7

Insights and Strategies from Cross-Sector Thinkers

The objective of the cross-sector panel was to highlight the perspectives of individuals working at the intersection of different sectors and who are knowledgeable about data, actions, and policies, including investments outside of the health sector or at the interface among sectors, that have implications for improving equitable health and well-being in communities around the country. Mary Pittman, president and chief executive officer of the Public Health Institute, welcomed and introduced the panel: Chris Parker from the Georgia Health Policy Center (GHPC); Alison Omens from JUST Capital; and Soma Saha from Well-being and Equity in the World (WE in the World). Key points from the panelists are provided in Box 7-1.

Pittman asked the panelists to talk about the work of their organizations and how the pandemic and movement for racial justice are reshaping their work. Chris Parker shared two concepts. First, he said he would reflect on the work of GHPC on wellness funds, how stakeholder groups across the country are thinking about financing to support community health improvement, and the effects of the pandemic on that work, whether as a catalyst or as a factor in some unraveling of the partnership. A second area is alignment across sectors, particularly public health, health care, and the social sector, and how COVID-19 has affected that alignment. Parker also clarified that when he says COVID-19, he is using it as shorthand for the triple threat of pandemic, economic downturn, and the light that the pandemic has shed on racial inequality and inequities in the United States. The threat posed by racial inequities has been known for some time, Parker

noted, but the pandemic has cast it into sharp relief and that may help move the conversation forward.

Pittman asked Parker to speak about wellness funds. Most people, Parker began, understand that the U.S. health care delivery system is designed so that a lot is paid for sickness care. Communities have to gather resources in an effort to try to move upstream, or in other words, to address the underlying factors that shape health. Five to 10 years ago, GHPC became aware of innovations happening across the country as people were thinking about how to sustainably finance the work of community health improvement. Local wellness funds are “funds that are put together in an effort to address a local community priority” pertaining to health and well-being. GHPC has been working to understand how these funds work and the extent to which they are either site-specific or have features that could be scaled and replicated elsewhere.

Omens shared how her organization, a nonprofit founded approximately 7 years ago, works “to understand how Americans feel about companies and align corporate actions with those priorities.” JUST Capital, she stated, conducts “extensive polling of what Americans think is important for companies to be prioritizing every day.” The current top issues are worker pay, benefits, training, and commitment to nondiscrimination and advancement. Additional priorities include impact on climate and the environment, and consumer privacy, but a considerable proportion of the priorities have to do with health outcomes. JUST Capital reviews a variety of publicly available and crowdsourced data and information about the 1,000 largest publicly traded companies on those priority elements.

In the past 2 to 3 years, Omens said, there has been a move in the direction of stakeholder capitalism,¹ a concept that reflects a company’s commitment not simply to shareholders, but to workers, communities, and consumers, as well as a company’s impact on the environment. In a larger context where trust in institutions has broken down, Omens asserted, it is interesting to note a level of public faith in businesses as societal leaders. For example, she shared that consumers are asking for things that are not simply for profit but also offer long-term returns.

During the pandemic, consumers are asking if companies have implemented hazard pay and if they have kept it, and if they have sick leave and what the parameters are for it with regard to COVID-19 (e.g., is testing required; paid versus unpaid). JUST Capital, Omens noted, reflects on the profiles of companies that represent more than 20 million Americans, and has been asking companies a wide range of questions. One line of questioning may begin with if the company has assessed its workforce to ask if workers are able to get by economically, and explored why or why not. It is understood that if someone is financially insecure—because their wages are too low, their health care, transportation, or housing costs are too high, or their children are experiencing an illness—then it affects the business and productivity may be affected. Similarly, “If people don’t feel respected on the job, they don’t feel like they have a voice on the job,” this has implications for the community, families, and the broader workforce.

Omens shared that JUST Capital frames the narrative about leadership as “doing well by workers” (with attention to better societal outcomes) as opposed to having the most buybacks or dividends. Pittman asked about key current findings among the companies tracked. Omens shared the example of Home Depot, which JUST Capital found gave workers adequate sick leave. Some companies that employ so-called essential workers offered hazard pay at the beginning of the pandemic, but many have discontinued it. The ramifications of the pandemic, however, are noteworthy if stores are located in places where there are outbreaks or if there are problems with the supply chain.

Pittman then asked Soma Saha to share the work of WE in the World and the Well Being In the Nation (WIN) Network. Two years ago, Saha said, nearly 100 organizations came together to work on the measures that were designed as a living library of measures, as reflected in the recent Milbank Quarterly article that showed how the measures were being used in the field (Saha et al., 2020). The Milbank Quarterly article describes frameworks and tools being used to advance equity, racial justice, and well-being measurement in real time in states ranging from Delaware to

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¹ See https://hbr.org/2020/01/making-stakeholder-capitalism-a-reality (accessed January 13, 2021).

