Board of Trustees Retreat

1. Board of TrusteesRetreat Saturday, October 13, 2018

2. Welcome&Prep for the Day

3. Retreat Goals • Build a sense of community and collegiality • Provide opportunities for high-level discussions to engage the board in strategic thinking and visioning • Demonstrate how the Strategic Parameters and Decision-Tree process provides boundaries and a pathway to achieving the Vitalyst vision • Greater understanding about the use of the Social Determinants of Health in Vitalyst’s work

4. Vitalyst Vision: All individuals and communities in Arizona are healthy and resilient Today’s Retreat: Show how the work of Vitalyst aligns to and helps realize this vision; and For board members to discuss a practical vision for the next five years

5. Introductions

6. Today’s Agenda

7. Getting to Know You On an index card, jot down a few answers to the questions: • What does “health” mean to you? • Why is the work of Vitalyst an important part of your life?

8. Vitalyst Program GoalsKey Updates

9. Goal #1: Improve access to care and coverage throughout Arizona. • Advancing Arizona’s Health Care Workforce • Enhance evaluation of workforce supply – Legislation & Rule-Making • Develop a centralized, accessible workforcedata repository – Legislation • Professional development for CHWs - Programmatic • Increase Health Insurance Coverage • Cover Arizona preparing for open enrollment, behavioral health integration • Exploring state options for consumer protections, lower costs, increased coverage – Spark Report, Convening • Protecting KidsCare – Legislation GOAL #1

10. Goal #1: Improve access to care and coverage throughout Arizona. • Care Delivery System Transformation • Telemedicine parity - Legislation • Highlighting Medicaid’s Role in Addressing SDoH – Spark Report • Standardizing SDoH screening practices – Convening • Community Health Data Integration (Health Current, 2-1-1) – Legislation, Convening • Children’s Vision Screening • Coalition developed • 42-state analysis conducted • Draft legislation developed GOAL #1

11. Goal #2: Advance community policies and practices that result in healthy communities that are accessible to all. Health in Policy & Practice • Opportunity Zones • Pre-Community Engagement Report • Tempe Equity in Action • Phoenix Tree and Shade Implementation Plan Healthy Transportation Options • Complete Streets Design Guidelines • MAG Extension of Prop 400 • System and Organizational Supports

12. Goal #2: Advance community policies and practices that result in healthy communities that are accessible to all. Healthy Food Environments • MarCo Food Fellow • MarCo Food Assessment: Economic Impact; Relationship Network Analysis • Phoenix Food Action Plan Safe, Affordable Housing • Public Policy Draft Housing Statement • System and Organizational Supports • Displacement Discussions

13. Goal #3: Increase the capacity and effectiveness of community-based leaders, organizations and coalitions. • Completed Facilitation for Accountability training • The Nonprofit Impact Accelerator closed the year with three successful interventions of capacity building • A Healthcare Facility Inventory of South Phoenix was completed • A report summarizing the impact of the civic participation pilot in South Phoenix was completed

14. Goal #4: Cultivate collaborations and innovations that leverage the elements of a healthy community. • A Programmatic Investment Evaluation report was completed • Instituted Vitalyst’s first Grants Management Platform integrating all grants, contracts and programmatic into one system • Three orientation sessions were conducted for our Innovation grants. 82 Letters of Intent were submitted

15. Goal #4: Cultivate collaborations and innovations that leverage the elements of a healthy community. • Adoption of Crisis Support Training by Phoenix Fire & Police. • The Arizona Mobile Integrated Health Network moved from planning stage to implementation with strategic plans for 2019. • Arizona Dementia Caregivers Alliance continues to mature with an added funder joining the funders. • Arizona Diabetes Action Plan (HB2258) is moving forward with data submitted by AHCCCS, Public Safety Personnel Retirement System, AZ State Retirement System, Dept of Administration Benefits • Initiated data visualization (mapping) project using Tableau with grants investments.

