In this episode of The Social Leader, Fr. Justin Mathews talks with Qiana Thomason, CEO of the Health Forward Foundation. They discuss the importance of understanding the social, environmental, and economic determinants of health and the need to intentionally build equity into our structures and systems.
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EPISODE 7 — TRANSCRIPT
Father Justin Mathews: Well, hello, my friends. Welcome back to The Social Leader podcast. The pursuit of health equity is rooted in over 100 years of data that shows that the morbidity and mortality rates for poor Americans, and in particular Americans who are people of color, are significantly worse than for those of the white mainstream. Welcome to the seventh episode of The Social Leader where today I will be talking with my guest Qiana Thomason, who is the CEO of the Health Forward Foundation. We're going to be talking about innovation. We're going to be talking about health equity. We're going to be talking about health care philanthropy and social leadership. Don't go away. This is going to be a critically important conversation today.
Fr. Justin: Well, again, my guest today is Qiana Thomason. Let me tell you a little bit about Qiana because her resume is incredible. She is a native of Kansas City and she currently serves as the CEO of the Health Forward Foundation. During her time there, she has already begun to bring wonderful thought leadership, including right when COVID-19 happened she put out an article on health equity. That is the reason I wanted to get her on the program so quickly today. We're going to get to those topics but before her time at the Health Forward Foundation as the CEO, she filled various leadership roles, eight year tenure at Blue Cross and Blue Shield of Kansas City, including being the Vice President of Community Health. She also spent eight years at Swope Health Services in Kansas City. And finally she had the role as Director of Clinical Operations, Behavioral Health, and Program Manager for the Kansas City Mental Health Court. It is my honor to welcome to the program, Qiana Thomason. Good morning and welcome.
Qiana Thomason: Thank you so much. Good morning, Father Justin. Thanks for having me on.
Fr. Justin: Absolutely. I want to tell everyone today's conversation is being sponsored by Reconciliation Services. You can find out more about RS at rs3101.org. Qiana, as I said, you have an unbelievable resume and I'd love to know, did I leave anything out? What don't we know about Qiana that we need to know?
Qiana: Well, I think it's important to know that I am born and bred right here in Kansas City. I grew up in the third district in Kansas City. I was a benefactor and a recipient of Kansas City's wonderful safety net system for folks who live in marginalized conditions as I did when I grew up, and I just count it as such a blessing to be able to serve and use my career to be able to give back to a system that blessed me so much.
Fr. Justin: Well, you've done that mightily. And to be honest as a partner, Reconciliation Services is a deep partner with Health Forward Foundation. You guys helped us launch Thelma’s Kitchen. You've helped us launch our men's mental health program called the R.E.V.E.A.L. (Restore Engage Value Encourage Act Lead) program. You all have helped us with everything, so many years now. I'm looking forward to continuing that partnership. And I think, as we talked about the other day on the phone when we got to have our first long conversation, I'm super excited about where you're wanting to take Health Forward Foundation. Today, I really want to focus in on what this current pandemic has highlighted. Because as you wrote in your essay, which was so wonderful that you put that out right at the tip of the spear, the COVID-19 pandemic has highlighted the inequities in our healthcare system, in the safety net system that you talked about. And in the Kansas City region in particular, you've talked about the fact that these disparities stem really from pre-existing income inequalities, as well as inequalities to access to healthcare, and then you also mentioned occupational segregation. And as the old saying goes, when America catches a cold, people of color catch pneumonia, and that has never been more easy to see than right now. So I recognize that I'm sure you have a lot of priorities in your new role as CEO at the Health Forward Foundation, but given our situation, what's your top ranking priority during this COVID-19 pandemic and what do we need to do to address it, Qiana?
