March Brunch and Learn

Making the Case for Equitable Healthcare Systems

By Dr. Tiffany Manuel

At TheCaseMade, we work with leaders and organizations from all over the world who care that
our health system is just. We work with these organizations because they have a vision for a
better world and are working hard to bring that vision to life. The challenge, of course, is that it’s
hard to get other folks to lean forward when we talk about "justice" for many reasons, not the
least of which is that there are always so many competing priorities. With COVID and its
aftermath making our entire country collectively rethink what they want and need from our
health systems, there has never been a better opportunity to make the case for equity and justice;
to center the experiences of those most in need; and to be act with bold intention!

If we don’t do it now, we will miss perhaps the best opportunity we've had in decades to
connect people to the health and well-being that we all deserve.

Our CaseMaking partners at Rippel Foundation/ReThink Health Initiative have made a serious
effort over the past few years to strengthen their internal leadership around CaseMaking and to
advance the skills of stewards across the country who are making the case for change. They’ve
created a strong narrative for system change and built the capacity of program staff to make the
case for equity. 

And they’ve learned along the way. In a recent TheCaseMade Brunch and Learn conversation,
our Rippel colleagues and partners from Jefferson Health/Thomas Jefferson University Hospital
and Build Healthy Places Network shared how CaseMaking has changed how they talk about
justice, frame the solutions that will take us on the journey to justice, and tell stories that get
people to come along. 

Let me set the table first. Building public will around a health system centered on justice must
reckon with the legacy of the systems we’ve inherited. The health systems we have today were
built for a different time, were not built to ensure universal access to all, are woefully out of date
and inefficient, and were created on racialized systems of oppression that do not correspond to
the values we hold today.   

The good news is that we can choose a different future and leave a different legacy for the next
generation. Here’s how our panelists are helping us to get there:  

Strengthening the CaseMaking muscle. CaseMaking is a leadership skill distinct from
communications and marketing. It is a joyful invitation to others to join the work to create health
care systems centered around justice. Panelist Jane Erickson, director of learning and impact at
Rippel: ReThink Health, said, “Ultimately, it's an exercise in entirely reframing what the work is,
and why it's important.”  

Our panelists said CaseMaking had not only changed how they speak about their work to
improve health care, but also how they think about it, how they raise funds, how they design
projects, and whom they bring to the table. 

When you build the CaseMaking abilities of your staff, you are investing in your organization. 

Flexing the casemaking muscle on their storytelling. Storytelling is a part of our humanity. It
brings the people we need to get the work done on board. But how you tell the story also matters.
Panelists Bobby Milstein, director of system strategy at Rippel: ReThink Health, and Elizabeth
Dale, executive vice president and chief advancement officer at Thomas Jefferson University
Hospitals, mentioned the importance of avoiding “backfires” that distract people with negativity,
and instead, “merging” narratives to tell a story of “us.” 

When raising funds for health care initiatives aimed at equity, it’s important, Elizabeth said, to
“merge the benefactor story with our story with the story of those that will benefit from
philanthropy. Narratives matter so much to a fundraiser. [Through CaseMaking] we've been able
to not only recast our conversations with benefactors but also our materials. It's really been
transformational.” 

Extra helping of solutions, fewer helpings of problems. Panelist Ruth Thomas-Squance, senior
director of field-building at Build Healthy Places Network, also pointed to the importance of a
system focus: “What are the systems of structural oppression and structural racism that have
created the environments that bring [negative] outcomes?”  

Focusing on solutions means being aspirational — having a vision for what our systems could
look like so that everyone thrives and a vision of what justice looks like.  

I liked these examples from Jane: “We at ReThink Health and Rippel, and with a lot of partners
in the field, really are focused on using words like ‘thriving together.’ ‘Building belonging.’
Things that are both a process and an outcome. And you as an individual know what it feels like
when you're thriving. You can look at a community on the whole and be able to feel viscerally
whether others are experiencing those things as well. So, it's a really effective way to widen the
invitation in a way that feels really grounded, actionable, and inspirational for people to join in
the work with you.” 

Breaking the silos and multi-solving. As Bobby Milstein said, “a system built for justice is a
multi-solver.” It will bring about equity not only in health care but also housing, food security,
education, the environment, and employment. And prevention, a watchword for many in health
care, is important but it’s not the same as justice. 

Too often, people feel there are too many issues to solve. But framing our issues as a matter of
justice, “Gives people the ability to think not just with their head, but with their heart and their
hands to participate in something different,” Bobby says. “You've got them in a very different
place.” 
Power shifting is what we're after! Core to CaseMaking is being radically inclusive, bringing
to the table people who never thought they’d be at those tables, and reminding them they have a
place there. Too often, people left out of systems of power think of themselves in terms of “haves” and
“have-nots.” They don’t see themselves as having the ability to change things — other people
do. 

One way to get people to recognize the power they have to make change is reminding them of
times in history when we did powerful things together — and reminding them that now is a
powerful moment in history.