without the constraints of market imperatives, Beveridge-style systems are free to adopt public-interest missions. For example, the VHA’s principal mission is to care for the nation’s veterans, while one of the missions (called its “Fourth Mission”) of its parent agency, the Veterans Administration (VA), is to improve the nation’s emergency preparedness and serve as a backup to the rest of the healthcare sector during emergencies.

While many of these healthcare systems have suffered times of severe underfunding and privatization attempts, their popularity with both patients and healthcare workers has generally endured over time. Even Brexiteers recognized the potency of the U.K.’s National Health Service (NHS) as a totemic expression of British values when they pledged that leaving the European Union would mean an extra £350 million a week for the NHS—a pledge that was emblazoned on the side of their campaign bus.

There are likewise valid criticisms of the VHA. It has certainly not always been managed in the best interest of its patients or staff.⁸ Persisting geographic variations in the availability and accessibility of some of its services disadvantage some groups of veterans over others.⁹ Chronic underfunding coupled with increasing demands by Congress and the executive branch have contributed to critical staffing shortages and unmet goals to modernize its infrastructure.¹⁰ But despite these challenges, the VHA has delivered impressive improvements in recent decades and—most important—health outcomes consistently equal to or better than those in the private sector.¹¹

The public nature of the VHA does not, by default, make it the perfect health system. But because it is free of the imperatives of profit seeking, the VHA can create space for other imperatives—for example, centering patients’ needs, training and retaining a highly skilled and effective healthcare workforce, and advancing the science of medicine. Also, as a single integrated system, the VHA can manage its shared assets across multiple sites and move both staff and supplies from one geographic location to another more easily than private-sector competitors. This ability to steward resources for the collective good is particularly useful in times of emergency or unexpected strain—such as a supply chain failure—on the healthcare sector.

Public Healthcare, American-Style

Building a Beveridge-style health system for all based on the VHA—a kind of “VA for all”—would transform the economics of U.S. healthcare by removing extractive profit seeking from health insurance, the provision of care, and the procurement of medical supplies. It would also drastically reduce political capture by the healthcare industry, thus removing one of the key obstacles to such long-sought reforms as Medicare for All and enabling the government to negotiate drug prices with pharmaceutical companies.

How could a “VA for all”–style system benefit payers, providers, and patients alike?

First, scaling the VHA would increase the efficiency of healthcare spending through strictly evidence-based care, reduced duplication in testing and procedures, and far lower prescription prices. Moreover, the VHA model relies on a foundation of comprehensive primary and preventative care services. These “first dollar” investments reduce demand for more costly care later. For example, a 2018 study of dual-eligible veterans showed that veterans who relied on the VA for their healthcare saw fewer emergency department visits and hospitalizations than those using private-sector care.¹²

Together, these features would make establishing universal health insurance coverage—a key goal of Medicare for All—less costly. Although the VHA serves patients who are, on average, older and sicker than the overall population, it achieves better results at a lower average per-patient cost than Medicare.

A VA Commission on Care study found that if 60 percent of VHA patients were to start seeking care in the private sector, costs to the VA for their care would quadruple.¹³ Rather than privatizing veterans’ care, the real cost savings for the country lies in bringing more patients under the care of the VHA, particularly as the overall patient population in the United States is on average younger and healthier than the average current VHA patient.¹⁴

Second, patients would experience better and more equitable outcomes from the kinds of integrated services provided by the VHA. The VHA’s “whole health” model starts with primary care teams that include a physician, a nurse serving as the care manager, a clinical associate, and an administrative clerk. Based on the individual needs of each veteran, and in consultation with them, other providers such as mental health professionals, pharmacists, and social workers may be added to that team to ensure all aspects of the patients’ health and well-being are understood, addressed, and monitored. This type of coordinated and individualized care is unavailable to most patients in the private sector, despite the importance of care coordination in reducing misdiagnoses and improving patient safety and outcomes.¹⁵

Multiple studies show this is working in practice. A 2018 Dartmouth College study compared performance between VHA hospitals and private hospitals across the country and found that in fourteen out of fifteen metrics, the VHA care fared “significantly better” than private hospitals.¹⁶ A 2010 systematic review of all studies from 1990 to 2009 comparing the quality of medical and other nonsurgical care in VA and non-VA settings found that studies “almost always demonstrated that the VA performed better than non-VA comparison groups” (emphasis added).¹⁷

Lastly, workers would benefit from a fully public healthcare system like a VA for All. The public sector has long done a better job of employing women and people of color than the private sector.

