A Conversation with Foundation President & CEO Ray Baxter

Foundation Chief Program Director Carolyn Wang Kong sat down with Foundation President and CEO Ray Baxter to talk about health as a unifying vision for social change. Ray served on the Foundation’s board for two years and is leading the Foundation while a search for a new president and CEO is underway.

Carolyn Wang Kong: It’s remarkable to think about the leadership roles you've held in very different types of organizations — from large integrated delivery systems to public health, to research organizations and think tanks — but they all shared a focus on prevention, which is at the heart of our new strategic direction. What do you think is our greatest opportunity at this time?

Ray Baxter: What's exciting now is the possibility to take a very different approach to health, which is not about biology, but human behavior, social forces, and the many ways we can create a better world. 

Carolyn: Given our strategic direction and our understanding that equity and inequity drive health, which levers do you think we are particularly well positioned to manage?

Ray: We can be the voice for health in the movement for equity. We can help people understand how inequity wrecks health and how real equity promotes health. But our unique position is to be anchored in health — mind, body, and spirit, and all the broad definitions of health — while we work on big social forces, institutions, and attitudes, all the while, never forgetting about the individual and how we can help the individual. 

Carolyn: We all come to an understanding of equity and its impacts in different ways. Can you talk about yours?

Ray: Like many who began their careers in healthcare, I started out with a clinical orientation that diseases, infections, injuries, and genetics were responsible for ill health.

However, early in my career, I helped the state of New Jersey deinstitutionalize its psychiatric hospitals. It quickly became clear that without safe, affordable housing, an income, an occupation, and people to care about you — community mental health services would not be enough.

Then, I walked into the AIDS epidemic, first in New York in 1983 and then in San Francisco in 1990. People used to say, "HIV doesn't know boundaries, doesn’t know gender, race, or class," but the ability to manage illnesses and the likelihood of an earlier death, clearly had a lot to do with social connectedness and circumstances. Being in San Francisco at the worst peak of the epidemic was a revelation, because I witnessed the incredible power of people, of communities, of science, to come together.

At the end of the line, what I learned was that people who did not have choices and almost invariably lacked wealth, power, privilege, connectedness to others, or all of those things — experienced the greatest health and social inequities. That’s a bit of a long answer...

Carolyn: ...but a really helpful one, thank you. And it leads to my next question. As we move more, as we say, “upstream” to prevent poor health and violence, it becomes trickier to measure our impact. What success signals should we look for?

Ray: One signal is that the dialogue starts to change. We will see a shared understanding and vision of health. Most people, non-healthcare people, talk about health broadly, as safety, a sense of security, the confidence to do the things they need to do to get through the day, as well as the absence of disease or injury. They may also talk about health in terms of their hopes and fears for their children or their elders. This is a far less restrictive and, a far more accurate, definition of health.

We’ll see a shift in perspective. We’re doing groundbreaking work to prevent people from experiencing domestic violence, in any form, as a harm-doer, as a survivor, or as a witness. We understand that witnessing domestic violence as a child can have lifelong, serious consequences and we’re encouraging others to rethink domestic violence as a whole-family condition.

Another signal will be that we attract partners to join with us because they are seeing something changing and want to be a part of it. And last, we’ll see policy proposals that include a health perspective. Right now, radical changes are being made around affordable housing, economic development, a living wage, education, all of which have enormous impacts to people's health, for good or for bad, so, if we start to see health-informed policies, we’ll know we’ve done our job.

Carolyn: To create this health-oriented worldview, what should we do differently?

Ray: We have to bring in new kinds of expertise and perspectives and listen in a different way to the voices of people with lived experience, who are truly the experts in developing the solutions. 

Carolyn: That’s an important point. People use their resources and expertise to perform a complex cost-benefit analysis every day, to find the best path for themselves and their families, but their choices are limited, so they make trade-offs.

Ray: Yes, too often, California families make complex, difficult choices between housing, economic security in a job, and healthcare or the health of their kids. Nobody should have to choose between these things, but they do, with profound consequences.

I’ll offer a personal example. My father was part of a very large family of thirteen children in rural Kentucky. My grandfather, who taught in a one-room schoolhouse, died young, and suddenly, my grandmother made the choice to send my father and the other older brothers away so she could take care of the babies and young ones.

My father and his brothers were farmed out to neighbors and ever farther away, to homes where they worked in exchange for a place to live. Eventually, the oldest brother located the others and helped them get into a free college prep school that was dedicated to kids who lived in the mountains. They all graduated, went to college, and did well.

But the fact is, I know that experience never left my father, of having to be part of a painful choice that his mother had to make. All of those brothers had, at some point, chronic health problems, whether that was because of poverty, their environment, the food they ate — it could have been a lot of things, including the separation.

On one level, it's such a rational decision, that it's almost terrifying. On the other hand, it's understandable and this is the kind of choice way too many people have to make. Ultimately, my grandmother had to make a terrible choice about her family’s health and well-being and I would want to do anything I could to prevent other people from having to make a decision like that.

Carolyn: Thank you, I appreciate your sharing that story because it shows that our personal stories are part of community health and that the connection between life experiences and health aren’t always clear. My last question is this, what is the link between our work and the many social movements we see today?

Ray: On the one hand, the fact that people are engaging in collective action creates social cohesion and a sense of power, which are associated with better health. On the other, if you look at the issues that people are engaged in, they all have really important health consequences. Whether you're talking about school shootings, violence against women in the workplace or in the home, violence in communities, systemic violence, environmental justice, and economic and gender inequality, people are coalescing around a shared vision for health, not just for individuals and families but for all people. That’s the vision that guides our work too.

Carolyn: Thank you, Ray, it was great to learn more about you, and I really look forward to working with you.