Texas.² A major lesson is that the systems are not working, and “we need one another.” A key insight shared by participants is that they need help both in thinking about how to effect inner transformation while also working toward structural transformation. Saha also mentioned contributing to Thriving Together: Springboard for Equitable Recovery and Resilience,³ a guide and list of web resources from the Well-Being Trust and supported by the Centers for Disease Control and Prevention Foundation, and highlighting key actions that communities can take to move through recovering from COVID-19 and toward health, well-being, and equity.

Pittman asked the panelists to share what they have learned about advancing equitable health and well-being over the years through cross-sector work. Pittman remarked on the effects of COVID-19 on Black and Latino communities and asked the panelists to speak about what they are observing in terms of cross-sector work in advancing equitable health and racial equity as part of the response to the pandemic. Omens shared that JUST Capital partnered with PolicyLink and the consulting firm FSG to develop the CEO Blueprint for Racial Equity, and outlined its three main recommendations.⁴ First, the blueprint calls on companies to be transparent about what they are doing internally, including the demographics, assessment on hiring and opportunities for advancement, and leadership training on antiracism. Second, the blueprint recommends that companies think about their effects in their community, including changing their approach to philanthropy and their relationships with local governments, organizations, and suppliers. Third, the blueprint asks companies to consider their effects at a societal level and in terms of lobbying and advocacy. For example, Omens said, “If you are a bank or you have capital, where is that capital flowing? Have you done an assessment of it?” There are considerably limitations to currently available public data on these topics, Omens noted, because companies generally do not share demographic data or data on their board diversity, but, she added, there is a real push both within companies at the board level and through investors asking for those data. Given the current context, Omens said that it will be important for the corporate sector to find ways to measure “what it means to be a company committed to antiracism.”

Parker shared that the antiracism question is a personal issue for him. He shared his sense of indescribable rage after seeing the Ahmaud Arbery

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² See https://www.milbank.org/quarterly/articles/well-being-in-the-nation-a-livinglibrary-of-measures-to-drive-multi-sector-population-health-improvement-and-address-social-determinants (accessed December 18, 2022).

³ See https://wellbeingtrust.org/news/well-being-trust-releases-thriving-together-a-springboard-for-equitable-recovery-and-resilience-in-communities-across-america (accessed December 18, 2022).

⁴ See https://www.policylink.org/resources-tools/ceo-blueprint-for-racial-equity (accessed December 18, 2022).

videotape, and coming to acknowledge that the question about antiracism is both organizational and personal. The components of this work include “do no harm” at the organizational level, the personal emotional intelligence to recognize that this is not merely a technical challenge, and also the need to consider and adopt multiple strategies. Change, Parker noted, needs to occur at all levels: internally in the organization, at the level of the partnerships in which the organization participates, and externally facing at the societal level to avoid perpetuating something that has been structural or systemic. Questions to be asked, according to Parker, should touch on contracting, hiring, and other aspects of the organization. Organizations outside health care, such as public health and the social sector, may believe that power resides in the health care system, and it is important to address that power dynamic. GHPC, Parker added, has begun thinking about the tools needed to help organizations sustain these conversations about race and power.

The WE in the Nation meeting after the killing of George Floyd, Saha stated, surfaced what seemed to be a moral crisis in people’s minds regarding how to act. WE in the Nation invited people to a dialogue facilitated by members of communities of color and groups with relevant experience to help co-create what became the WE WIN Together Racial Justice Journey. Saha echoed Parker’s remarks that relationships need to change and power dynamics need to be addressed as organizations set out “to transform our policies, our investments, our practices, our system, our culture.”

Pittman asked the speakers to describe one or two strategies for responding to the pandemic and the movement for justice that they have found to be effective. Saha shared that her organization has been working to gather links for resources and has disseminated them on the WE in the World website, on Community Commons, and elsewhere. Saha also shared an insight from the racial justice community—that accompaniment matters and that people who feel energized and motivated after a training or conference will need day-to-day support and a group of peers to walk with them on their journey. Saha also shared that Transformation 2020 from the Center for Popular Democracy was starting the following day.

Parker added that partnerships across organizations require additional support that is different from what is needed for internal, institutional work and for outward-facing work.

Funders and organizations such as GHPC provide support to some of these cross-sector collaborations. For example, Parker mentioned that the Atlanta City Council approached GHPC for help with facilitating the council’s own conversations about racial equity and bringing information and tools to the council table.

