Unequal Outcomes: Why a Health Funder is Focused on Marginalized Communities

This spring, the Maine Health Access Foundation announced an investment of $600,000 in eight organizations that serve “communities that face disproportionate barriers to health and well-being.” The targeted populations include those in poverty and who are minorities based on gender, race and/or sexual orientation.

MeHAF grants about $4 million annually in one of America’s poorest and most rural states. It organizes its investments into three priorities that include healthcare access and improving community health through collaborative, place-based efforts. MeHAF tends to support a wide range of local causes and diverse minority populations.

The foundation's grantmaking offers a good example of how regional health funders are grappling with the complex interplay between issues of poverty, power, and health.

“Research consistently shows unequal health outcomes based on factors like race, sexual orientation, gender identity, disability status and homelessness, to name a few,” said Barbara Leonard, MeHAF’s president and CEO, in a statement on the latest grants.

She’s right. In the U.S., members of “sexual minority groups,” such as people identifying as gay, lesbian or transexual, have been found “more likely to encounter barriers to care than their straight counterparts.” It is more common for this population to be poor, as well.

Also, blacks and Latinosare still more likely to be in poverty or uninsured. The same is true in Maine, where about 43 percent of blacks and 18 percent of Latinos were poor in 2016, compared to 11.5 percent of whites. Around 8 percent of Maine residents lacked health insurance in 2016. The uninsured rates in Maine during this year for Latinos and blacks were 16 and 10.5 respectively.

In March 2018, MeHAF released a data brief with the University of Southern Maine showing more than half of the state’s uninsured, low-income adults did not have a usual source of care. The same percentage had problems paying medical bills.

MeHAF seeks to address these myriad, and at times intersectional, inequalities through its grantmaking initiatives. Intersectionality refers to the convergence of identities like gender and race, and the term is often used to point to the ways overlapping minority identities can compound inequity. MeHAF is awarding eight three-year operating support grants that include technical assistance to these diverse beneficiaries:

Amistad, Inc., which offers peer-led mental health services
In Her Presence, which works to empower women from minority communities
Maine Access Immigrant Network, which provides multilingual access to health and social services
Maine Transgender Network, Inc., which gives support and resources to the trans community
Mano en Mano/Hand in Hand, which celebrates diversity “while building unity in Downeast Maine,” with a focus on education, housing, and “access to essential services”
New Mainers Public Health Initiative, which endeavors to identify and solve health problems, specifically for immigrant and refugee youth and their families
Portland Outright, which supports underserved members of the LGBTQ youth community, and
Wabanaki Health and Wellness, which provides health and wellness services for tribally enrolled Native Americans

The inclusion of factors like housing, education, language services and community-based support show that MeHAF is another organization taking an upstream approach to local health care. Upstream strategies integrate these types of social determinants of health into their plan to bolster community care and well-being.

With the recent investments, MeHAF also specifically chose to bolster organizations whose leaders mostly come from among the communities they serve. This method arose from the recommendations of a 2017 MeHAF equity subcommittee—a group MeHAF formed to evaluate how it addresses health equity. The subcommittee made up of members of its Board and Community Advisory Committee also recommended MeHAF make its application process simpler and invest in “equity accommodations” like translation and interpretation services for applicants.

MeHAF is a health legacy fund and the largest private nonprofit healthcare foundation in Maine. As Inside Philanthropy has reported, health legacy foundations are making a big impact in rural areas, where major philanthropy has typically been lacking. Along with grantmaking, MeHAF partners with the groups it backs by offering meeting support, technical assistance, and leadership development programs, while also engaging in research, advocacy, public policy and media efforts.