Qiana: So you hit the nail on the head in so many areas for Health Forward Foundation, being a public charity, deeply steeped, in this community, our first priority is to partner with and stabilize, and as best we can, help recover as quickly as they can our grantees and our partners. And so right out the gate, we wanted to make sure that our grant making was responsive, that we got advanced payments out the door quickly, that we converted all current grantees to core operating funds to use the funds flexibly how you needed it, that we relaxed or decreased reporting requirements, all those types of processes and issues that our partners just don't have time to be thinking about in this pandemic as they serve the people in our community. In addition to that, we are expanding our attention to emergency funding. So a lot of emergency funding has gone out the door. We reserved up to $3.7 million for safety net medical behavioral health providers, as well as essential services like childcare, food, and all those types of insecurities that people were already struggling with that this pandemic really just exacerbated. But as we pivot from response to more focus on resiliency, it will be important that we go upstream and work with our partners, our grantees, our policymakers, and a whole host of stakeholders across this community, public and private, to focus on issues even outside of healthcare that impact health and health outcomes, issues like transportation, issues like affordable housing, livable wage. There are a plethora of issues that impact the daily lives of our communities and we know that it's on us in partnership with other folks in this community to drive those upstream changes for health equity.
Fr. Justin: Yeah, and by the way, I think that the Forward Foundation, as well as really the entire philanthropic community, moved with unprecedented speed. In the 22 years of nonprofit leadership that I've been a part of, I've never seen a response like that of the Kansas City, philanthropic community and Health Forward Foundation again, huge partner of Reconciliation Services. And so my hat's off to you and to the entire philanthropic community. Because without you I think a lot of us who are on the frontlines would absolutely be in the tubes right now. And that would mean that literally, for example, the 5,000 people a year the Reconciliation Services is caring for and walking with, we wouldn't be here without you. But what you're bringing about in your perspective, as you really shift to talk about those root causes and those barriers, it's really highlighting that not only are there structural barriers, but specifically there are socioeconomic structural barriers at every level of our society. So for example, coronavirus economy. We know it's going to devastate the after economy, it's going to affect people who can least afford it. 53 million Americans, about 44% of US workers, are making a median of $10.22 cents an hour or about $24,000 a year. You can barely make it on that. And as I prepared to talk to you today, I had scenarios of our clients playing through my mind like, what would happen if this snowball began? You have a low wage worker who doesn't have paid sick leave. Maybe they’re hourly. They don't have benefits. Maybe they miss work due to a family member or a child being ill, then they lose that crucial income. That can be the difference between making rent or not. Maybe they become homeless. You run the risk of being let go from your job and just it's snowballs, snowballs, and it's one thing and one moment that can make that happen. So here's the question that I have for you. How do you plan, as an innovative leader who gets these things innately, to lead the Health Forward Foundation to address these structural socioeconomic barriers and health equity issues in our region? What are you going to do to pivot? Or what things are you exploring right now?
Qiana: Well, I think it's first it's important as leaders and as organizations that we really take the time to ground ourselves and how we got here, and not to the point that we're fixating on the problem, but it's important to have a healthy appreciation for the problem to understand how to fix it. So from my vantage point, and many others share it, inequities, not just in health but in life, are typically the result of two things in this country and that's structural racism and systemic racism as well as income inequality and the wealth gap that we struggle with as a country. And so with those root cause factors in mind, I think we must as leaders and as organizations focus our strategies and our tactics around being just as intentional at building equity into our systems and our structures, because there was a great deal of intentionality to build inequity in.
