3

Social Sector

The social sector, as reflected in the panel’s discussion, encompasses several different dimensions of society. Those include human and social services organizations in the private and public sectors; the faith community in its many manifestations, including congregations and their social activities (e.g., to serve or feed the community) and faith-based nonprofit organizations; and community-based coalitions and partnerships devoted to addressing social, human, and health needs. Milton Little, president of the United Way of Greater Atlanta, introduced the session and the panel, and launched the discussion by asking “What is the most important function of the social sector during two pandemics—COVID-19 and racial injustice?” Key points from the panelists are provided in Box 3-1. Gary Gunderson, vice president for faith–health at Wake Forest Baptist Health and Wake Forest University, remarked that the social sector is often noticed for the minor role it plays as a delivery mechanism for responding to social needs and social risks around the health care sector. However, he asserted, the thing that the sector is best at is social adaptation—the social nature of the creative process by which communities can adapt to predictable and unpredictable threats, from hurricanes to disease outbreaks.

Cathy Baase, board chair of the Michigan Health Improvement Alliance, said it may be too early to have a definitive statement on the role and contribution of the social sector in the pandemic, but she sees the sector’s role as a connector, able to convene and unify organizations and facilitate alliances. Susan Dreyfus, president and chief executive officer of the Alliance for Strong Families and Communities, noted that she

represents America’s human service organizations and underscored the sector’s influence and advocacy in lifting up the voice of the voiceless in fighting against racial injustices. Jason Purnell from Washington University in St. Louis echoed the commitment to equity but added that community organizations themselves are assessing their own institutional attention to furthering equity and justice. He also acknowledged the extraordinary level of collaboration in the sector. In response to Little’s question about the challenges that the sector is facing, Purnell commented on the fiscal and logistical vulnerability—the very existence of organizations is in question as they are forced to operate in new ways in response to the COVID-19 pandemic. Dreyfus added that unrestricted funding is invaluable to the sector, noting that 2020 was the first year that the sector had to begin adapting to the loss of the charitable deduction for tax filers who do not itemize, leading to a decrease in charitable giving. Little shared the findings of a survey of nonprofit organizations in Georgia that

showed that most had only 3 months of fiscal reserves on hand before COVID-19 arrived on the scene. He emphasized the funding differences between social-sector organizations that are situated in the health care space and those that are not, with the former receiving Medicaid funding and the latter relying primarily on donations.

Gunderson spoke of the history of the sector, which shows that many social-sector organizations sprang out of a faith-based context. The United States has more than 250,000 religious congregations that people in need turn to, and many of those institutions, perhaps as many as 20 percent of them, are not expected to survive. “How will the durable compassion present in every American community be reconfigured as the nation emerges from this crisis?” Gunderson asked. Underscoring the faith community connections, Little noted that three of the four people who founded the United Way in Denver in 1887 were clergy.

Returning to the question about sustainable funding for the sector, Dreyfus agreed that the field is facing a resource challenge, and asserted that it requires a reassessment of the nation’s investments in prisons and other flawed “solutions” that reside at the deep end of the system, instead of investing in vital services, primary care, prevention, and the social determinants of health. What the nation also needs, she added, are opportunities for the health care and social sectors to testify to the same congressional panel advocating for one another—there is a need to combine forces to advocate for “the system that we want to see that produces population health for our neighbors.” Gunderson agreed that what is needed are new and more transparent business models (including for health systems, regarding the use of their resources) that allow the social sector to play the roles that it is so well suited to, given its understanding of the social dynamics of people’s lives.

Little asked if the social sector will ever be valued for its roles, and Dreyfus responded with a sense of hope. The pandemic, she asserted, has highlighted health inequity and provides an opportunity to consider and address the contexts to people’s lives that create inequitable conditions. For example, the evidence about adverse childhood experiences has helped the field understand toxic stress. Health care reform, she noted, focuses on care coordination, prescriptions for food, and other individual-level solutions for a person’s needs, but there is a need to address the context to people’s lives, which, the field has learned, is shaped by root causes such as systemic racism. Purnell added, however, that it is not enough to present data about health inequity or stir society to a “greater consciousness about systemic racism”; the case must be made that Americans do not have “a viable economy, a viable democracy” if they do not “confront this existential challenge.” Baase agreed that the economic case, not merely the altruistic motive, is an important rationale for responding to racial injustice.

