How One Foundation Is Flipping the Paradigm on Social Change

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Ruth Shaber discusses Tara Health Foundation's approach to philanthropy.

The practice of choosing investments that take gender into account, specifically those that address women’s issues and promote female leadership, is gaining ground. One philanthropist making a difference in this arena — which has become known as gender lens investing — is Ruth Shaber. A devoted physician and disciplined researcher, Shaber is the founder of Tara Health Foundation, which aims to improve the health and well-being of women and girls through the creative use of philanthropic capital. She recently spoke to Sherryl Kuhlman, managing director of the Wharton Social Impact Initiative, about how her organization is doing things differently in the philanthropy space.

Sherryl Kuhlman: Tell us about the Tara Health Foundation and your background.

Ruth Shaber: My pleasure. I’m an OB-GYN physician, and I spent my career working for Kaiser Permanente in California. In addition to being a provider of general OB-GYN care, I also had the opportunity to have many different administrative roles. Most significantly, I had the opportunity to oversee the evidenced-based medicine program at Kaiser Permanente.

Kuhlman: Can you explain what evidenced-based medicine is? Isn’t all medicine evidence based?

Shaber: We hope so. But what that means is, how does medicine translate the research and the basic science and human physiology into actual care? How do we go from understanding how a drug might work to how we actually use it in people to have them have better outcomes, healthier lives? That can be basic science. It can be a clinical trial. It can also be what we call implementation research. How do you create programs that reliably deliver some sort of technology to people so that they have the benefits of that science?

Kuhlman: That implementation aspect is very interesting. What you’re saying is, let’s have some sort of a standardization based on this kind of evidence rather than each of us doing it our own individual ways.

Shaber: That’s exactly right. We talk about manufacturing and other types of industries, in addition to medicine, as evolving from a craft into a production system where you end up getting the reliability and quality and standardization through systems engineering. That was my background at Kaiser Permanente. When I started my new career in philanthropy, I had been very interested in bringing all that I had learned, not just in the content, not just in how do we take good care of people and women, but also how do we create more reliable systems in this new discipline.

“We firmly believe that improving a woman’s opportunity to control the size of her family is going to optimize both the economic and social aspects of her life.”

Kuhlman: How is the Tara Health Foundation doing that?

Shaber: Our overall mission is to improve the lives of women and girls, and we’re doing that by demonstrating creative uses of philanthropic capital. That means that we’re looking at 100% of our assets — from how we make grants, how we develop the fields, how we do direct and private investing, and how we use the largest part of our endowment in public equities and public investing. We want to have 100% mission alignment in our specific area of social interest, which is in reproductive health. We firmly believe that improving a woman’s opportunity to control the size of her family is going to optimize both the economic and social aspects of her life. By looking at improving access to reproductive health care, we can do that in many different ways. We can do that by funding grants to improve clinic access or by investing in companies that are creating new products for contraceptive use. Or we can think about how we are using our public investing strategy to improve the lives of women and girls. We’re looking across all of our aspects.

Kuhlman: Give me a specific example of an investment or a grant you made that could help illuminate some of these approaches.

Shaber: We believe that not only do we need to improve access to reproductive health technologies, we need to improve access to capital for those who are providing reproductive health. One example of how we’re using capital in an integrated fashion and creatively is in how we’ve supported Whole Woman’s Health, an organization of clinics led by Amy Hagstrom Miller. Whole Woman’s Health was the plaintiff in a Supreme Court case that was decided last year that was arguing against the restrictive laws in the state of Texas. Whole Woman’s Health has been a vibrant, entrepreneurially led organization and was thriving in its provision of women’s health services and reproductive health and abortion care, in particular. But because of the burden of the litigation, they needed to open and close their clinics multiple times. As a result, they had a large amount of debt, and the only place they were able to get capital from was high-interest credit card debt.

When we got involved in supporting them, we had an opportunity to refinance their debt with a very low interest rate, very favorable terms for them. Yet it still was providing an investment for Tara Health Foundation. As opposed to giving them a grant, we were able to do this private debt. It’s giving us a 3% return over five years.

