Addressing Health Inequities in Rural California: An Interview with Roque Barros, Jr.

This blog is part of a series of conversations with rural leaders that FSG is publishing in conjunction with the release of our report Rural America: Philanthropy’s Misunderstood Opportunity for Impact. In this conversation, Joelle Cook of FSG interviews Roque Barros, Jr., executive director of the Imperial Valley Wellness Foundation (IVWF), who discusses how philanthropy can help support rural communities facing health inequities through partnership, capacity-building, and community-building. Neyat Daniel provided editing support. 

Please tell us about yourself and your background.

I was born and raised in the Imperial Valley in California. I came back after serving as director of the Ford Institute for Community Building in Oregon for six and a half years and fifteen years at the Jacobs Family Foundation in San Diego before that. My dream has always been to someday come back to the Imperial Valley to make a difference in my community, and I’m so thrilled that has come to pass. I’m excited about an increased interest of funders in rural areas and want to support them to engage with these communities, especially the Imperial Valley, as funders learn more about the impacts of the Salton Sea and opportunities presented by the lithium deposits in the region.

I realize that my journey as a community builder started as a child growing up in the Imperial Valley and has continued to guide my work throughout my adulthood, whether I was working for a nonprofit organization or foundation. Along my journey, I’ve been fortunate that I’ve come across folks that have sat side by side with me, walked side by side with me, and taught me a lot. I’ve learned a lot from all of these people and experiences. As a child, I learned compassion from my mom, I learned the importance of building relationships from my dad, I learned from my siblings how to share. From my friends in Calipatria where I grew up, I learned how to play as a team. As an adult I have learned about the importance of working side by side with community residents to make things better. I realized it was okay not to have all of the answers and if I sat together with people in communities, we would figure it out, together.

How have you seen the health of the community change over time in the Imperial Valley? To what extent do you feel that these trends mirror changes in health in other rural communities?

As a child, from my perspective, the Imperial Valley was a great place to grow up. The area was rich in natural resources—we had land, water, and a beautiful place to live and play. Today the Imperial Valley I see is challenged by poverty and health disparities. One in 5 kids has asthma, we have the number one rate in diabetes deaths per 100,000 people, and we have high rates of stroke. All communities in the Imperial Valley have a social vulnerability score in the 90th percentile and above, meaning they are highly susceptible to adverse impacts of natural hazards, including disproportionate death and injury. In addition, they experience social and economic inequities through environmental exposures such as air pollutants, pesticides, and hazardous waste, and socio-economic stressors like a high poverty rate and linguistic insolation. 

Overall, there is a 25% rate of poverty, but some communities are even further challenged, such as Niland, a frontline community on the Salton Sea, which has a poverty rate of 60%.

The foundation is organized around serving as a rural development hub. Can you talk about what that looks like in practice?

When I started my role with the foundation, I started by listening and letting the communities guide me to determine the most appropriate role for the foundation. I realized that the region lacks voice and visibility due to the small size of our county (180,000), plus being nestled between two large counties with 2-3 million people. In addition, I found that the smaller towns in Imperial Valley were even further underrepresented, as they also lacked voice and visibility locally, within the county.

To address this problem and support the implementation of the changes needed, IVWF has embarked on a process to create a Rural Development Hub in the region. This is more than just a convening mechanism, it is a way for the community to be reimagined as a whole, to build capacity and to gain more voice and visibility.

A recent report by the Aspen Institute acknowledges the importance of Rural Development Hubs. Findings indicate that “Hubs are a critical piece of our nation’s rural development ecosystem. In short, strengthening the enabling environment for Rural Development Hubs is an essential component for building equity, health, and inclusive wealth in rural America and strong, vibrant, 21st Century prosperity for our nation.” 

Another way we play the “hub” role is by bridging foundations to the work of communities. As a person of color who grew up in the Imperial Valley and with a professional career that spans work in community building and philanthropy, I am uniquely positioned to guide IVWF and other funders who are interested in supporting the people and region. I recognize that many foundations are not located in rural communities, and therefore are not familiar with the specific norms, culture, and priorities of those regions. There exists a desire to support rural communities, but not an understanding of how to in the most strategic way. It is critical for any vulnerable community, especially ones that have been historically excluded, that there is a trusted partner who can bring together people, voices, and perspectives, and lift them up in investment or philanthropic funding conversations.

The third thing we do is build capacity among our community leaders to help folks have a stronger voice and increase their visibility so they can take the lead and develop their own agendas.

In practice I have learned that we must start with where the community is and with what they know and then build on what they have. We need to honor the pace of the community despite our own pace and deadlines. Ultimately, we need to provide ownership opportunities for individuals to build wealth. If we are going to get people living in rural areas out of poverty, they must have more agency in their lives and individual wealth, not just programs and services.

Can you talk a little bit more about why it’s important to focus on things like civic engagement and community building as a health foundation?

IVWF recognizes that capacity building enhances outcomes related to the work of public health.  As such, because the Imperial Valley faces social and economic inequities, the communities’ capacity must be addressed in order for residents to take the lead to create their own solutions and lead the change they want to see. Right now, a lot of people are using the word “equity,” but they don’t define equity. For us, equity means the control of decision making and the control of resources. So, to build health equity, we have to engage or lead these discussions.

