Fostering an equitable and healthy Richmond Region.
Equity: We commit to act in ways
Access to Health Care: A renewed
that promote fairness in opportunity for all people.
commitment to primary care with a sharper focus on significant gaps in oral and behavioral health services, as well as improved outreach to new populations who face significant barriers to basic health care.
Inclusion: We recognize, value, and seek to better understand and integrate the contributions and experiences of all members of our community.
Equity and Health: A unique Fellowship
Learning: We are curious, eager to listen to and learn with our partners, and focused on how data can lead to responsible action.
and a Visiting Artist Program, known as HEArts, that build regional support for policies to improve social determinants of health.
Invest Health RVA: A regional project
Respect: We honor the diverse voices,
bringing together public, private, and nonprofit leaders to transform housing policies through a comprehensive approach that includes research, education, and community engagement.
perspectives and experiences of the people in our communities.
Stewardship: We responsibly manage our investment resources in alignment with our values and mission.
Impact Investment: A tool for the
Transparency: We are accessible and
creation of lending opportunities that lead to positive social change.
honest in our communication.
Impact: We invest in people, organizations, ideas and solutions leading to positive, sustainable change in our communities.
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We work collaboratively as investors, conveners, learners and network builders with our communities. We look for
We invest primarily in Chesterfield County, Goochland County, Hanover County, Henrico County, Powhatan County, and Richmond City, and are open to considering regional and statewide investments that align with and advance our mission.
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We nurture relationships and invest in solutions to eliminate health disparities in our region.
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partners and allies who share our values and are committed to analysis, community engagement, action, impact, and accountability. We celebrate the diversity of our region and affirm the critical need for inclusion in decision-making and shared action that leads to improved health outcomes.
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We work to address the social, economic and structural conditions that contribute to poor health outcomes. We operate with a sense of urgency and a deep commitment to longterm change, emboldened by the resilience, creativity, and capacity of our communities.
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Richmond Memorial Health Foundation’s Board of Trustees adopted a four-point strategic framework in 2016 that preserves its commitment to access to health care while refocusing its vision more broadly to address deepening inequities in health outcomes and the socioeconomic conditions that contribute to these disparities. Each strategy is structured to support the Foundation’s mission for fostering an equitable and healthy Richmond Region. RMHF believes that meaningful change requires active engagement and investment at the regional level, given changing demographics and the interconnectedness of the area served by the Foundation, which covers the city of Richmond and the counties of Chesterfield, Goochland, Hanover, Henrico, and Powhatan.
depicts a starkly different reality. The number of people living in poverty in Chesterfield, Hanover, and Henrico counties more than doubled between 2000 and 2014. Combined, the impoverished population of the three counties now exceeds the total economically challenged populations of the city of Richmond. The growth and spread of concentrated poverty require leaders in all jurisdictions to be engaged and contribute to solutions designed to build a stronger region. There is compelling evidence that this endeavor must be rooted in an approach that addresses the social determinants of health. People need safe and affordable places to live, educational and job opportunities, access to healthy foods, safe places to exercise and play, money in the bank, and positive and supportive social relationships.
New demographic research is testing longheld myths about poverty in the region and
Changing Demographics Suburban Poverty 120000 100000 80000 60000 40000 20000 0
2000 Suburbs
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2014 Richmond
Spatial Analysis Lab at University of Richmond Source: US Census Bureau ACS 2010-2014
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The connections between these factors and health outcomes are clear, and they inspire RMHF’s commitment to think more expansively about its work, investments and strategies. The framework that will guide RMHF’s work for the next three to five years consists of the following four strategies:
A pragmatic blueprint for access to health care that pairs a renewed commitment to health care with a sharper focus on significant gaps in oral and behavioral health, as well as improved outreach to new populations that face significant barriers to basic health care. A unique Equity + Health Fellowship and a Visiting Artist Program known as HEArts (Health Equity Arts) that seek to build a network of advisors and allies committed to working together to promote equity in the region.
Invest Health RVA, a regional project bringing together public, private, and nonprofit leaders to transform affordable housing opportunities and encourage equitable development through a comprehensive approach that includes research, education, and community engagement.
An embrace of impact investing as a new tool for the creation of lending opportunities that lead to positive social change. RMHF is committed to learning with its grantees and assessing the impact of these approaches on a regular basis, and it will make midcourse corrections as needed. Each of these strategies represents a distinctive, integrated response to the pressing needs of the communities served by RMHF. Together, they offer a framework for fostering an equitable and healthy Richmond Region. The following sections provide a more detailed explanation of each strategy.
