Responding with Resilience

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The Upstream Imperative, Volume 4

This article is part of “The Upstream Imperative,” a series exploring the challenges and opportunities facing the social services sector.

By Adair Mosley, President and CEO, Pillsbury United Communities

We are in a difficult moment.

For some in our community, COVID-19 is an uncomfortable disruption. For others, including many we serve, the pandemic threatens their livelihoods and lives. At Pillsbury United, we see the impact firsthand in the surge of people facing job loss as well as food and housing insecurity across our community.

Emergency support is desperately needed, and we are heeding the call. But this moment raises another urgent question. What can we do to reduce the inequities and disparities that compound the harm to our community — and emerge from this crisis more resilient than we were before?

If we are serious about preparing for the next emergency, we need to talk about systems.

Seeing the systemic

As extraordinary as events feel in this moment, we know that disasters are inevitable. And when they occur, they reveal our vulnerabilities. Whether it’s a tornado, a fire, a foreclosure crisis, or an epidemic, disasters do not affect us all equally. Some are inconvenienced while others are devastated.

Why is that? One narrative has it that some people choose not to prepare, that they should have more foresight or more financial cushion. But we know differently. Because of choices we make as a society, many in our community are more vulnerable to disaster, a judgment borne out by the numbers.

Here in Minnesota, we know more black, Latino, and indigenous low-wage workers are exposed to and contract the virus because they do a greater share of essential jobs. What’s more, COVID-19 most threatens people living with chronic diseases like asthma, diabetes, and cardiovascular disease — conditions that disproportionately impact black and brown communities due to a history of food insecurity, lack of access to healthcare, and adverse environmental impacts.

Systemic health care issues also contribute. Beyond barriers of cost and access, cultural disconnects and mistrust lead many in our community to delay care and let chronic conditions go untreated. When a crisis like COVID-19 arrives, they are often hit first and last to get proper treatment..

That’s why I say that emergency remedies are not enough. We need to address the systemic factors that make a bad situation worse.

A strategic policy push

As COVID-19 persists around the globe, we are deeply focused on the local impact and how our agency can help. While we can be consumed with the acute needs, we also need to claim this moment as an opportunity to rebuild a more just and inclusive society — for all.

Systemic challenges are complex and intersecting. Addressing them takes concerted action on many fronts: housing affordability; healthy mothers and births; school stability and early education; criminal justice reform; healthy food access; and many other priorities. When we engage the full picture, we start to remove the multi-dimensional barriers that leave people vulnerable.

In times of crisis, I choose to pursue an unconventional goal: strategic planning for the future. Last year, we released a bold and disruptive strategic plan. As we revisit our thinking and approach in this moment of challenge, we see our plan stands strong. Everything so far in this pandemic validates our focus on upstream systems that exacerbate downstream inequities.

Our plan lays out several strategic priorities that include forming cross-sector partnerships focused on social determinants of health to improve community outcomes and investing in students of color as an engine of equitable and sustainable economic prosperity. Critical to the success of these initiatives is advancing policies that promote, protect, and galvanize the community we serve.

Addressing root causes begins and ends with addressing policies and their consequences, intentional and unintentional, on our community. We know the disparities of our communities are strongly linked to the oppressive policies of our past. Through a catalytic investment from the Kresge Foundation and Target Foundation, we are investing in policy change in a way never before possible in our 140 year history. We are moving from a supporting role to a leadership role in shaping critical policies at the city, county, and state level. We fully understand that policies are the accelerating force to move more individuals and families to social and economic wellbeing.

We will use the proven tools of active listening, co-creation, and ongoing feedback to inform matters of planning and prioritization because policymaking for a just society must be driven by community. People, place, and race are too often treated as abstractions in policymaking but we need stakeholders to understand the humanity of those affected by policy choices. To that end, we will increasingly use multimedia to illuminate people’s lived experiences — to bring the faces and voices of our community into the discussion and to positively influence policies that affect them.

