Our 5 Grantmaking Principles for Reducing Racial Health Disparities

As we further our commitment to justice, equity, diversity, and inclusion (JEDI) — both internally and externally — one area of high priority is our grantmaking. Part of implementing Archstone Foundation’s strategic plan is changing from being a responsive grantmaker to working proactively with our partners to design and develop grant projects. As we do this, we want to share our thinking and approach.

Reducing health disparities is central to our mission

Awarding grants that intentionally focus on reducing racial and ethnic health disparities is mission critical to the change we are seeking to make in the lives of older Californians and their caregivers. Improving health and well-being means reducing the differences among demographic groups in the rates of chronic conditions and diseases, access to health care, and mortality. All of us — regardless of race, gender, geography, or ability — should have the same access to high quality care and should be able to expect similar health outcomes. Unfortunately, this is not currently the case.

We believe reducing disparities requires addressing the intersectionality of age with race, gender, physical ability, socioeconomic class, sexual orientation, and gender identity. Intersectionality recognizes how our identity markers do not exist independently but rather are overlapping and connected. This means we do not arrive at old age as a blank slate; instead, the advantages and disadvantages we have seen throughout life determine our health and ability status in later years. Further, we recognize our healthcare and social support systems are some of many institutions that have been built on racist, sexist, ableist, and ageist foundations, and we will seek to change those systems and the resulting policies wherever possible. In other words, health disparities have resulted from inequitable programs and policies, not individual failures.

Tracking progress on decreasing these inequities begins with understanding the current situation so we can measure change over time. To date, as an organization, we have adopted the D5 Coalition definition of diversity, equity and inclusion. We are also working to understand the composition of the boards and staff of our applicants and grantees as well as the demographic characteristics of the populations they serve. We’re having conversations with grantees and applicants about how they incorporate commitments to equity and justice in their work. Gathering this information is a starting place for testing and building our grantmaking ideas.

We are committed to centering JEDI principles

In addition to those conversations with community partners, the Foundation board and staff are having ongoing discussions to ensure we effectively integrate JEDI principles throughout our own work. To focus attention on funding projects that take intersectionality into account and promise reductions in racial and ethnic health disparities, we have committed to working with our partners to adhere to five principles when constructing, selecting, and implementing grant projects:

• Inclusive, person-and family-centered, and universal design. Care that is intended to support diverse older adults needs to have methods to elicit goals and preferences and a broad range of capacities to meet those goals, despite person’s differences in financial, physical, cognitive resources. Different people have different preferences, and we each have different abilities; both of these concepts are important to inclusive design. Equity is enhanced by comprehensive, person-and family-centered care that places individuals’ wishes and preferences at the center.

• Focus on historically marginalized populations. To test the principle of universal design and ensure we are supporting development of a system that can meet the most complex needs, our ideas and models should be tested for their ability to benefit communities that have faced the most discrimination and disadvantage, including Asian Americans and Pacific Islanders; Hispanics, Latinos and Latinas; African Americans and Blacks; American Indians and Alaska Natives; LGBT populations; persons with disabilities; and women. This will be applied from the outset of our projects, and is especially important to our Three T grantmaking strategies.

• Focus on areas with the greatest disparities between racial and ethnic groups. There are pronounced differences in health outcomes among racial and ethnic groups. Hospice utilization in California, for example, varies greatly between white and Black/African American people. And while rates of dementia among Black and Hispanic populations are almost double those for whites and Asians, people who are Black, Hispanic, and Asian are all less likely to be diagnosed. In our efforts to create a system that works for all, we will have an intentional focus on narrowing racial disparities.

• Test and determine if disparities are reduced. While seeking to improve results overall, whenever possible we will measure to assess if disparities in outcomes among racial, ethnic, and other groups have been reduced. We will not assume that efforts that are successful in general are also successful for each demographic group. This focus on outcomes will require assessments that over-sample groups we suspect are subject to disparities in outcomes.

• Seek relevant staff expertise. We do not necessarily know what needs to be done to ensure that innovations in care and the systems of the future deliver more equitable results. We want to be respectful of grantee organizations’ existing staffing and leadership, and we do believe it necessary for teams to have people from, or knowledgeable about, the social groups we wish to serve. We will listen to our partners, work with them to understand the expertise and experience they bring to the work, and support those who are seeking to build and strengthen their systems and knowledge.

These principles will guide us as we continue to learn from and listen to others about how we can make a difference in reducing health disparities. We will also incorporate these principles into our grantmaking from the very beginning of each project we will seek to support. This means we are prioritizing taking the time to educate ourselves, individually and as team members. It also means we will continue to carefully listen to and learn from our grantees and partners and the community about their work and what impact their programs are having on older adults and their caregivers.

These principles aren’t static. They will evolve as we continue to learn and understand opportunities for improvement. As we test these principles, we would like to hear your views and we invite your feedback. What else should we consider? What have we missed? How are you approaching reducing health disparities? Where can we best assist your efforts?

Christopher Langston, Tanisha Davis, Jasmine Lacsamana, Ryan DoyLoo, and the Archstone Foundation JEDI Committee contributed to this post.