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RMHF has its roots in access to health care, and it will maintain its support for organizations that ensure the region’s uninsured and underinsured residents receive quality medical services, including preventive care. America’s health care system is experiencing a period of extreme volatility, and that trend is likely to continue for the foreseeable future. The only certainty for safety-net providers is that the system was, is and will continue to be an imperfect one. The need for their services will persist. RMHF will retain its focus on health care while also identifying and seeking to address unique challenges and gaps in the existing safety net related to oral and behavioral health care, as well as investing in strategies to better serve new populations.
Access to health care
This year’s Virginia Oral Health Report Card gave the Commonwealth a C+ for oral health care. The analysis highlighted gaps in services stretching from inadequate preventive care for toddlers to the lack of insurance coverage among adults. The report card also noted inequities in access based on race, income, education and geography. For example, half of adults ages 45 to 64 experienced tooth loss due to decay or gum disease, compared to 83 percent of adults with less than a high school education. Oral health remains a significant challenge even as more adults obtain insurance through the Affordable Care Act because most plans offered through the Federal Marketplace provide little or no dental care. RMHF will consider opportunities to expand its
“ RMHF will be more open to providing general operating support to ensure that its partners have the resources to care for the patients who walk through their doors every day.”
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Holistic health care remains at the heart of RMHF’s mission. The Trustees are committed to strengthening the safety net by viewing the needs from the perspective of the grantees, providers and their patients. In addition to considering proposals that address emergent challenges, RMHF will be more open to providing general operating support to ensure that its partners have the resources to care for the patients who walk through their doors every day. The environment in which safetynet providers exist is changing rapidly. The Foundation recognizes this reality and the need to provide support that empowers grantees to devote their time and energy to the needs that represent their very reason for existence. Requests for general operating support will be considered in cases where the applicant’s mission aligns with the Foundation’s, and where there is evidence that RMHF can have its greatest impact by investing in the organization’s core mission.
Oral Health
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Virginia’s system of behavioral health care is failing its most vulnerable citizens. Inadequate public funding and unclear lines of responsibility have resulted in large gaps in services persisting over decades. Incremental progress, typically in the wake of a tragedy, is invariably followed by retrenchment due to budget cycles and competing demands for limited public resources. In 2016, Mental Health America ranked Virginia 38th in overall mental health care among the states. Particularly troubling was the finding that fewer than one in four young people with major depression receive mental health services. Only two other states have a worse track record for responding to mental illness among youth. Substantive changes in the Commonwealth will require both immediate action as well as a long-term commitment to increasing access to behavioral health services. As a first step in developing its strategy to address these challenges, RMHF will make a limited number of grants in 2017 to organizations working to provide quality, accessible behavioral health services to vulnerable populations. Grantees selected for these investments will be asked to meet on a voluntary basis with RMHF staff as the Foundation develops its longer-term strategy in this area.
The greater Richmond Region is experiencing rapid change as new immigrants and refugees settle in the city and surrounding counties. These new populations contribute to the economy, expand the workforce and enrich the region with their cultural traditions. They are an important part of the region’s future, but they also face profound barriers in accessing the health care system. In keeping with its value for inclusion, RMHF recognizes the complex diversity of the region and the dignity of all its residents. During the upcoming year, RMHF will be open to proposals from nonprofit organizations in the region working to address and reduce the barriers to affordable, quality health care for these new populations. The Foundation will also look for opportunities to foster meaningful engagement, not just token acknowledgement, of these newcomers. The goal is two-fold: to alleviate the fear many new residents have in seeking assistance, and to demystify these new populations and build trust between them and long-time residents. A successful outcome will lay the groundwork for the creation of a welcoming, compassionate, unified region in which all residents can be healthy and thrive.
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investments in oral health in recognition of that need and the knowledge that preventive dental care is an inexpensive method for addressing a broader set of health challenges, including diabetes, heart disease, and premature births.