Kuhlman: And it saves your grant money for another opportunity.

Shaber: It’s not a program-related investment; it’s coming out of our endowment. Whole Woman’s Health also has a nonprofit arm. Once the Supreme Court case was settled last year, they had the opportunity to reopen their flagship clinic in Austin, which we were able to finance through a grant. In addition to the debt as a private investment, we also were able to provide grant money through two different parts of our portfolio.

“The traditional paradigm for how foundations drive social change should be turned upside down.”

Kuhlman: One of the things we’re seeing a lot when we’re talking about impact investing and the work we’re doing at the Social Impact Initiative is that there is a range of capital tools that can be used to drive towards a particular end. People are saying, “Grants aren’t enough. There are other things I can do with my capital. Let’s just figure out those different opportunities.” I know you’re looking at that very closely.

Shaber: Ultimately, I believe that the traditional paradigm for how foundations drive social change should be turned upside down. If you ask most of the large foundations operating in any of the social sectors, they’ll say that the engine that drives social change is their grant-making. They believe the income that comes off of their endowment is the feeder for that social change. They firmly believe, for good reason, that the returns on their investments should be the priority.

I believe that we have an opportunity to think about this differently. If we think about our endowments and our investment strategy as the primary engine of social change, and the 95% of the capital that sits in that space, and instead start using our grant-making as opportunities to do the research to better understand what are the best investing strategies for that social change, that is going to unleash a huge amount of capital and really drive change in a way that we could never have dreamed of.

Knowledge@Wharton: I like that you brought in the research angle as well. It’s clear you’ve got that evidenced-based approach leading a lot of the work that you’re doing.

Shaber: Absolutely. Just like in medicine, the only way that we’re really going to understand the best use of capital is by investing in research. We can’t just rely on good intentions and intuition, that there is a lot to learn. When I talk about this in medicine, I’ll say, “Well, there was probably 500 or 600 years where we really thought that bleeding people was going to cure all of their diseases.” They had a technology — leeches — and they were looking for a disease to apply it to and just said, “Well, we’ll just try it on everybody.” It was only through a little bit of science and rigor that they realized people are actually dying from this.

I think that if we can change our thinking a little bit and apply some discipline, some standardization, just like in medicine, just like in many fields that have benefited from science, that we’re going to have a lot more opportunity for the social change we all crave.

Kuhlman: How do we share the information? How do we build the data around this? There are so many angles to take in building that evidence base around that. It’s something that we’re really passionate about at the Social Impact Initiative.

“Just like in medicine, the only way that we’re really going to understand the best use of capital is by investing in research.”

Shaber: Yes. You talk about how important knowledge-sharing is and dissemination. There was a fascinating study that came out in the Journal of the American Medical Association about 20 years ago that showed that the average time between when a piece of evidence was established and how long it took for it to trickle down into everyday practice was 17 years. That’s just unacceptable.

Now that we understand the importance of science and sharing what we learn, I really do think that there are opportunities for us to be much more proactive. I think that what you’re doing at Wharton is really a great example of how we can get information out into the public space and into the hands of the people who are doing the work and creating the change that we want.

Kuhlman: This is really a thought-provoking conversation. Any final thoughts on what you would tell a philanthropist about how they can be more intentional and strategic about their work?

Shaber: I haven’t thought about that question, and I like that question. I would tell my peers and others who are interested in the power of philanthropy to create the network. Start talking to people. Don’t just stay in your silo. We have so much to learn from one another. And bring your heart to what you’re doing, and follow your heart in the social change that you want to see. But don’t be scared to bring in some science and some rigor into making sure that it’s not just your intuition that you’re using, that you really can learn from the many people who have gone before you.

Kuhlman: I think this goes to a willingness to acknowledge when something isn’t working.

Shaber: Absolutely. We talk a lot about failing and failing often. But we have to be willing to learn from our failures, too.

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