Achieving Equity Through Grantmaking: The Importance of Intention and Accountability

We just turned the page on another Black History Month when, as a nation, we recognize the meaningful contributions and sacrifices of Black leaders, pioneers, and every day Americans in shaping our country. One of the ways we can continue to honor the considerable legacy of Black Americans is by working to create a society where being Black in America does not limit one’s ability to be healthy.

To achieve good health, a person must first have a fair and just opportunity to be as healthy as possible, also known as health equity. But for many people living in North Carolina, this opportunity has been limited.

Geography, gender, veteran status, and socio-economic status – these all create health inequities that exist in our state. When you factor in race and racism – the result of generations of public policies, institutional practices, and social norms reinforcing inequities among people of color – poor health outcomes are compounded.

“The American health care system is beset with inequalities that have a disproportionate impact on people of color and other marginalized groups. These inequalities contribute to gaps in health insurance coverage, uneven access to services, and poorer health outcomes among certain populations. African Americans bear the brunt of these health care challenges… They still experience illness and infirmity at extremely high rates and have lower life expectancy than other racial and ethnic groups while also being one of the most economically disadvantaged demographics in this country.”

The Century Foundation

Beginning in 2020, we worked to develop a greater understanding of the ways in which racism drives inequities in the areas of our work and determined the best ways to address the issues. This resulted in a formal commitment to prioritize racial equity as a critical dimension of supporting health equity. In short, racial equity is achieved when racial identity no longer predicts, in a statistical sense, how one fares in life.

While this commitment takes many forms, a core tenet will be achieving equity through our grantmaking – or to put it more bluntly, putting our money where our mouth is. As a foundation, our grantmaking is one of the most significant means by which we can impact racial equity, both in who and in what we fund - from racial equity-focused grants and initiatives to grants specifically supporting leaders of color and people of color-led organizations.

As we approached our goal of achieving equity in grantmaking it was essential that we be intentional about a high level of self-interrogation; using data to assess where we are with our funding, where we are making progress, and where we can grow and improve.

A key component of this was a Grantee Demographics Survey which was designed to help us better understand grantee and partner demographics at the board, head(s) of organization, leadership, and staff levels, as well as gather baseline data on their diversity, equity, and inclusion (DEI) work. If we were going to advance racial equity through our grantmaking, we first must know from where we were starting.

Ultimately, though, good intentions must be grounded in deliberate actions and mechanisms for transparency and accountability. Setting targets, and being accountable to those targets, is essential in reaching broader objectives.

To that end, the goals we established are as follows:

By 2024, at least 60 percent of our grant funding will prioritize racial equity.

By 2026, at least 60 percent of our grant funding will support people of color-led entities.

To achieve these goals we intend to increase both the number of grants and the dollar amount of grants in these categories. The dollar amount is equally as important as organizations receiving more grant opportunities in order for them to have more substantial means of accomplishing the goals they hope to achieve for their communities.

In addition, in establishing our racial equity goals, we are striving for equitable funding, which is substantively different than equal funding. Recognizing that people of color are disproportionately impacted by poor health outcomes, we are setting targets that reflect the need for intentional, equitable investments that address the size and scale of the issues that impact those communities.

Connected to our goals for increasing investments in people of color-led organizations, there is great value in supporting organizations and leaders who are most proximate to the issues, who reflect the lived experience, and who can lift and center community voice in addressing the social problems we are all aiming to solve. We want to do more than a set a numerical target; embedded in our goal is a commitment to help build the capacity of organizations that may not have been able to get grants in the past.

These goals will have a substantial impact on our grantmaking strategy and programmatic approach going forward. We are now tracking demographics for all applicants and monitoring data in real time. Transparency is also key, and we plan to share data so that it might help others to improve racial equity in their own practices and processes.

We understand there are risks involved with being so transparent; however, we think showing both our progress and our shortcomings is an important part of the process. We hope this will spark important conversations and encourage other philanthropic organizations to examine their approaches to supporting racial equity, how they award grants, and who receives them going forward.

It is paramount that grantees across all spectrums are represented and supported as they work to build better communities. For North Carolina to be a healthier state, all communities need to be healthier, and for those communities that have been marginalized and disinvested in, health is much harder to attain. That is why this work is so important to us.

Our belief is simple, everyone in North Carolina deserves the opportunity to be as healthy as possible. Realizing this will take many things. For us, that includes striving to achieve equity through our grantmaking and fulfilling our broader commitment to supporting racial equity.



About the Authors

John Lumpkin, MD, MPH

John is the President of the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about John.








