At The Kansas Health Foundation, A New Leader Driving A New Focus On Equity Over Equality
The new leader of the Kansas Health Foundation wants to shape a new image and direction for the nearly 40-year-old nonprofit.
Teresa Miller said the goal is to have the foundation focus more on equity rather than equality and to concentrate on areas that need the most help, like Wichita and Wyandotte County.
She became president and CEO of the foundation earlier this year after serving as secretary for the Department of Human Services in Pennsylvania. In that role, she was in charge of 16,000 employees and oversaw a budget of $45 billion.
Miller, a native of Oregon, also has worked at the Centers for Medicare & Medicaid Services during the Obama administration.
The Kansas Health Foundation, which has an endowment of $200 million, was formed after the sale of Wesley Medical Center in 1985. According to its website, it “creates strategies and develops partnerships to improve health for all Kansans, by reducing health disparities and focusing on health equity.” (The foundation is also a financial supporter of the Kansas News Service, which includes KMUW.)
She talked with Tom Shine and The Range about the importance of health equity, the foundation’s interest in expanding its policy footprint and her move from government to the nonprofit world.
The interview was edited for length and clarity.
Do people think of you as a grant operating agency … that you just sit up here and … rain dollar bills down on people. You want to change it? What do you want to change?
Recently I was talking to a federally qualified health center who's gotten money from us in the past. And I said, ‘What is your perspective of us? What's your perception?’ She said, ‘You're a checkbook who I could tell had a good heart, but you were a faceless checkbook. I'd never seen a face. I had just gotten a check and I always appreciated it.’
That's what I want to change. And that's where I think our board wants to change … I've had people talk about the ivory tower we sit in and, as you pointed out, we write our checks and send them out. And, I'm not criticizing that at all, but just as we move forward, I think one of the things we need to do is get out of our ivory tower and get into these communities that we want to serve.
Can you explain the difference between health equity and health equality?
Equality is treating everybody the same. And I think for a long time, we thought as a society that that's the right thing to do.
And so equity really acknowledges that we all have differences. And when we come into the world, we don't all have the same opportunity for the same healthy life. And we don't have the same opportunities for a long life. So equity really acknowledges what I think we've all been talking about over the last year, that there are real differences; that systemic racism has played a real role in our society. And so we need to tackle this from a, ‘Who needs a little more assistance?’ rather than, ‘We're going to give everybody the same assistance.’
The health foundation continues to support expanding Medicaid in Kansas … Is that any closer to happening?
There's no question it is the right thing to do. The fact that it's taken a decade of having these conversations and we still haven't gotten it done, I worry.
At the same time, though, I think it's also important to note that while Medicaid expansion would be a huge step forward, when we talk about some of the health disparities and some of the life expectancy data that … Medicaid expansion wouldn't really address those significant disparities.
So it would certainly be a step forward. It's kind of a no-brainer from my perspective; we should have done it a decade ago. But I do think that we need to acknowledge that it's not the be all, end all.
When I was going through the interview process for this job, one of the things I heard from the board is we want to do more in policy. Medicaid expansion has been kind of the only area so far, but we really want to expand that. So we talked about expanding our policy footprint to include things like voter engagement, voter participation, criminal justice reform, which many people may not think is really related to health.
But I would argue it gets at the heart of root causes of some of these disparities.
Given the divided nature of our political landscape right now, are you worried, as you become more active in the policy area in Topeka, … about pushback against the foundation?
Whenever you try to do something to make an impact, I think it's possible you get some pushback. In my career, I've always tried to focus on what's the right thing to do. And I think as an organization, we do a lot of wonderful work. And as we move forward, we want to continue doing that and really focus on what's the right thing.
I think today politics have gotten very, very divisive. When I was a lobbyist years ago in Oregon, where I'm from, it didn't really matter whether somebody had an R or D behind their name. We were just all trying to work together to solve problems, to move things forward and make life better for at that time Oregonians.
That's kind of the approach I have. Partisan politics doesn't really interest me. Trying to figure out how we can work together to make progress on some of these issues is what really interests me.
The health foundation supports a whole bunch of different efforts that people might not see as health-related. Ending the digital divide … promoting voter engagement. How does getting people to vote improve health outcomes?
I actually believe people engaging in the process and using their voice to vote, that gets to the heart of power.
Those social determinants of health that we talk a lot about – whether you have a job, whether you have affordable housing – all of those things play a much bigger role in whether you're healthy and whether you have a good health outcome.
So to me, voting is just the core of that because either you have the power to help make change in your community and get to a better life, or you don't.
What are your thoughts on rural Kansas and the work that foundation can do out there?
I think historically we've done a lot of work in rural Kansas addressing a lot of these issues. Going forward with our policy work, I think a lot of that will impact rural Kansas.
As I think about targeting areas that have the greatest disparities, I think we may end up focusing in areas that may not be rural Kansas, but areas that we haven't necessarily focused on before.
I think the problem has been now that we've been through this pandemic, some of the areas with the greatest disparities, you know, Wichita and Wyandotte County in particular … really stand out as areas with very significant disparities in health outcomes and life expectancy.
And those are areas that we have not necessarily focused on before. So again, as we take kind of that equity focus instead of that equality focus, I think we might end up spending more time in places like Wyandotte County and Wichita.
You spent the last six years or so working in state government. Why did you decide to make the switch to a nonprofit foundation?
I've had a lot of jobs where I was kind of a political appointee. I worked for the Obama administration, worked in Oregon, and then in Pennsylvania. And every time you have those jobs, you have a set deadline for when you're done with those jobs. And so for me, part of it was just trying to get a little more stability for my family and think about doing something where I don't have a set deadline for when I'm done with the job, but also can still do work that's really meaningful and has an impact on people's lives.