And we have to apply the same level of resolve when we consider the different systems that influence that. And for us, we know that healthcare is largely influenced by socioeconomic and environmental factors, as you pointed out. So 80% of our health outcomes are driven by the social determinants of health. I prefer to say the social influences of health because people are resilient and they can transcend their environment and their circumstances. And so those influencers are 40% behavioral, 30% socioeconomic, your education, your income, all those different types of factors, as well as about 10% environment, violence, nutritional deserts in your community that contribute to obesity, and poor food intake, and all the chronic conditions that we know really were the underlying issues around COVID-19 and contributed to our over-representation as people of color in confirmed cases, as well as mortality. So when we think about that very broad space of the social determinants of health and economic inclusion, and all the things that contribute to it, we have to ask ourselves, what is our unique position to engage in community in this space? Where can we be most impactful? So as a team, we began having those conversations prior to this crisis and the perverse gift of the crisis was that it really underscored for our team, Health Forward Foundation, that it was time for us to commit more than ever to really digging in and applying that lens that thinks outside the box of healthcare, and considers those social, environmental, and economic factors that drive our health. So we'll be spending a lot of time the rest of this year into next year with our partners, with our Board, with our community advisory council talking through what's our unique differentiator to play in this space and where can we be most impactful?
Fr. Justin: Yeah, in the Business Journal, you were quoted when you were first made CEO saying that the vision of healthy people and healthy communities is going to remain intact under your leadership of the Health Forward Foundation, but that the methods and the initiatives will likely evolve over time. So this whole area that you're in, this space of health equity and a health equity lens and grant making and in partnering, this is a rapidly evolving and very ripe space for innovation. I'd love to know, what are some of your early ideas or some of the things that you're imagining that you can do in health, philanthropy, in order to lift up voices that aren't being heard or to foster real innovation in approaches, particularly in our region? This is a cutting edge space. What are you thinking?
Qiana: Well, there's three spaces, if you will, that we see as our core competencies at Health Forward and that's leadership, advocacy, and resources. So we continue to cultivate leaders, and have for the past 10 years, in our Healthy Communities Leadership Academy. That's produced over 100 champions for health equity and those who promote a culture of health in this community. We're thinking about how to position Kansas City's players as leaders in our equity journey together in community. What's our role in cultivating equity champions, beyond the Healthy Communities Leadership Academy? From an advocacy perspective, the lowest hanging fruit that I've shared with you is around Medicaid expansion. We gotta pass it. It's the no brainer, right thing to do, smart thing to do with respect to recovery for both Missouri and Kansas from a health and an economic standpoint. But there are other factors outside of Medicaid expansion that are in the policy realm that need philanthropy’s action and advocacy and so looking at that. We are paying a lot of attention to our wonderful city of Kansas City Council who last year approved a resolution to apply a racial equity lens to its decision making and policymaking. I was so inspired and impressed with that and I even mentioned to Mayor Lucas just yesterday, we want to play a role in that. There's a role for philanthropy to play in that space.
Fr. Justin: You're talking about the resolution that was put forward by Melissa Robinson in the 3rd District?
Qiana: Yeah.
Fr. Justin: We were really honored to get to work on that and Reconciliation Services’s contribution with her was really to put a focus around mental health and race and health equity and so a couple of the places in there. You're right, I mean, that's a very important document. Let me push you a little bit further though, because we talked a little bit in an earlier conversation about program-related investments and there is actually a lot of possibility that that health philanthropists can bring about. The traditional kind of grant making modalities are still going to be needed, apply for a grant, get a grant, report on a grant, apply again. But I wonder what's the role of tech right now? What's the role of social entrepreneurship right now? And how can Health Forward Foundation, which is arguably one of the most influential and best endowed health focused philanthropists, play a role? How are you thinking you might play a role, whether it's PRIs (program related investments) or some other modality? What are you thinking in that tech space or innovation space?
Qiana: Yeah, so traditionally, grantmakers, especially grantmakers in health, have a very kind of orthodox historical method of being responsive to grants that come in and we provide funding for different types of programs and initiatives in the community. But in wanting and needing to go upstream to address inequities that are more structural, you can't grant make your way to resolve those inequities. And so as you point out, we are talking as a team and have begun early conversations with our Board, our finance and investment committee, about the notion of social impact investing in community, not ready to share any commitments in that space, but we're learning about it.
Fr. Justin: We want to hear more! We want you to share, but I know you gotta wait.