Shelia Reich

Shelia is the Director of Racial Equity and Healthy Communities for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Shelia.






For some, the last couple of months has been full of over-indulging, food comas, and even meat sweats. Many of us celebrated by getting together with friends and family where we enjoyed abundant holiday meals. Yet for many others, it wasn’t that simple.

The lack of access to affordable, healthy, local food is an urgent issue for communities in North Carolina. It’s a frustrating one given the fact that our state is ranked in the top 10 nationally as it pertains to agriculture and in the bottom 10 when it comes to food security.   How can a state that produces so much food be a place where certain communities cannot consistently enjoy the benefits of healthy food options? This has been an issue for years, and the ongoing pandemic has pulled the curtain back more to reveal just how prevalent it is.

However, while attending a recent grantee site visit, my eyes were opened to the work of an organization that is providing real hope for their county and making great strides in ensuring that fresh food is getting into the hands of more residents in the community.

Working Landscapes is a rural development organization founded in 2010 by Carla Norwood, PhD and her husband Gabriel Cumming, PhD.  Its headquarters is located in the community where Carla grew up, and it’s clear how much she cares about Warren County.

The overarching mission of Working Landscapes focuses on building a better quality of life in rural communities by leveraging the value of community assets. At its core, Working Landscapes is a food hub, which is defined as a business or organization that actively manages the aggregation, distribution, and marketing of food products primarily from local and regional producers to strengthen their ability to satisfy wholesale, retail, and institutional demand. They are also involved with education, research and engagement, climate crisis and mobilization, and building reuse.

They are the only North Carolina food hub, out of the nine nonprofit hubs in the state, that, in addition to aggregating produce from small local farmers, wash and chop the produce for easy use by institutional purchasers like schools. As a result, they are the first food hub to become part of the North Carolina Department of Agriculture’s Farm to School Program, which sells a variety of locally grown fresh produce to schools.

Food hubs are an important, and unique, component of the food system in North Carolina. In addition to helping feed their communities healthy fresh food, food hubs support local farmers, contribute to a more equitable food system, and enhance overall community development.

“Food hubs play an important role because they disrupt the current mainstream method that we have for transacting food which tends to be very corporate, consolidated, and driven by profit,” says Carla. “Food hubs tend to be mission-driven organizations and have a broader sense of our obligations to the people that we’re working with. We’re really playing a role that hasn’t been played—at least in this country in terms of food distribution.”

The oldest food hubs in North Carolina have been around for about 10 years, but in the last couple of years, there’s been a maturation of efforts and networks.

“Organizations are starting to do more collaborative work, which is good in building an effective system throughout the state in a pretty intentional way,” continued Carla.

This expansion and collaboration were well-timed assets as the state, and the resiliency of the food system, came face-to-face with the impacts of COVID-19.

“Within one year in the pandemic, seven North Carolina food hubs worked with approximately 270 farmers and moved 700,000 pounds of food in addition to working with more than 75 community organizations.”

Carla Norwood, PhD

Within one year during the pandemic, seven North Carolina food hubs worked with approximately 270 farmers and moved 700,000 pounds of food while also working with more than 75 community organizations,” says Carla. “The impact that food hubs are having now is significant, but it’s not nearly as large as it can be.”

Working Landscapes also expanded their services during the height of the pandemic to become a senior meals provider preparing and providing fresh frozen meals utilizing “local products first” through a partnership with the Warren County Senior Center.

Despite the positive impact they are having throughout their community, there are challenges. Food hubs are trying to do something different than the way things are typically done. They’re working in ways that run counter to the mainstream narratives about efficiency, cost, and price.

Simply put, they provide quality food that can often cost more, due in large part to their commitment to paying farmers a fair price and workers a living wage, in addition to the added costs in serving rural areas.

Another challenge Working Landscapes deals with is their focus on value- added processing which is beneficial but also complex and takes additional resources and focus. Cutting, peeling, washing, packaging, and freezing food are examples of the additional value. According to the Rural Health Information Hub, this level of processing increases the value of the food for both the producer and the purchaser.

“There’s a lot of regulation around value-added processing, but we’re very committed to producing a very safe product,” says Carla.

Preparing meals for a greater purpose

While visiting Working Landscapes I was fortunate to meet Cyril Murphy, a chef now leading their Healthy Meals Program that provides fresh frozen meals to local seniors. Chef Cyril lost his job in May 2020, just a few months after he and his wife received their first foster child placement. By the time Thanksgiving arrived that year, they were reliant on boxes of food they had been receiving from the government for five months.

