A Conversation with Susan Mims, President and CEO of the Dogwood Health Trust
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Susam Mims, President and CEO of the Dogwood Health Trust
Susan Mims leads the Dogwood Health Trust, a grantmaker based in the city of Asheville, North Carolina. The trust works to improve the health and wellbeing of all people in western North Carolina by centering its work on the “upstream” social determinants of health, like housing, education and economic opportunity.
Before joining the trust, Mims, who received her master of public health and MD degrees at the University of North Carolina at Chapel Hill, worked at Asheville’s flagship hospital, Mission Health, before joining the Mountain Area Health Education Center as chair of its Department of Community and Public Health. “Sometimes people think, ‘Oh, you’re a physician, so you were seeing patients the whole time,’” she told me. “But when I worked at our public health department, I realized that I could not write a prescription for the things that were affecting my patients’ health.”
That reflects Mims’ unique professional arc across the past 20-plus years. “I would say that I was a public health physician disguised as a hospital administrator doing population health,” she said. “And now, at Dogwood, I get to just focus on a systems approach to improving health.”
I recently caught up with Mims to discuss her career trajectory, advice she’d give her younger self and the adage that “when public health works well, nothing happens.” Here are some excerpts from that discussion, which have been edited for clarity.
You mentioned how you transitioned from practicing medicine to public health. How did you make the jump to philanthropy?
Having moved into the field of public health, I was on the receiving side of philanthropy in terms of applying for grants, but I never saw it as a career until I was approached to move into the interim CEO role at Dogwood [in December 2020]. I’d been working in western North Carolina since 2000, and my heart is here, and I feel very dedicated to Dogwood’s mission and taking a systems-based approach to improving health. It’s been very rewarding to learn about these issues in greater depth, and the rapidly changing practices of philanthropy.
I realize I’m preaching to the choir here, but given how medical care is so reactive, it’s incumbent on philanthropy to address upstream public health challenges.
Absolutely. There’s a story I often share, and it’s how I was seeing a little girl, about seven or eight years old, and doing a pre-op physical for a dental procedure. It was going to be a whole mouth restoration for a mouth full of cavities she had after getting an abscess treated. I was talking to her about the importance of brushing her teeth and I asked her, “What gets in the way of you brushing her teeth?” and she said, “There’s nowhere to spit in the back of our station wagon where we live.”
What do you do with that? As a physician, you’re sending a little girl for general anesthesia for something that is 100% preventable. We’ve got to do something different.
What surprised you the most about your transition to philanthropy?
Having come from the other side of working with foundations and receiving grants, I am grateful for philanthropy because donors supported my work at the children’s hospital [at Mission Health] to create innovative healthcare delivery. Without philanthropy, some of what we know and are working on now would never have gotten off the ground.
But I don’t think I appreciated or understood how hard it is to thoughtfully and intentionally steward philanthropic resources to enact the change. One thing that I carry with me as a physician is the Hippocratic oath to do no harm, and as I think about how philanthropy can do wonderful things, just like any profession, it can [also] cause harm. So while we can’t mitigate that completely, I always try to consider what the unintended consequences of any investment might be.
What advice would you give your 20-year-old self?
I give plenty of advice to my 20-something-year-old son, so I’m pretty good at that (laughs). Probably the biggest advice is to get out of your comfort zone and get to know people who are not like you. I was very fortunate when I was 22 — I had the opportunity to live in Guatemala for a year. And I would say that was a year that changed the trajectory of my life and probably led me to public health work. There's a big world of diverse people, thought and lived experience that will serve you well.
What makes you pessimistic about the state of population health? Optimistic?
I used to have a boss who said, “When public health works well, nothing happens.” That is, it’s only in times of crisis, like we recently experienced with the pandemic, that people notice the importance of the work. Once the immediacy dies down, we go back to overlooking the importance of a strong public health system.
Public health often is under-resourced because the need is often not in the forefront. So my pessimistic side worries about our short memories for our collective future. I worry about how, despite great improvements in healthcare interventions, the health gap remains too wide. The growth in the business of healthcare also concerns me because a market approach will not reach those most in need.
On the optimistic side, in my role at Dogwood and in the work that I’ve done in my career, I have had the opportunity to see creative people doing amazing work in collaborative ways. In western North Carolina, we see that every day through our not-for-profit and governmental organizations who are working to improve health and wellbeing. The dedication of so many in service provision, but also in advocacy, who are speaking up to change the policies that perpetuate the disparities we see, gives me hope.
You mentioned collaboration, and I think it underscores the critical role community health funders play as a bridge between the general public and public agencies and healthcare providers.
There are some great things that we get to play a role in. We helped form an organization, the Healthy Opportunities pilot program, to support the upstream social determinants of health by creating a network of human service providers that get folks into affordable housing, or provide access to healthy food, transportation and personal safety. Any organization that provides those services can bill Medicaid and receive payment for providing that service.
In fact, I just finished writing a paper for the North Carolina Medical Journal that’s going to come out in a month or so about the public-private partnership between philanthropy and North Carolina’s funding, along with federal funding, to support that kind of innovation.
What’s one book everyone who reads this should check out?
I just finished reading “The Immortal Life of Henrietta Lacks” by Rebecca Skloot. It’s fascinating for folks who are in health, but it’s also a great human interest story about Henrietta Lacks, who is the source of the immortal cell line called HeLa. Seventy years ago, doctors took cells from her biopsy without her consent to be used in research, and it turns out that her cells just kept growing and growing, and they have been used as the foundation for many medical tests, interventions and vaccines. It’s a foundation of modern medicine and a lot of people in medicine have no idea who Henrietta Lacks is.
I love this book because it tells her story so she can finally get the recognition she deserves. In addition to the human interest story and the historical component, it addresses important ethical considerations of informed consent.
Anything else you’d like to add?
I want to stress that at Dogwood, we don’t focus on healthcare delivery, but on those social determinants of health, like affordable housing, for people like the little girl I mentioned. So while Dogwood emerged from the healthcare industry, the funding goes upstream, and based on what I’m seeing and the discussions I’m having, there appears to be an increasing recognition of the importance of this kind of work. The more foundations focus on this work, the more other entities in the health space will make that connection.
