What if philanthropy took on structural racism with the dedication it reserves for issues like education or health? It would require seeing structural racism as the problem and the racial disparities and inequities as a manifestation of that problem. After all, as the National Equity Project points out, structural racism has become so normalized, our policies and practices ensure access to opportunity for some and exclude others. How then do funders move from merely embracing a racial equity lens in their philanthropy to truly giving in ways that will help create an equitable society?
In our conversations with clients and others across the sector, we frequently hear hesitation because the kind of work needed to achieve racial equity can, for funders, feel slow, amorphous, hard to measure, even risky. The feedback convinced us of the need for a more accurate understanding of how addressing root causes leads to lasting equitable change on other issues. Our recent research, “Unlocking Social Progress by Addressing Structural Racism,” offers examples of how that happens.
What does addressing structural racism look like?
The Racial Equity Institute’s groundwater metaphor helps to illustrate structural racism — how race and racism are intricately linked to our biggest social problems. Imagine there are five lakes around your house and in every lake half the fish are dead. To figure out what happened, you wouldn’t stop after dissecting a fish or sampling a lake. You would need to analyze the groundwater to find out how the water in all the lakes ended up with the same contamination. That is the case with structural racism: it is in the groundwater of society and thus infects every system.
Cleaning up the groundwater is a daunting task, but there are ways to make progress. For instance, the Greensboro Health Disparities Collaborative (GHDC) — an 18-year-old organization made up of community leaders and advocates, public health researchers, and healthcare professionals that brings about social change through their work in organizing and research — closed the gap in health outcomes between Black and white patients with breast and lung cancer at a medical center in North Carolina. Before the Collaborative, white patients were completing their cancer treatment at a rate of 7 percent higher than Black patients, a gap with tragic consequences.
GHDC managed to close the gap and improve treatment completion rates for everyone by focusing on the structural racism in the healthcare system itself. Research suggests that people of color receive lower quality healthcare than whites even when insurance status, income, age, and severity of conditions are comparable. Using the Collaborative as a model, we found that efforts to achieve equitable structural change — groundwater change — often exhibit several critical characteristics. Here is what they looked like for GHDC:
- Building shared analysis: All members of GHDC attended anti-racism workshops that offer a historical analysis of the structural and systematic nature of racism. It grounded members with a shared understanding of how structural racism leads institutions and systems to produce the racial inequities the Collaborative seeks to change.
- Leverage the expertise of communities: Early on, members participated in a structured storytelling exercise to explore and understand their collective and individual experiences with racism in the healthcare system. The exercise revealed that most community members had been impacted by cancer, specifically breast cancer. Therefore, such community experience and expertise was at the heart of determining what issue the Collaborative would focus on and also shaped interventions that were developed.
- Bringing in the institutions they seek to transform: GHDC purposefully included a medical institution, Cone Health Cancer Center, as a fellow collaborator alongside the academics and community members. Getting institutional buy-in to the mission was difficult at first. Hearing GHDC’s focus on the structural racism of the institution left some Cone physicians feeling attacked as individuals. It wasn’t until the Collaborative presented data specific to the institution itself that illustrated a pattern of different care based on race that the physicians were convinced.
- Establish trust: Through in-depth discussions, GHDC collectively created norms for collaboration, formalized in a document called the “Full Value Contract,” which all members sign. Critical for a group with people from varied backgrounds, the contract affirms “the belief that every group member has value and by virtue has a right and responsibility to give and receive open and honest feedback.” GHDC also invests time to build relationships among members at every meeting.
- Engage with and learn through conflict: Like any collaboration, especially one that values equitable participation and decision making, GHDC’s work has not been without conflict. To deal with conflict GHDC has something they call “pinch moments” or the practice of not ignoring tensions but examining them as they arise. The Collaborative’s longevity despite pinch moments through the years helps illustrate how conflict is often part of transformative work and does not have to be feared.
- Treat the system: GHDC’s work led to initiatives including health equity training at the institutions, data tracking on care quality disaggregated by patient race in real time, race-specific feedback for treatment providers, and nurse navigators working to improve communication with patients. Mindsets shifted along the way. For instance, when medical professionals realized that bad health outcomes did not have to come from individual patients being noncompliant but a system failing to ensure all patients get the quality care they need, it had ripple effects across the institution beyond cancer care.
- Maintain momentum: Given the baked-in nature of structural racism, it is critical to ensure institutions remain committed and do not revert back to business as usual. Having a community-based partner, like GHDC, question the status quo, drive priorities, monitor progress, and push the institution to do better is the foundation of the work and its success.
By highlighting these characteristics, we hope that this type of work becomes easier for philanthropy to recognize and therefore fund, as well as easier for social change nonprofits to emulate. The truth is, GHDC is not a singular case — the nation is filled with organizations, collaboratives, networks, and grassroots efforts that are similarly doing work that thinks in big, innovative ways to dismantle our inequity. Philanthropy can do more by giving to these many groundwater efforts and therefore allow for a more equitable world to finally take root.
Britt Savage is a manager in The Bridgespan Group’s San Francisco office, Cora Daniels is an editorial director in Bridgespan’s New York office, and Peter Kim is a partner in its San Francisco office. They are all members of the firm’s research team devoted to advancing racial equity in philanthropy and co-authors of “Unlocking Social Progress by Addressing Structural Racism.”