For example, I saw a need and an opportunity in the town of Niland. Niland is a frontline community of the Salton Sea, a toxic seabed that is the cause of significant health and environmental issues for the community. In this community there lacked a non-profit to provide greater voice and visibility for the issues they experience. However, there was a great group of women bringing programs and services to their community and engaging people. Over the past year we have worked together to build their capacity and supported their achievement of becoming a 501(c)(3). This status is a gamechanger for them and enables them to fundraise and be in the driver’s seat on local issues. They are now the North End Alliance 111 and are recognized for their work and input. Organizations and state agencies are now coming to them about the Salton Sea or about lithium mining in the Imperial Valley—they are sitting at the table and representing their voice and that of their community members.

What about some of your biggest challenges?

It can be a challenge to elevate the challenges and needs of those living and working in a rural area. Only seven percent of philanthropic dollars come to rural areas in the US. Why is that? I think it’s because we don’t have mechanisms in place in rural communities that bring all stakeholders, funders, and communities together. We need mechanisms that are community-led, and we need to be comfortable with letting communities guide us. Under-invested communities and vulnerable populations are invited to metaphorically sit in the car with funders and others, but they’re never invited to drive the car. How do we flip that so that the community is driving the car and more importantly, that they own the car?

There is a lot of talk about equity, but I would like to see more equity put into action. Communities have not had a lot of decision-making opportunities and do not control a lot of resources. There has to be a shift in power. I always say, if we can’t figure it out, let’s bring people to the table and let’s figure it out together. And while we do so, we help people prepare for those conversations, so that they are comfortable when they are sitting at the table and emboldened to actively engage and represent their own voice.

What are some examples of philanthropy engaging in ways that are supportive of rural communities?

At the Jacobs Family Foundation, we were looking at resident ownership of neighborhood changes. Though we had a goal to redevelop 20 acres of land that we wanted to support, we didn’t say how we would do this. We started with the community developing the vision and the plans and eventually managing and owning it. In the end, it might not have worked out exactly the way we thought it would, but having these principles and practices guide the work was important.

Another example is from when I was with the Ford Family Foundation. The foundation funded over a decade of leadership capacity-building so that communities were ready for more comprehensive community-building work. The capacity-building allowed the community to work side by side with other sectors to develop long-term comprehensive visions. After the leadership training, we funded communities to implement their long-term plans. In 2019, we found that our $100,000 investment in the community-building work resulted in $12.5 million of funds from outside the area that the region was able to attract.

At Ford Family Foundation, we also spent a lot of time documenting how we did our work and why, and in the process we were clear with communities about our beliefs about how change happens: That real and lasting change wells up from within the community. That communities are best positioned to know their own needs. That everybody has a role to play in community change. That communities can lead and guide the change they want to see. And that community-building takes time and is worth it. We didn’t come in with a colonialist mindset and say, “Here’s what it looks like to build your community to our standards.” We asked, “What are your ideas, priorities, and vision for your community?” And to be clear, those aren’t quick and easy conversations, but we found that it was important for people to have a unified vision for their community.

A third example is The Alliance Healthcare Foundation, which committed to transferring 10% of its corpus, which is $7.5 million, to the Imperial Valley Wellness Foundation. They are not only defining equity, but they are demonstrating equity in action. They said rural areas should make their own decisions and have their own money, and they are transferring the money to us to do so. To us, this feels like an equitable partnership.

When has philanthropy missed the mark or perhaps even caused harm in rural areas? What are the lessons for funders?

One lesson that I learned along the trajectory of my work is to listen for the opportunity. When I do training for other community builders, I’ll take them to meetings and ask what opportunities they heard. A lot of times that’s where people miss it; they don’t hear that opportunity. This is true for philanthropy—some are not embedded enough in communities to hear or see the opportunity that exists in rural areas. As a result, key opportunities are missed.

I think a second misstep is that a lot of funders are interested in helping Imperial Valley and rural areas, but sometimes don’t know how or where to help. Funders need to spend the time on the ground in rural communities, listen for the priorities that communities are concerned about, find the trusted mobilizers and energizers that can take the lead in organizing the community towards the future change and vision they would like to see. I have learned that it’s really critical to start with the community’s agenda and not your own. Funders must honor the community’s pace, take their time with the community, and listen in order to learn from them.

Based on these lessons learned, I am developing a community-led learning partnership right now that focuses on addressing the inequities in health and philanthropy in the Imperial Valley. Groups from the Imperial Valley will be leading and facilitating the conversation with funders. For me, it’s really critical to make sure the community has the capacity to engage in these discussions, so that when they do meet with funders, they are prepared.

What are one or two things that foundations could be investing in right now to support health in rural communities like yours?

Foundations can be helping communities with voice and visibility. Foundations need to invest in the people in these communities in a way that prepares them to sit at tables and to know what to ask for now. Foundations should help communities work together to create their own solutions. When folks come together, they can figure out their solutions and foundations can really help by supporting these convenings.

And lastly, foundations can provide hope. I always tell people it’s about hope. It helps to have somebody come in and say they believe in you. Sometimes people just need an outsider to help build their confidence and give them hope that it is possible for them to do it. And to offer support in whichever way they can. I really do believe that a group of committed, passionate people who see a need, if given the resources, support, and time, will be able to solve the greatest problems of our day.

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