Several months of data gathering and analysis provided important lessons and will help inform The Colorado Trust’s future work.
Some social determinants affect health more than others.
While there are numerous social determinants of health, a smaller subset of them appear to have an outsized impact on health and well-being among people living in Colorado. This is supported by multiple data sources—but also, importantly, it aligns with perceptions of community members and leaders as to which social determinants have a significant influence on the health of their communities.
The health equity funding landscape has expanded in the last decade.
In terms of The Colorado Trust’s recent grantmaking initiatives, there has been increasing overlap with other funders that are working to advance health equity in the state. While it’s important to avoid redundancy when possible, this also means there are now ample opportunities for leveraging collaboration, partnerships and multifunder initiatives to help increase impact.
Sharpening the foundation’s focus can lead to better results.
The Colorado Trust likely diffused its impact over the last decade by attempting to fund efforts to address virtually every social determinant of health. In some cases, this appears to have potentially minimized or limited the outcomes of funding initiatives.
There are numerous experienced, successful entities addressing health equity in Colorado.
The Colorado Trust should focus its primary role on funding efforts by such entities to address social determinants of health, rather than attempt to undertake such work itself.
Community-informed grantmaking remains vital to advancing health equity.
The Colorado Trust should continue to listen to and honor the role of communities in identifying opportunities for improving their own health and well-being. This includes establishing and maintaining relationships with community members and leaders, as well as nonprofit and governmental entities.
Health equity can be addressed both “downstream” and “upstream.”
Social determinants of health can be addressed along the full spectrum of approaches, from the individual or personal level (such as the delivery of direct services) to systems and structures (such as changing or implementing new laws and policies).
Patience is necessary.
Experience indicates that meaningful change on health equity issues can take time, especially at a systems level, and can and should be measured both quantitatively and qualitatively. While this strategic plan is for three years, evaluating the results of funding initiatives should potentially stretch beyond this time frame.
Food insecurity has markedly increased across Colorado recently, with major contributing factors including the COVID-19 pandemic, sustained inflation despite stagnant wages, and consolidation within the supermarket and grocery industry. Access to nutritious food remains significantly worse among non-white people living in Colorado, as well as people living in rural areas of the state. Colorado also has one of the lowest enrollment rates nationwide for the Supplemental Nutrition Assistance Program—44th out of 50 states as of 2018, according to the Colorado Blueprint to End Hunger. People living in Colorado who report experiencing food insecurity are several times more likely to also report worse mental and physical health outcomes.
Numerous surveys have found that housing affordability is one of the top issues faced by people living in Colorado; this is especially true among people of color, many of whom have been denied the opportunity to build generational wealth due to discriminatory housing policies over the last century. By one measure, Colorado ranks as the 8th most unaffordable state for housing in the U.S. and is facing a dual crisis in terms of affordability and availability. By 2032, median rent in Colorado is expected to reach $2,700 per month, requiring an income of $106,000 per year or a job that pays nearly $51 per hour. Wages have not come close to keeping up with housing prices; between 2009 and 2019, the average Colorado home price increased 77%, but the state’s median income went up just 4.5%.
MENTAL AND BEHAVIORAL HEALTH
Mental Health America ranked Colorado last in the country for adult mental health in 2022, meaning Colorado has a particularly high prevalence of adult mental illness and significantly limited access to care. Mental Health America also found that Colorado has some of the worst rates in the county for mental health care unaffordability, unmet needs, lack of health care coverage, and unfavorable ratios of providers to patients. People in Colorado identifying as LGBTQ+, or people experiencing food insecurity or housing instability, are more likely to report poor mental health; many people of color in Colorado report accessing mental health care less than whites. Lower-income adults have significantly lower self-reported rates of receiving mental health care services than higher-income adults. Substance use disorders are associated with higher rates of chronic disease, suicide, drug overdose, violence, homelessness, recidivism and unemployment.
Strategic Goals and Objectives
These overarching strategic goals were established by staff and approved by the board of trustees:
Increase access to nutritious and affordable food for those who face barriers to living a long and healthy life
- Increase access to nutritious food
- Increase economic stability for those experiencing food insecurity
- Promote healthy eating
Increase housing affordability and stability for those who face barriers to living a long and healthy life
- Increase comprehensive housing services focused on unhoused individuals
- Increase stability for those at risk of losing housing or unable to secure adequate housing
- Reduce stigma associated with people experiencing homelessness
Increase and improve access to quality mental and behavioral health care for those who face barriers to living a long and healthy life
- Expand access to quality mental and behavioral health services
- Improve the quality of mental and behavioral health services
- Increase the diversity of the mental and behavioral health workforce
The Colorado Trust will announce new funding initiatives starting in 2024 for the focus areas of food, housing, and mental and behavioral health. These funding initiatives will endeavor to support organizations working to address these focus areas along the full spectrum of approaches, from the delivery of direct services to policy advocacy and more.
Interested parties may sign up to automatically receive email notifications of new funding opportunities starting in 2024.