The dire health impacts of COVID-19, climate change and racial injustice have made it clear that we need to fundamentally transform our health systems. Fissures throughout our public health infrastructure have been ripped open by racial, political, and economic divides that can no longer be ignored. Because we cannot simply spend our way towards transformed health systems, we must reimagine systems of care and create new forms of collaboration, accountability, and opportunity with communities, particularly those that continue to experience disproportionate trauma and death.

Through the progress and limitations of our work, we recognize that access to safe, equitable, and high-quality care requires shifts in power and accountability so that communities are engaged, served, and centered in the priorities and practices of health institutions.

After a decade of sustained grantmaking to help integrate health and human services, The Kresge Foundation’s Health Program is rearticulating its commitment to health systems change through our Community Health Ecosystems focus area.  More than the infrastructure required to ensure public health, community health ecosystems include the dynamic constellation of environments, people, relationships, practices, services, and opportunity that sustain safe and holistic health systems. With this focus, our intention is to make explicit the critical contributions that communities—residents, leaders, and organizations—make to strengthen and sustain systems of care.

The opportunity to recalibrate our priorities and approach has motivated us to deepen our investments in community-centered solutions to climate change, community safety and public health leadership development through these initial strategies.

Strengthen Community Power and Health Institution Accountability

We believe that community engagement and participatory decision-making are necessary to strengthen community power and ensure that health Institutions are accountable to the communities they serve. Our investments in equitable community-centered approaches to climate change, community safety and racial inequities in health can help increase community participation and decision-making. For example, through a partnership with Human Impact Partners, pairs of local health departments and community power-building organizations are adopting inside-outside strategies to tackle complex social determinants of health.

Support Resilient Health Workforce Pipelines and Infrastructure

We understand that both leadership development and institutional capacity building are needed to sustain a diverse and resilient health workforce. Our investments help train future public health leaders, and expand access to training, employment, and economic opportunity across the health workforce. While the Emerging Leaders in Public Health will continue to equip local public health leaders to transform the role of public health in their communities, new partnerships with community-based training centers, workforce development organizations, and health systems will enable us to invest in diverse, resilient, and community-focused health workforce pipelines and infrastructure.

Expand Community-Centered Health Programs and Services  

We also recognize that community-centered budgets, programs, and services must be expanded across the health sector. Our investments include a renewed focus on community access to culturally responsive, trauma informed wellness programs, services, and care. The Center for Community Resilience currently supports community resilience networks address childhood trauma, and new partnerships with youth-serving and community advocacy organizations will guide our upcoming investments in community safety and well-being.

Advance Racial Justice and Health Equity

To sustain community health ecosystems that acknowledge, repair, and prevent cycles of harm and trauma we must deepen our commitment to, and investments in, racial justice and health equity. As part of our grantmaking, we are committed to resetting the table for engagement. We understand that we too are accountable to the communities we serve and have a responsibility to demonstrate the value of community wisdom by creating equitable opportunities for community participation, influence, and decision-making in our work. We believe, deeply, that strengthening community health ecosystems requires us to leverage the full array of our organizational resources in service of the visions for well-being that communities articulate.

As we move forward in this work, we welcome the insights of our new and current partners to guide our learning along these and other dimensions of inquiry.

• How do we engage the wisdom of young people and those who have been harmed because of their identities and experiences with the criminal legal system?
• What is needed for public and private health institutions to center racial justice and health equity across all practices, programs, and services?
• How can we deepen community capacity and help shift the community power and accountability imbalances within the health sector?
• What are the pathways that connect community health impact and investments in local health workforce development, climate resilience, and community safety?

The momentum, creative energy, and bold leadership within the communities we serve compel us to look at our contribution through a different lens — and we’re grateful for this opportunity.