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Equity + Health Fellowships Inequities are deeply engrained within the Richmond Region, but few residents understand their full impact. For example, the life expectancy of an individual living in an economically struggling neighborhood can be as much as 20 years shorter than a resident of a high-income area. RMHF is conducting a unique program in which 18 Equity + Health Fellows representing leaders from the public and nonprofit sectors will be tasked with developing an agenda to inform the Foundation’s investments and recommending strategies to address the social, economic, and structural conditions contributing to poor health outcomes. RMHF Trustees are committed to supporting the Fellowships program for two years. The 18 initial Fellows represent the first cycle in the process, with a second group planned for 2018. The Fellowships are central to the Foundation’s goal of building regional engagement and educating diverse citizens about the meaning and importance of equity and health. The initiative brings together a group of smart, creative men and women who will spend a year examining the impact of inequities on health outcomes in the region. The Fellowships further the Foundation’s goals to work collaboratively as a convener and network builder in the greater Richmond Region, while encouraging diversity and inclusion in the decision-making process to achieve solutions to the region’s challenges. The 18 Equity + Health Fellows are:
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Ram Bhagat, Ed.D., Former Board Member Richmond Peace Education Center, Trauma Healing & Conflict Resolution trainer. Created Richmond Youth Peace Project. Registered Yoga Teacher designing mindfulness programs.
Tanya Gonzalez, Executive Director, Sacred Heart Center, Inc. Experience teaching adults, children, and youth in dance, Spanish, and English; previously with Richmond Office of Multicultural Affairs.
Tracy Causey, Chief Executive Officer, Capital Area Health Network More than 17 years of experience in the health care industry, as well as five years of military experience.
Margaret Nimmo Holland, Executive Director, Voices for Virginia’s Children Policy work focused on improving access to mental health care for the one in five children who have a mental health disorder.
Karen Faison, Ph.D. Professor and Department Chair, Virginia State University Maintains teaching, scholarship and service responsibilities in the Dept. of Nursing. Coordinates VSU Healthcare Initiative (VSU Cares) on health equity.
Sarah Bedard Holland, Executive Director, Virginia Oral Health Coalition Released an Oral Health Report Card this year highlighting significant inequities, and is convening partners to address those disparities.
Amy Howard, Ph.D., Assistant Vice President Community Initiatives, Bonner Center for Civic Engagement, University of Richmond Chair of Housing Task Force for Richmond’s 2013 Anti-poverty Commission Report, working to engage public housing residents. Joyce Jackson, Vice President of Community Social Work, Better Housing Coalition Experience working on mixed income developments and housing assistance for young people aging out of foster care. Damon Jiggetts, Executive Director, Peter Paul Development Center Created a “mental health first aid” program equipping East End residents to identify mental health issues in their homes and community. Yvette Johnson-Threat, M.D., Chief Medical Officer, Bon Secours Richmond Health System Piloted successful intervention programs for diabetes and telemedicine to address health disparities in the East End of Richmond. Patricia Mills, Director of Health Equity, Richmond City Health District Coordinates program for first-time pregnant teens to support positive health outcomes and parent education. Kendra Norrell, Green Team Manager, Groundwork RVA Works with teenagers on volunteer conservation projects including the James River watershed and beautification of urban neighborhoods.
Pamela Parsons, Ph.D., Director of Practice and Community Engagement, Virginia Commonwealth University School of Nursing Primary focus is promoting health and wellness for underserved older adults in the urban Richmond area. Nelson Reveley, President of RVA Rapid Transit Board and Ph.D. Candidate at UVa. Member of Clergy Committee for Rapid Transit and project coordinator for Thriving Cities initiative along the Jefferson Davis corridor. Michael Royster, M.D., Vice President, Institute for Public Health Innovation Worked with Richmond city and Richmond City Health District to develop a decision-making approach that promotes health and social equity. Martha Shickle, Executive Director, Richmond Regional Planning District Commission Community development professional for 12 years with focus on community engagement, affordable housing development and homelessness. Antonio Villa, M.D., Director, La Casa De La Salud Pioneered nonprofit to empower the Hispanic community with health information and education through community health workers. Jonathan Zur, President and CEO, Virginia Center for Inclusive Communities Worked on projects to reduce K-12 achievement gaps, increase diversity in higher education and address bullying of LGBTQ teenagers.
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Visiting Artist Program Equity tops the list of RMHF’s values, but few people have a clear understanding of its meaning and importance. The word “health” generates an immediate mental image – perhaps a doctor with a stethoscope or a family growing a vegetable garden. But most people struggle to envision the word “equity.” In essence, public perception of this important value is a blank canvas. To fill that canvas, RMHF will invite up to six local artists and artist collectives in 2017 to create works of art that communicate the concept of equity and its importance to residents of the greater Richmond Region. Through the Health Equity Arts, or HEArts, program, artists and artist collectives will receive an award of $10,000 to support their individual projects. They will also participate in periodic discussions to share their insights and progress with each other and Foundation staff. Their completed works will be exhibited at RMHF’s offices.
