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Building the Will, and the Way, to Advance Equity at the Maine Health Access Foundation

April 2019

Barbara Leonard, President & CEO, Maine Health Access Foundation

Over 70,000 people in Maine’s 16 counties identify as other than white. Some of these families have lived in Maine for several generations, some communities for tens of thousands of years. Still others have just moved to the state. Yet, news story headlines about Maine often seem to focus on what proportion of the state is white (Kaiser Family Foundation 2019; Arnold 2019).[i],[ii] This fact alone makes it imperative to work in ways that advance racial equity.

In 2016, the Maine Health Access Foundation (MeHAF) Board approved an extension of its strategic plan, as a bridge between the founding CEO and a new leader. Two issues were added to MeHAF’s work: equity, and the opiate epidemic. We had ideas about how to tackle the latter. We did not know where to start with the former. No parameters were placed around what was meant by “equity.” 

What follows are highlights: what we did first, how we defined our concept of equity, and where we are headed.

Looking Inward

As the new leader of MeHAF, I knew that a traditional foundation approach of releasing a request for proposals for project grants to advance equity was not the right first step. We needed to do some serious thinking about ourselves as an organization, paired with introspection and open conversation among the people who make up the organization: Trustees, Community Advisory Committee (CAC) members, and staff. We sought advice about who could lead us through a process before we put forth any kind of process for others.

We found OpenSource Leadership Strategies (OSLS)[iii], with whom we have worked for two years. Their approach to exploring equity focuses explicitly on structural racism as a template for understanding systems of power that privilege some while oppressing others. This became our working concept.  Understanding structural racism led to deeper thinking about the structural barriers and opportunities that determine and predict outcomes not only on the basis of racial identity, but also of disability status, sexual orientation, and interaction with the criminal justice system.  For example, in Maine, racial bias that impedes equal access to medical care has corollaries that result in barriers for other groups.  Bringing down these barriers requires us to advance fundamental changes in systems and structures of belief, practice, and policy.

Early in the process, Trustees, CAC members, and staff participated in a daylong workshop to build understanding about race as a constructed system that produces inequitable outcomes. Led by OSLS, and informed by an Equity Subcommittee composed of Trustees and CAC members, the day included an exploration of the history of race and racism in Maine, as a means to build a common understanding about the current state of health outcomes. The group also learned about how inequitable systems can be interrupted and transformed to produce more equitable results. The Equity Subcommittee worked with OSLS as they conducted a comprehensive equity assessment of MeHAF’s work and then identified a set of recommendations by which MeHAF would intentionally advance equity. This set the stage for equity-informed strategic planning that would begin in late 2017.

By August 2017, the Board endorsed the Equity Subcommittee’s recommendations, which include over 30 directives addressing all areas of foundation functioning, from grantmaking strategy and process to the foundation’s leadership voice, visibility, internal operations, and culture. As we sought strategic planning consultants, we shared with candidates the expectation that they would incorporate the equity recommendations into the new plan. The new strategic framework, approved in June 2018, is grounded in MeHAF’s Equity Recommendations. “MeHAF is taking a leadership role on equity within Maine’s philanthropic community,” says Equity Subcommittee Co-Chair Gloria Aponte Clarke, a MeHAF CAC member, and a program officer at another Maine-based foundation.

What We’ve Done

One step was to launch a new grants program focused on equity capacity building in 2018. General operating support grants to organizations led by and serving communities facing the greatest barriers to health and health care are combined with jointly constructed learning community meetings and individualized technical assistance that often comes from experts within the communities. A learning community for Technical Assistance Consultants brought together mainstream consultants to build their understanding of structural racism and to embed advancement of equity in all their work. Our cohort of advocacy grantees was expanded beyond the usual statewide health policy groups, to include organizations led by and working on behalf of people of color, older Mainers, new Americans, LGBTQ+ groups, people who are incarcerated, migrant workers, people living with mental illness, and other groups experiencing barriers to access.

Our focus is not only outward. A staff equity workgroup (including program officers and grants management leadership) created a shared long-term internal work plan based on the recommendations, which we regularly review in staff meetings to facilitate and monitor progress. Equity Subcommittee co-chair and Trustee Dr. Connie Adler notes, “I’m so impressed that staff was adamant that developing the recommendations was not finishing the task. They make sure that their own work and our leadership as Board members stays true to the plans.”

The Future

In January 2019, MeHAF staff met for a full day with the equity capacity grantees. We discussed power, and how to leverage MeHAF’s power to better support their work. We talked about how everyone in the room has both social and personal capital, which can advance equity and promote reciprocity. We agreed that the meeting was incredibly beneficial to building relationships—and an opportunity for MeHAF Trustees and CAC members to meet with the grantees is in the offing.

Later this year we will work with OSLS again, on an organizational equity culture audit. Based on input from a joint Board and CAC meeting, we have revised our Trustee job description, adding a statement of individual intent for continuous learning about equity. We are exploring whether we should consider new investment vehicles to ensure that our endowment equity meets both our requirement to exist in perpetuity and our commitment to advancing social equity.

We are working toward a future of a more diverse, multicultural, equitable, and therefore, healthier Maine. Supporting community-based organizations to build their own leadership capacity, deepening relationships with leaders from communities that face the greatest barriers to health, and continuously broadening our staff, Board, and CAC are just some of the ways we will get there.

These highlights only begin to describe all we have done and all we have planned—and to share the positive results and lessons that have come along the way. We are eager to answer questions and share information about the equity recommendations and our work, and to keep learning, knowing that many have been deeply engaged in advancing racial equity for far longer than we have. Our journey continues.



[i] According to 2017 data, Maine is the whitest (94%) state in the nation. Kaiser Family Foundation. Population Distribution by Race/Ethnicity. (Based on data from the U.S. Census Bureau’s American Community Survey, 2008 – 2017).   

[ii] Arnold, Willis Ryder. “Why Is Maine So White? And What It Means To Ask The Question.” February 14, 2019.