Lisa Medellin, MSW, Director of Programs, Healthcare Georgia Foundation
Samantha Bourque Tucker, MPH, Evaluation Manager, Healthcare Georgia Foundation
Some years ago, in reference to Georgia’s economy, the claim was made of the existence of two Georgias: one, the vibrant metropolitan areas of the state; the other, rural Georgia – described as its poor economic cousin. Today, this Two Georgias distinction applies to the growing disparities in health and health care between the metropolitan areas and rural communities, home to nearly 2 million Georgians.
In response to this growing disparity, Healthcare Georgia Foundation launched The Two Georgias Initiative in 2017, a multiyear, place-based grantmaking program designed to achieve health equity in rural Georgia. The goals of The Two Georgias Initiative are to foster health care innovation by supporting local coalitions seeking to address health disparities, improve health, and expand access to quality health care services. To achieve these goals, the social determinants of health are recognized as essential elements to address health inequities.
The Foundation funded 11 lead organizations representing a cross-section of rural communities in Georgia. By offering flexibility and choice to determine the direction and focus, each rural community used the first year of the Initiative as a planning year. The grantees established a Community Health Coalition and developed a Community Health Improvement Plan with an Evaluation Plan to serve as a roadmap for community engagement. This process, along with technical assistance, helped disrupt the existing power structures within the communities. It allowed people most adversely affected by health inequities to have a seat at the table and voice their solutions to the myriad of existing health challenges. This multi-layered approach has been key to the early successes of The Two Georgias Initiative.
Over the past four years, The Two Georgias Initiative has pushed the foundation to think outside of the box in several ways and we have learned to:
Embrace equity. Equity is a way of thinking and acting that dismantles barriers, policies, and systems that prevents all members of a community from having an active role in what happens in their community. It recognizes that providing training and technical assistance to address the challenging issues that emerge is an ongoing process and not a singular event. Determine how grantmaking practices may be a barrier for non-traditional organizations to apply for funding.
Understand that change happens at the speed of trust. Many communities are distrustful of outsider’s and local leader’s intentions. It is critical to establish relationships, have a visible presence in funded communities, and be responsive to needs. Acknowledge that power and privilege undermine trust within the community.
Build leadership capacity and create a learning community. Community coalitions are largely comprised of volunteers and nonprofit representatives who may have very limited experience with leading a community driven project. Build leadership capacity to ensure community buy-in and strengthen those who will maintain the coalition beyond the grant. Provide technical assistance so barriers and challenges are addressed immediately, and progress can be maintained in a consistent and frequent manner.
Contribute to best practices in measuring equity. Health equity-focused evaluations help determine if a program is reaching the underserved population that is experiencing inequities. The evaluation is designed to understand what works, for whom, under what conditions, and to reveal whether health inequities have decreased, increased, or remained the same. This is important because population-wide strategies to improve community health can lead to overall improvements in health but at the same time, widen gaps in disparities. The evaluation must be sensitive enough to capture this.
Explore other options besides grant funding. Impact investing is an untapped opportunity to expand and align resources with the causes of poor health, including the social determinants of health. Working in rural communities has led the Foundation to engage Community Development Financial Institutions (CDFIs) in health impact investing – an exciting, new financing strategy for health nonprofits, which combines traditional charitable resources with existing public and private capital to improve health outcomes.
Take time to look at all the data. Yes, there is an abundance of data that exists for countless indicators. But is it broken down by county-level or census tract? Is it stratified by race, ethnicity, age, gender? Could the data show change in health equity? Does it identify where basic human needs are being met or unmet? Take these questions into consideration and provide technical assistance to grantees to guide the design of the program and its accompanying evaluation.
The time has come for philanthropy to embrace equity as a core value that anchors strategic grantmaking rather than simply serve as theoretical principle. The COVID-19 pandemic has further exposed inequities and has pushed philanthropy to step outside of our collective comfort zones and work with others in unprecedented ways. Let us continue to work in new, uncharted arenas, like rural communities, or create funding opportunities that address the social determinants of health. Invest in placed-based approaches with a view toward long-term funding, provide staff or extended staff in the form of qualified diverse technical assistance providers with a proven track record of working in rural communities and communities of color, evaluate if grantmaking practices and funding guidelines are barriers for organizations led by people of color, and advocate for equitable inclusion within communities to elevate the concept of “nothing about us, without us.”
Addressing health inequities will not be easy or quick. Long-term, sustainable change in communities, especially in rural areas, will require addressing the history of policies and institutions that allow inequities to thrive. Many of these communities are comprised of people of color and other marginalized individuals whose voices go unheard. Philanthropy is positioned to be a partner and a champion for communities that are often undervalued or forgotten, while simultaneously leading the charge for equity to become the norm and not the exception.