Well Being Trust and the de Beaumont Foundation are national foundations with the ambitious mission to improve health and well-being in communities across the country. Another thing they have in common: a commitment to professional development through fellowship programs. Ashley Hill was the Executive Fellow at Well Being Trust from November 2017 to June 2019, and Lizzie Corcoran was the Association of Schools and Programs of Public Health (ASPPH) Philanthropy Fellow at the de Beaumont Foundation and now serves as a program associate there. Recently, Ashley and Lizzie created a “staff swap” experience, which took Ashley to de Beaumont in Bethesda, Md., for a week and Lizzie to Well Being Trust in Oakland for a week. This swap created an exchange of organizational strategy, visions for impact, opportunities for collaboration, and many other lessons. This blog post is a conversation between Lizzie and Ashley as they reflected on their fellowship experiences.

Ashley: Okay, first question for you: Why did you decide to take a philanthropy fellowship after graduate school?

Lizzie: It’s funny to think back to my job search after school. I honestly had no concept of philanthropy and wasn’t looking for philanthropy jobs. I found the philanthropy fellowship as part of a set of fellowships that ASPPH creates and supports for MPH graduates. What caught my eye in the position description was the systems-level approach to policy, partnerships, and the social determinants of health. I wanted to combine my programmatic skills with an understanding of how different sectors work together in public health system. As one of its focuses, the de Beaumont Foundation works to improve the governmental public health workforce under the vision of Public Health 3.0, meaning advancing health in all policies, improving the social determinants of health, and building cross-sector coalitions.

Working at de Beaumont on our various programs and projects has given me great insight into how different sectors work together on health, but ultimately governmental public health agencies hold the fundamental responsibility to improve health for their communities. Since coming to de Beaumont, I’ve been inspired to dedicate my career to improving public health practice in the public sector and forming partnerships with other sectors. I was lucky to have gotten this opportunity right out of graduate school; it will continue to influence what I do and how I approach community health for the rest of my career.

I was lucky to have gotten this opportunity right out of graduate school; it will continue to influence what I do and how I approach community health for the rest of my career.

Ashley: Similar for me. Like you, I wasn’t looking to get into philanthropy at all. I was trying to get a role where I could learn more about community health — somewhere that understood the connections between what we learn in public health school as the “social determinants of health” (housing, jobs, education, etc.) and traditional health care.

The MPH program I did sends many of its recent graduates into administrative fellowships at hospitals and health systems. While I believe in a strong health care system, I couldn’t ignore the research telling us that health is more influenced by a person’s choices and environment than whether they have a good doctor or good genetics. So I was looking for a fellowship that would give me exposure to the leaders thinking about those community conditions and how they affect health.

It was only after I got to Well Being Trust that I realized many philanthropic organizations in the health sector share this perspective, that health is more than just health care. I would attribute that fact to the relative financial freedom that comes with being a philanthropy. Because our organizations are endowed with stable resources, we don’t have to follow the money the same way other organizations do. The U.S. healthcare system overall follows the money through fee-for-service, which in turn drives medicalization and disproportionate amounts of spending on health care vs. overall health. This reality is changing with the shift to value-based care, but it’s been a very slow shift.

This is actually a good segue to a question about the role of philanthropy. What do you think is the most exciting about working at a philanthropic organization and the role philanthropy plays in our society?

Lizzie: In philanthropy, we can test ideas and take risks because of our sustainable funding. Working in philanthropy is a huge privilege and a huge responsibility. At de Beaumont, our approach is to find the gaps and the levers that will have an impact on the whole field. Then we invest in these ideas, trying to find what solutions and tools will help public health improve the social determinants and, ultimately, community health. For instance, we created the first national survey of the public health workforce, which helped us learn what skills and future trends are emerging in the workforce. Our CityHealth project in partnership with Kaiser Permanente is a one-of-a-kind policy tool for cities to improve community health. The BUILD Health Challenge created a funding collaborative to support more than 30 communities all over the country with model innovative community partnerships that work upstream on root causes of health issues. Not only do these programs and projects have an impact, but they are new ways of making a difference. The entire field of public health can learn from them and use them collaborate within and across sectors to multiply their impact.

Ashley: I agree, philanthropy is a very exciting place to be, for all the reasons you named: getting to test new ideas, taking risks, filling gaps. I especially appreciate how working at a foundation allows us to take a systems approach to an issue and really understand the many sides, stakeholders involved, and the biggest opportunities to make an impact. We’re then able to pinpoint our areas of action, whether that’s funding certain research or serving as a neutral convener for stakeholders with divergent interests in order to solve a common problem, such as how to better integrate clinical and community efforts for well-being.

I also appreciate that being at a philanthropy allows us to challenge the status quo and elevate programs and people that might be overlooked by the established system. Typical ways of doing business often undervalue or ignore ideas and programs from those considered “risky” or “nontraditional” — in other words, people of color, low-income communities, the LGBTQ community, and others whose voices are often marginalized in typical institutions of power. I think philanthropy has a responsibility to lift up those voices and ideas wherever possible, as part of challenging the status quo.

Lizzie: Okay, so we’ve talked about what philanthropy does well. What about the limitations, or things you wish were better about philanthropy?

