Matej Kastelic/shutterstock
Matej Kastelic/shutterstock

It makes intuitive sense that our physical health is influenced by our access to nutritious food, adequate housing, financial stability and a clean environment—that’s why these factors are known as “social determinants of health.” But despite the obvious cause-and-effect connection, healthcare systems have traditionally considered social determinants outside their purview, and focused narrowly on clinical care.

The ProMedica Foundation believes this narrow focus is one reason the U.S. lags behind other countries in key health indicators, including rates of chronic disease and life expectancy, despite our eye-popping annual healthcare bill. Over the last decade, the ProMedica Foundation, the philanthropic arm of ProMedica, a nonprofit health system based in Toledo, Ohio, has taken steps to address social determinants of health in the communities it serves.

ProMedica is one of a growing list of private funders that are focusing on social determinants, or so-called “upstream” factors, that influence health, a trend that IP has kept a close eye on in recent years. The Robert Wood Johnson Foundation has been a leader, along with the Kresge Foundation, the Kellogg Foundation, and more recently, the Gates Foundation, as well as some regional funders. These philanthropies have been joined by health insurance funders, including the Anthem Foundation, the Humana Foundation and the Aetna Foundation.

Seeking to build on this trend, the ProMedica Foundation is hoping to encourage other health systems to join them through its ProMedica Impact Fund, which it describes as “a national call to provide a coordinated, national response to a national crisis.”

A hand up, not a handout 

Social determinants of health (SDOH) and their impact on communities is something Gary Cates, the chief philanthropy officer at the ProMedica Foundation, has been thinking about for a long time. It started in 2009, when ProMedica sent dietitians into local schools to talk about nutrition.

“They came back and told us, ‘The problem is that these kids are hungry.’” Cates recalled. “We realized that a lot of kids were coming from food-insufficient homes and that began to open our eyes to the issue of social determinants of health.” Since that time, the health system has treated hunger as a health issue, providing food clinics and offering meals when patients are discharged.

The ProMedica Foundation expanded its SDOH work in 2015, after it received a $1.5 million gift from Russell Ebeid, a former glass industry executive and ProMedica trustee. The foundation, which is funded primarily through individual donations, also supports the health system’s hospice program, ancillary care for cancer patients, a camp for children with cancer, a playground accessible for people with disabilities, and other health-related programs.

Ebeid, who believed in giving people “a hand up, not a handout,” wanted to address health issues in a way that would lower the need for services. The result was the ProMedica Ebeid Center, located in the UpTown neighborhood of Toledo. The center includes a grocery store, a financial opportunity center that provides financial and career counseling, as well as health screenings and GED, nutrition and cooking classes. The market provides healthy, affordable food in an area that was formerly a food desert, as well as employment for local residents.

Ebeid died in 2017, and his family gave the ProMedica Foundation an additional $28.5 million to create the Ebeid Neighborhood Promise, which builds on the center’s work to address social determinants of health. Initiatives include a program to improve prenatal care, a preschool pilot project, job training programs and affordable housing.

It’s difficult to precisely measure the impact on an individual—or a community—when social determinants are addressed, particularly in the short term. Cates says this was something he and Russell Ebeid often discussed. “We wondered, ‘How can we measure success?’” Cates recalled. “And Russ said, ‘Show me 100 changed lives.”

So Cates began collecting stories of people who had received assistance from ProMedica. One single mother, for example, had fled an abusive living situation with her three children, and was homeless. The ProMedica SDOH team helped her get benefits and find stable housing. Another formerly homeless woman went through the job training program at the grocery store and now has a job, a car and a stable place to live. Many of the stories are about people who came to the Financial Opportunity Center with maxed-out credit cards and piles of unpaid bills (often as the result of medical issues that added to their bills and made it impossible to work) and were able to inch their way out of the red with the help of a financial coach.

Before Russell Ebeid died, Cates showed him some of the stories. “The last time I saw Russ, I gave him a book with examples of 50 people whose lives had been changed and I said, ‘This is a down payment.’” Cates said. “I knew he was ill, I didn’t know that was the last time I would see him. I’m glad he got to see that evidence of his work.” Since then, the ProMedica Foundation has collected 150 such stories.

Late to the party

Cates and the ProMedica Foundation are hoping that the ProMedica Impact Fund will scale the SDOH work they’ve been doing to reach communities across the country. They launched the initiative in April 2020, and while it has geared up slowly because of the pandemic, they already have some fledgling projects in the works with partners in Cleveland and Chicago.

The fund will provide grants to nonprofits and seed capital to new businesses and agencies doing SDOH-aligned work, and create a national database to keep track of interventions to track of what’s working so best practices can be shared and scaled.

Meanwhile, Cates has been working to raise money for the initiative. The goal is to raise $1 billion in eight years, and Cates says they’ve held meetings with over 170 funders. The project has sparked a lot of excitement. “It’s an area that many health systems are interested in,” Cates said. “There’s a lot of awareness around social justice and ending inequities in healthcare.” Still, the approach is not something healthcare funders are used to. “Healthcare philanthropy is usually very brick and mortar, building medical buildings and other types of infrastructure, so this is an approach that takes some explaining,” he said.

Cates believes the time is right for the initiative—and for more health systems to broaden their scope to include social determinants. “Social service organizations have been engaged in this work for many years,” he said. “The healthcare industry is really late to the party.”