Kresge Foundation President and CEO Rip Rapson delivered the following comments at the opening of the National Association of County and City Health Officials 2024 NACCHO360 conference on July 23, 2024. 

Good afternoon, everyone. Welcome, and thank you all for being here.

And what a pleasure it is to follow in the considerable wake of Dr. Mandy Cohen. Thank you, Doctor Cohen – and the entire Biden-Harris team – for your inspirational leadership.

What an extraordinary privilege it is to be standing in front of so many people dedicated to supporting our nation’s health. At a time when the public discourse is consumed with terms like needing to lower temperatures, heal divisiveness, and prescribe new norms of civility, it seems only just and right that we would hand over that conversation – at least for the next number of days – to professionals who actually know how to lower temperatures . . . heal . . . and prescribe. I, for one, am more than comfortable with getting serious about putting the fate of our country in your hands.

But as I think about it, that is exactly what our country has done, whether or not it fully thinks of it that way. Because the work you do all day, every day, is profoundly inspiring even when it is emotionally and physically exhausting . . is transcendentally important even when, as it too often is, underappreciated . . . is preternaturally courageous even when carried out in relative anonymity.

There are no better exemplars in contemporary America of true and abiding commitment to community – of what it takes to labor in a spirit of selflessness . . . what it means to embrace empathy and compassion. . . what it means to elevate long-term common good over the easy, immediate and expedient.

Thank you. Thank you.

It would be foolish and presumptuous of me to try to foreshadow the intricate tapestry of issues and ideas . . . practices and policies . . . networks and relationships that will be woven over the next couple of days. Let me instead talk briefly about how my sector – philanthropy – might be relevant to your work.

Tackling the challenges facing American cities

One hundred years ago, Sebastian Kresge – the founder of the five-and-dime store chain that would become K-Mart – created a foundation in his name with the mission to promote human progress. Since then, Kresge’s board members, staff and presidents have collaborated with people and communities in cities across the country to give shape and direction to that charge.

We continue to believe that there is a meaningful and compelling role for philanthropy to play in helping set the long-term trajectory of American cities.

We’ve come to the view that that role is not to stand outside the fence-line of civic decision-making in deference to the public and private sectors. It is not to wait passively for the safe and sheltered moment to engage tough issues. It is not to define ourselves solely as a gilded ATM machine waiting to dispense to the select few who discover the secret passcode.

We instead see our role in a more proactive light:

• Providing patient capital and intelligence that help communities chip away at seemingly intractable social challenges without sacrificing a sense of urgency.
• Taking market and political risk to advance unexplored but potentially transformative ideas where others will not.
• Recognizing that problems of racial injustice, or urban disinvestment, or systemic impediments to economic mobility are not one-dimensional, but are instead fractals, requiring multiple forms of response from every corner of civil society.
• Mixing and matching grants, loans, intellectual heft and other tools to crack open and recalibrate ossified and unhelpful patterns of policy and practice that stand in the way of opportunity and equity.
• Searching out the intersections across disciplines without becoming paralyzed by complexity.

2. Capacity-building

The second role we can play is to strengthen the capacity of community residents to participate meaningfully in health-oriented decisions and investments that shape their daily lives.

Too many citizens see in the complexity, formality and remoteness of public health systems an insurmountable obstacle to engagement about shared interests. That perception can rob them of any sense of agency in community health decisions that shape their lives . . . can strip away any incentive to find channels for giving voice to their concerns and ideas.

Philanthropy can help.

Kresge and the Robert Wood Johnson Foundation, for example, have invested in a project called “Power Building for Partnerships in Public Health,” which pairs local health departments and community organizations with an eye toward building a common vocabulary around, and shared approaches to, housing, safety, environmental protection and other social determinants of poor health outcomes.

In a similar vein, Kresge has invested in a program in Memphis called “Friends For All,” which is partnering with Shelby County Public Health Director Dr. Michelle Taylor – whom you’ll meet in just a minute – to help primary health care service providers collaborate with community residents to identify, and put into practice, holistic services that address the racial and social inequities experienced by patients and clients.