Already, the VHA’s workforce is salaried and almost entirely unionized. For nonclinical staff, VHA jobs offer more stability and better benefits than many private sector healthcare administration jobs, which tend to be based on at-will contracts. And clinical staff can focus on patient care, since they do not have to build a practice, recruit patients, or bill multiple insurers. Research and training opportunities abound for staff inside the VHA. Because the institution plays such a large role in training the U.S. healthcare workforce, it has explicit career ladders; and, as it engages in significant amounts of in-house research, clinical staff can also easily engage in ongoing research and both further their own careers and their scientific field.

Toward a VA for All

Currently, around nine hundred hospitals across every state outside the VA system are on the verge of shutting down due to financial losses.¹⁸ Even before the pandemic, the United States had fewer hospital beds per one thousand residents than many other high-income countries.¹⁹ If cash-strapped hospitals have no incentive to stay open, where do the patients seek care? Where do the jobs go? And how is the broader local and regional economy expected to recover? Some will undoubtedly be purchased by large health systems, consolidating their economic and political power. But many will close—leaving critical gaps in access to care.

We could empower the VHA to acquire and administer many of these hospitals. These acquisitions would not only ensure that communities can access affordable, high-quality healthcare but also help to preserve local community economies.

The VHA could also be tasked to work with Federally Qualified Health Centers (FQHCs), which provide comprehensive primary care to low-income and medically underserved populations and receive support from across the political spectrum. Both could be scaled in a public–public partnership to achieve access to quality primary, secondary, and tertiary healthcare services for all, regardless of income or geography.

Like VHA patients, the FQHC patients experience more chronic health conditions than the overall U.S. population. Yet the health outcomes of FQHCs rival those of the private sector.²⁰ Numerous studies suggest that FQHCs are associated with lower total per-patient costs to Medicare and Medicaid, as well as economic benefits to the local communities in which they operate, through job creation and purchasing.²¹ Moreover, primary care is associated with more equitable health outcomes than specialty care.²² Thus, expanding the network of FQHCs and linking them to other public healthcare infrastructure like that provided by the VHA could both advance health equity goals and contribute to overall health system savings.

Additionally, FQHCs offer a model for democratized governance of healthcare services and responsiveness to local community needs due to their “consumer board” structure. By federal mandate, 51 percent of each board must come from the patient population served by the health center in terms of demographics, and “of the nonpatient health center board members, no more than one-half may derive more than 10% of their annual income from the health care industry.”²³

Transformation, Not Reformation

As the healthcare “system” of the world’s wealthiest country is teetering, if not close to collapse, the pressing need for transformative solutions is obvious. Scaling publicly owned healthcare to serve all would be just that—a way to take healthcare from a source of private profit, mass suffering, and financial ruin, and make it a public good.

Leveraging healthcare investments to actually improve the health and well-being of our people, our communities, and our economy is eminently possible. The models for how to do it already exist. Building on the successes of the VHA and FQHCs offers a path to delivering better healthcare at lower cost, with greater stability for our healthcare workforce.

***

As patients and healthcare workers know, sometimes the body can heal itself—but only if nutrients it takes in are feeding the body’s essential organs rather than a cancer or pernicious bacteria. Sometimes a tumor must be excised—and tissue must be irradiated—to stop a malignant growth. But with the proper support and care, a body can transform itself, develop new habits and abilities, and return to a state of health and well-being.

Likewise, the U.S. healthcare system needs major surgery before it can heal. The malignancy of profit seeking must be cut out, so that life-giving resources may flow where they are most needed. Only then can the dream of healthcare as a human right be truly realized.

