Reaching Out for Rural Health: The Story Behind the Healthcare Georgia Foundation's Two Georgias Initiative


This year's Annual Meeting was going to feature the presentation of the 2022 Truist Promise Award to the Healthcare Georgia Foundation for its Two Georgias Initiative, a five-year effort to address health inequities in rural Georgia. Due to the meeting's cancellation, our award presentation could not take place. However, we still want to put a spotlight on this incredible work – below is the article about the Two Georgias Initiative that will run in the upcoming issue of our Inspiration magazine, arriving in late December or early January. Congratulations to the Healthcare Georgia Foundation for its inspiring work!

By Scott Westcott

Foundations face daunting challenges when they attempt to improve the health of people living in rural communities.

Communities located far from metro areas often lack ready access to medical care. Many are virtual food deserts and are chronically short on resources and funding for schools, libraries, social services and transportation options.

Healthcare Georgia Foundation in Atlanta identified these challenges and took them head on – in a big and bold way.

In 2017, the foundation launched the Two Georgias Initiative, an ambitious five-year project to identify and address systemic inequities that, in essence, had created two Georgias divided between better- resourced metro areas and often-forgotten rural communities.

The initiative focused on delivering funding and robust resources to support 11 rural Georgia coalitions to address the most vexing challenges within their communities, ranging from the opioid crisis and high incidence of diabetes, to establishing literacy and education efforts and pursuing economic development initiatives.

Now formally concluded, the initiative produced physical results in the form of new health clinics, food banks, basketball courts, fitness trails, and satellite libraries as well as innovative programming to encourage greater health literacy, educational achievement and effective drug and alcohol rehabilitation.

Woven throughout was an emphasis on building a greater awareness and understanding of equity and how long- standing systemic challenges have often further held rural communities back.

Adding to the challenge was the fact that the foundation’s efforts to address rural health equity came at a time of intense change and challenge – a period that included the reckoning on racial justice sparked by the murder of George Floyd and the COVID-19 pandemic.

“Equity was the north star throughout the Initiative,” said Lisa Medellin, Healthcare Georgia Foundation’s director of programs. “Often, programming similar to this can have equity as a side issue or as an extension. We put equity at the center and really leaned in on that – and I think that was hugely beneficial to the communities for their growth on their equity journey.”

In recognition of this groundbreaking work, Philanthropy Southeast recently named Healthcare Georgia Foundation as the winner of the Truist Promise Award. The award, Philanthropy Southeast’s top annual honor, recognizes an initiative or innovative grantmaking strategy or approach that is focused on significant and systemic issues facing the region and the country.


Laying the groundwork for rural progress



Addressing systemic health inequities in rural Georgia was largely unchartered territory for the foundation prior to the launch of the Two Georgias Initiative. However, in 2016, Dr. Gary Nelson – who at the time was the foundation’s president – visited several rural communities and began to formulate a vision for how the foundation could begin to address the stark inequities he saw during his visits.

An estimated 2.75 million Georgians live in rural communities, and Nelson said both data and anecdotal evidence demonstrated that rural residents faced a significant “health penalty” based on where they call home.

From the start, the foundation realized that to make a measurable and sustained impact, its commitment had to go beyond a pilot program. The foundation looked to the Social Determinants of Health as a guide to taking a holistic and inclusive approach to identifying the issues affecting health and quality of life in rural Georgia.

The foundation also established partnerships with several organizations that could bring expertise and insights to the process and provide ongoing support for the work happening in the field. Among the partnerships developed:

  • Experienced coaches from Georgia Health Decisions were enlisted to serve as strategic thought partners and an on-the-ground resource to 11 rural Community Health Coalitions.
  • To ensure health equity remained front and center, the foundation recruited the Partnership for Southern Equity to provide ongoing expertise to the foundation and host equity conversations and training in each community throughout the life of the initiative.
  • Georgia Tech’s Health Analytics Group developed and deployed a comprehensive measurement approach for improving community health. Georgia Tech’s team created an interactive mapping tool, the Health(care) Data Portal, to help coalitions identify needs and opportunities within their communities.
  • Emory University’s Prevention Research Center joined the team to evaluate the impact of the entire Two Georgias Initiative. The center helped identify local evaluators to work with each community coalition as well as common indicators across all sites for the overall initiative evaluation.


Planning for progress

Communities selected for the initiative were each given one-year, $70,500 planning grants during which the coalitions formed and established community health improvement plans that identified priorities and how to best address them.

While priorities differed from community to community, similar challenges existed in all of them, particularly a dearth of transportation options, lack of quality broadband service and difficulty accessing healthy foods.

In 2020, as the initiative was hitting its stride, COVID-19 created an unprecedented challenge. Nearly overnight, in-person meetings that had been the lifeblood of many coalitions were shut down. The foundation provided free Zoom accounts and offered as much technical assistance as possible to keep communications flowing.

Many of the coalitions pivoted to focus more on food security and bolstering support for mental health services. Additional focus was placed on providing education on COVID-19 and hosting testing and vaccination clinics.

In the initiative’s final year, the foundation hosted listening sessions to capture key insights from participants across the participating communities.