Being a talented chef, Cyril certainly knows his food, so one can only imagine his reaction when opening up one box that included two and half pounds of processed American cheese, a questionable chicken substance, and other food with no redeeming nutritional value. Fast forward a bit, and Cyril was contacted by the Department of Social Services who informed him that his family would be getting a special food delivery for Thanksgiving. He assumed he’d be receiving the same type of food he’d been getting regularly. He was pleasantly surprised.

As Cyril tells it, one of the DSS workers showed up with bags of organic vegetables, an organic turkey, and other healthy foods.

“I literally sat down and cried,” says Cyril. “Because I hadn’t been able to be creative, and I also knew this food was much better for me and my family’s bodies.”

He came to the realization that once he was able to go back to doing what he loved—what he thinks he’s meant to be doing—it needed to have a bigger purpose. Working Landscapes is a perfect fit.

A year later, Cyril was back at the place where he could shop at grocery stores like Whole Foods and buy the food he wants while also understanding that not everyone has that opportunity or privilege.

“I’m now in a position where I can design menus and recipes that fit different people’s life stories,” says Cyril. “I’m from the North, and over the years of working in kitchens, I’ve taken the time to learn from people here in the South on how to cook collards, chicken, and the important ingredients they feel should go into that pot because I’m actually listening.”

Vision for the future

Working Landscapes is already doing important work, but Carla’s vision for the organization is to process food on a full-time basis, provide reliable markets for the farmers they work with and good jobs for the people they employ while creating high quality, convenient, and exceptionally good products. They recently finished up construction on a new food processing facility and cold storage space and processed their first batch of kale which was then served to students in Halifax County Schools. The kale was grown on two farms – Green Leaf Farm, which is a farm and outdoor learning lab run by Halifax County Schools and Davis Family Farms, a growing farm in Warren County run by Larry Davis whose ancestors were once enslaved on the same land. Carla also wants the organization to be a viable business that’s an example of how well our local North Carolina food system can work.

It seems that vision for the future is well on its way to becoming a reality.

Working Landscapes is a current Blue Cross and Blue Shield of North Carolina Foundation grantee. We are proud to support their continued efforts to increase access to healthy foods, strengthen the local economy, and build a more equitable food system.  


About the Author

Brian Edmonds is the Communications Officer for the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about Brian.



For many, the end of the year is a time to get plans in place for what lies ahead. While we value this pursuit, it is also important to pause and take stock of the year that’s passed. And because our work is greatly influenced by, and has bearing on, our partners, grantees, and friends, we are taking this opportunity to share these reflections with you.

As hard as it is for us to believe, this year marked the start of our third decade as a foundation. While this was a chapter in our history that we looked forward to turning the page toward, like most, we had just as much eagerness to turn the page away from the difficulties of the prior year.

Of course, this was more symbolic than anything. The realities of 2020 continued even as the calendar marked January 1. As such, remaining responsive to the challenges brought forth by COVID-19 was essential; however, so too was advancing our commitments to confront racism and support racial equity, as well as progressing a greater body of work in service to the health and well-being of everyone in North Carolina.

We can’t overstate the admiration we hold for the tireless work of our grantees, and the thousands of other nonprofits across the state, that have spent what will soon be two years addressing the impacts of COVID-19 while simultaneously carrying forth their missions every day despite the pandemic.

While our initial COVID-related response supported our full portfolio of grantees to do just this, in 2021 we narrowed our focus to where we thought support was most needed. This included investing $5 million in support of emergency food assistance as well as in Black, Latino, and American Indian-led organizations and communities to help stem COVID's negative short- and long-term health and social impacts on people of color. You are welcome to learn more about our full response.


We knew we must do more to center racial equity in our work and to invest more in breaking down barriers to good health for those who have historically been denied this opportunity.

Last year not only further opened the world’s eyes to the realities of a global pandemic, but it also continued to shine a long-overdue and much needed sustained light on the pervasive, systemic racial injustices in our society. Like many, we knew we could, and must, do more. We knew we must do more to center racial equity in our work and to invest more in breaking down the barriers to good health for those who have historically been denied this full opportunity.

We spent much of 2020 listening and learning – seeking perspectives from those most impacted as to how we would do this. This past year, we continued to build out our approach based on these findings and initiated concrete steps to advance this commitment across all aspects of our organization. We invite you to learn more about our approach to support racial equity.