Qiana: Yeah, new territory for Health Forward. It's new territory for much of health philanthropy. What we know today, though, is that it will take social impact investments in our community and in partnership with public and private organizations. We can't do it alone. That can pool our dollars to create sizable, longitudinal impact in and for this city. So those are some of the things and concepts that we are beginning to explore as a team and a Board.
Fr. Justin: That's a fantastic answer. As you know, Reconciliation Services, we have Thelma’s Kitchen, which is a social venture donate-what-you-can restaurant. We're working on a number of other social venture ideas and innovations. So definitely, I'm waiting with bated breath to see what the Board approves and would love to support you in that.
Qiana: Really quickly, so that we don't miss the opportunity to help people understand what applying a racial equity lens to policy does. People most people get that there is a health implication to transportation, a health application to food and food procurement and food policy. There's a health implication to affordable housing. When a racial equity lens, which is really kind of like the book ends of inequity in our society, when that's applied to policy, it raises all boats including health and health equity. And so we want to partner with the community and with our city council, led by Melissa Robinson, of course, and Mayor Lucas, to really support that initiative, as well as focus a lot on data, as we are active in this space with letters to our governors in Missouri and Kansas, around the need to collect data around race and ethnicity, not just for COVID. Let's use COVID as a jumping off point to solve some of these data challenges that we have so that we can understand where we are, track where we need to go, and use data to reconstruct narratives.
Fr. Justin: I appreciate you bringing us back to the root again. There isn't enough data out there. There isn't enough work being done. And I think people look at these initiatives, when they hear about a health equity lens or racial equity lens, I think to just be honest about it, a lot of people's minds just kind of turn off. But the reality is, and I like to bring it back to this, and this is where the social entrepreneurship angle does come back in, when you start talking about the fact and you hinted at this, that racial equity and initiatives around diversity, equity, and inclusion, they are a superior growth model economically for the region. And when people begin to get that idea in their head and go, okay, well, not only do I feel good about it morally, maybe I've learned enough about it that I understand why it's needed. But now I'm going to see it hit the pocket book, not only of my company, but of the entire region, and we're all going to be able to do more together. Do you see a direct correlation the same way between the socioeconomic plight of those who are excluded or have minimal access and the racial equity lens? Can you tie those two together directly for us?
Qiana: Yeah, absolutely. When you look at history, it teaches us that laws were used to be weapons against people of color to lock them outside of opportunity. When you look at our GI Bill in terms of education and home ownership, when you look at redlining in communities, when you look you see that resulted in underinvestment and disinvestment in communities that resulted in food deserts and in play deserts. So all of these types of policies shape our daily lives that contribute to the social and economic conditions for all people, but particularly people of color, who these laws were constructed to lock out from opportunity. So we have to be all that more intentional when we think about creating laws and policies, even organizational policies, to lock equity in so that all are included and have a fair and just opportunity to thrive.
Fr. Justin: I could not have said it better and I'm so thankful for you breaking it down and breaking it down so that somebody who's listening right now live or listening to the podcast later who maybe hasn't done so much reading about the racial equity lens and the health equity lens, they can maybe understand a little bit more about what you're saying. Okay, well Qiana, we're going to take a quick break. We're going to go and talk about our sponsor Thelma’s Kitchen. When we come back, I want to dive in and get a little bit personal, so don't go away. We'll be right back with you.
Everybody, I want to tell you that The Social Leader podcast is sponsored by Thelma’s Kitchen, which is Kansas City's first donate-what-you-can restaurant. You can go to ThelmasKitchen.org to find out more. Right now, of course, the restaurant is closed. We're at the corner of 31st and Troost. Normally, we're open for lunch from 11am to 2pm but because of COVID-19, and while we're making preparations to open, we're still closed right now. However, we're giving away food, literally 300-350 meals every single day, Monday through Friday. And I'll tell you, there's a note of urgency right now. So again, thank you for your sponsorship, those of you who have donated a meal online, who have sent in a gift, or sent in plates or any kind of utensils, things that we need to make this happen during these extraordinary times. We're so grateful. You can find out more about the work of Thelma’s Kitchen, as well as Reconciliation Services, on our website.