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Funded by the Robert Wood Johnson Foundation and Reinvestment Fund, Invest Health RVA is part of a national network of 50 cities aimed at supporting community leaders as they work together across the health and development sectors to help low-income communities thrive. The RVA team was selected from more than 170 communities nationwide. RMHF is the fiscal agent for the planning grant to establish the project. The Invest Health RVA team brings together a network of partners in community development, health care, philanthropy, and local government to support strategies for increasing and leveraging private and public investments in neighborhoods where residents face the greatest barriers to better health. The values that will guide Invest Health RVA over the life of the initiative are a commitment to equity, a passion for community engagement, a recognition of the importance of addressing the social determinants of health, an understanding of the built environment and its influence on health, a desire to align community development with health goals, and a willingness to leverage innovative financial tools to maximize impact. The Invest Health RVA team reached out to more than 60 stakeholders to ensure deep community engagement in the project from its beginning. Based on that input, the team developed a three-pronged strategy for 2017 to prepare the region for greater investments in low-income neighborhoods that promote improved health and housing stability for local residents. The intent is to place
residents’ health at the center of community development and to help people of mixed incomes remain in their neighborhoods of choice. These three complementary strategies are best pursued simultaneously to meet the urgency of the need over the next year.
Research and Data Analysis RMHF and its partners will fund a Market Value Analysis to create an objective real estate map that identifies opportunities for equitable development and a pipeline of bankable real estate options where investments will benefit the health of lowincome populations. A Market Value Analysis (MVA) is an analytical tool developed by Reinvestment Fund that helps communities understand real estate market conditions and plan a coordinated and equitable investment strategy. Cities, counties, and states have used the results of the MVA to target funding in priority neighborhoods, generate new investors for economic development, and build support for changes in public policy related to affordable housing and community development. The leadership and staff of VCU’s Center for Urban and Regional Analysis (CURA) will support the work of Reinvestment Fund by coordinating the planning and development of the MVA with their mapping resource, Metro View. The Invest Health RVA team and a local advisory board will work with Reinvestment Fund and CURA to supplement the MVA with local data and expertise. The MVA will be guided by an advisory group including representatives of the public and private sectors, as well as citizen members from distressed neighborhoods.
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Policy and Education The Invest Health RVA team and its network of supporters will convene regional experts for discussions to better understand the public policy barriers and opportunities that exist for promoting equitable housing. The group will assess existing public policy around affordable housing in the region and identify gaps in research and knowledge that need to be addressed in order to pursue effective strategies for equitable development.
Community Engagement and Outreach Inclusive engagement of the populations affected by poor health outcomes and neighborhood displacement is an essential part of the Invest Health RVA strategy. The Invest Health RVA team seeks to engage a broader spectrum of the community in efforts to foster equity and improved health in neighborhoods, and build support for sustainable activism and engagement. To do so, the Invest Health team will build and cultivate support for equitable development at the grassroots and decision-maker levels. At the grassroots level, the Invest Health RVA team seeks to understand how to engage residents with the tools they need to understand equitable development and express neighborhood needs throughout the region. As leaders in the community, team members will continue to conduct outreach to key decision-makers to build support for a more intentional link between community development and health, building the case for equitable development. The team will explore opportunities for new and expanded strategic alliances that will enable the engagement effort to take on new dimensions as the initiative unfolds. This three-pronged strategy for 2017 will lay a foundation on which Invest Health RVA can build on its knowledge base and proactively pursue next steps that assist in the development of a thriving and vibrant Richmond Region.
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In their commitment to align the Foundation’s investment capital with its mission, the Trustees made impact investing a core component of RMHF’s strategic framework. This approach to investing gives the Foundation a new avenue for creating positive social change that supports the well-being of all neighborhoods through sustainable, socially responsible strategies in areas such as affordable housing and job creation. As a first step toward a comprehensive view of impact investing, the Foundation will identify potential partners and portfolio options in 2017 that fulfill its investment criteria. By adhering to sound impact investment practices, the Foundation can fulfill its fiduciary responsibility while providing longterm, low-cost capital that empowers organizations and people throughout the region to find solutions to the region’s most pressing problems. In short, impact investing enables RMHF to measure its return on investment not just in dollars but in the improved health and quality of life for the greater Richmond Region.
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