More resilient moving forward

We applaud the outpouring of effort and resources we see easing people’s hardship during this disaster. Now we challenge everyone to think beyond the crisis. Good conversations are happening at the media and policy levels, but we need to shift into action.

As an agency that’s built trust with our communities over generations, we have a central role in advancing their voices, hopes, and solutions in policymaking. We are fighting for a community that drives its own agenda, has real input on decisions that affect them, and enjoys equal representation in institutions that touch their lives.

This is what I mean by responding with resilience. Let’s use this opportunity to meaningfully engage our community in building a more equitable future post-COVID.

Another crisis is inevitable. If we make resilience our priority now, disparity is not.

Reimagining Education for Economic Prosperity

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The Upstream Imperative, Volume 3

This article is part of “The Upstream Imperative,” a series exploring the challenges and opportunities facing the social services sector.

By Adair Mosley, President and CEO, Pillsbury United Communities

It’s a report card no Minnesotan is proud to see.

In 2019, the Twin Cities Metro was named the fourth worst place in the country for Black Americans. It’s just one of many rankings that show the depth of our region’s racial gaps, from academic achievement to wealth. Our state ranks 44th for racial disparities in standardized test scores and in the bottom tenth for disparities in who earns a high school diploma. Median household income for Minnesota’s Black and Indigenous families is less than half of what white families earn.

These disparities have a tangible impact on people’s lives. Less able to own homes, start businesses, or gainfully participate in the economy, our families of color are stuck in a cycle of poverty that leaves them sicker, less happy, and less safe. Our young people see their dreams curtailed before they get an opportunity to try.

It’s a crisis that makes our whole state poorer. According to the think tank PolicyLink, Minnesota’s annual GDP would be $16.4 billion higher if these racial gaps were erased. As retirees exit the workforce in large numbers, our state is facing an estimated shortfall of 400,000 workers by 2024. People of color are the fastest-growing segment of our population, yet our education gaps leave us unprepared to fill these jobs.

This isn’t the progress we expect in our progressive state. We have the resources to fuel prosperity. How do we unlock them for everyone in our community?

Expanding choices

We know that when we equip people with the knowledge, skills, and connections to thrive, they seize their opportunities. But too many Minnesota students and their families are not given that chance.

Despite deliberate effort and investment, our system of academic high schools is not meeting the needs of thousands of black and brown students. Unengaged by traditional classroom-based programs and unmotivated by their prospects after high school, roughly half do not make it to graduation, and so leave the system unprepared for work or further education. Those who are prepared face additional barriers. Where once a four-year college degree was a reliable path to prosperity, it’s become unaffordable, saddling students with debt that actually limits their future prospects.

There is more than one way to be successful and prosperous in life. But the choices our schools provide leave many students out of the equation. Some, but not all, will prosper in a four-year college program. Some will embrace a professional career track. Others have ambitions that check a different box.

How do we prevent students from falling through the cracks? By providing new choices and incentives and broadening how we define success. A four-year degree shouldn’t be the only outcome. We need a learning environment that meets students where they are and lets their interests and ambitions lead them forward.

Learn to earn

For students not driven by the promise of a four-year degree, landing a good-paying job out of high school can be a powerful motivation to stay in school and focus on their future.

That’s the promise of Career and Trade Education, or CTE. Once sidelined as a lesser diploma for low-performing students, CTE is having a renaissance. Today’s CTE model lets students personalize their education around their interests and unique learning needs. Instead of being a one-way ticket, CTE keeps all the options open, preparing students to jump into living-wage jobs or go on to two- or four-year college programs when they’re ready. CTE focuses on the innovation-driven careers our future economy needs: building trades, IT, health care, clean energy, entrepreneurship, and many more.

Opening this avenue to students during high school has a bottom-line impact. According to the U.S. Dept. of Education, eight years after their expected graduation date, students who focused on career and technical education while in high school had higher median annual earnings than students who did not focus on CTE.