Finally, complementing this all was an expansive approach to advance work across our four areas of focus and organization as a whole. While this took many forms, a few examples include:

Deepening and expanding our approach in early childhood, including:
  • Supporting efforts to assess the impacts of COVID-19 and spotlight the current workforce crisis in child care.
  • Implementing an open opportunity to fund community-based organizations led by and serving people of color.
  • Initiating what will be a sustained effort to address the racial bias that exists in pre-school suspensions and expulsions.

Investing in improving access to healthy food by breaking down barriers
, including:
Partnering in support of strong, healthy communities, including:

Realizing progress in pursuit of more accessible and affordable oral health
, including:
  • The continued expansion of school-based oral health programs working in partnership with The Duke Endowment.
  • The passing of Senate Bill B146 this summer, which was due in large part to the continued efforts of our grantees and partners and formalizes the practice of teledentistry and streamlines rules for public health hygienists.

Continuing to strengthen our organization
, including:
  • Establishing an Operational Excellence functional area to foster a culture of continuous improvement.
  • Engaging in formal evaluations of grant programs and our grantmaking processes.
  • Welcoming two new team members, Program Officer Marquita Mbonu and Communications Officer Brian Edmonds.

Looking back, we all had high hopes that this year would be better than 2020, and despite continued challenges and disruptions, the spirit, determination, and hard work of people and organizations across North Carolina moved us further down the road of meeting the needs of the state.

Of course, the pandemic is not yet behind us and that is a reality we all must continue to face. So too is the reality that everyone in North Carolina is yet to have the same opportunity for good health. We will continue to center this truth in our approach as we welcome the new year, and as we work alongside and in support of many partners, new and old, that are committed to righting this.

As we move further into our third decade, we remain humbled and inspired by those willing to share their commitment, insights, and experience to advance our shared goals; the collaborations we are fortunate to be a part of; the organizations we have the opportunity to support; and the many people who work tirelessly within their own communities to make life better for everyone.





This summer, Senate Bill 146 (SB 146) was signed into law, a significant step toward creating a better oral health care system in North Carolina. It was a long time coming, yet it’s also just a single milestone on a much longer journey to ensure everyone in North Carolina has access to quality, affordable oral health care.

To achieve this longer-term goal, we will have to do oral health differently — particularly by meeting patients where they are and increasing access to preventive services and the providers who deliver them. Two specific components of SB 146 go a long way to making care available outside the dental office (which many have difficulty accessing) while still ensuring patients have a dental home:

  • Formalizing the practice of exam by teledentistry — allowing a hygienist caring for patients where they are (in a school or other community setting, for example) to collect x-rays, photos, and other needed diagnostic information. This information is then used by a dentist working at a “distant” location from the patient, such as in their dental practice, to evaluate and examine the patient remotely.
  • Streamlining rules for public health hygienists — creating new opportunities to deliver preventive care in schools and other community-based settings in underserved areas.

These changes were achieved thanks to the persistence of committed partners, including lawmakers, dentists, hygienists, and advocates such as the North Carolina Oral Health Collaborative (NCOHC).

We have been part of this campaign for accessible, affordable oral health care for nearly a decade. Our foundation began focusing on oral health in 2013. At that point, in partnership with the State’s Office of Rural Health, the Oral Health Section of the Division of Public Health, and Division of Medicaid Assistance, we supported a task force — convened by the NC Institute of Medicine — that made policy recommendations to increase access to preventive oral health care among children enrolled in Medicaid.

Although only two of the 14 taskforce recommendations were fully implemented as of 2020, the legacy of the collaboration lives on in 2021’s Senate Bill 146 and other endeavors. Leadership by task force members and others has resulted in some significant changes since 2013, including many that weren’t even envisioned then:

  • NC Medicaid has changed payment policy to cover teledentistry and increase access to re-mineralizing treatments, including Silver Diamine Fluoride
  • The North Carolina Dental Society (NCDS) has convened a Council on Oral Health and Prevention, with active work groups on school-based care, teledentistry, and special needs dentistry
  • Our state’s dental schools have convened symposia focused on teledentistry
  • NCOHC has grown from a dozen-person workgroup to a network of more than 200 advocates from a variety of professional backgrounds and lived experiences that has become a leading voice on oral health in the state with a policy agenda of its own

While all of this is significant, there is much more to be done. These policy changes mark the beginning of our work together, not the end.