Little relayed an audience question on the role of the social sector in shaping or engaging with public narratives (e.g., about the pandemic and strategies to control it), many of which are incorrect, and bridging science and community. Dreyfus spoke about the sector’s role in elevating the importance of the stories of human beings. Baase shared that one of the greatest successes of the field is partnership, but division is one of the great societal challenges at the moment. The social sector can bring people together, and it may be easier to accomplish that at the local level and to persuade people to pursue the common good. The current division is troubling, noted Baase, but there are pathways to unity and opportunities to work together.

Faith groups and entities are a great generative factor in communities, Gunderson reflected, but quoted Rosalyn Carter that the first word of faith communities in the public sector should be an apology for their history of stigmatizing behaviors and for being tribal. There is a great need for crossing boundaries and for working across sectors, such as for clergy to get to know and work with their local public health directors, Gunderson said. Being able to draw on the foundational relationships in the community is essential in a crisis such as the current public health emergency. Dreyfus reflected a basic tenet of public-sector work, namely, recognizing the importance of having a two-way relationship. It goes both ways, and social-sector leaders need to recognize that it is the heart of their work to reach out and bridge divides with faith-based entities and others in the community.

Little asked what is needed to build sustainable funding for the social sector. Baase shared that the coalition she is working with seeks to overcome the challenges of scale, sustainability, and coordination. For scale and sustainability, she suggested a funding and financing “utility” (a set of mechanisms) that matches the plan of work. There are other streams beyond philanthropy that can be harnessed for that work, to tie a plan of work from the social sector with a carefully orchestrated range of other funding mechanisms. Examples include drawing on Community Reinvestment Act funding, block grants, deployment and investment of reserve dollars from health systems that have embraced their anchor mission, and so on.

Little asked how the social sector can educate the public and the sectors it works with on the subject of health equity. Purnell shared that as a social scientist, he recognizes that categorizing people is not a “bug” but a feature of human nature. Ultimately, he said, breaking down barriers may be accomplished by bringing people together to work on a common problem. He added that the current crises offer “a real opportunity to rethink who gets included and who is part of this common in-group, and what can we do together.”

“I don’t think our sector can bring its best self to the table until we have that painful journey,” Dreyfus stated, of identifying and responding to implicit bias and the fundamental “rooting” of the human services system in slavery, similar to corrections and other systems. Dreyfus said:

Baase shared that her organization had made a concerted effort to change its commitments and principles to reflect its values, and made changes in the composition of the board in considering whose voices are represented at all levels of decision making. Purnell underscored the crucial value of “having robust, reliable conduits to the experience of people in the community.” Purnell said that this requires a different frame of reference and an openness to listening with intention, as well as building an infrastructure for listening, including a mechanism for compensating community members for their role in informing the work of an organization.

For example, Purnell shared, meetings about gun violence prevention should have someone in the room “who hears gunshots every night, who has had family members and friends shot and killed.” Having individuals with lived experience at the decision-making table could accelerate and improve the planning, implementation, and ultimately the outcomes of interventions. Dreyfus spoke about human services organizations, like BakerRipley in Houston, Texas, that use the approach of appreciative inquiry to ascertain if a funder’s request will meet the community’s needs,¹ and when they hear residents say that that is not what is needed or desired, then the organization communicates that information to the funder. Little added that engaging in this manner ensures that the lived experience of communities is transmitted back to funders.

Gunderson shared how his hospital in Winston-Salem, North Carolina, has a great deal of data and was using it to prioritize its activities in the community. The hospital’s neighbors had been conducting asset mapping and other work, and recently the hospital leadership met with community leaders to hear about the community’s needs. The hospital had assumed that the “ask” would be for clinical resources, such as a clinic or a mobile van, but

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¹ See https://appreciativeinquiry.champlain.edu/wp-content/uploads/2017/09/TheGift-of-New-Eyes-Reflecting-on-30-Years-of-Appreciative-Inquiry-in-Organizational-Life.pdf (accessed December 5, 2022).