Okay, I want to jump back in and talk a little bit more with Qiana. Qiana, I want to switch a little bit and get personal if you can. I want to dive in because I know you’ve said you were born at Truman Medical Center, you grew up in Kansas City, and even at the beginning of the podcast, you said that you were an uninsured child and that you were a recipient of the social services safety net here in Kansas City. And then from there, you went on and you've led divisions and now, as the CEO of Health Forward Foundation, leading whole movements in this area around health equity. Is there a memory for you, something personal in your life or in your work life, that really drove home for you the structural and environmental barriers that make up the inequity to health access?
Qiana: Yeah, there are probably too many to mention, Father Justin. I’ll just say that my overall experience of being raised by a single mother, having three brothers, she struggled to put food on the table, relied very heavily on our grandparents to stabilize us, as well as an extended village, oftentimes to support us just for some basic needs until she was able to get on her feet and with the help of the village, pull herself up and go on to lead companies as well. I'm not the first leader in my family, I need to say that, we have a multi generational leadership. And so even despite those circumstances of being born uninsured, receiving services from the safety net, that was such a nurturing community to me, and my brothers, by the way, I should say, loved the village that we had at Swope Health that was very endearing, which I counted a blessing to return there to lead as a mid careerist. But all those factors of watching her struggle, watching her stand in line for welfare checks and cheese and just basic services, really cements in your mind the importance of resilience and the importance of looking at the assets that individuals and communities possess: assets of fortitude, assets of determination, assets of commitment despite adversity. So when I think about those factors that were passed down to me, from an asset perspective, it fuels me and fueled me to be able to rise above those circumstances and to use the privilege that I now carry as being an educated African American leader, who's committed to social justice, committed to equity, committed to uplift from the communities that I serve and from as well as broader communities. So it's really just fueled me in general, for a resolve for equity and for social justice. And I've been very blessed to use my career to be able to do that.
Fr. Justin: Which you've done mightily. Qiana, one of the things that you brought out was this idea of an asset-based community development approach rather than a deficit-based community development approach. And we like to reinvent Reconciliation Services logo, RS, as actually standing for “reveal strength” and kind of realizing that the neighborhoods that we live in, although they may not have the same kind of green currency that some neighborhoods have, they have assets in them that are priceless. It's actually not enough to look at return on investment, what we really have to be looking at also is return on relationship and where does that currency play apart. And as you think about that, from a healthy community standpoint, from a grant making standpoint, how do you encourage that? That's a neighborhood organic thing that takes place. But is there something that you all can do at Health Forward Foundation to nurture that kind of return on relationship in Kansas City and in the region?
Qiana: That's one of the things that impresses me most about my colleagues at Health Forward is that they have their fingers on the pulse of what is happening in communities at the neighborhood level. And I love that about my team. They translate those needs into what's happening at the neighborhood level, with grassroots organizations, and sometimes through grassroots organizations does our insight and our information come, and then they show up at the table to advocate for these communities and for these neighborhoods from a grant making perspective. And so having a very deep and connected relationship with community, oh my goodness, it can't be overstated. And so our team knows our community very, very well. They spend a lot of time with organizations like yourself, Reconciliation Services, and various leaders and workers. And I think understanding the uniqueness of the characteristics of the organization positions them as the best advocates for them, even beyond grant making, but also from a policy perspective, as well as connecting them in with other opportunities and community.
Fr. Justin: When you took over as CEO recently of the Health Forward Foundation, in one interview that I read with you, you said that you want to always lead with purpose and with impact. So I'd love to learn from you and I'd love for you to share with our audience on the podcast right now, what personal leadership practices help you sharpen your purpose and your impact as an innovator in health equity and philanthropy?