Ongoing Priorities

First, we must ensure that clinical and workforce practices designed to increase access and lower the cost of care (including delivering more care in community settings such as schools) are adopted in the areas that need them most. Too many adults and children have been failed by the system we have: patients often have a hard time getting an appointment, getting to an appointment, and/or affording the care that they need. Recent evidence in North Carolina shows that adoption of new, prevention-centered practices happens first in areas where patients have relatively good health and low social needs and then spreads more slowly to the areas where access is lower. We can accelerate the spread of these practices by targeting our efforts regionally.

Second, we must ensure that our system supports prevention and value with a focus on preserving tooth structure. Creating new access points and incentives for preventive and less invasive care is a first step to long-term improvements in quality of life and decreased out-of-pocket costs.

Finally, we must evaluate whether these practices are working to change outcomes and — just as importantly — reduce the inequities in oral health that exist today by race, geography, and income. To this end, we will need more data to know whether, and to what extent, these efforts impact inequities. Such data and analysis will allow us to  better focus future efforts.

We know our Foundation has a continued role to play as well, and we are committed to this work over the long term. As we embark on a soon-to-be second decade of funding in oral health, we are deepening our focus on value in the care delivery system. This includes a partnership with CareQuest Institute and the North Carolina Oral Health Collaborative to support dental practices implementing medical-dental integration and value-based approaches to care. We are also recommitting to the spread of school-based oral health care alongside The Duke Endowment and BlueCross BlueShield of South Carolina Foundation.

The latter initiative will place high priority on ensuring that school-based models spread from the 200 North Carolina schools they serve now to areas where there are persistent barriers to access and significantly worse outcomes than other areas of our state. We are currently soliciting proposals to support new school-based programs in both states.

Beyond the tangible outcomes of the bill, the legacy of SB 146 will also be in what it symbolizes — that change can happen when stakeholders with varying perspectives find common ground for common good. What lies ahead of us all is continued opportunity — to look forward with curiosity and united around shared purpose, until good oral health is the expected outcome for all.


School-Based Oral Health

Tooth decay is the most common chronic disease among children. Creating access to oral health care in a setting where children spend much of their time - schools - has the potential to address many barriers to oral health access.

Since 2019, our foundation has been working in partnership with The Duke Endowment and the BlueCross Blue Shield of South Carolina Foundation on an initiative to increase the number of school-based oral health care programs that deliver preventive services and address restorative treatment needs for children.

Proposals are being accepted to be part of the next phase of the program. Learn more. 


About the Author

Katie Eyes is the Vice President, Program and Strategy for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Katie.




Parents who have relied on the early childhood care and education system will tell you that high-quality and reliable programs allow children to learn and grow among their peers, all while under the supervision of qualified teachers and support staff. The nurturing and collaborative environments created by dedicated care providers across the state give kids the opportunity to establish the social, developmental, and interpersonal skills they’ll rely on for the rest of their lives.

There is also the reality that child care providers are a critical engine in our state’s economy. Simply put, all sectors – from business to government to health care and everything in between – need employees in order to keep their doors open, and employees need child care in order to work. Early educators are truly “the workforce behind the workforce.”

Yet, early educators remain among the most under-compensated professionals in the economy given the social importance of their profession and difficulty of their job. This inadequate compensation is at the root of the staffing crisis that existed prior to the pandemic, but that has deepened dramatically in recent months. This labor shortage is threatening the viability of care centers and businesses across the state.

More than 80 percent of surveyed care providers say that it is more difficult to hire and retain qualified staff now than it was before the pandemic.

A recent survey of North Carolina child care programs funded by the Blue Cross and Blue Shield of North Carolina Foundation illustrates just how concerning the staffing crisis is for the child care system and the state’s economy.

More than 80 percent of surveyed care providers say that it is more difficult to hire and retain qualified staff now than it was before the pandemic. The staffing crisis has forced one-third of providers to temporarily close their classrooms with little notice to parents. The disruptions affect our children and send parents, and other primary caregivers, scrambling.

Child care providers have made efforts to shore up this staffing crisis by offering teachers and staff higher wages and additional benefits. Yet, these increases are small, and many program operators openly acknowledge that the wages they’re able to offer staff are comparable to those in sectors where employment requires far less education, training, or responsibility.

In large part this crisis is driven by a market failure. Child care centers are desperate for staff as personnel leave for higher pay. Unfortunately, the child care system is unable to generate the revenue needed to increase educator pay. Families can’t afford increased rates.  According to Child Care Aware of America, the average cost of center-based infant care in North Carolina ($9,254/year) is $2,000 more than the average tuition at the state’s public four-year universities ($7,220/year).  Add to this the fact that COVID-related safety measures and staffing requirements have increased expenses for centers, which further affects their financial stability. As one child care operator explained, it's a never-ending juggling of priorities between staff, children, or the business, and never a full balance between all, as it should be.

