2021 Pulse Check on Shared Stewardship for Thriving Together Across America

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Pursuing Equitable Opportunities: Most respondents felt that people in their communities do not have equal opportunities to lead their best possible lives, but a majority expected that opportunities for people to thrive will become more equitable over the next five years. There was no clear consensus, however, about how to prioritize investments to produce greater equity.

Relevant Stewardship Stance: Stewardship entails an understanding that we cannot thrive together when large numbers of us are struggling, suffering, and experiencing unfair adversity. Stewards should also recognize that many groups of people have been systematically disadvantaged throughout our history and even today are denied equal opportunity. Accordingly, a steward prioritizes investments that help those who have been struggling and suffering the most.

Most respondents felt that a majority of people in their communities are either struggling or suffering (60%). This is a higher level of struggling and suffering than is reported in nationwide surveys, which fluctuated over the past decade between 41-54% (Riley et al., 2021; Witters and Agrawal, 2021). Contributors to this Pulse Check may perceive lower levels of thriving, in part, because their work typically involves encounters with those who are struggling and suffering. The timing of this survey could also have skewed perceptions because it occurred during a period of conspicuous adversity due to the COVID-19 pandemic.

Most respondents did not feel that people in their communities have equal opportunities to live their best possible lives (78%, see Figure 12). Together with the perception that many people are struggling or suffering, this suggests that a majority of respondents recognize that structural inequities are linked with widespread struggling and suffering.

Figure 12: Do all people in my community have equal opportunities to live their best possible lives? (n=348, % who somewhat or strongly agree)

A majority of respondents (64%) anticipate that opportunities for people in their communities to thrive will become more equitable in the next five years. Here too, this positive outlook is consistent with the belief that current crises present an opportunity to shape a better future (91%).

A plurality of respondents think that the most effective way to enable all people in their community to thrive would be to invest more resources among those who have the most to gain (43%), a view matching the principle of “targeted universalism.” By contrast, two smaller groups prioritized investing among those who need just a little more help (29%) or investing evenly and equally among all groups (27%) (see Figure 13).

Notable Differences

• Among respondents affiliated with organizations that focus on system change, 54% prioritized investing in those who have the most to gain. Such investments were favored by only 16% of respondents whose organizations do not discuss system change.
• Respondents affiliated with business associations were less likely than others to perceive inequality in their communities, with 66% believing that all people in their communities currently have an equal opportunity to thrive. In marked contrast, only 7% of respondents affiliated with government public health departments believed the same thing.
• Looking across the four institution clusters, half of all respondents affiliated with hospitals, as well as about 40% of governmental public departments and community non-profits, prioritized investing in those who have the most to gain (see Figure 14). Those affiliated with business associations were much less likely to prioritize investing in this way (22%).

Figure 13: Which investment strategy would have the greatest impact on enabling all people in your community to thrive? (n=348)

Figure 14: Which investment strategy would have the greatest impact on enabling all people in your community to thrive? (By organization type) (n=348)

These findings indicate that respondents have differing beliefs about how well-being can best be expanded. But, on the whole, close to half of the respondents believe that we can build a more equitable future by investing more among those who have been structurally disadvantaged.

Close to half of the respondents believe that we can build a more equitable future by investing more among those who have been structurally disadvantaged.

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Prioritizing Vital Conditions: Even during a time of national crisis, which increased adversity and acute needs, there was a strong belief that it is important to prioritize vital conditions over urgent services.

Relevant Stewardship Stance: A steward knows that when vital conditions are absent or impaired, people tend to struggle and suffer, driving demand for urgent services—and a steward’s priorities reflect this understanding. Urgent services are essential, but they are temporary fixes that don’t by themselves produce the experience of thriving.

Overall, respondents emphasized that investments to expand vital conditions should be the higher priority right now in their communities (in terms of everyone’s time, money, and effort)—more so than urgent services (44% and 32%, respectively) (see Figure 15). At a time of especially acute demand for urgent services, this emphasis is notable, indicating a strong orientation toward long-term thinking and a preference for solutions that advance multiple goals at once while also offering many co-benefits (often referred to as “multisolving”).

Even during a time of national crisis, which increased adversity and acute needs, there was a strong belief that it is important to prioritize vital conditions.

