PROVIDENCE – Which ax blow felled the tree? It was a question once posed to ConvergenceRI in 1979 by Tom Campbell, who organized benefit concerts by Jackson Browne, Bonny Raitt and The Eagles, among others, in support of the No Nukes movement in California, talking about the importance of recognizing that no one person and no single event can spark a sea change in political consciousness. It was always a team effort, Campbell argued.

This month, an enormous sea change occurred in Rhode Island: the state’s leading philanthropic investor in nonprofits, The Rhode Island Foundation, with nearly $1 billion in assets, changed directions in its investments, putting renewed emphasis on community health outcomes, not health care delivery systems.

• In its next round of $2.8 million in grants through its Fund for a Healthy Rhode Island, the Foundation said that it would focus on factors outside of the clinical setting in the health care delivery system in Rhode Island.

“We plan to support collaborations which will decrease health disparities and improve the health of Rhode Islanders by improving social and environmental determinants of health – the context in which we live, work, play and learn,” said Larry Warner, who oversees grant-making in the health sector at the Foundation, in the news release announcing the shift in emphasis.

Warner said that The Rhode Island Foundation would give priority to proposals that bring together clinical organizations, community-based organizations, and residents to improve the health of communities with high rates of illness, chronic disease or other adverse health outcomes.”

“Achieving and maintaining good health is more likely when people are part of communities that promote health and healthy choices. Creating healthier and more equitable places requires meaningful, sustained collaboration,” said Warner.

What caused the sea change to occur? Good question.

The forces of synergy and convergence
During a time of enormous disruption in the health care marketplace, when hospital systems, health insurers and pharmacy chains are in the midst of a frenzy of consolidation to capture greater market share, and corporate mining of Big Data dominates the discussion around the future of health care, it would be political malpractice not to try to identify and to recognize the forces behind the recent sea change that occurred.

• A large portion of the credit must go to Dr. Nicole Alexander Scott, director of the R.I. Department of Health, and her right-hand person at the agency, Ana Novais, for championing the concept of creating 10 health equity zones, or HEZ, in Rhode Island to develop sustainable, community-based solutions to health, social and economic disparities.

• Another large dollop of the credit must also go to the often unheralded work by community groups and agencies that have worked in collaboration to develop and to implement community-driven action plans as part of the HEZ effort.

• A third share of the credit must go to those stalwart advocates of public health, including Dr. Michael Fine, who has been willing to challenge the status quo when it comes to talking about expanding the vision of what public health encompasses, and the willingness to ask what Studs Terkel aptly called the “impertinent” question.

What other forces were at play?
ConvergenceRI asked Neil Steinberg, president and CEO of The Rhode Island Foundation, to weigh in with his opinion about the other forces were at play behind the sea change in investment strategy.

“As the demographics of Rhode Island continue to change, closing gaps will become an even more important investment in the health of Rhode Islanders and the health of the medical system,” Steinberg said, adding: “It’s important that local media outlets [emphasis added] cover these issues in detail.”

Without explicitly saying so, Steinberg appeared to acknowledge the important role that ConvergenceRI has played during the last five years in being a consistent voice in the local media market, reporting on the efforts to create health equity zones in Rhode Island, and on the efforts by communities to develop their own solutions to health and economic disparities.

Dr. Peter Simon, a retired pediatrician who led the statewide efforts to combat the lead poisoning of children in Rhode Island, was much more explicit in directly acknowledging the role that ConvergenceRI had played in the sea change.

“The announcement by The Rhode Island Foundation this week that they will be investing significant amounts of funds to address health disparities in Rhode Island by addressing social and environmental determinants of health is one of the most hopeful things I have heard in many years,” Simon said. “I want to thank ConvergenceRI for its efforts over the past four years to shed light on the good work being done in Rhode Island by the R.I. Department of Health in their Health Equity Zones.”

Simon continued: “I hope this kind of commitment is the beginning of a new way to improve the sustainability of Rhode Island. Our government can add more resources if it can start to make equitable investments in healthy housing, better access to fresh food, high quality early care and education, and more opportunity for adults to acquire skills and jobs that bring them into the middle class.”