A Regional Funder Gives Big to Upstream Solutions to Chronic Illnesses

photo: Phawat/shutterstock

photo: Phawat/shutterstock

While big, national funders like the Robert Wood Johnson Foundation and Kresge have long grabbed headlines with their groundbreaking work to take healthcare philanthropy upstream, many state-based and corporate foundations have lately been moving in the same direction, as we've been reporting.

A case in point: A Texas funder has quietly been making big investments to target social determinants of health in that sprawling state.

The Episcopal Health Foundation, which has assets of over $1 billion, recently pledged $10 million over four years to 13 health clinics in Texas that are working to address the underlying community conditions that affect health.  The grants are through the foundation’s Texas Community Centered Health Homes Initiative (CCHH).

“Medical care alone isn’t enough to keep many Texans healthy,” said Lexi Nolen, the foundation’s vice president for impact. “When patients keep coming back with recurring health problems, community clinics are left asking the same frustrating question—‘What good does it do to treat people if we keep sending them back to the conditions that make them sick?’ This is a new approach to go beyond patient-only treatments and promote change at the systems and community levels.”

The clinics will get up to $500,000 each to tackle factors that affect people’s health, such as poverty, substandard housing, lack of access to healthy, affordable food, and limited safe spaces to exercise. Through these projects, the clinics hope to stop chronic health issues like obesity, diabetes, asthma and other illnesses before they develop. Clinics will partner with other groups in the community, government agencies, schools and businesses to develop prevention strategies that cut across sectors.

“By complementing healthcare delivery with community action, CCHH clinics focus more on prevention and addressing the community conditions that are often the root causes of poor health outcomes,” Nolen said. “The goal is less illness and injury, reduced demand for medical treatment, and more opportunity for more Texans to achieve their highest level of health.”

The project fits in with the growing movement led to look at social factors that affect health. The approach embraces the idea that there are things in people’s environments making them sick. To treat them, those environmental and social factors need to be taken into account.

For example, if a child came to the ER with asthma, a doctor would treat the symptoms, but would also send the family home with instructions for a housing assessment. That’s one of the methods adopted by the BUILD Health Challenge, a collaborative of national and regional funders, bringing an upstream approach to health to several communities across the country.

Related: Looking Upstream: A Funder Collaborative Goes Local to Address the Roots of Health

The collaborative’s work on childhood asthma was based on a link between asthma and houses with mold, damp basements and poor ventilation and AC systems. In Des Moines, where this BUILD project was based, $150,000 went to home repairs, which translated to on average five fewer asthma episodes a month for 40 families.

Episcopal Health Foundation is one of the many funders behind the BUILD Health Challenge. The foundation has brought an upstream approach to its health work in Texas for a few years now, but formally committed to the method in its five-year strategic plan released last November.

Related: Getting More Strategic: A Big Texas Funder's New Game Plan for Health Equity

Founded in 2013, the funder is relatively young, but has substantial resources to invest in the 57 Texas counties that comprise its primary focus. This financial muscle is part of a larger story we've been reporting in recent years: the rise of large health legacy foundations that have become critical players in regional philanthropy, often in places that lack the older institutional grantmakers found in coastal cities. 

Episcopal's deep pockets will come in handy, because it has its work cut out for it. Texas leads the nation in the number of uninsured children and adults. The Affordable Care Act’s uncertain future means those numbers could grow.

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On top of that, Texas is in the middle of a growing rural healthcare crisis, as we’ve reported at IP. About 75 percent of the state’s population lives in the triangle formed by its three largest urban centers, Houston, Dallas and San Antonio. The state’s best hospitals and medical specialists are also located within the triangle. In contrast, in rural Texas, hospitals and clinics are shutting down, and a growing number of Texans are living with chronic conditions.

The Episcopal Health Foundation has been at the forefront of funders addressing the crisis. The foundation has supported several studies to track the state of rural healthcare in Texas, examining hospitals and insurance coverage. The data has informed the foundation’s grantmaking around community-based primary care clinics and some work around remote telehealth.

Like so much of the philanthropy addressing social and environmental conditions that affect health, the latest gifts from the Episcopal Health Foundation are going to clinics in or near Texas' big cities. However, as a champion of rural healthcare, the foundation must be aware that rural environments shape health too. With $1.2 billion in the bank and a strategic plan spotlighting upstream methods, it will be interesting to see where this foundation's work takes it next.