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Health Equity: When Good Intentions Aren’t Good Enough

By on June 1, 2017



I recently completed many years of service as a board member for a local nonprofit that improves the lives of girls and young women. I loved it and felt we were making a real difference in our community. In the last decade, we quadrupled the number of girls served and had measurable, positive outcomes. We increased scholarship funding nearly threefold, ensuring that no girl was denied participation due to financial need. We even grew reserves in the aftermath of the Great Recession of 2008. We were successful by nearly any measure. Yet something was missing, particularly in our early days. Most of the other board members and staff were a lot like me: white, straight, middle-class, professional women from Generation X who were college-educated, English-speaking, Christian, and without significant physical, mental, visual, auditory, or other challenges.

The nonprofit sector is rife with similar examples. This illuminating article in the Nonprofit Quarterly confirmed that in 2014, people of color comprised just seven percent of chief executives and 18 percent of staff—even though nearly two in three nonprofits serve minority populations. The Chronicle of Philanthropy recently released a report showing that the trustees of America’s 20 largest foundations with national reach “look little like America when it comes to class, race, and gender.” More specifically, of these 232 trustees, 72 percent are white; 63 percent are male; 40 percent have Ivy League degrees; just a handful live in the country’s poorest states; and, while 16 of the trustees are former or current university presidents and dozens come from business and finance, only two have had military careers and just four are religious leaders. This homogeneity increases the likelihood that the practices, policies, and systems that fuel the nonprofit sector are less attuned to the needs of the populations they’re intended to serve.

Like me, most board members and staff are committed to our missions. We care about diversity. We have friends and colleagues with a range of lived experiences. And we may even actively seek to understand how privilege shapes our lives and impacts our effectiveness as change makers. And yet we still fall short. Good intentions simply aren’t good enough.

In a recent post on his popular blog, Nonprofit AF, author and nonprofit leader Vu Le notes, “For the past few years, everyone has been talking about Equity, Diversity, Inclusion, and Cultural Competency. This is good. But when these things do not come with profound changes in systems and processes, they can actually cause more harm.”    

Indeed they can. I’ve seen—and no doubt contributed to—many instances in which good intentions alone:

  • led to tokenism;
  • generated major blind spots that impacted new program planning, policy advocacy, and investments; and
  • created negative, unintended consequences that perpetuated the very disparities we trying to eliminate.

So what can we do? We can start by learning from those who are taking small but important steps forward, even as they recognize that the complex, long-term nature of this work requires more from all of us. For instance:

  • Oakland’s Public Health Institute and Resourceful Communities, a program of The Conservation Fund, believe that internship programs are an important pipeline to long-term employment. Among an array of practices intended to help their organizations advance equity objectives, they have cultivated authentic relationships with historically black colleges and universities (HBCUs) and with grassroots community organizations to ensure consideration of young people with diverse life experiences.
  • As the anchor organization for the Jefferson County Health Action Partnership (HAP), United Way of Central Alabama requires all of its Leadership Team members to attend a health equity orientation and commit to these health equity guiding principles. While this is still relatively new, leaders believe these important first steps will lead to changes in practices, policies, and systems within the HAP and its member organizations.
  • The Praxis Project strives to change some of the funding practices that have obstructed marginalized communities for generations. When staff started working in communities of color, there was limited direct funding for indigenous/First Nations organizations. In response, Praxis worked with a number of indigenous advocates to support gatherings that grew into the Native Organizers Alliance, which was able to receive and distribute funding on behalf of its members. What started as a project to address gaps in infrastructure grew into a network that helped catalyze efforts like the movement to stop the Dakota Access Pipeline.

There are also an array of resources available for those who are ready to accelerate their commitment to equity. For example, last month the Robert Wood Johnson Foundation (RWJF), in collaboration with researchers from University of California San Diego, released What is Equity? And What Difference Does a Definition Make?. This new report intends to “stimulate discussion and promote greater consensus about the meaning of health equity and the implications for action.” This is just one of several RWJF resources intended to help shift the national conversation from disparities to health equity and to give champions from every sector the tools they need to carry a health equity agenda forward.

While these tools provide a great starting point, systems transformation requires fundamental changes in organizational practices and policies. To that end:

  • Members of the RWJF Health Equity team meet regularly to identify how they can infuse a health equity lens into all of the organization’s investments and activities—and they regularly assess their progress.
  • The Consumer Health Foundation created and adopted this tool to promote and maintain diversity in its operational and grant-making practices. It has fundamentally changed the way the organization thinks about its work and the people it serves.
  • King County, WA, developed the Equity and Social Justice Strategic Plan, a blueprint for change that was co-created by community partners and county employees. To achieve better outcomes, the Plan pledges to “integrate and implement pro-equity policies in our major functions of government where we can effect change, including leadership operations and services; plans, policies, and budgets; workplace and workforce; community partnerships; communication and education; and facility and system improvements.”

So what’s the status of that local nonprofit whose mission I care so deeply about? It’s been gratifying to see how the organization is evolving. It recently hired bicultural, bilingual staff members. It piloted a program to serve girls with physical challenges. Because of that, efforts now are underway to assess and remove all barriers to participation. Even the board is changing, with more men, people of color, young adults, parents, and other direct stakeholders recruited. But they know they can’t celebrate yet. Because as Darren Walker, CEO of the Ford Foundation and a leader in this work, recently reflected, “It’s a journey—you never slow down, and you never declare victory.”

Sarah Strunk

Sarah Strunk |

Strategic Advisor

Healthy communities networker, integrator and distance runner on the go.

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