On recent visits to CTE schools in Denver and New York City, I saw Black and Latino youth whose passion for learning was evident. Not only were they deeply engaged in their course of study, they knew exactly how they would apply their skills after graduation. Rather than reach for a lesser dream, they saw the experience as a launch pad to a better life. And the opportunity awaiting them is enormous. Instructors told me that local employers are coming to their school to find workers. You can feel the enthusiasm in the community. I saw everyone leaning in: encouraging students, contributing skills, and creating a network to carry students far beyond graduation.

It’s our time 

At Pillsbury United Communities, we see career and technical education as an essential new option for Minnesota youth, one with the power to change the economic outlook for families of color in high-poverty communities.

Realizing this model won’t be easy. It requires parents to demand more of a system that isn’t serving them well. It means prioritizing the needs of children and parents over the demands of the system. We need the engagement of industry leaders and lawmakers to create a model that works for business, families, and teachers as well as students.

We believe CTE is the engine of improvement we need to grow homeownership and entrepreneurship, to create better health outcomes and safer neighborhoods, and to give families a pathway out of poverty.

It’s time we expand opportunity to everyone. We have work to do, Minnesota.

An Upstream View of Population Health

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The Upstream Imperative, Volume 2

This article is part of “The Upstream Imperative,” a series exploring the challenges and opportunities facing the social services sector.

By Adair Mosley, President and CEO, Pillsbury United Communities

If you’re like me, you want to solve the stubborn disparities that exist in our community. It can be daunting to talk about, and there are no easy answers. But I believe the change we want is possible if we are willing to zoom out. Only by tackling the root causes that brought us to this place can we get past them as a society. 

This is what I mean by the Upstream Imperative: elevating our strategy to engage the systems — not merely the symptoms — that hold back people’s lives across generations. 

Facing the factors

Nowhere is this upstream response more needed than in population health. We know that the health of our community is shaped to the greatest extent by social determinants: factors including neighborhood livability, housing, education, and economic prosperity. These factors influence people’s lifelong wellbeing more than any hospital, doctor, or medication. 

Why does Minnesota have some of the largest racial disparities in the nation? Because life in black and brown communities has long been adversely impacted by systemic racism and inequity. This context affects everything: people’s access to nutritious food and health education, their exposure to environmental hazards, and their likelihood of living in substandard housing. It imposes extra costs and barriers when they access healthcare and produces toxic stress that puts people at risk for lifelong health problems.

If we’re serious about closing these gaps, we need to think at the scale of this systemic challenge. That means bringing all stakeholders to the table to innovate with an inclusive approach. 

Assessing root causes

We can’t solve problems we don’t clearly understand. Which is why the Affordable Care Act mandated that non-profit health systems conduct health assessments in the communities they serve. Such assessments can unite payers, providers, and policymakers around the same goal — be it care access, nutrition, housing, education, or all of the above — and guide a coordinated response. 

Without a mandate to address social needs and root causes, the efforts of health systems to date have been largely reactive and disconnected from the people they’re meant to help. As that mandate changes, organizations like Pillsbury United have an essential role to play. As a connector between healthcare systems and our communities, we can help produce a truer picture of life and health in our neighborhoods — the first step in creating an effective response based on the community’s real needs and assets.

Human connections

Foremost among these assets are people. In communities of color, there have always been navigators — people who deeply understand their neighbors’ perspective and help them navigate their critical social needs, from health care to housing. The role they play is usually hidden and seldom compensated, but their impact is no less important than that of doctors. They guide people to overcome cultural and economic barriers to better health in ways the traditional healthcare model cannot. 

That’s an opportunity. By investing in the capacity of these navigators and elevating their role as true Community Health Workers, we can empower our communities’ human resources to do even more. They deserve better tools and support and to have a voice in matters than affect their families and neighbors. Despite proof that such a model works, it is not as well funded as it should be. Policymakers, payers, and healthcare systems can help change that. 