Ashley: The flip side of what I was just describing is that philanthropy can often fall into the very traps that other traditional institutions fall into. Philanthropies too often fund things that are well studied, or currently trendy, or championed by someone who is white, straight, well-educated, or who knows how to speak “corporate-ese.” When we continue to disproportionately fund dominant perspectives, we’re also disproportionately reinforcing the very systems that have gotten us into the problems that we all say we want to change!

One good example is the two of us. Taking on early-career fellows is a great way for any foundation to elevate new voices and challenge its thinking, so in a way, we’re examples of foundations taking risks. But at the same time, we’re both white, well-educated women. We look and sound familiar and “safe.” From my observations, philanthropy has a lot of room to improve in this respect. There’s really no one stopping us but ourselves. I highly recommend the books Winners Take All  and Decolonizing Wealth for more commentary on these limitations of philanthropy — and what to do about them.

I will say, though, that I wouldn’t have been so quick to recognize and to call out some of these systemic problems before working in philanthropy. Working at a systems level has helped highlight these issues for me. Racism, economic inequality…these are systemic issues, so you see them come up over and over again, whether you’re thinking about the roots of poverty or poor health or poor education outcomes. Once you start seeing the patterns, you can’t unsee them.

Taking on early-career fellows is a great way for any foundation to elevate new voices and challenge its thinking.

Lizzie: I hear you. Unlike government and nonprofits, our endowment frees us from the limitations of grant cycles and the time-consuming search for funding. This allows us to think long term about the future and take risks with our investments. However, philanthropies are typically accountable to only their boards. Depending on who makes up the board, they might not be representative of the people the philanthropy is trying to help. So you can have a mismatch between who you are serving and the people you are accountable to, which creates room for mistakes and misalignment between what we want to accomplish and what we can accomplish. In one of the books you mentioned, Winners Take All, Anand Giridharadas criticizes the way that philanthropy subtly absolves government from doing its job and solving social issues like homelessness and food insecurity. However, this is what inspires me about de Beaumont. We are focused on improving governmental public health practice and encouraging public health to partner with other sectors to reach our collective goal of healthy communities. We aren’t trying to undermine the public sector, we are supporting it.

Ashley: Let’s turn back to us and our experiences. As part of our fellowship experience, we arranged a “fellow swap” where each of us had the chance to visit the other’s foundation for a week. I went to Bethesda and shadowed you and the de Beaumont team, and then you came to Oakland and shadowed me and our team. Do you want to describe your biggest takeaways from that experience, anything that particularly stuck with you?

Lizzie: My biggest takeaway was about the different ways organizations like ours lead. Well Being Trust is well-positioned to take on a leadership role in changing mental health in this country; however, it seeks a distributed leadership model that builds consensus and momentum across sectors and organizations. This type of leadership is more of a social movement approach to making a difference than the more traditional “return on investment” approach that philanthropies use to make sure their dollars produce results. It’s much harder to capture the impact of a movement! I was really inspired about the social movement tactics that Well Being Trust was adopting, not only for themselves but to better the entire field. It is a huge undertaking and is capitalizing on the potential of multiple sectors and organizations for a culture and norm-changing approach to mental health and well-being.

Ashley: My biggest takeaway was really how similar our foundations are. We were both dealing with similar organizational issues, like how to set goals and measure our impact, and how to structure partnerships with other funders and grantees and partners. I was very impressed with de Beaumont’s signature programs, like CityHealth and PH WINS, and how those filled existing gaps in the ecosystem of support for de Beaumont’s mission of championing public health. Well Being Trust’s own signature programs, like our ED & UP Learning Community with the Institute for Healthcare Improvement and our Well Being Legacy community-level well-being work, are newer, so it was great to see a foundation a few years farther along in the process and hear what you’ve learned so far.

Speaking of CityHealth, I was pleased to notice that both of our foundations share a commitment to policy as a means to institute lasting change. The de Beaumont Foundation places a huge emphasis on the role of changing laws, rules, and regulations on the local, state, and national levels, and so does Well Being Trust. We have specific mental health policy issues we champion, like access to quality mental health care and well-defined quality standards for behavioral health care, but we’ve also championed the same upstream policy areas that de Beaumont does, like affordable housing, healthy food, and universal pre-K, since these policy areas undergird the well-being of whole communities of people.

So, Lizzie, we’re both young people in public health. You in particular have done a lot of research and thinking about being early-career in public health. Can you share some of what you’ve learned? What do young people want in a public health career, and how their employers support them?

Lizzie: I think the most impactful finding from the reading and research I have done about people our age comes from the Millennial Impact Report, which is a survey supported by the Case Foundation and researched by Achieve. They studied how millennials engage with social causes and institutions. A particularly powerful conclusion from the survey was that millennials are more loyal to causes than they are to institutions. We can see this trend play out in public health, as undergraduate students flock to graduate and undergraduate programs, pursuing public health and social justice as tandem causes. In the workforce, we see young people bouncing between institutions and sectors every few years, as we prioritize the pursuit of public health over the mission or goals of one particular organization or sector. For instance, young people are more likely to come to philanthropy because we are passionate about what philanthropy can accomplish in improved public health and social justice, not necessarily because we are passionate about a particular agency, nonprofit, or foundation. Understanding this, organizations that want top talent to come, stay, and contribute as much as they can need to appeal to the cause that young people are interested, rather than just expecting loyalty to a single organization and mission. Understanding this is key to engaging young people to the greatest effect in philanthropy and all public health organizations.

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