In Philanthropy, We Must Be Willing to Invest in Addressing the Complexities
In part two of Laura Landy’s three-part series on “bold philanthropy,” she asserts that investment in system integration and redesign will be important if our aim is to solve multiple problems at the core of our health challenge.
Back in February, I wrote a post about using ReThink Health’s System Dynamics Model to assess the impact of President Trump’s proposed policies on health. I wondered about the potential impact of a possible repeal of the Affordable Care Act (ACA) as well as policy and program changes related to climate, crime, and the economy. Our analysis revealed that health and productivity would become much worse as money was being saved–and the model helped us understand more about why this was the case. Savings would be attributed mostly to repeal of the ACA. But reduced productivity and poorer health (increased death and chronic disease) would be attributed mostly to the faltering economy, many experts predict.
Think about it. If I have money–presumably because I have a job–I can buy insurance, pay a doctor, eat good food, live in a safe place, and access good schools. In other words, the economy has a lot to do with my access to insurance, preventive services, and social assets that are positively associated with health. Currently, however, our philanthropic investments don’t reflect this reality. Charity Navigator reports that, in 2014, more than $30 billion was donated to health and another $40 billion to human services. There is no category (yet!) for donating to fix the economy.
If foundations were truly committed to changing the system–to addressing the real challenges that keep our people and our communities from thriving—it seems to me we would all be working, at least in part, on improving the economy. We would more boldly acknowledge the critical role institutions play in shaping a different and more viable future, commit to determining a realistic strategy to simultaneously solving the multiple problems at the core of our health challenge, and act accordingly.
If this were our commitment, where would we, as leaders, show up and invest? Would we change our approaches to improving health, care, costs, equity, and productivity? How much would we continue to invest in health directly, and what would happen if we invested more in revitalizing our economy and rebuilding our middle class (the former members of which are now dying at a rising rate)?
As philanthropists, we are caught in a difficult conundrum. People are suffering right now–they are hungry, they need a cure, they need homes and education. But simply providing these needs does very little to change the conditions that result in their suffering in the first place. Last week, my colleague Stacy Becker elaborated on this idea in her ReThinkers’ Blog post:
. . . [S]uppose you want to improve lifetime earnings. A typical response would be to invest directly in education or job training (and those are good things). But what about investing in infrastructure that reduces lead poisoning? Children with high lead levels in their blood are more likely to require special education, have lower IQs and ADHD, and be involved in crime. They are less likely to be ready to start school and to graduate from high school.
Investing upstream makes a lot of sense. Still, it’s troubling to many foundation boards and government leaders that making a choice to invest in identifying and addressing the root conditions of our health challenges does not bring immediate returns. Slow results don’t help build the public’s perception of the value for systems change, and when results do come they’re not as obvious as a cure or a home. It can be difficult to justify the expense.
Thankfully, some foundations are starting to understand the complex system that creates the conditions for health, and are increasingly willing to explore investment in system integration and redesign. The Blue Shield Foundation of California, the Robert Wood Johnson Foundation, The Kresge Foundation, and others are each taking a new approach by leading the commitment to a “culture of health,” integrating health and human services under a single lead, or shifting to a more system-oriented funding agenda. All of them are supporting multi-sector coalitions–made up of health systems, foundations, government, public health, independent nonprofits, employers, and others–to create neutral, regional forums for convening, planning, program development and implementation, community engagement, and evaluation.
The Rippel Foundation’s ReThink Health team is working with a number of these coalitions to determine the most promising strategies for bringing about health system transformation. Is the full array of stakeholders always at the table and doing their part? The straight answer is no; but, they are off to a good start. Hospital systems are starting to look at investing in housing and community development as part of their health agenda, and are exploring how they can use their purchasing power more strategically to create local jobs. Corporations are stepping up, not only for their employees, but also for their communities, to create healthier living environments. When they do so, everyone benefits–measurably.
These are promising steps forward, but we have yet to honestly confront the larger question: how do we better balance short-term needs with our awareness that longer-term investments in system integration and redesign will eventually make those needs obsolete? At the Rippel Foundation, we are investing more and more resources in the systems thinking we believe is critical to health transformation. Check back next Monday to learn more about what we’re up to. We invite you to join us in digging into the complexities, so we can find and create value around the best ways forward.