16. Goal #5: Increase civic participation for inclusive decision-making to advance health equity. • "Civic Participation Beyond Voting: Community-Based Participatory Action Research Project in Maryvale," report was completed. • CAN forum conducted in September about the impact of Storytelling with 2 related publications • Working with the Maricopa Association of Governments, the Arizona Grantmakers Forum and the City of Phoenix coordinate efforts for a successful Census count. • Race Forward staff training and equity readings for trustees. Incorporating Racial Equity Impact Analyses in programmatic work.

17. Communications: Dimensionalizing and Amplifying the Brand. • Substantial Earned Media Growth: Impressions and Breadth • Consistent impressions trajectory +20% growth • Greater breadth of outlets/publications • Frequency greatly increased e.g. grants + resurfacing • Social Media Strategies Paying Off • “I am a Vitalyst” videos are “huge hit” • Impressions, reach, extension • Continuous social media presence • Health care, transportation, grantees, mini-grants, topical news ties • Sustained email and publication success • “Working” website: fully programmatic GOAL #1

18. Igniting the Spark • Seven episodes in 11 months • Longform • 5-topic minisodes • Single-focused minisodes • 710 downloads • 58,000+ feed hits(subscriber proxy) • Strong feedback • Pipeline of directions

19. Roundtable Discussion on Program Goals • What highlights from the program goal reports stood out for you and why? (5 mins) • What questions do you still have to be able to talk about our work? (5 mins)

20. Evolution of the Year of Healthy Communities/Live Well Arizona Effort

23. Seven webinars -> seven hours of dialogue • 24 featured guests across the 12 elements (2 per element) • Live attendance 850 • More than 4,900 playbacks

24. Over 100 presentations, workshops and group dialogues • Gross live attendee reach of 7,900+ • Broad range of contexts • Consistently strong feedback: “excellent,” “really got us thinking,” “come back” Events • Universities – ASU, NAU, U of A • Councils of Government • Arizona Forward, Westmarc, East Valley Partnership, Valley Leadership, Greater Phoenix Chamber of Commerce, Arizona Hispanic Chamber of Commerce • AZTA, Arizona Rural Policy Forum, AIA, American Society of Landscape Architects, League of Cities and Towns, Nat’l Brownfields Conference, AZ APA, APA, SVP, ULI • AZ4A, AAA, AHCCCS, AzCHOW, AZ Women’s Rural Health Network, Crisis Response Network, Dignity Health Communities of Care, First Things First, Health Current, Rural Health Policy Forum, Yuma Regional Health • Piper Trust, Pulliam, NARBHA Institute, ACF, CFSA, Legacy Foundation of Southeast Arizona, TFN • Cities and Towns statewide • Tribes – statewide health leaders • Sinema, Flake, McCain, McSally, O’Halloran • Counties statewide

25. What Have We Done? • The most consistent and expansive framing, awareness and reach campaign of Vitalyst’s 22-year existence • Impact ripples yet to be realized • Infiltration -> filtration • Lived experience in catalyzing cross-sector collaboration • Getting out of boxes • Mini-Grants -> Incubator • Progress on Live Well indicators • National peer recognition - and expectation

26. What Do We Have? • The Wheel • Comprehensive yet simple • Engaging, inspiring • Catalyzing • Growing partnerships • County Health Departments • Freeport McMoran • ASU, UA and NAU • Tribes • Valley Leadership • AZ Hispanic Chamber of Commerce • Arizona Town Hall 2020 topic • A shared framework and context • The foundation of a movement

27. Questions and Discussion • How does this help contextualize the work you’ve heard about? • How does this affect how you feel about the work of Vitalyst?

28. Vision: All individuals and communities in Arizona are healthy and resilient. Mission: To connect, support & inform efforts to improve the health of individuals and communities in Arizona. Convener | Capacity-Builder | Investor/Grant Maker | Policy Advocate | Mission Steward | | Data Provider | Match-Maker | Communicator | Systems Engineer | Deal Maker Cultivate Collaborations & Innovations Increase Civic Participation Improve Access to Care & Coverage Advance Community Policies & Practices Increase Capacity & Effectiveness

