This summer, we were lucky to attend two new conferences that focused on emerging trends in the health sector. Building off the momentum of the Affordable Care Act (ACA)’s implementation, Aspen Spotlight: Health and SOCAP: Health touted prevention as a key market opportunity and presented ways philanthropists and impact investors can look beyond the treatment of disease in order to improve health disparities. We were particularly excited to learn more about the potentially game-changing approaches, innovations, and partners philanthropists can employ to address the root causes of disease, improve health outcomes among the most vulnerable, and build vibrant communities.
There were a few consistent themes that especially resonate with our work with families and foundations—some of which are just beginning to fund health. First and foremost, speakers noted how important it is to consider the social determinants of health and toxic stress when thinking about improving health outcomes. In other words, if philanthropists want to help reduce health disparities—i.e., the fact that people from certain socio-economic backgrounds, races, and ethnicities don’t live as long as other segments of the population—they need to recognize the role that the communities and environments into which people are born and where they live play in determining health outcomes. At Aspen, the Robert Wood Johnson Foundation announced its new philanthropic vision is to build a “culture of health,” underscoring this exciting and needed shift in focus.
Both conferences also paid particular attention to how the convergence of big data, social entrepreneurship, and new technologies could improve human health. The implications of more accessible, scaled-up, and targeted use of data are far reaching: it could enable better decision making for public officials and, over time, reduce health-care costs and disparities and increase quality of care. And yet, speakers in Aspen and at SOCAP cited the glaring fact that, despite the ACA’s commitment to incentivizing and funding prevention, shifting practices in how we do allocate health resources will take a while: of all health-related spending, only three percent is devoted to prevention, while 97 percent is focused on treatment—even though 75 percent of health-care costs relate to preventable conditions.
The issues that emerged both in Aspen and at SOCAP will continue to dominate the conversation in philanthropic circles. How can philanthropists cut through the noise and identify which opportunities are most promising in making a sustained impact? Here are a few of the more powerful efforts to consider:
Identify and scale community-driven innovation. Community groups who work most closely with vulnerable populations are critical partners in informing health-care innovations—and, in many cases, may drive the innovations themselves. While it may not always be easy, philanthropy can play a vital role in helping to identify and scale these innovations. One simple way will be to provide flexible capital to community clinics and other neighborhood nonprofits that will allow them to test or improve models of providing prevention-oriented care and services, such patient-centered medical homes. Another is to draw from the availability of big data and to fund community organizations that are creating environmental mapping apps and encouraging citizens to track environmental hazards in their towns in order to improve larger community health outcomes. And, where there are pockets of success in communities, philanthropists can deepen their investments in the organizations behind these successes to expand their model to other communities. Philanthropy can also help structure and fund pay-for-success and social impact bond models that seek to finance social services to help governments target dollars to achieve a positive, measurable outcome. These models are now being explored throughout the health sector.
Use convening power to create and sustain collaboration. Collaboration among—and even integration of—community groups, hospitals, and the public sector will be critical to any successful model of preventative care. Currently, in order to receive comprehensive and supportive care, most need to navigate a complicated web of public systems that don’t communicate with each other. The siloed mental health and physical health systems are one example of this. And it gets even more complicated when you factor in housing and job development systems—which are key elements to the state of individual and community health. Hospitals also need to work more closely with community partners that have the trust and credibility among vulnerable populations to ensure—for example—that patients are adhering to the health regimens that will keep them from coming right back through the hospital doors (and thus paying fees, per ACA regulations). Philanthropists can use their convening power to bring diverse actors together to focus on solutions and help sustain their collaboration over the long term. Philanthropists can also help ensure that evaluation and learning is infused into the approach to inform course corrections and policy choices.
Maintain a relentless focus on addressing the needs of the most vulnerable. Entrepreneurs and other innovators are developing new tools and technologies that will help us better understand our health and nudge us toward making healthier choices. But few of these innovations are designed for the poor. Fitbit certainly may help health-minded suburbanites, but what about people who don’t even have a safe place to walk? Similarly, while electronic medical records help put data in the hands of the patient, what does this mean for individuals who do not have one primary place of care but rather data scattered across multiple ERs or safety-net clinics? To address persistent disparities, philanthropists can help incentivize entrepreneurs to develop technological innovations that ensure there’s an upside for the poor, too. Prizes and well-designed competitions are one tool philanthropists and social investors can use to help bring about this kind of product innovation.
And of course, a focus on the poor does not just have to be (and should not be) through the social investment lens alone: while ACA has expanded coverage, there are still significant funding gaps that will leave many of the most vulnerable without coverage. Philanthropy can help plug this hole by providing operating funds to community care providers—or even better, by putting dollars toward policy advocacy to expand ACA and prevention-related funds in the future. Given the vast need for additional funding and the limits of philanthropy, a focus on maternal health and early childhood well-being may be an especially wise investment in light of the growing evidence that impacts of toxic stress on health begin early in life.
It’s an exciting—and crucial—time for funders to become part of the solution to creating healthier, more vibrant communities. While this is an enormously complex issue that will require multi-faceted and sustained investment over years to come, there are ample opportunities for philanthropists big and small to take a step toward generating true impact.
Anne Lebleu is a director in Arabella’s Washington DC office, where she manages the philanthropic strategies and operations of Arabella’s family and individual clients and provides essential strategic grant-making knowledge and expertise. In this role, Anne serves as program officer of the Forsythia Foundation, whose mission is to promote healthier environments and people by investing in efforts and enterprises that build the field of environmental health and green chemistry.
Melanie Torres is a senior director in Arabella’s New York office, where she provides strategy, evaluation, and project implementation consulting services to a variety of clients.