Figure 15: Portfolio priorities, current and future (n=348, % selected as highest priority)

Current percentages reflect the extent to which each area is currently a top organizational priority for contributors. Future percentages reflect the extent to which contributors think each area should be a top priority for their entire community.

Figure 15 summarizes patterns of investment based on a larger list of questions about priorities (see the detailed heat maps for Questions 5 and 6 in Appendix 3).

When asked to assess which areas should be the highest priority (in terms of everyone’s time, money, and effort), respondents tended to emphasize their own organization’s area of work. However, over 50% of all respondents selected a consistent set of future priorities, all of which are aligned with the vital conditions, including:

• Safe, affordable housing (78%)
• Job opportunities and economic development (65%)
• Racial and social justice (64%)
• Better pay, living wages, and family wealth (63%)
• Education, including early childhood, K-12, and youth development (62%)
• Routine health care (57%)
• Healthy food (52%)

When respondents reported on their organization’s current activity (i.e., not what should be prioritized across their community but what they are presently prioritizing), there was an unsurprisingly strong connection to their own organizational mission. However, there were some unifying current priorities, including:

• Healthy food (36%)
• Emergency food assistance (39%)
• Civic life (32%)
• Racial and social justice (32%)
• Education (33%)

Notable Differences

• A close analysis revealed noteworthy patterns about future priorities within hospitals and public health departments. Contributors from hospitals assigned relatively low priority to unemployment assistance (15%), reliable transportation (20%), and safety (38%). Contributors from public health departments assigned relatively low priority to unemployment assistance (17%) and acute care or testing for illness or injury (34%) (see Appendix 3 for a detailed heatmap).
• It is significant that civic life was a relatively high priority for current work among all respondents. Civic life consists of a broad set of activities that strengthen social cohesion and make it possible to achieve society-wide change. It includes voting, volunteering, leadership, organizing, engaging in public work, and building power or civic muscle to do things that no one could do alone. Civic life is the only area to achieve double-digit support from respondents in every sector (see Appendix 3).

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Infusing Stewardship in Organizational Norms: A large majority of respondents reported that their organizations are enacting a common set of stewardship norms and practices.

Relevant Stewardship Stance: Stewards ought to be committed to constantly translating their values into action. They look to infuse norms and practices for shared stewardship in all facets of their work.

The vast majority of respondents said that their organizations are enacting a common set of stewardship practices, a promising signal that stewardship may be taking hold as a norm in many organizations across the nation (even if actual practice may lag behind) (see Figure 16). Nearly all respondents reported working with members of their communities as full partners (94%) and embracing new ideas and experimenting with new approaches (93%). Setting priorities based on a long-term view (beyond 10 years) was the lowest rated practice among all contributors: public health departments (57%), hospitals (55%), community non-profits (58%), and businesses (59%) (see Table 1).

A large majority of respondents reported that their organizations are enacting a common set of stewardship norms and practices.

The majority of respondents said that they prioritize actions that address many problems at once (78%), invest resources to expand well-being in their communities (78%), share data with other organizations in their communities (73%), have an explicit strategy to improve equity within their organizations (69%), and take a long-term strategic view (58%).

Figure 16: Thinking about your organization’s internal norms and processes, how much do you agree with the following statements? (n=348, % who somewhat or strongly agree)

These are encouraging findings, insofar as they indicate widely preferred practices. But we note that our previous field work with hundreds of organizations across the country has found a persistent gap between stated and actual stewardship behavior. People who are relatively new to stewardship often overstate the depth of their practice compared to veteran stewards, who tend to be more aware of their own shortcomings and room for growth.

Notable Differences

• When asked if they have an explicit strategy to increase equity in their broader community, respondents from hospitals were least likely to say yes (60%) compared to all other sectors (see Table 1). The same was true when contributors were asked about sharing data (securely and confidentially) with other organizations in their communities. Sixty percent of hospital respondents said that they do so, the lowest of any sector.
• Prioritizing actions that address many problems at once (multisolving) is an important stewardship practice. A high percentage of respondents from governmental public health departments said that they do so (88%), followed by community non-profits (79%), hospitals (68%), and business associations (69%).
• A similar pattern existed for prioritizing investments that expand well-being in the community. Ninety-one percent of governmental public health respondents said that they do so, followed by community non-profits (79%), hospitals (75%), and business associations (59%).
• Across all sectors and stewardship practices, setting priorities based on a long-term view (e.g., beyond 10 years) was consistently the practice with the lowest adoption (58%).

