December 2023: Three Lessons for Growing Health Equity Efforts Effectively

Dear friends,

There comes a critical moment in any growth process when you need to reflect, retool, and refuel for the next phase. That is where HealthBegins—and the Upstream Movement as a whole—are right now. It’s an exciting moment, and an important one to pursue intentionally.

For years, health equity was an unofficial endeavor in healthcare, pursued by a small group of passionate caregivers, administrators, and community partners in the tiny gaps between official duties. Now, many health equity leaders across the country are stepping into new, official roles in health systems and managed care plans, with equity as their explicit mission. Many are starting to recruit talent to join their teams, strengthen community partnerships, and marshal the resources they need to deliver on big, bold commitments.

HealthBegins went through a similar moment six years ago, when we transformed from a part-time labor of love into a formal, full-time, mission-driven firm. Now we’re shifting gears again, moving from startup mode into a strategic growth phase, developing systems, standards, and capacity to answer the increasing requests for support that we’re receiving from courageous leaders initiating change.

One thing we’ve learned through these transitions is that we need to give these growth moments due resources and attention. In order to be effective going forward, we need to invest in ourselves, our systems, and our capacity. Doing this work well is not just about stratifying data or implementing strategies—it’s about tending to the transformation that this work requires. 

The lessons we’re learning through our current phase of growth will hold value for the newest cohort of Upstreamists in years to come. Here are three that we’ve distilled so far:

  1. Tending to the transformation means being intentional at each of its stages. Many organizations go through development because of a crisis or existential challenge. It takes wisdom and courage to pause and proactively invest in your development when you’re not experiencing upheaval.
    At HealthBegins, we’re doing that by reflecting on the work we’ve done and the impact we’ve made over the last six years to plot a refined path forward. We’re mapping the knowledge we’ve gained and the tools we’ve developed, and identifying ways to elevate the innovations that have made the most difference for the most people. One of these is the Compass for Health Equity Transformation, which illustrates the multiple levels at which we seek change and which we’ve refined to increase its utility to an even broader set of health equity pioneers.
  2. Growth is not just organizational but individual. Health equity requires more than a technocratic understanding of data, systems, and standards. The journey upstream is transformational, not transactional, and that necessarily entails a transformation of ourselves as leaders.
    With that understanding, we intentionally make spaces within our team and with our partners to discuss the intense emotional and energetic demands of this work, especially when it involves helping others see and counteract structural violence (in other words: how systems and policies put some people in harm’s way). We must continue to provide each other not just tactical support but emotional and moral solidarity to navigate the inevitable challenges and internal growth that accompany equity and justice-focused transformation.
  3. Intentional growth involves attending to the connection between organizational development and impact. At HealthBegins, we’re building stronger links between our work and each of the four levels of transformation identified on the Compass: Programs and Care (such as our work helping a Los Angeles primary care collaborative embed and advance equity through quality improvement and practice transformation), System (such as supporting Michigan’s largest health system develop a multi-level strategic portfolio to improve maternal health equity), Ecosystem (such as helping one of California’s largest Medicaid managed care plans develop and invest in Community Impact Councils to address community priorities and infrastructure needs), and Societal (such as co-founding the national Medicaid Food Security Network, where we’re working with Share Our Strength and Benefits Data Trust to convene advocates and accelerate learning and action to advance Medicaid support for food security).
    What we’re doing for our own organization, we’re also doing for our client partners as we help them develop the business case and internal capacity to work within and across these levels of transformation to advance health equity and improve its social, institutional, and structural drivers.

With these lessons in mind, I wish you and your colleagues and families a safe and peaceful holiday season, replete with the love and rest we need to ready us all for growth in the new year.


Rishi Manchanda, MD, MPH.

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