29. Proceed Y Y Aligns with Vitalyst’s current work Vitalyst has bandwidth to add to our agenda AND opportunity warrants dropping existing work Y A) Work is aligned with Vitalyst’s goals B) Work is focused on decreasing disparities, pursuing health equity Opportunity for high impact and in an underdeveloped sector Falls within Vitalyst’s organizational roles Y N Proceed w/ Caution Y Mission Alignment Work is collaborative and cross-sector Refer to Partners N Contributes to systemic change N N Refer to Partners Do Not Proceed N Do Not Proceed Do Not Proceed

30. Strategic Parameters/Decision Tree/ ‘Go, No-Go’ Criteria • Mission Alignment • Goal Alignment • Health Equity Lens/Addresses Heath Disparities • Alignment with Vitalyst’s organizational roles • Opportunity for high impact and in an underdeveloped sector • Work is collaborative and cross-sector • Contributes to systemic change • Vitalyst has, or can develop, the necessary bandwidth +

31. Roundtable Discussions How does the decision tree framework help you understand the context of Vitalyst’s work? What social determinants of health intersections hold the greatest opportunity for Vitalyst?

32. Addressing the Social Determinants of Health:Options and Critical Questions for Vitalyst Doug Easterling, Ph.D. Department of Social Sciences and Health Policy Wake Forest School of Medicine dveaster@wakehealth.edu

33. Outline • Background on SDOH & health conversion foundations • Brief review of our study of 33 conversion foundations • 6 distinct approaches to addressing SDOH • The key underlying distinctions that need explicit attention • What needs to be defined and decided before selecting an approach

34. Health Foundations are Increasingly Embracing the Logic of Addressing SDOH • According to a 2017 survey of GIH board members, addressing the social determinants of health is a primary challenge for health philanthropy (now and in the future) • In 2016, staff at GIH identified 50 health conversion foundations (out of ~250) that they knew were making grants to address SDOH • Interest in SDOH approaches has increased significantly in the past 2 years • The newest cohort of large conversion foundations are adopting an explicit focus on SDOH • Group Health Foundation (Washington State) • Mother Cabrini Health Foundation (New York) • Dogwood Health Trust (Western NC)

35. “Gaining Leverage over the Social Determinants of Health: A Study of 33 Conversion Foundations” Easterling D & McDuffee L (2018), Becoming Strategic: Findings Leverage over the Social and Economic Determinants of Health, Foundation Review, 10 (1), 90-112. Color Black = Local Red = Statewide Blue = Multi-County Circle size Small = Assets <$100 M Medium = $100-500 M Large = >$500

36. Collectively these foundations are addressing a wide range of social and economic determinants

37. 6 Distinct Approaches • The Rapides Foundation – Alexandria, LA • The California Wellness Foundation – Los Angeles, CA • HealthSpark – Colmar, PA • Danville Regional Foundation – Danville, VA • Health Foundation of Central Massachusetts – Worcester, MA • The Colorado Trust – Denver, CO

38. The Rapides Foundation • Characteristics • Created in 1994 • Serves multiple parishes in central Louisiana • $256 M in assets • SDOH focus area(s): • K-12 education • Strategic leverage point(s): • Quality of teaching • Leadership development • Exemplar strategy • Introduced new programs that provide professional development for teachers, mentoring for students and build kindergarten readiness • Created a new organization to administer the programs (The Orchard Foundation)

39. The California Wellness Foundation • Characteristics • Created in 1992 • Serves all of California • $941 M in assets • SDOH focus area(s): • Economic: Financial security, Employment, Job creation • Strategic leverage point(s): • Financial coaching, new financial products, predatory lending policy • Workforce development • Microenterprise development, Worker-owned cooperatives • Exemplar strategy • Supported multiple nonprofit organizations with developing and implementing new programs, as well as policy advocacy work • East Bay Alliance for a Sustainable Economy • Inner City Advisors • Working Partnerships USA

40. HealthSpark Foundation • Characteristics • Created in 2002 • Serves Montgomery County, PA • $46 M in assets • SDOH focus area(s): • Homelessness • Strategic leverage point(s): • Enhance and improve the various services that address the needs of the homeless population • Build a more complete and integrated system of services • Exemplar strategies • Convened, supported and participated in a collaborative planning process that produced the “Your Way Home Montgomery County” plan to reduce homelessness • Created a Housing Fund • Provided programmatic funding for key agencies