Table 1: Responding organizations that somewhat or strongly agree with the following statements (n=348, % somewhat or strongly agree)

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Strengthening Cross-sector Alignment: The vast majority of respondents (94%) believe that working together is the best way for their organizations to achieve maximum impact in their communities, versus going it alone. Most perceived relatively close alignment within their own sector but low alignment with organizations in other areas.

Relevant Stewardship Stance: Stewardship is not a solo act, and it becomes increasingly powerful as more people and organizations are drawn into the work together. A steward seeks to understand the values and priorities of others and to support community well-being in complementary ways and with similar aims.

The vast majority of contributors (94%) said that organizations can achieve more impact by working together, whereas a small fraction felt that the cost of working together across organizations outweighs the benefits. Respondents had generally positive opinions about the effectiveness of working relationships across organizations in their communities, with 54% saying that such ties were moderately effective and 38% saying that they were highly effective, compared to only 8% who reported low levels of effectiveness (see Figure 17).

The vast majority of respondents believe that working together is the best way for their organizations to achieve maximum impact in their communities.

Figure 17: To what extent are working relationships across organizations in your community effective? (n=348)

Most respondents indicated that efforts within their own organization type were well aligned but felt that alignment with other organization types was comparatively low. For example, contributors from public health departments reported strong alignment with other public health organizations (71%) but reported much lower alignment with hospitals (45%) and social justice organizations (11%). This pattern holds true even when comparing perceptions between institution types with higher levels of alignment, where 20% or more of respondents said they were well or somewhat aligned (see Table 3).

Figure 18: Where is the strongest alignment? (n=348, sized by average perceived alignment)

The size of each circle reflects the average perceived alignment among contributors from that same sector (i.e., a measure of within-sector alignment). The width of each line shows the relative strength of perceived alignment from respondents who work in other sectors (i.e., a measure of between-sector alignment). To isolate the alignments for a sector, hover over its circle.

The highest levels of perceived cross-sector alignment were from multisector partnerships (88%), public health departments (83%), and organizations focused on food (80%) (see Figure 18 and Table 2, first two columns). The lowest levels of alignment were reported from organizations that focus on the environment (37%) and housing (24%), as well as businesses (22%) and hospitals (20%) (see Figure 18 and Table 2).

Table 2: To what extent do you think your organization and others are aligned? By “aligned” we mean working in complementary ways towards similar aims. (n=348, % of respondents)

Table 3: Which organization types are well-aligned? (n=348)

Cells show the average perceived alignment among respondents in each column relative to other organization types in each row (cells reflect average percentages).

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Building Collaborative Capacity: Most respondents reported that their own organizations were involved in many collaborative activities with other organizations to support an equitable, thriving community (like assessing and planning for community-wide well-being). But they tended to believe that other organizations were less engaged in these activities. This indicates a need for organizational leaders to better understand the collaborative efforts being undertaken by others.

Relevant Stewardship Stance: A steward always searches for ways to engage constructively with others and strives to identify the unique role that each steward can play. To be effective, stewards ought to lean into their own strengths and assets while actively enabling others to lead in areas where they have expertise and capacity.

ReThink Health’s fieldwork and nationwide research over the past 10 years has indicated that all organizations that support well-being in their communities ought to be involved to some degree in collaborative action, with dedicated investments in integrative activities that make collaboration effective. The types of collaborative activities an organization takes on should be informed by its mission, experience, and capacity.

Most respondents believed that other organizations were less engaged. This indicates a need for organizational leaders to better understand the collaborative efforts being undertaken by others.

Across every type of surveyed organization, respondents reported engaging in collaborative activities to a high degree, most commonly: strengthening collaboration across organizations (97%), supporting policies to expand community well-being (96%), and assessing and planning for community-wide well-being (95%) (see Figure 19). Importantly, these findings indicate a strong normative commitment to collaborative activities, but they do not characterize the strength or quality of particular efforts. Given that only 37% of respondents perceive a high degree of effectiveness in working relationships across organizations in their communities, there appears to be a disconnect between the reportedly strong commitment to collaborate and the quality of those connections.