The results of those conversations were crystallized in what the foundation framed as five “key factors for change.” These include:

  • Changes in mindsets: Prior to receiving the grants, partners often described their communities as paralyzed by the complexity of the problems that put their residents at risk of poor health. 

    As the initiative wound down, partners expressed an overarching hopefulness for the future as they continue to set aspirational goals. They describe communities that are taking ownership and responsibility, residents who want to be of service to others and their community, and an overall greater sense of empathy toward others. Conversations continue about intractable issues such as racism, poverty, homelessness, and drug addiction and are working on solutions to these deeply rooted, hard-to-solve challenges.
  • Stronger collaboration: While pre-initiative collaboration varied among the communities, each expressed a lack of consistent and optimal collaboration when it came to issues related to health equity. The foundation’s early decision to require grantees to form community coalitions to identify and address priorities proved to be a game-changer in the way organizations, government agencies, schools, businesses, and individuals work together. The focus on equity helped broaden the range of faces and voices that assembled around tables to represent sectors and populations that often had been left out of the process.
  • Shared vision: By encouraging each coalition to develop a Community Health Improvement Plan, the foundation provided the framework for each community to identify priorities and the connective tissue necessary to pursue those priorities in a collaborative way. Its emphasis on the social determinants of health created broader awareness of the vast web of issues that influence health equity. Now, the 11 communities are thinking longer-term and focusing on more systemic approaches to achieve greater impact.
  • Community capacity: As awareness of health needs deepened and the coalitions got a clear view into existing resources and glaring gaps, they became more strategic. Many communities have since expanded capacity through new or expanded programs and services, strengthened local organizations, created a pipeline of future leaders, and broadened communications. 

    Through initiative funding and grants from other funders, growing partnerships, and volunteerism, coalitions oversaw or aided the development of programs and services that promote healthy lifestyles: community gardens, walking paths/ trails, geocaching, parks, sporting events and exercise programs, nutrition education, farmers’ markets, food pantries and food distribution, gleaning of leftover produce after harvests, and Hunters Ending Hunger, which allows hunters to donate venison to local food banks.
  • Leveraging Resources: It’s difficult to fully leverage resources without a comprehensive view of a community’s health and wellness infrastructure and capabilities. That was largely the case with coalitions in the early stages of the initiative. 

    Coalition members built relationships with regional and state organizations such as area agencies on aging, extension services, and public health, while departments and existing agencies focused on hunger, education, and doing more to amplify impact and pave the way for sustainable change.


Optimism for the future

While the Two Georgias Initiative has ended, there is widespread optimism that the seeds of hope and opportunity it planted will continue to grow. Each community coalition established detailed sustainability plans with strategies for building on the momentum established by the initiative.

Meanwhile, a recent announcement should serve to bolster efforts even further. In November, philanthropist MacKenzie Scott made a $9 million unrestricted donation to Healthcare Georgia Foundation.

“We are honored and grateful to receive this donation, and it arrives at a crucial time for Georgians across the state who continue to face systemic barriers gaining access to the services and conditions they need to thrive,” said Healthcare Georgia Foundation President and CEO Kristy Klein Davis. “Our board and staff are thrilled to utilize these funds to expand upon our work with communities to advance health equity.”

Indeed, Scott’s donation, the largest in the foundation’s history, provides an opportunity to build on work accomplished through the Two Georgias Initiative by continuing to foster collaborative conversations that bring Georgians together around the health issues impacting the state’s communities.

“These funds will help us elevate conversations and further leverage statewide partnerships that will create a better and healthier future for all Georgians,” said Dr. Doug Patten, the foundation’s board chair.


“I’ve seen a big change”

During recent interviews for an upcoming report on the Two Georgias Initiative that will be released in the first quarter of 2023, rural participants spoke of both transformative change as well as countless smaller, yet meaningful victories that have improved quality of life for residents and fostered greater collaboration among local social service agencies, schools and governmental entities. Many expressed the belief that the Two Georgias Initiative can serve as a model for creating sustainable change in rural communities throughout Georgia, as well as the country.

In Early County, for instance, the Two Georgias Initiative made an impact and created momentum that coalition members there plan to maintain.

“I’ve seen a big change for Early County from when we first started with the Two Georgias Initiative,” said coalition member Chakhara Smith, the office manager at Primary Care of Southwest Ga. Inc.. “Today we are more of a caring community. We had the opportunity to come to the table and talk about our differences and share different ideas and see the community come together as a whole to make a difference.

“We’re not going to stop. We’re going to continue on this path to being healthier people, decreasing obesity, and just demonstrating a different perspective on having a healthier life.”

For the foundation’s Medellin, the ongoing commitment from the community coalitions even after the grant period has ended demonstrates the potential for foundations to be a catalyst for sustained change.

“Investing in rural communities is a worthwhile effort,” Medellin said. “While rural communities and their needs and their challenges may be different than those in the urban areas, there is a commonality that people really like to have involvement and input into what’s happening in their community. It’s not about coming in and dictating what needs to change, but empowering them to address the issues most important to their community.”


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