Notes

1. Dan Keating, Akilah Johnson, and Monica Ulmanu, “The pandemic marks another grim milestone: 1 in 500 Americans have died of covid-19,” Washington Post, September 15, 2021, washingtonpost.com/health/interactive/2021/1-in-500-covid-deaths/. (This statistic, sadly, is already out of date.)
2. Vishal Khetpal, “Just Say It: The Health Care System Has Collapsed,” Slate, September 7, 2021, com/technology/2021 /09/healthcare-system-collapse-icu-ration-beds.html.
3. Roosa Tikkanen and Melinda K. Abrams, “U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?,” The Commonwealth Fund, January 30, 2020, commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.
4. Veterans Health Administration, “VA Fourth Mission Summary,” accessed October 5, 2021, va.gov/health/coronavirus/statesupport.asp.
5. “An Inside Look at the VA’s COVID-19 Response,” Veterans Healthcare Policy Institute Blog, January 12, 2021, veterans policy.org/va-covid-19-response.
6. See UK Parliament, “1942 Beveridge Report,” parliament.uk/about/living-heritage/transformingsociety/livinglearning/coll-9-health1/coll-9-health/, accessed October 5, 2021; and Matthew Smith, “The NHS is the British institution that Brits are second-most proud of—after the fire brigade,” YouGov, July 4, 2018, yougov.co.uk/topics/politics/articles-reports/2018/07/04/nhs-british-institution-brits-are-second-most-prou.
7. No national healthcare sector in the world is currently 100 percent Beveridge-style, in that some private providers or supplementary insurance coverage is allowed alongside the comprehensive coverage and treatment offered through the public sector. The Cuban healthcare system comes very close to being 100 percent public, however, with only a handful of private practitioners remaining on the island. In most Beveridge-style systems, there are some limited private options available, but they do not tend to account for a large portion of total healthcare use.
8. German Lopez, “The VA scandal of 2014, explained,” Vox, May 13, 2015, vox.com/2014/9/26/18080592/va-scandal-explained; Charles Ornstein, “Agent Orange Act Was Supposed to Help Vietnam Veterans—But Many Still Don’t Qualify,” ProPublica, July 17, 2015, www.propublica.org/article/agent-orange-act-was-supposed-to-help-vietnam-veterans-but-many-still-dont-; and “‘The Administration is Setting Us Up to Fail,’ says VA Workers Union,” AFGE, February 20, 2019, www.afge.org/publication/the-administration-is-setting-us-up-to-fail-says-va-workers-union/.
9. Lei-Nikki Bowser and Donna L. Washington, Access to Care Among Rural Veterans (Washington, DC: Office of Health Equity, Veterans Health Administration, S. Department of Veterans Affairs, March 10, 2020); and Karli Kondo et al., “Health Disparities in Veterans: A Map of the Evidence,” Medical Care 55, no. S2 (September 2017): S9–S15.
10. “‘The Administration is Setting Us Up to Fail’”; and Meagan Day, “The Assault on Veterans’ Health Care: An Interview with Suzanne Gordon,” Jacobin, June 11, 2018, com/2018/06/veterans-administration-health-care-privatization.
11. William B. Weeks and Alan N. West, “Veterans Health Administration Hospitals Outperform Non–Veterans Health Administration Hospitals in Most Health Care Markets,” Annals of Internal Medicine 170, no. 6 (March 19, 2019): 426–28; Rebecca Anhang Price et al., “Comparing Quality of Care in Veterans Affairs and Non-Veterans Affairs Settings,” Journal of General Internal Medicine 33, no. 10 (October 2018); and Amal N. Trivedi et al., “Systematic Review: Comparison of the Quality of Medical Care in Veterans Affairs and Non-Veterans Affairs Settings,” Medical Care 49, no. 1 (January 2011): 76–88.
12. Ashok Reddy et , “Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team,” Health Services Research 53, no. S3 (December 2018): 5201–18.
13. Suzanne Gordon, Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans (Ithaca, NY: Cornell University Press, 2018), 383.
14. The VHA patient population is older and sicker than the overall U.S. population. In general, being older and sicker makes one more costly to care So, the math suggests that if the VHA is already caring for an “expensive” patient population, and doing it at relatively low cost compared to the private sector (its being more efficient and effective with its investments), bringing more patients into the system would be cost-saving on average. Thus, if more of the U.S. population gets its healthcare from the VHA, total health expenditure for the country should decrease.
15. Agency for Healthcare Research and Quality, “Care Coordination,” ahrq.gov/ncepcr/care/coordination.html, accessed October 5, 2021.
16. Weeks and West, “Veterans Health Administration Hospitals Outperform Non–Veterans Health Administration Hospitals in Most Health Care ”
17. Trivedi et , “Systematic Review.”
18. Ayla Ellison, “State-by-State breakdown of 897 hospitals at risk of closing,” Becker’s Hospital CFO Report, January 22, 2021, beckershospitalreview.com/finance/state-by-state-breakdown-of-897-hospitals-at-risk-of-closing.html.
19. Peterson-KFF Health System Tracker, “Hospital Resources,” accessed October 5, 2021, www.healthsystemtracker.org/indicator/quality/hospital-resources.
20. Elayne J. Heisler, Federal Health Centers: An Overview, Congressional Research Service (7-5700/R43937), May 19, 2017.
21. “Health Centers Provide Cost Effective Care,” National Association of Community Health Centers, Fact Sheet #0815, July 2015, nachc.org/wp-content/uploads/2015/06/Cost-Effectiveness_FS_2015.pdf.
22. Barbara Starfield, Leiyu Shi, and James Macinko, “Contribution of Primary Care to Health Systems and Health,” Milbank Quarterly 83, 3 (September 2005): 457–502.
23. Health Resources and Services Administration, Health Center Program Compliance Manual, “Chapter 20: Board Composition,” hrsa.gov/programrequirements/compliancemanual/chapter-20.html, accessed October 5, 2021.

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