Qiana: I think personally it's critical that we know what is our personal why. And we're not always clear on that in every season of our career, but for me my personal why, at least in this season, is to improve the lives of folk living in marginalized conditions. And note that I did not say marginalized people. I hate that phrase. I said marginalize conditions.
Fr. Justin: That's that strength-based approach that you're talking about.
Qiana: Yeah, people are resilient. Communities are resilient. And so that is my personal purpose. And so, when and where possible throughout my career, I've done my best to align my personal purpose and value system with the organization. And if alignment wasn't there, I created it. And, for example, with my great friends at Blue Cross and Blue Shield of Kansas City, I went to Blue Cross as a social worker coming from the nonprofit realm who was a little bit intimidated to go over to the corporate side. I was also energized by the fact that I had done policy in the US Senate. I had done care delivery in the safety net system. I hadn't learned payment and I knew that that was key to health care. But I want it to also introduce healthcare payment to the social side of healthcare that I knew was a significant influencer on health outcomes. So it took me about six and a half, seven years to do that, but I was able to leverage the social capital that I've built within Blue KC to help them also realize the business value. As you pointed out earlier, sometimes it's not just the moral imperative, it's the business imperative. And when you can merge both, it's wonderful. So I was able to champion the inclusion of the social determinants of health and health equity into that corporate strategy. So I just use that as an example. We won't always have the luxury of finding a career opportunity that aligns with our passion and with our purpose, but use your capital, your social capital, your own assets to create that value, and find those win-wins.
Fr. Justin: Yeah, I love to talk about moving away from charitable intentions to integrated priorities because to me that's really what you're talking about, sort of getting beyond the charity bucket and saying well in my excess time, in my excess bank account, what's leftover I'll give. But what you seem to be talking about is really finding that missional alignment, really working, doing the self work that it takes to integrate your priorities, particularly in the social sphere in order to do social good from whatever company that you're in. Well, I always end every podcast with a question similar to this and I hope you'll be able to take us home with some really strong words of wisdom and some practical lessons that we can apply. But what do the leaders who are listening need to do in order to step up their social impact and become social leaders?
Qiana: I think a self assessment of your personal value system is always a great starting place. It should be our compass and identify a way to marry that to the social change and the leadership and the championship that this point in time in our country calls for. Then look about and see how you're positioned within your career within your company, how your company is uniquely positioned to make a change and to be a part of change. Whether it be in the health and human services sector, in the policy, sector, government, wherever it is, you have influence. And I encourage folks to use their influence for good and to do that with equity being centered in mind for all folk.
Fr. Justin: Thank you so much Qiana for spending some time with us, for just being such a wonderful Kansas City social leader, for typifying the kind of social leadership that this podcast is trying to highlight, and the amazing work of the Health Forward Foundation. I hope we get to visit with you again sometime very soon.
Qiana: Thank you. I appreciate it, Father Justin. Thanks for the time.
Fr. Justin: Hang tight with me for just a second while we wrap up. I wanted to tell you again that this podcast, The Social Leader, is sponsored by Reconciliation Services and in particular Thelma’s Kitchen. We've got something new and exciting that is coming up and it's called The Social Leader, a brand new experiential leadership development program that we'll be launching in the fall of 2020, as soon as the world opens up again. It will be an awesome opportunity to really go deeper. If you're interested in accelerating your social impact from the company that you're in now or if you're interested in differentiating yourself as a potential candidate for a job, because we all know there's a couple hundred million people that are going to be applying for jobs in the next couple of months, this is an awesome opportunity. So go to our website, down to the bottom of the page, answer a few questions, and one of our team will reach out to you to talk to you more about The Social Leader program, which is coming up very soon. So once again, thank you so much for joining me on The Social Leader episode seven. I hope you had a chance to learn something about health, health equity, and how we're going to move forward as a region with a health equity and a racial equity lens to do more social good together. Until next time.