Omens spoke from the perspective of business, and echoed the questions about cross-sector partnerships. JUST Capital works to understand, for example, what a company’s policy is on its relationship with the com-

munity, how it chooses where to spend its philanthropic dollars, or how it chooses to hire. Omens added that JUST Capital has been experimenting with content and creating lists, such as “10 things businesses can do right now to support essential workers or to promote racial equity,” which has gotten considerable attention on Google and other search engines.

Pittman asked Parker to respond to an audience question about supporting Accountable Communities for Health. Even though many have been successful in building strong, cross-sector collaboratives, had Parker observed in his research any strong, sustainable funding commitments that he could share? What would it take to make that kind of investment or that change in financing happen so these local collaboratives can be sustained over time?

Parker acknowledged that over the past 5 years, there has been greater interest and engagement of health systems in population health, perhaps from an initial standpoint of “How do I make the bottom line feel better?” or “How do I take care of our patients and not necessarily the broader community?” Some of this work has been led by the mission-oriented hospital systems, and some of the conversations about the power imbalance have come from health systems being at the table. Then, COVID-19 happened, and it is unclear what the effect has been aside from destabilizing the finances of health systems.

Parker noted that the opportunity presented by COVID-19 may be overshadowed by the need to stanch the bleeding, and a second wave of COVID-19 may further affect the appetite of health systems to engage in this work rather than work on improving hospital infrastructure. Parker also outlined the framework for what GHPC describes as alignment:

• trust and power,
• power distribution,
• data sharing,
• a common vision, and
• sitting together at the table for the good of the community.

The groups that are working toward sustainability, Parker noted, are the groups that are working through these issues. Saha shared an observation that partnerships that have co-invested in community capacity building and that have approached the work with equity in mind have been able to develop far greater resilience and preparedness in their ability to solve problems. However, she added, in aiming to do good quickly, some collaborators have made some other sectors serve the ends or align with the approaches of the health care system, she added. She said,

Saha underscored the value of achieving some quick wins. For example, in work taking place in San Antonio, where 60 percent of children did not have an Internet connection for virtual learning, the effort to improve access for telemedicine became a broader effort for jobs and community health. However, Saha noted that “you can’t shortcut that recipe if you’re actually going to create well-being and equity out of that well-being trust. The trust is an enabler … and the communities that approach it in that way achieve far better outcomes.”

Pittman shared the unique opportunity that the Public Health Institute has as a result of 12 California foundations coming together to fund COVID-19 contact tracing work in high-impact communities. The funders organized the work rapidly in response to the pandemic, and, she added, there may be other examples of such unlikely but exemplary rapid responses to the pandemic.

Omens remarked that people are seeing a shift in the business community in real time. Adding to her earlier comment about stakeholder capitalism, Omens noted that the Business Roundtable signed a new statement of purpose in August 2019, saying that the purpose of business is not just to their shareholders but to their workers and communities and suppliers. There are questions, Omens said, such as “Does business have a role to play in addressing inequality? If the retail and restaurant industry are paying really low wages, is that a business question? Is that a question for business operations?” The sector may begin to see collaborations that are just about philanthropic dollars going to local sports teams shift to conversations about “aligning investments along with philanthropy, along with paying living wages, and you can start to see the outcomes that are connected in a whole different set of ways,” Omens added.

Parker shared that a topic that he has encountered in his work that pertains to the role of public health vis-à-vis health care is the sense that “the public sector acquiesces the role of leadership to the private sector.” The (governmental) public health role of connector between the health care system and the community at large is important, Parker noted. He acknowledged that the leadership role in a community health improvement partnership could be played by any number of entities, from a health care organization to a social services agency. However, he noted that public health workers and officials have traditionally acted as facilitators of leadership and data gatherers or data sharers in the community, and although (governmental) public health as the go-to-source for credible information has been imperiled somewhat, there is a unique role that public health plays that may not be easily be transferred to other entities.⁵

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⁵ See the description of public health agencies as the community’s “chief health strategist” that has shaped the field’s thinking about the current and potential role of government public health agencies at https://www.resolve.ngo/docs/the-high-achieving-governmental-

Pittman said that she would agree, and then asked Saha to reflect. Saha said that she “would love to see public health, which brings that ability to see across sectors, be the coordinating entity.” She appreciated what Pittman had shared about community health workers in the context of COVID-19 operating not just as COVID-19 tracers, but rather

Saha noted that the public sector is uniquely positioned to create an enabling policy environment. For example, she described how a policy environment could provide incentives, such as tax benefits, for “businesses that measured their contribution to the well-being of their people, the well-being of community, and their investments [in] racial justice.”

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health-department-as-the-chief-health-strategist-by-2020-final1636869407709140046.pdf (accessed January 13, 2021).