3. Risk mitigation

A third role philanthropy can play is to peel back the first layer of risk in potentially powerful, but untested, transactions.

Private philanthropy is a potent source of social venture capital, able to deploy our grantmaking, lending and balance sheets to demonstrate the viability of approaches that the public and private sectors have concluded aren’t investible or cost-effective.

A quick example from a decade ago.

Kresge sought to convince the nation’s largest affordable housing investor – the Local Initiatives Support Corporation (LISC) – to create a mechanism to co-locate affordable housing developments and federally qualified health clinics along transit lines. It was an idea about as alien as they come to the then-head of LISC. But Kresge made a grant to cover the cost of a dedicated LISC staff person . . . . agreed to guarantee any losses projects might incur . . . . worked with Morgan Stanley to supply $100 million of commercial debt . . . . and figured out how to secure both Low Income Housing Tax Credits and New Markets tax credits – the first time a project had ever utilized both.

The fund – called the Healthy Futures Fund – was so successful in bringing projects online that it was subsequently re-capitalized by Morgan Stanley without our guarantee, leading to multiple mixed-use health and housing projects.

Think of the countless possible applications of this kind of risk-amelioration capital. Health systems seeking to invest in worker housing located in adjacent neighborhoods. Community clinics upgrading their systems to become resilient to the kind of catastrophic storms that can make electronic records inaccessible, medical equipment inoperable, and medicines and vaccines unusable. Tough sells in conventional financing markets; less tough when done hand-in-glove with philanthropy.

4. Serving as a Sherpa

The fourth role I wanted to mention is place-based philanthropy’s ability to serve as a “sherpa” for investors who need reliable local ground truth.

This has been cast in bright relief as the Biden-Harris Administration seeks to ensure that localities can effectively absorb and deploy the waterfall of dollars flowing from the CARES Act, ARPA, and the Infrastructure Investment and Jobs Act.

Kresge has, for example, supported Bloomberg Philanthropy’s creation of a national resource hub to match some 1,000 local communities with the expertise they need to submit successful grant applications to the feds, resulting in billions of dollars moving to ground in a way that reinforces and advances local priorities.

Similarly, Kresge and others have invested in something called CHARGE – or Community Health Access to Resilient Green Energy – a collaboration among the National Association of Community Health Centers, Collective Energy – a nonprofit specializing in alternative energy solutions – and Capital Link – a non-depository community development lending institution. By blending philanthropic and federal dollars, CHARGE  provides financial, educational, design, installation and technical assistance to increase the climate resilience of local health centers serving low-income communities most vulnerable to electric grid outages.

The imperative of cross-disciplinary, cross-sectoral effort

You all certainly didn’t show up this afternoon to be tortured by a lecture on philanthropy. I apologize if this has taken on that quality. My intention was to encourage you to think more seriously about the place philanthropy might occupy in the work you do:

• By helping you step outside the fence-line of your traditional partners;
• By enlisting unconventional resources to excavate novel solutions to gnarly issues;
• By providing an on-ramp for expanded forms of community engagement;
• By re-imagining the kind of investments that could connect you more directly with your host communities.

I would note that the four roles activate with greatest potency when deployed in combination. Think of this as an exercise in reverse engineering: first, clarifying what we want to accomplish, then working backward to assemble the right players equipped with the right tools . . . applied in the right proportions . . . in the right sequence . . .  at the right pace.

Only then do we forge a truly effective, equitable, and accountable civic problem-smashing machinery and strengthen the health of communities through practices and policies that are people-centered, innovative and grounded in racial equity.

It is the people in this room who will need to take these steps. Not our friends holding election certificates. Not our friends focused on meeting quarterly shareholder expectations. Not even our friends revolving through the doors of the White House. But you. You who are closest to the ground. You who understand both the complexities and possibilities of principled public service. You who have devoted your professional careers to improving people’s lives.

Thank you again for your courageous and powerful leadership at a time when we need it the most.

And let me just say that I hope – and trust – that you will have a productive – and enjoyable – time in our city. Another speech for another time. But Detroit’s recovery has been a miracle.  I hope you can experience a bit of it.

Thank you. And have a good conference.