Recognizing this market failure, other countries across the globe invest dramatically more money in child care than the United States. However, that appears to be changing. State policymakers recently tapped into newly allocated federal funds – upwards of $800 million – to temporarily shore up the industry. This essential stop-gap funding will be used for a range of needs including personnel costs, but also rent, personal protective equipment, and supplies. It is meant to stabilize the industry in the short-term, during the recovery from COVID-19, but it does not address the market failure and chronic underfunding facing the state’s child care industry. For that we’ll need bigger, more sustained solutions. Congress is currently considering a massive and permanent infusion of resources for child care that could change the market forces that keep teacher wages low and parental costs high.

The challenges facing North Carolina’s child care sector were not born out of the COVID-19 pandemic, but they were certainly amplified by it. A historically underfinanced system needs to be rebuilt to serve North Carolina’s growing workforce and economy through the recovery and beyond. That will take the federal and state government working in tandem and alongside key stakeholders to identify and fund solutions that enable child care programs to hire and retain the qualified workforce needed to support healthy children and working parents.



About the Author

John Lumpkin is the President of the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about John.




High-quality child care helps children get off to a strong start while ensuring parents can go to work and support their families. Unfortunately, the ongoing pandemic has undermined this already fragile system as revealed by a new survey of North Carolina child care programs funded by the Blue Cross NC Foundation.

The responses illustrate the resiliency and dedication of child care providers through the ongoing public health emergency, but also paint a troubling picture for the future. Unlike many other states, North Carolina did not mandate the closure of child care centers during the first several months of the pandemic. As a result, providers largely remained open, citing the need to care for the children of healthcare heroes and other frontline workers. Financial interventions from the state buoyed providers at key moments to ensure they kept their doors open to the communities they serve.

The survey nevertheless paints a concerning picture for the future of the state’s child care industry. More than one in five North Carolina child care providers (21%) say they are now at serious risk of permanently closing within six months without additional help. This comes at a time when many parents are making plans to return to in-person work environments and will rely on child care services being readily available. If additional policy interventions and financial assistance don’t come through soon, these providers may not remain in business – something that would have far-reaching negative consequences across several sectors.

Of the more than 1,800 licensed child care centers or family child care home operators that completed the survey, nearly one-third of centers (31%) reported revenue losses that exceeded $45,000, with 16 percent reporting losses of $75,000 or more. These are significant losses in an industry where margins are already exceedingly tight. At the same time, programs must now compete for employees amid a workforce shortage without the resources to provide competitive benefits and wages.

While leaders did what was necessary to support early education throughout the first year of the pandemic, including freezing subsidy payments at pre-pandemic levels and providing operational grants, more must be done to put the state’s child care industry on stronger financial footing for the long-term. With federal relief funds continuing to flow to states amid the COVID recovery, leaders and policymakers have the opportunity to rethink and reshape the state’s child care industry. A chronically underfinanced system needs to be retooled to serve the state’s growing workforce and economy.

Working parents’ access to affordable, quality child care is critical to increased employment and continued economic recovery. As the country moves forward, the time is ripe to address the needs of the state’s child care industry. Child care providers are the ‘workforce behind the workforce’ and supporting them can be a linchpin in a system that serves the state’s children, parents, and employers who are all united in their pursuit of creating a brighter future for everyone in North Carolina.


About the Author

Rob Thompson is the Director, Early Childhood for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Rob.




By now, we all understand just how deadly COVID-19 is, and even though we’re cautiously optimistic there’s light at the end of the tunnel, the virus further exposed inconvenient truths that could no longer be ignored. Social and racial inequities were brought to the forefront like never before as COVID-19 ravaged Black, Latino, and historically under-resourced communities across the United States. And North Carolina was no exception.

According to Census data, Black North Carolinians, despite making up 22% of the population, accounted for 36% of COVID-19 cases and 35% of deaths at one point. Additionally, North Carolinians who identify as Hispanic or Latino represented 50% of all COVID-19 cases last summer while accounting for just about 10% of the state's population.

As the pandemic took hold in early 2020, urgent action had to be taken, and like so many others, we believed we had a responsibility to respond.

However, it’s not enough. While many across the country and North Carolina have been working to rebuild post-COVID, more than a year later the need has not diminished. Community-based, direct service organizations are still very much in a disaster response phase as disruptions to education, economy, supply chains, transportation, health care, and other aspects of daily life continue. And demand for emergency food is at an all-time high. In North Carolina, food insecurity soared from 12.9% of households in December 2018 to an estimated 24% last spring. North Carolina ranks ninth among states in the latest Household Pulse Survey for adults who said they sometimes or often did not have enough to eat in the last seven days.

