A Tale of Two Georgias: One Healthcare Funder's Roadmap for Rural Health Equity

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The Healthcare Georgia Foundation, a health legacy foundation formed from the merger of BlueCross BlueShield of Georgia and WellPoint Health Networks, has been funding work on a range of health needs and disparities across the state for about 20 years. As in many states, the last decades have seen Georgia's cities — including the huge Atlanta metro area, but also smaller cities like Athens — experiencing economic growth and cultural development, while the state's rural communities slid down a demographic slope of diminishing population, increasing youth flight, loss of business and investment, and a narrowing of opportunity in general.

This led to what Healthcare Georgia identifies as “the two Georgias,” in which urban residents had access (at least potentially) to healthcare and other resources that improve quality of life, while the 2.75 million residents of rural counties might live in something of a medical and overall resource desert. Such communities often lack basic provisions like emergency health services or face round trips of hundreds of miles to see specialist or even a primary care doctor.

So just over five years ago, under founding President Gary Nelson (since retired), the foundation launched its Two Georgias Initiative, aiming to reduce health disparities between the more developed urban and suburban communities and the struggling rural regions. The initiative provided 11 rural communities with financial backing and a support system aiming to help the residents address longstanding health and equity challenges. Now, Healthcare Georgia has released a new report, “Journey Toward Equity,” outlining the initiative's approach and its results — insights that could be useful to others around the country working to reduce health disparities for residents of rural areas.

"Most urban areas have an established social service infrastructure backed by significant funding to attempt to support addressing healthcare challenges," wrote the report's authors. "Not so across much of rural Georgia, where you can often drive for hours in solitude between expansive farmland and the occasional small town."

The initiative's topline lesson, according to Healthcare Georgia Foundation President Kristy Klein Davis, was the realization that the path toward equity had to be guided by the people living in the communities the foundation served. That’s an increasingly familiar refrain that has emerged in recent years, as funders have discovered the weaknesses in top-down, elite-driven approaches that loomed large in philanthropy and NGO work over the years. It’s an especially important lesson for work in rural communities, where funders often lack direct connection and experience.

"What's happened for decades is that (philanthropy) has come into rural communities with these solutions and tried to hand them over," Davis said. "But those solutions haven't been tested in rural areas, and there's some real basic parts of those solutions that just don't work."

So Healthcare Georgia didn’t roll into these communities with a portfolio of programs, Davis said. What the foundation did do was provide support, including facilitators, to help people in each community create agendas and establish goals. For example, throughout the five-year initiative, the Partnership for Southern Equity, an organization focused on equity issues and on facilitating conversations with people from all backgrounds, was an active partner, providing equity-focused technical support and advice for the 11 communities and project managers.

Another key aspect of the funder's initiative is an emphasis on social determinants of health and equity that currently guide much of philanthropic giving — recognizing, say, that resources like playgrounds and libraries figure into the overall wellbeing of a community. This, too, has been a common thread running through funding for health equity in recent years, and rural health foundations have taken a major role in trying to understand and address the many factors that influence a community’s overall health and wellness.

About five years in, Healthcare Georgia can point to significant advances achieved through the initiative in every county that was involved. Achievements included the construction of children's playgrounds, enhanced mental health services for students, development of mobile health units to deliver preventive services, vaccines and education, food services for those in need, expanded behavioral health services, opening a new pharmacy, opening and furnishing of a library, launch of diabetes programs, establishment of community gardens, launch of substance use and overdose prevention programs, opening of a free dental clinic, and exercise classes.

The report also seeks to note other, less easily quantified impacts, particularly those related to Georgia's long-time scars of racism:

But how do you measure the outcomes that can’t be readily seen, and don’t fit neatly onto a spreadsheet? For instance, how does one quantify this change in Clay County? There, a long-standing town parade had for years been unofficially segregated: Black residents on one side of the street and whites on the other. Yet through relationships that had developed from the coalition’s work, people started crossing the street, mingling and enjoying a community activity together.

The Two Georgias initiative won accolades from the philanthropic world, including Philanthropy Southeast's 2022 Trust Promise Award, and also the notice of innovative philanthropist MacKenzie Scott, who made a $9 million unrestricted gift to Healthcare Georgia Foundation in late 2022.

Health is not the only field where philanthropic support has been scant in rural regions, but it's obviously one of the most pressing, and it's a space that we have increasingly highlighted. For an overview of recent philanthropic giving for rural America, take a look at this article by IP’s Martha Ramirez.

Ideally, the Healthcare Georgia report will prove useful to other rural-focused funders seeking to help advance progress in healthcare and equity. But the principles that guided Healthcare Georgia's grantmaking can likely be applied to other needs that philanthropy might seek to address in rural communities. Another thing worth noting: considering the benefits, the Two Georgias initiative wasn't that expensive — about $12 million since its launch in 2017.

"The key thing was trusting the knowledge of rural communities to be able to do this work and do it well," said Davis.

You can read the Healthcare Georgia Foundation report on the Two Georgias Initiative here