The desire to impact community health outcomes has inspired funders to think about their role in advancing policy and system-change efforts. In particular, the Iowa Council of Foundations has partnered with Mid-Iowa Health Foundation to convene conversations for its philanthropy network on what supporting healthy equity work in rural areas can look like.
To kick off a February discussion, Dr. Nalo Johnson, President and CEO of Mid-Iowa Health Foundation, shared how she is thinking creatively about opportunities to inform policy decisions that address the social determinants of health, with a particular interest in The Commonwealth Fund’s approach to: “Develop and disseminate the right information for the right people at the right time in the right way.”
“I view the philanthropic sector as a key partner to be able to either provide the research data or provide the funding to do work in an innovative manner,” she said. “This allows the ability to test new approaches that may ultimately lead to more effective and impactful program and policy changes.”
Supporting advocates through the HealthConnect Fellowship is an example of how the Foundation has advanced practice and policy changes. “What we’ve learned through supporting the fellowship is that often individuals are working in nonprofits and wearing multiple hats,” Johnson said, “so being able to provide individuals with some dedicated time and some dedicated resources to support their advocacy work helps strengthen their system-change efforts that often times includes a focus on policy.”
During the discussion, Johnson facilitated a panel presentation of HealthConnect Fellows that highlighted examples of health equity work in action and how funders can better support these efforts. The panelists were:
Here are insights the three leaders shared:
The Central Iowa Trauma Recovery Center is a model that provides holistic care to survivors of violent crimes. Simmons’ team recognizes the importance of removing barriers that may prevent people from receiving and staying with services that support recovery. For the one-third of the Center’s clients that live in rural areas, removing barriers may look like providing technology access to telehealth services and visiting people in their homes, instead of having them come to the office.
Proteus takes a similar approach of providing health services through mobile clinics on site or near where farmworkers and their families are located. If someone is referred to receive additional services, Proteus provides transportation to appointments, interpretation, and, at times, payment to cover costs. The organization also is testing an approach to address hypertension – providing patients with a Bluetooth blood pressure cuff that syncs with their electronic health records, so providers can monitor and follow up with additional support if needed. This model could be a way to monitor and address other chronic health issues as farmworkers travel across state lines.
While Iowa Public Health Association does not provide direct services, it serves 600 members across the state who are primarily working in public health through government agencies and community-based organizations. Its approach is to normalize health equity by providing education and training, as well as to support individuals in sharing their perspectives of health. For example, IPHA worked with Coco Creative, a Black-owned marketing agency, to provide storytelling training to help Black Iowans share their experiences of accessing the health care system.
Tucker Reinders also highlighted how health equity efforts must start with internal work. The organization has reviewed its diversity, equity, and inclusion policies and practices and is working on identified areas for growth, including engaging more diverse stakeholders.
Supporting individuals who have experienced violence and trauma means looking at all the factors that impact their stability and well-being, not just providing mental health services, says Simmons. Telehealth has made mental health care accessible in rural areas, but requires ensuring patients have a computer, are trained on how to use it, and have other assistance to access that service. Simmons’ organization is also infusing health equity approaches into training and technical services for other agencies who serve survivors of violent crimes – influencing how the entire support system approaches its work.
Proteus now offers breast and cervical cancer screenings to farmworkers and their families after struggling to find partners who could provide these services. Integrating the screenings into its work has given farmworkers and their families access to a type of health care many have not received previously and is leading to identified cancer that is then treated. As part of providing this service, the team has had to consider how to support workers who are undocumented and will not want to receive treatment from a hospital.
Iowa Public Health Association is striving to ensure authentic voices are guiding the process of developing and delivering public health messages. To encourage people to get vaccines during the COVID-19 pandemic, IPHA partnered with the University of Iowa College of Public Health to hold focus groups with community leaders and residents in micropolitan communities (cities with populations between 10,000-50,000 people) that serve as hubs for rural areas. Using focus group feedback, they developed messages that were then tested with individuals in micropolitan and rural areas before being shared broadly with public health partners across the state.
The Central Iowa Trauma Recovery Center collects data regularly through full clinical evaluations at every eighth session and by having patients complete a life stability assessment that staff developed. With this data, the Center helps individuals receiving treatment see their progress over time, as well as shares the data with policymakers and funders to support ongoing investment in the model. Data collection also helps inform a movement toward building Trauma Recovery Centers across the nation.
As a Federally Qualified Health Center, Proteus must capture a lot of data about its programs that is shared publicly, including aggregate demographic information and health outcomes. The organization uses the data to identify a handful of areas to focus on for a quarter and to monitor progress. The organization also is establishing relationships with research partners who can study models being tested. For example, Proteus recently tested providing health care services on site to workers at meat-processing plants and used evaluation data to make a case that these services reduce turnover and increase productivity.
Iowa Public Health Association has found that disaggregated quantitative data on Iowans health is often unavailable because sample sizes are too small or demographic information is not properly collected. This limits the ability to see health disparities among populations. Instead, IPHA relies on national data sets to assume that similar trends are occurring in the state. Qualitative data, however, offers a deeper understanding about what is happening with Iowans’ health. Its data that Tucker Reinders hopes is increasingly recognized as valid and valuable to health equity efforts.
The panelists provided feedback to funders on what would help advance health equity efforts in rural areas. Ideas included:
Increase flexibility with funding requirements: Simmons shared how current funding structures prevent the Trauma Recovery Center from receiving greater support. For example, funding to support survivors of violent crimes is often bucketed into sexual assault, domestic violence, and other specific areas. Because the Center serves all survivors of violent crime, it is limited in where to apply for support. Tucker Reinders noted that requiring match funding can also prevent organizations from applying as there is often little unrestricted funds in the budget to put forward as a match.
Ask organizations what information would be most meaningful to share: Simmons noted that funding applications should be created with subject matter experts to ensure they are set up in a way that allows organizations to share the impact they are making. Zinnel noted that funders can also ask organizations what data they are already collecting and work collaboratively to examine what both entities want to learn, instead of telling organizations what data they must provide.
Support general operating and administration costs: All panelists agreed that operating support would help advance health equity work in a strategic and sustainable way. “There has to be an administrative process in place to ensure what is being done is being done in a certain way,” said Simmons. “Direct service dollars are very restrictive.”
“If the focus is on one-year funding, fund general operations and allow us to determine where it’s best suited for,” said Zinnel. “If funders are interested in new and innovative projects, fund for multiple years to see it through to be successful. It takes time to get a new project off the ground, create the evaluation process, implement, and pilot.”
Tucker Reinders also encouraged investments in organizations’ endowments to build long-term sustainability and to provide at least half of the funding upfront if a model of reimbursing for services is preferred, so that organizations can get work off the ground. “Give more flexibility to spend money,” she said, “and trust that 1) we are fiscally responsible, and 2) we know what the need is.”
View the work the HealthConnect Fellows are leading to improve health outcomes for children and families.
Teenagers in jumpsuits lying on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention, a place where youth arrive shaken, dysregulated, and scared about their future.