Band-Aids Aren’t Enough: How One Foundation Is Embracing a Broader Definition of Healthcare

Carolyn Wang Kong. Photo courtesy of BSCF.

Carolyn Wang Kong, chief program director at the Blue Shield of California Foundation, understood at a young age that healthcare has to be about more than just repairing bodies. 

Wang Kong is the child and grandchild of immigrants, and as a young person, she interpreted for her grandmother during medical appointments. She remembers one incident in particular, when her grandmother was undergoing eye surgery, and had to be conscious so she could take instructions from the surgeon.

“I was unexpectedly called into the operating room to interpret for her,” Wang Kong recalled in a recent speech. “She was on the operating table, scared out of her mind because no one told her what was going on. I held it together as best as I could, interpreting maybe 30% of what was said. My hands were shaking, I was so angry. They would never have allowed this to happen to an English-speaking family.”

That incident helped shape Wang Kong’s professional path. She led language access at Kaiser Permanente, ensuring that every patient had video access to a qualified medical interpreter. At the Blue Shield of California Foundation (BSCF), where she has worked for over five years, Wang Kong has helped promote a broader definition of healthcare. The foundation works on issues like economic security, housing, domestic violence prevention, immigrant rights and anti-Asian violence. 

A growing list of health funders today recognize the impact of so-called “social determinants of health,” which include economic security and access to education, healthcare, social support and a safe environment. Major funders like the Robert Wood Johnson Foundation and the Kresge Foundation, as well as community and regional health foundations around the country, are employing a variety of tactics to address issues that fall outside traditional definitions of healthcare, but nevertheless impact health. 

Still, Wang Kong would like to see health funders go even further in their advocacy for actual systems change. “We often tend to medicalize issues, so if there is food insecurity, for example, we bring a food pantry into the clinic,” Wang Kong said. “Those kinds of programs are great, but they don’t change systems. We need to ask why food insecurity is a thing to begin with. So instead of a band-aid approach, we’re really encouraging health funders to use their influence to advocate for broader social policies that are outside of the health system.”

Health funding without borders

Wang Kong points out that in recent years, many health funders have focused on health coverage and preserving the Affordable Care Act. “Coverage, yes. Access, absolutely,” she said. “But there are many other ways for us to address the upstream issues that are so important to health.” 

As an example, Wang Kong points to the important role that health funders like BSCF and Kaiser Permanente played in the eviction moratorium adopted in the city of Vallejo, California, after the pandemic hit. The two organizations joined housing advocates and others in support of the moratorium, which was the first passed in the United States. Similar measures were subsequently enacted across the country.

Wang Kong believes health funders underestimate the influence they can have by simply supporting a particular issue. “In many cases, funders don’t have to give money; they just have to give their voice,” she said. “In Vallejo, we went to the board of supervisors, and that helped pass this momentous piece of policy. And that had a cascading effect across the country.” 

Behind closed doors

Another area where the Blue Shield of California Foundation has taken the lead is domestic violence prevention, as IP has reported. The issue is part of the foundation’s mission: “To build lasting and equitable solutions that make California the healthiest state and end domestic violence.” The foundation is the largest private funder of domestic violence prevention in California. 

Wang Kong believes many funders don’t want to address domestic violence because it is considered a private matter, one that happens behind closed doors. But, she argues, domestic violence occurs as a result of the convergence of many inequities and stressors. It’s also a legacy passed from one generation to the next. BSCF recently conducted an analysis of domestic violence, and found that childhood exposure has a multigenerational impact. 

“Domestic violence is more than a moment of harm between two people,” Wang Kong said. “Kids who are exposed to domestic violence are at higher risk for not only growing up to be adults in unsafe relationships, but they are at higher risk of chronic health conditions.” 

Given the long-term impact of domestic violence on health, Wang Kong would like to see more health funders support its prevention. “Whether you are a funder of economic justice or criminal justice reform or education—all of us have skin in the game to prevent domestic violence. Our research shows that over half of all Californians have either experienced domestic violence or know someone close who has. We can’t afford to not pay attention to it.” 

Rapid response

Since 2017, BSCF has also provided rapid response grants to address immediate issues, an approach that Wang Kong helped lead. To get funds out the door more quickly, for example, the foundation trimmed its grantmaking timeline from 12 weeks to about six. Doing so helped inform the foundation’s response to COVID. In 2020, BSCF streamlined its grant proposal template even more, and increased the amount it offered for general operating funds. BSCF gave more than $6.8 million in grants to support Californians who were hardest hit by COVID-19.

Wang Kong conceded that introducing this kind of flexibility into the grantmaking process isn’t easy, but she believes it’s important. “I think it’s part of our responsibility as funders to gear flexible funding to organizations so they can read the moment and react accordingly,” she said. “It means letting go of a narrow view of what solutions can be. If I just fund an organization to work on policy X, and then 10 other issues come up, that’s a huge missed opportunity. Providing general operating funds enables organizations to act nimbly and with agility.” 

BCSF also reacted quickly after Governor Gavin Newsom unveiled the California Immigrant Resilience Fund (CIRF) in response to the pandemic. As a leading seed funder for the program, BCSF provided $1 million and encouraged others to step up. More than 230,000 immigrant families received cash assistance from CIRF and the state of California. 

Outsized influence 

In June of this year, Grantmakers in Health recognized Wang Kong with its Terrance Keenan Leadership Award in Health Philanthropy. She used her acceptance speech to urge health funders to act. “In this moment, communities have lost so much, particularly communities of color, and yet there could not be more at stake,” she said. “The risk of doing nothing or not enough is that we will entrench inequities.” 

Health funders can have outsized influence, Wang Kong argued. “The health sector is incredibly powerful, especially when we show up on issues that the world doesn’t expect us to: economic security, housing, community development—because we know these things drive health. We need to show up differently, we need to engage other sectors, and we need to build a more comprehensive picture of what creates health.”