Understanding this, earlier this year we committed an additional $5 million to continued COVID response, with a majority of the funding allocated to emergency food assistance. Though our Healthy Food grantmaking is focused on changing systems and policies that impact the root causes of food insecurity, we saw the imperative to also help address the growing need for food at this time. This included placing a statewide emphasis on emergency food assistance with a focus on locally-grown food to also support local economies.

Our continued pandemic response also includes centering racial equity by investing in Black, Latino, American Indian, and other people of color-led organizations and communities to help stem COVID's negative short- and long-term health and social impacts. For example, funding is being allocated for operational grants that are exclusively to grantees who historically experience more barriers to fundraising and play a pivotal role in uplifting communities of color. Read about all 38 grants.

While we value the necessity of an immediate response, longer-term measures have to be taken to deal with the fallout of the pandemic and work to eliminate disparities and inequities within our communities that existed before COVID, but have been exacerbated in its wake. Addressing structural racism and creating more equitable opportunities for health is central to all aspects of our work.

It’s often been said that through adversity, you find out who you are and what you’re really made of. This pandemic has demonstrated that when we come together for a common purpose – as a state, as communities, and as neighbors – incredible things can happen.

This is the momentum we must harness for lasting change when the pandemic has finally subsided.

About the Authors

Merry Davis is the Director, Healthy Food for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Merry.




Marquita Mbonu is a Program Officer for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Marquita.

There it was in the Sunday edition of the New York Times. An issue that is increasingly important for our state, and for our nation, was getting its due in a major national publication. The issue: preschool suspensions and expulsions. It is an overlooked, often unknown, and certainly under-reported aspect of America’s early care and education system.

However, there was one shocking omission. There was not a single mention of the role of racism.

The piece  – "A 4-Year-Old Child Is Not a Problem. And Expulsion Is Not a Solution” – which appeared earlier this Spring, was a guest essay by David L. Kirp, professor of public policy at the University of California, Berkeley. Overall, his premise is correct – a trauma-informed approach to early care and education is essential for preventing preschool suspensions and expulsions. However, it failed to mention a critical factor at the root of this phenomenon: racism.

Data from the US Department of Education shows that Black children are greater than three times more likely to be suspended than white children. One could argue that this is a result of racialized trauma manifesting in classrooms, but research tells us something else. Dr. Walter Gilliam (quoted in the article) has produced groundbreaking research since 2005 documenting how implicit racial bias negatively affects the ways early educators perceive behavior among Black children.

This matches the experiences we have heard from parents and early childhood advocates in North Carolina. And this is driving work we have just funded with Wake County Smart Start to lead a five-county research project to understand preschool suspensions from parents’ perspectives. We hope to learn more about when and how preschool suspensions are happening, the impact on children and families, and the role of race and racism.

If anything became crystal clear by reading the Times piece, it was just how invaluable this work is going to be. There should not be another story, or another opinion piece on the issue – whether in the New York Times or the News and Observer for that matter– that doesn’t mention the profound racial disparities among children that are being suspended and expelled. Failing to connect those dots only makes the mountain we have in front of us that much harder to climb.

And so, as the consciousness of the nation is being raised to the many systemic injustices caused and perpetuated by racism, this is one we can’t ignore. The trajectory of the lives of millions of Black children is at stake.

About the Author

Rob Thompson is the Director, Early Childhood for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Rob.

The ongoing economic and health crisis posed by COVID-19 highlights longstanding inequities that must be addressed to ensure a better future for everyone in North Carolina. With that in mind the time is ripe for us all to work together to address a number of resulting and related challenges.

Key among these is food insecurity. In North Carolina, food insecurity soared from 12.9 percent of households in December 2018 to an estimated 24 percent as COVID took hold last spring, with families of color hardest hit. We also rank ninth among states in the latest Household Pulse Survey for adults who said they sometimes or often did not have enough to eat in the last seven days. This puts the health and nutrition of mothers, children, and others at risk.

One way to tackle this mounting crisis is to maximize enrollment in, and use of, federal food and nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This work should be guided by the experiences and needs of the people who interact with food assistance programs the most - participants and those who administer them locally.

This is just what researchers at Duke University’s Sanford School of Public Policy Center for Child & Family Policy did. Led by Carolyn Barnes, Ph.D., researchers conducted nearly 300 interviews with program participants and staff members in eight counties across North Carolina over the past several years.

