How This Regional Funder Fights the Race Gap in Child Mortality

It’s hard to imagine a grimmer way to measure racial inequity in our country than through the lens of child mortality. In 2017, 17 out of every 100,000 children in the U.S. aged one through 14 passed away, according to data from National Kids Count. But among black or African American children, the rate was 25 out of every 100,000, far outpacing all other racial groups. That’s at the national level. The disparity is often even more acute on the ground, reflecting local histories of chronic disinvestment.

One example is California’s Sacramento County, home to the capital of a state that faces significant racial equity challenges despite its avowed progressivism. Over a decade ago, a report revealed that the county’s black children were dying at twice the rate of any other ethnicity, a horrific disparity that led the county to convene a special commission to dig deeper into the problem. At the conclusion of that effort in 2013, County Supervisor Phil Serna lamented how little had been done so far to address the child mortality gap, “despite the fact it is something we’ve known about for decades.”

To close that gap, the commission determined that Sacramento needed to address four leading causes of child death in black communities: infant sleep conditions, perinatal conditions, child abuse and neglect, and third-party homicide. That’s where philanthropy comes in. The Sacramento-based Sierra Health Foundation has been a key player in the fight to dial those problems back, particularly through a public-private partnership effort called the Black Child Legacy Campaign (BCLC).

The Black Child Legacy Campaign has seen some promising successes. Over the past three years alone, the mortality disparity between black children and other racial groups has declined by 25 percent. And last year, not a single juvenile died of homicide within Sacramento city limits. That’s partly the result of “a lot of hard work by community actors who’ve done unconventional things to make that happen,” said Chet Hewitt, CEO of the Sierra Health Foundation.

It All Starts With Trust

The Sierra Health Foundation is one of the oldest health conversion foundations in the Golden State. Serving northern California, the foundation approaches its work through the lens of health’s social determinants. That’s a framework more and more health philanthropies are adopting these days, with national funders like Robert Wood Johnson leading the charge. The Sierra Health Foundation’s approach to wellness prizes efforts around equity, social justice, and a focus on communities, populations and geographies left behind.

The Black Child Legacy Campaign ticks all of those boxes. It’s organized around tackling the four leading causes of death identified by the county commission, a set of issues that reflects the need for more attention to the social and environmental factors threatening black children. Crucially, Sierra Health and the other partners involved (we’ll get to them in a bit) have taken pains to empower community groups, rather than dictating from the top down. “We want to change the dynamic that ‘if something’s wrong, we would come and take your children,’ to ‘we’ll help you take care of your children,’” Hewitt said.

That meant going into seven Sacramento County communities—where 82 percent of black child deaths were concentrated—and asking people which local organizations they trusted already. Seven of those organizations, primarily faith centers and community centers, went on to act as “community incubator leads,” receiving support from BCLC to host a range of prevention and intervention services. “We wanted folks to understand that we weren’t picking for them,” Hewitt said. “Many of these groups may have had capacity issues, but we said what we can’t do for you is get communities to trust you. Trust is a byproduct of relationship.”

Hewitt highlighted how important it is to engage and hire people with different backgrounds and skill sets. Some of the most effective cultural workers, he said, “aren’t folks you’d see working in most social service organizations. Their credibility is borne of them having personal experience with the challenges communities face.”

In addition to supporting the Black Child Legacy Campaign monetarily, the Sierra Health Foundation provides an administrative home for the entire effort. The Center at Sierra Health Foundation, a spin-off nonprofit from the main foundation, manages the campaign. The center was launched specifically to build the capacity of northern California communities during a time of public sector belt-tightening. It administers a number of partnerships, often involving the public sector, working on a range of issues including opioid abuse, census outreach, economic development, and racial and youth justice.

Collective Impact

Like many of the initiatives running through the Center at Sierra Health Foundation, BCLC involved multiple sectors from the get-go. After Sacramento County’s commission completed its initial look into the roots of the problem, the county convened a steering committee to lead the charge, with Hewitt co-chairing. The county also committed resources to the project totaling $7 million over five years, on top of initial commitments by the Sierra Health Foundation. The city of Sacramento came in to back the steering committee, as well.

The state of California is also in the mix, supporting BCLC in several places. The project benefited from revenues from a state tobacco tax channeled into early childhood development via a program called First 5. And BCLC secured a state grant from the California Board of State and Community Violence Prevention to support Healing the Hood, a violence prevention and intervention program that began in the summer of 2018 and will run through June of this year. Healing the Hood is a good example of the kind of wraparound model the Sierra Health Foundation champions through BCLC, combining interventions on the street with services like case management, job training, parenting education and programs to help students with disciplinary problems at school. The Obama Foundation supports Healing the Hood and the wider BCLC project through its My Brother’s Keeper initiative.

The Sierra Health Foundation partners with several California-focused philanthropies on programs aligned with the BCLC mission. They include the California Wellness Foundation and the California Endowment, both of which support Advance Peace, an organization that gives stipends to individuals likely to commit violent crimes in an effort to steer them away from trouble. The city of Sacramento adopted Advance Peace’s incentives program in 2017. The Center at Sierra Health Foundation also manages California Funders for Boys and Men of Color, a collaborative of many of the state’s biggest health and racial equity funders, as well as equity-minded community funders like the San Francisco Foundation and the East Bay Community Foundation.

According to Hewitt, making these partnerships between philanthropy and the public sector work is “more art than science, more jazz than a concerto.” He cited the need for large national funders to work with local foundations to identify the best community actors to support—and emphasized that community groups often need capacity support just to reach a point that they appear credible to program officers. “It’s like a hamster wheel. We can’t find groups in communities, so we don’t fund them,” he said. “We need to think about our portfolios as having an ample amount of risk associated with them.”

New Avenues

Although BCLC’s work is far from done, measurable declines in mortality among Sacramento’s black children have led to a sense of momentum. “People are beginning to believe change is possible,” Hewitt said. Next, the Sierra Health Foundation wants to find ways to activate community groups around economic development as well as health and human services. A natural outgrowth of BCLC’s work, Hewitt said, is that “once people get to a hopeful place, the first thing they say is: I need a job.”

Housing is another issue the Sierra Health Foundation wants these partnerships to address. Especially for those at the lower end of the economic spectrum, housing insecurity can greatly increase stress and tension on families. Funders like Sierra Health see that as yet another negative determinant of health outcomes.

Whatever direction the BCLC initiative eventually takes, Hewitt emphasized that it’s not just about reducing a number, but about taking people to a new place. He was referring to the communities BCLC serves, but that could apply just as well to philanthropic and public sector administrators accustomed to tight control and quantifiable results. As more philanthropies partner with local government to deal with entrenched problems like racial inequity, it’ll be illuminating to see whether these cross-sector initiatives can actually get people to think bolder and take more risks.

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