The challenges of rural philanthropy have been getting new attention in recent years. One leader in the push to learn more about grantmaking in remote regions is the Rural Philanthropic Analysis Project, which, in partnership with Campbell University, aims “to better understand rural places and funding practices that are leading the way towards health improvement in rural regions across the country.”

The centerpiece of RPAP’s work is a set of field studies of philanthropy in four distinct regions of the United States—Northeast Iowa, New Mexico, Eastern Washington, and New England. These areas were chosen due to the importance of local funders in those areas; RPAP’s research has examined the significance of regional philanthropic organizations to rural populations.

Among the regions studied, Eastern Washington has particularly unique funding needs due to its geographic isolation from the state capital and long distances between sparse population centers.

Key Challenges

“Limited access to coordinated, high-quality medical care, higher rates of foster placement and chronic disease, and a life expectancy lower than the state average are among the major issues facing eastern Washington’s rural populations,” says Laura Martin, Empire Health Foundation (EHF), Communications Director/Senior Program Associate, of the greatest issues facing the region.

It was EHF, headquartered in Spokane, Washington, that drew the researchers’ attention to the area. EHF was created in 2008 from the sale of the nonprofit hospital system, and its funding projects focus largely on obesity prevention, mental health, and access to care. 

The board of the foundation determined that flexibility in granting procedures would provide the best opportunity to respond to shifting needs in the philanthropic landscape. According to Martin, “EHF’s approach to funding is called Philanthropy 3.0, which, at its core, means we collaborate with partners to challenge current practices and work upstream to develop new, innovative approaches that change policies and systems.”

EHF has nearly $76 million in assets and averages $3.75 million in grants annually from its endowment. In an effort to increase its reach, the foundation has tasked its staff with identifying “new revenue streams for the region, resulting in an additional $68 million in grantmaking funds—some of which have been reallocated to help grantees attract an additional $250,000 in federal and state funding,” according to the RPAP report. 

Being locally based has given EHF special insight into the needs of the area’s population, and has enabled the foundation to be more responsive in its community grantmaking. Its approach allows it to serve as an intermediary for national funding organizations that may want to fund programs in the area but don’t know the local philanthropic landscape as well.

One challenge for outside funders is navigating an area with 14 Native American tribes across three reservations. EHF’s flexibility has allowed it to break free from rigid funding protocols and create new health funding strategies to accommodate tribal priorities. “EHF is actively engaged in supporting eastern Washington’s Tribal Alliance. The Tribal Alliance is developing a behavioral health treatment model based on traditional, whole-person healing methods that emphasize spiritual, mental, emotional and physical well-being,” says Martin.

Success Stories

Currently, there appear to be several success stories in EHF’s funding model. As of 2019, $3 million has been invested in an obesity prevention initiative to help rural schools avoid serving unhealthy processed foods, many of which tend to be more cost-effective. Results are promising so far, achieving a 5 percent drop in the average body mass index among students in the program’s pilot district.

Another unique issue in this area of eastern Washington is the difficulty in implementing the Affordable Care Act and in successfully maintaining the child welfare system. EHF has leveraged affiliations with other nonprofits to better implement its programs and leverage more opportunities. Better Health Together will oversee $70 million in funding between 2018 – 2021 to fill gaps in Health and Human Services funding affected by the ACA. Meanwhile, Family Impact Network deals with documenting and funding child services and healthcare visits that often cost more because of large travel distances.

Antony Chiang, the EHF leader in the RPAP report, recently announced that he has been named new CEO of the mega-rural funder Dogwood Health Trust. EHF’s assets nearly doubled since Chiang assumed leadership in February 2010. 

A Larger Inquiry Into Rural Philanthropy

The RPAP was part of a larger national project partially funded by the Robert Wood Johnson Foundation, the largest public health philanthropy organization in the U.S. Of the significance of the project, Allen Smart, director of the RPAP, said, “I think rural philanthropy is something that needs to be uplifted/defined and represented within the general philanthropic discourse because, for the most part, it hasn’t been.”

The other field studies in the Rural Philanthropic Analysis Project included Northeast Iowa’s Community Foundation of Greater Dubuque, which focuses on bringing the region’s rural populations together with local government and businesses; New Mexico’s Con Alma Health Foundation, a granting organization which funds healthcare-oriented nonprofits; and New England’s Endowment for Health in New Hampshire and the Maine Health Access Foundation, both of which must address the needs of more racially homogeneous populations.

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