“Aligning to a North Star of Health Equity.” Five Things to Know About Texas’ St. David’s Foundation

St. David’s Foundation in texas has a growing focus on serving older adults. Photo courtesy of St. David’s Foundation.

As one of the largest health systems in Texas, St. David’s HealthCare is a partnership between hospital management company HCA Healthcare and two nonprofits — St. David’s Foundation and Georgetown Health Foundation. The company was established in 1996, but has deep roots in the community, as the original St. David’s Hospital was established in Austin in 1924.

St. David’s Foundation reinvests its distributions from the partnership back into the community, with a goal of advancing health equity and improving the health of underserved Central Texas residents.

It’s one of many health-focused funders, regional and otherwise, that are looking beyond basic provision of care and digging deeper into matters of equity, including looking at the many social and economic problems that shape a community’s wellbeing and the challenges specifically facing low-income people, seniors and other vulnerable populations. Health funders like the Robert Wood Johnson Foundation and the California Endowment are two leading examples, but there are many more, often philanthropic byproducts of hospital and healthcare systems that serve particular regions.

St. David’s Foundation is one such funder, and it’s serving a booming part of Texas that includes new tech hub Austin, but also rural, lower-income areas. In 2022, the foundation disbursed $80 million, including $71 million awarded in grants, $9 million in direct dental care and funding to local safety net clinics, and over $2 million to students through the St. David’s Neal Kocurek Scholarship program, which is the largest healthcare scholarship program in Texas. The foundation has $1.6 billion in net assets. 

Here are five things to know about this grantmaker.

It is adapting to a regional population boom

The foundation serves a region that includes Bastrop, Caldwell, Hays, Travis and Williamson counties. As of 2020, the area’s population stood at 2.3 million people — a 33% increase over 2010. In addition, Austin-Round Rock-Georgetown is the fastest-growing metropolitan area in Texas.

“Central Texas is a place that people want to live, so the challenge is how to ensure that everyone can thrive,” said foundation President and CEO Edward Burger in an email to Inside Philanthropy. “Equitable access to healthcare and affordable housing are two of the most pressing issues facing communities across the country, and Central Texas is no different. This means our work is evolving, which it must, and we are deepening our commitment to advancing health equity so that as our community grows, so does the opportunity to achieve health and wellbeing.”

Historically, the foundation considered Travis County — where Austin is located — as the region’s center of population, and the surrounding region as rural. As a result, it would center its resources in the county while deploying targeted strategies for rural areas.

Now, however, “costs have driven many to the rural counties and people are living, working and playing across county lines in new ways,” Burger said. “Taking a regional approach to supporting the Central Texas community will be vital as resources at the county level vary drastically. For many of these communities, they feel separate — so one important role of the foundation is to help them also become part of regional solutions.”

It’s pivoting from “health” to “health equity”

In August 2021, the foundation published a paper explaining that it was shifting its focus from “health” to “health equity.” For Burger, this “aligning to a North Star of health equity” means “reorienting our strategy from just funding services for the most vulnerable to also working to eliminate systemic and cultural barriers preventing healthy outcomes from the outset for generations to come. It also means re-examining our processes and practices, such as what we require of grantees and scholarship recipients, who we serve with our programs, and who we fund.”

The paper identifies three principles and “guiding questions” to help leaders reshape its practices — Systems (“What would be different if systems were designed to support those most underserved?”), People (“How are the people closest to the problem involved in this work?”) and Social Connection (“How is this strengthening the relationships among community members?”) The foundation will begin operationalizing its newly evolved mission over the next year.

It publishes assessments of health needs in the region

Every three years, the foundation completes a Community Health Needs Assessment to provide a deeper understanding of the region’s health needs, inform its grantmaking strategy, understand its impact and identify action items to close the health equity gap.

Last December, the foundation published an assessment for residents served by the North Austin Medical Center who hailed from five surrounding counties. Created with input from partner organizations like Georgetown Health Foundation and the Texas Health Institute, the report looks at the community health impact of factors like housing and transportation, lists “priority health issues” like diabetes and mental health, identifies barriers to access, and provides recommendations to improve access and strengthen outreach. The foundation will publish its implementation plans in April 2023.

Organizations can get on program managers’ radar

While the foundation primarily solicits proposals on an invitation-only basis, it provides a process by which organizations can receive an invitation. Interested grantseekers can visit its Strategic Priorities page and contact the relevant program officer to see if the program might be eligible for funding. If so, the foundation will invite the organization to apply for a grant. 

The foundation also issues requests for proposals, which are open to any eligible applicant. The foundation also encourages grantseekers to sign up for its newsletter to learn about these opportunities. 

It plans to expand mental healthcare and support for low-income, older adults

The foundation has begun developing a strategic five-year plan. Burger sees this as “an opportunity — through a process that deeply engages community voice — to refine and reimagine our ways of working to center equity and employ new tools to address underlying causes of health disparities in Central Texas.”

The foundation will ramp up two new programs as part of this effort. The first, “Libraries for Health Initiative,” expands the delivery of mental healthcare by enabling nonclinical mental health supports and practices within libraries. Seven libraries in Central Texas have been selected to participate in the pilot, totaling nearly $1 million to support expanded access to behavioral health pathways. “Other components of the initiative include a learning cohort with other funded libraries and field-building activities to build momentum, disseminate early learnings, and increase awareness of the initiative,” Burger said.

The foundation will also roll out a home-based “aging in place” intervention for low-income older adults in Central Texas through the replication of the Community Aging in Place — Advancing Better Living for Elders (CAPABLE) model. Developed by the Johns Hopkins School of Nursing, the model uses a multidisciplinary team approach to help vulnerable seniors live safely in their homes. 

Burger said the target population served by the CAPABLE program will be low-income adults over age 60) living in Central Texas “who have the desire and cognitive ability to remain in their home, but who have difficulty with activities of daily living that threaten their ability to remain safely at home.”