They summarized their insights in a brief published this month, funded in part by our Foundation, that provides recommendations to enhance access to food nutrition programs in the state and offers a springboard for increasing program participation and enhancing them in the future.

This needed conversation comes as North Carolina is establishing - by July 1- a new Division of Child and Family Well-Being that will bring together complementary programs from the Divisions of Public Health, Mental Health, and Social Services to administer SNAP and WIC.

The benefits of both programs are federally funded through the U.S. Department of Agriculture and administered at the county level - SNAP through local departments of social services, and WIC through county health departments and health clinics. SNAP’s nutrition benefits supplement the food budget of families who are low-income so they can purchase healthy food. WIC provides nutritionally at-risk pregnant women, postpartum mothers, infants, and children up to 5-years-old who are low-income with nutritious foods, nutrition education, breast feeding support, and referrals to health care. Both programs support health and economic security and improve multiple health and even educational outcomes.

The brief points out that COVID-related changes in program administration - such as telephone appointments and extended certification periods, food flexibilities, and increased SNAP benefits - have helped reduce barriers to obtaining this important assistance. However, those who were eligible were often unaware of the changes, resulting in limited opportunities to receive the support.

The researchers also note that the programs could be greatly enhanced in North Carolina if the recommendations by those who administer and receive benefits are followed. This includes improving customer service, enhancing appointment reminders, giving greater flexibility in appointments, increasing benefits, and loosening eligibility guidelines. WIC participants also highlight the difficulty of redeeming benefits at the grocery store, underscoring the need for interventions to improve the shopping experience.

I encourage you to read the full brief to gain more on these insights, as well as the specific resulting recommendations for change.

There is an opportunity in this for us all - philanthropies, community organizations, and public leaders. Swift action to increase program participation and improve the participant experience is an important step in reducing food insecurity across our state.


About the Author

Merry Davis is the Director, Healthy Food, at the Blue Cross and Blue Shield of North Carolina Foundation.
Learn more about Merry.

In a typical year, we’d be sending out a message this week to our friends, partners, and grantees expressing appreciation for their work and celebrating our shared accomplishments over the past 12 months.

Alas, 2020 is anything but typical. And while perhaps more than most years, we feel such deep appreciation for our friends, for our partners, and for the tireless and visionary work being done by our grantees, it just doesn’t seem appropriate to celebrate much at all.

Instead, our 2020 – like that of most others – was filled with unanticipated challenges that caused us to adapt, both personally and professionally, at whiplash pace. Plans were set aside to respond to the needs of our grantees and the communities they serve, as the pandemic unfolded and continued to wreak havoc. And while we are proud of what we – and our grantee partners – were able to do amidst this unparalleled circumstance, there is no escaping the feeling that we could always do more.

It is this idea of doing more that became our call to action as time moved on.

COVID-19 was not the year’s only seminal development. The callous killing of George Floyd – and the resulting demonstrations flooding our streets – raised the public consciousness to the pervasive, systemic injustices in our society, not for the first time, but in a way that has ignited a long overdue call for change.

In the face of this, we simply asked what more we could do. What more can we do to confront structural racism? What more can we do to center racial equity in our work? What more can we do to break down the barriers to good health for those in North Carolina whose skin color has historically impeded this?

We have spent the last six months searching for these answers. We sat down with our board. We met with our peers from leading foundations. We interviewed leaders working to elevate racial equity as a priority in their communities. We convened focus groups of our grantees. And we asked the public at large to provide their thoughts as well.

These are not straightforward questions we are asking, and therefore there are no straightforward answers. However, what we heard was candid, insightful, humbling, and inspiring. And above all, what we heard has set the course for our work today, next year, and beyond – the beginnings of which we have outlined here.

This year has been extremely trying, perhaps unprecedented. It has exposed and exacerbated vulnerabilities. It has widened disparities. It has made life harder for many who call North Carolina home.

But 2020 did have its silver linings. It has shown that as a state and as a society, we are resilient. It has opened the eyes of millions to injustices and incited a much-needed call for change. And for us, it has helped codify our commitments: to confronting inequity; to ensuring everyone has a fair opportunity for good health; and to working in partnership with organizations of all types, of all shapes and sizes, in pursuit of our shared vision for our home state.


About the Author

John Lumpkin is President of the Blue Cross and Blue Shield of North Carolina Foundation and Vice President, Drivers of Health Strategy at Blue Cross and Blue Shield of North Carolina. More about John.