41. Danville Regional Foundation • Characteristics • Created in 2005 • Serves multiple rural counties in southern VA and north central NC • $220M in assets • SDOH focus area(s): • Transforming the economy of the region (after the demise of textile and furniture industries) • Strategic leverage point(s): • Create a more educated, better trained workforce • Encourage entrepreneurship • Build the capacity of local institutions, especially around leadership development • Exemplar strategy • Offered to fund a search firm to expand the pool of candidates for superintendent of the school system • Foundation-initiated grants to stimulate business recruitment in target sectors • Foundation-initiated grants for workforce development programs • Developed Middle Border Forward program to train next generation of community leaders • CEO continually brings his ideas into community decision-making and priority-setting forums

42. The Health Foundation of Central Massachusetts • Characteristics • Created in 1999 • Serves Worcester County and 21 contiguous communities in central Massachusetts • $71M in assets • SDOH focus area(s): • Focus is NOT on improving a particular social or economic condition • Instead, improve and enhance the services and programs of a wide variety of health-related nonprofit and government agencies • Strategic leverage point(s): • Improved quality of programs and services (e.g., more rigorous and evidence-based) • Higher functioning cross-agency systems • Exemplar strategy – Synergy Initiative • Collaborative approach to analysis, planning, implementation, experimentation, adaptation, and sustaining evidence-based programs. • Local nonprofits and government agencies submit proposals to address health-related issues that they regard as critical • The Foundation funds the problem-solving process and implementation of strategies – average of $2 million over 5 years • The Foundation participates actively in the process and pays for an evaluation consultant • 17 Synergy Initiative projects have been supported since 2000 • Sample topics: expulsions among pre-school students, self-sufficiency among public housing residents, re-entry after incarceration, homelessness

43. The Colorado Trust • Characteristics • Created in 1985 • Serves all of Colorado • $459M in assets • SDOH focus area(s): • Focus is NOT on improving a particular social or economic condition • Rather, focus is on health equity. • Inequity in social and economic conditions (especially power) is viewed as a critical determinant of health inequity. • Strategic leverage point(s): • Increase civic engagement, political power, collective efficacy and leadership among historically underserved residents • Support the development and implementation of community-defined solutions • Raise consciousness about health equity, its manifestations and origins • Exemplar strategy • Community Partnerships – The Trust hires locally based Community Partners who organize and support Resident Councils • Participatory grantmaking – The Trust funds projects selected by Resident Councils

44. Addressing Health and Well-Being through Social Determinants of Health Ned Calonge, MD, MPH President and CEO

45. Health disparities • A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage • Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on: • racial or ethnic group • religion • socioeconomic status • gender • age • mental health • cognitive, sensory, or physical disability • sexual orientation or gender identity • geographic location • other characteristics historically linked to discrimination or exclusion Healthy People 2020

46. Health disparities associated with race and ethnicity • Perinatal and infant mortality • Low birth weight • Child and adult obesity • Child oral health • Teen pregnancy • Liver disease mortality • Motor vehicle injury fatality • Homicide mortality • Mental health • Suicide • Cervical cancer incidence and mortality • Lung cancer incidence and mortality • Prostate cancer mortality • Diabetes incidence and mortality • Infectious disease (HIV, TB, HBV)

47. Social determinants of health • The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness • These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics World Health Organization Commission on the Social Determinants of Health (2008)

48. Social determinants of health • Think in terms of opportunities and barriers: • Early childhood development, schools, education, literacy • Economy, jobs, employment, occupation, working conditions, income, wealth • Housing, transportation, public safety, parks and recreation, healthy food access • Racism, social status, culture, social network, political clout, justice • Environment, pollution, hazards

49. Impact of social determinants of health Life expectancy disparities in New Orleans, LA and Kansas City, MO SOURCE: RWJF, 2013.

50. Impact of social determinants of health Life expectancy disparities in Phoenix Source: RWJF, 2015.