For organizations to collaborate effectively, it is important that they have knowledge of the ways in which other organizations in their communities engage in collaborative activities. Respondents tended to report that their own organizations had high levels of involvement in collaborative activities but that other organizations tend to be less involved: for each proposed activity, respondents rated their own organization’s involvement in collaborative activities as being about twice that of other organizations (see Figure 19). This may reflect either a true difference between organizations, a weak understanding of others’ collaborative activities, a tendency to overestimate the strength of one’s own involvement, or a combination of the three.

Figure 19: To what extent does your organization—and others in your community—participate in collaborative activities? (n=348, % with limited and active participation)

Notable Differences

• Active participation in collaborative activities was more common among respondents who were affiliated with organizations that see system change as their most important goal (69%). Among those whose organizations never talk about system change, only 33% participate actively in collaborative activities.
• Ninety-one percent of respondents from public health organizations and 83% from hospitals indicated that they actively assess and plan for community-wide well-being, while a much smaller percentage from business and community non-profits say they do (56% and 54%, respectively). This is likely a reflection of the assessment and planning activities public health departments and hospitals lead that are tied to accreditation (public health departments) and IRS requirements (non-profit hospitals).
• Businesses tended to report the lowest levels of active participation in monitoring and evaluation (34%) and working closely with individuals in their communities (38%).

Table 4: Organizations that have active participation or leadership with other organizations, by type of activity (n=348, % selected)

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Surfacing Sticking Points and Fostering Momentum: A significant majority of respondents cited a lack of funding as their primary barrier to fostering equitable well-being in their communities. Financial barriers were also top-of-mind when respondents thought about what would enable their organizations to expand equitable well-being.

Relevant Stewardship Stance: Stewards should adopt an abundance mindset, rather than one rooted in scarcity. That means solving problems by being creative with existing resources, rather than always looking to gather additional resources.

The vast majority of respondents indicated that their largest barrier is funding for services, programs, or policies (82%). Respondents were not limited in the number of barriers they could pick from the supplied list (see Figure 20), yet 41% selected only a single barrier. This suggests that many organizations see themselves as struggling with a narrow set of challenges, rather than contending with a diverse array of obstacles. When asked what would most help their organizations expand well-being, 74% indicated that their greatest need was for additional resources (see Figure 22).

A significant majority of respondents cited a lack of funding as their primary barrier to fostering equitable well-being.

Figure 20: What barriers stand in the way of your organization contributing to equitable well-being in your community? (n=348, % selected)

Although resource constraints are certainly real and an infusion of new resources would provide important benefits in many instances, we note this orientation toward scarcity-driven thinking with concern, because working to increase financial resources often comes at the expense of investing existing resources in more equitable or effective ways. That being said, a large percentage of respondents (45%, see Figure 21) noted that most problems can be improved by being more creative with existing resources (versus obtaining more resources), indicating that mindsets oriented towards abundance are relatively common.

Figure 21: Which statement best represents your view about the resources (e.g., time, money, effort, knowledge, and other assets) that your community needs to expand well-being? (n=348)

In addition to the quest for resources, two other barriers stand out in the survey responses: the need to overcome a focus on short-term results (vs. long-term gains) (27%) and uncertainty or disagreement about what works (24%). In an open-ended question about perceived barriers, respondents cited competition for funding, the tendency for funding to be limited in scope, divisiveness and inefficiency among institutions, a lack of trust between institutions, and a bias towards maintaining the status quo.

When asked what would help their organizations be more effective in expanding well-being, more than half (55%) selected placing greater value on sustaining long-term progress and 43% chose embracing a new narrative for thriving people and places (see Figure 22). In an open-ended question asking about potential momentum-builders, contributors identified leadership development; improved trust and cooperation; as well as greater awareness about system change, equity, and the root causes of complex social issues.

Figure 22: What momentum-builders would help your organization to be more effective? (n=348, % selected)

Notable Differences

• An abundance mindset (i.e., improving problems by being more creative with existing resources) was most evident among businesses (50%) and was cited the least by hospital-based respondents (38%), with public health and community non-profits falling between the two (48% and 44%, respectively).
• A similar pattern existed when assessing whether an unwillingness to disrupt the current system is seen as a barrier. Many more respondents from public health departments (26%), hospitals (23%), and community non-profits (20%) selected that option, compared to only 6% of business-affiliated respondents.
• The opportunity to embrace a new narrative for thriving people and places was identified as a potential momentum builder by only 20% of respondents affiliated with hospitals, much less than respondents from public health departments (52%), businesses (47%), and community non-profits (45%).