Gunderson said the community was asking the hospital to provide access to its market as a commercial purchaser, and thereby help the community feed itself. Tracing one of the fault lines in the health care delivery sector, Gunderson noted that health sector leaders who work to improve population health and who interact with the community or faith-based organizations “are not in the revenue cycle.” They are not involved in procurement or business decisions, and it is important that they learn to bring internal colleagues in dialogue with community partners and other organizations. There are professionals in the medical industry, he added, who do not see how they can become “a part of the emergence of healthier communities.”

Little raised another audience question. How do organizations help leaders and people push past the “I am not a racist” mentality and toward conducting self-inventory? Dreyfus responded that performance is a compelling argument—that organizations are high performing only if they get the best out of their workforce, including the greatest diversity. This requires leadership that is willing to be vulnerable and to be alert to the need to start the journey, and it requires behavior and action. Regarding diversity, Gunderson remarked that “if none of your friends are embarrassed by any of your friends, you are probably not diverse enough. The diversity may be political or faith or racial.” Leaders can review their schedule and see who they have had lunch with or met with or listened to, as well as who they quote or “hang out with.” Moreover, Gunderson added, “How do we listen to the people who are on the lower paid ranks of our organizations?” Purnell added, quoting Dr. Martin Luther King, Jr., that the law “cannot make a man love me, but it can stop him from lynching me” to assert that although the heart and mind may not be changed, those outcomes are secondary. What matters, Purnell said, is whether or not grant funding, performance evaluation, or employment are contingent on demonstrating that the work is advancing equity and “increasing opportunity for people who have been left out.”

Little noted that the philanthropic community faces similar questions about whether it is hindering the fight for equity and diversity in not only the sector, but in the community. Baase echoed Purnell’s earlier remarks, noting that she has come to recognize that not everyone values equity, and that instead of waiting for people to change their minds, leaders and organizations need to “build a pathway based upon value and outcomes and the economic case of this to many different parties.” Changing consciousness is important, but the field cannot wait for it.

Dreyfus answered Little by underscoring the importance of moving from program thinking to systems change thinking. He reflected on a sense of frustration that a considerable segment of philanthropy remains focused on plans and services instead of affecting systemic change. Drey-

fus stated that her organization will no longer accept grants if there is not a policy interface to them. Systems change happens when “regulatory and fiscal mechanisms are aligned to the very practice and policy we believe in,” and it is insufficient to focus only at the practice level. Both philanthropy and public sector funders need to expect and fund for systems change, and grantees need the space to work across the continuum and toward systems change. Little shared that he is engaged with launching a racial equity and healing fund. A common question he faces is “What kind of programs are you going to support?” He said he emphasizes that “we have equity challenges in the United States not because there are not enough programs.” Echoing Dreyfus’ observations, he noted that there are foundational issues,

Gunderson commented that “as long as the social sector is funded in terms of categorical problems that we are considered relevant to, we will never get paid for systems change.” He called on the sector to stop being a part of that pathology. Instead, he asserted, the sector should borrow and wield the intellectual tools—such as David Cooperrider’s “appreciative inquiry,” asset mapping, Arvind Singhal’s work on “positive deviance,” and insights from the “Leading Causes of Life” Network—to transform itself toward greater intellectual diversity and the crossing of boundaries.

In his closing comments Purnell shared that he feels a sense of hope about the possibility for the sector to move forward strategically, and he underscored earlier comments about the need for the philanthropic funding of system change, not merely of individual organizations or programs. Dreyfus said that it is time to stop talking about health care reform as technical change (e.g., care coordination) and turn to facilitating adaptive change and transforming human services from the inside out to improve population health. “We need to see each other’s humanity and lean in with love,” she added. Baase spoke about the need for capacity, including the need to fund capacity building in order to achieve systems change, and the need to bring along the next generation of sector leaders.

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