Convener and conduit

Health has been at the center of our work for over 140 years. Supporting whole people in whole communities is part of our Settlement House roots. We understand the importance of working in, for, and with community, listening to people most affected and giving them tools to create solutions relevant to their lives.

As healthcare systems begin to embrace more encompassing, community-based solutions, agencies like Pillsbury United are poised to make them successful. As intentional partners, we can ensure an intersecting regional response big enough to create historic change aligned with the goals of stakeholders and needs on the ground.

We envision a future where people achieve greater personal health and wellbeing together. For the communities we serve, this future can’t wait.

Planting Our Flag

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The Upstream Imperative, Volume 1

This is the first article in “The Upstream Imperative,” a series of articles exploring the challenges and opportunities facing the social services sector.

By Adair Mosley, President and CEO, Pillsbury United Communities

Here’s a hard truth: our systems are failing our communities. The black and brown families we see every day inhabit a society where they are in last place. Minnesota is 49th or 50th nationally for disparities in earning high school diplomas. We are 49th for racial gaps in home ownership. Mortality rates for African-American and Native residents are up to 3.5 times higher than for other racial and ethnic groups.

While these challenges disproportionately affect people of color and families living in poverty, they are a legacy of choices we’ve made as a community. So how will we respond to these shared problems as a society?

Will we focus on providing services that ease suffering in the short term, while ignoring the systemic causes that have brought us to this point? Or will we embrace deeper, more lasting solutions?

Make no mistake, traditional human services are a lifeline our communities can’t do without. Our sector improves millions of lives in thousands of communities by working to close gaps in food, housing, education and beyond. These efforts must be preserved and strengthened.

But on their own, they are not enough. Beyond delivering programs and services, it’s time to re-envision the ecosystem and impact of our work as a whole. To remove systemic barriers that hold back people’s lives, we need to embrace radical and disruptive innovation. And urgently.

Social needs: widening the scope

Agencies often say they address social determinants of health when in reality they treat symptoms. Food shelves help feed families, but they don’t solve the financial and transportation burdens that put grocery stores out of reach for many communities. Health education can save lives, but it only succeeds when supported by healthcare infrastructure that makes the knowledge actionable to people where they live.

While providing near-term services to individuals is necessary, it does little to change the systemic issues on the ground — most importantly the long-term economic disadvantages faced by families living in poverty. Until we confront that social reality, food, housing and health assistance will be a temporary salve at best.

Responding only to individual needs can give us a false sense of progress. We celebrate the number of people we’ve served through our programs while ignoring the conditions that make these programs necessary.

To move the needle on a population scale, we must take a broader view. If we are serious about addressing social determinants of health, we must dismantle the systems that perpetuate inequities and hold people back across generations.

Changing the ecosystem

Shifting the context in which people live their lives is hard work. System-wide solutions take more effort, money, and political will. They require cross-sector partnerships that can reform complicated entities like our health care and education system. They require us to ask difficult questions, demand more of ourselves and our partners, and refuse to be complacent.

The social services sector can’t be expected to move these mountains on its own. Partners in government, philanthropic community, and businesses must also step up. When money is restricted to incremental solutions, entrenched problems fester and our communities remain unstable. We need brave financial partners willing to collaborate on ambitious solutions — and allow those with proximity to the community to focus dollars and energy where it matters most.

In over a century working with and for our community, we have learned that the best solutions flow from the community itself. But only when we understand the lives behind the challenges and stay anchored in their dreams and aspirations.

This is where we plant our flag as an agency. We envision communities where people achieve greater personal health and wellbeing together. Where cultural understanding creates social connections. Where prosperity is shared by all through equitable education and employment opportunities.

This is our motivation: going upstream to reform entrenched systems that can meaningfully change people’s lives long term. As an agency, as a sector, and as a society, we must be willing to think bigger and do the hard things. Only then can we realize a healthier, happier, more prosperous future for everyone in our community, no exceptions.

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