Editors’ Note: Today, we begin a discussion on philanthropy and inequality with posts by HistPhil co-founder Maribel Morey and, below, by Faith Mitchell, president and CEO of Grantmakers in Health (GIH).
James Crawford, my great-great grandfather, was an American taxpayer who could not vote or own property. His children were able to attend school only when the white community approved of it, and some local schools for “African” children were burned. James did not live in the Jim Crow South. His home was in Pennsylvania, in the 1840s, and he was nominally a free black man.
James Crawford’s experience reflects not only the long roots of inequality in American history, but also its ubiquity in the structures of everyday life—civic representation, capital production, education. This pattern repeated across the generations, in every part of the country. Now, we are living with its historical legacy, as well as coping with contemporary, worsening trends—not just in the United States but globally. The problem of inequality is enormous, as are the conditions it generates. Is there a role for philanthropy in addressing these inequalities?
I believe there is one, and that there is evidence that philanthropy can do this effectively. True, the private sector does not have the financial resources or reach of government when it comes to solving problems. But its independent status makes it particularly suited to tackling structural, big-picture issues—if that is what it chooses to do.
In the case of inequalities, philanthropy’s role hinges on a willingness to recognize their structural nature, and a commitment to transforming those structural elements. It is typical—and safe—for funders to make grants that address the symptoms of inequality: summer camps and tutoring programs for low-income children, health fairs in high-risk communities, and so forth. But these grants do nothing to change the structural conditions that create the problems. They are essentially patches that may have a short-term positive effect, but whose long-term impact is at best limited.
Addressing inequalities takes a different vision. It requires focusing “upstream”—as we say in the health field—that is, focusing on root causes. There must also be a willingness to invest for the long term, for problems with longstanding origins cannot be solved overnight.
The Ford Foundation’s Fellows program is one example of a philanthropic long-term, upstream strategy. Since its establishment in 1962, the fellows program has enabled hundreds of scholars from diverse backgrounds to complete advanced academic training; former fellows include Condoleezza Rice, Cornel West, and other academic and intellectual leaders. By creating opportunities for new faces, voices, and perspectives, the fellows program acted as a disruptive innovation that displaced the academic and professional status quo. Private support for education has played this role vis à vis inequalities for some time, as in the example of the 19th century missionary societies that took on the challenge of educating the newly freed slaves.
Health is another sector of philanthropy in which there is a strong interest in reducing inequalities. In health, that interest is often framed in terms of the goal—achieving equity—rather than the problem—ending inequalities, with an accompanying focus on structural and institutional change to address the conditions that produce illness and disease. The interest in equity often aligns with government policies, but health funders are able, in many cases, to be more innovative than the government, and to be more responsive to community dynamics.
Work to support equity takes several forms. For some funders, it means working to influence federal policy change, as many did in the years leading up to the passage of the Affordable Care Act (ACA). Post-ACA, many health funders continue to support health system reform, in hopes of eliminating the inequalities in health status and health care that currently affect millions of Americans, especially people of color. They also focus on system-level changes related to reducing health care costs and ensuring that the health care workforce is sufficient to meet demand. In both of these instances, both the long-term nature of the issues and the major role played by the government will shape their efforts.
Other health funders are taking a broader view that addresses inequalities by moving beyond health care. For example, The California Endowment’s $1 billion, 10-year, Building Healthy Communities initiative is an example of philanthropy aspiring to have a lasting influence on policies that reduce inequalities, but operating independently of government programs and with more comprehensive goals than government agencies could typically accomplish. The initiative supports health equity, but intentionally does not fund health care services. Instead, its goal is to “change rules at the local and state levels so that everyone is valued and has access to the resources and opportunities essential for health: affordable housing and fresh food, jobs that are safe and pay fair wages, clean air, and the other ingredients essential for a healthy life.”
The initiative addresses four areas that have a social impact as well as affecting health outcomes: access to health care, obesity, criminal justice, and school attendance. The inclusion of criminal justice and school attendance reflects the field’s emerging understanding that these systems are among the structural components that not only shape the life experiences of individuals, but also contribute to the broader community’s wellbeing.
These examples show that within structural systems—education, health, etc.—philanthropy has had a role in addressing inequalities, chipping away at a large problem. Taking on the challenge of working across these systems would be a major test of philanthropy’s prized nimbleness and could potentially lead to larger accomplishments. It would certainly be an opportunity to test new ways of doing business, like partnering with other organizations and government, using convening power and relationships to exert leadership, working collaboratively with other funders, and using philanthropy’s voice to effect change.
Faith Mitchell is President and CEO of Grantmakers In Health, the professional association for health foundations and corporate health philanthropy. She has worked throughout her career on social and health issues, in a variety of sectors. She holds a Ph.D. in Medical Anthropology from the University of California-Berkeley. (Full disclosure: the author is a former Ford Fellow).