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North Sound Accountable Community of Health

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Liz Baxter

November 2022: Giving Thanks

November 29, 2022 by Liz Baxter Leave a Comment

Our communications team will tell you that writing the ‘newsletter update’ is the hardest task they ever assign to me, mostly because writing something brief is so much harder than writing something long.

From now through the end of the year is often when we gather, feeling gratitude for those we love. In his blog, Kareem Abdul Jabbar described it this way: “Thanksgiving is the start of a month-long celebration of gratitude for those we love and those who love us. And for the whole glorious, improbable idea of selfless love. We always hope that if we cherish this month enough, it will last longer into the year.” We wish that for all of you. 

As November 2022 comes to a close, here are a couple of things that are top of mind for me. 

  • Even though it is from a few years ago, please take a minute to read this piece from Candice Wilson which was in a past newsletter. We had been chatting about what the holidays mean to Indigenous community members, where traditional Thanksgiving is based on a false narrative about turkey and pilgrims and Native people. 
  • So excited that 29 people from the North Sound region spent time in Phoenix to attend Race Forward’s first conference since 2018! Being in space with 3,000 people, predominately leaders of color, was powerful, inspiring, and also tough. Listening to leaders, especially young and emerging leaders, trans youth, high school students, artists, and others share the ways that they are fighting racist policies and structures filled me with many strategies that we could support here in the region, and having partners together with our team in Phoenix deepened important relationships.
  • We just passed the one-year anniversary of flooding that left more than 2,000 families displaced in Whatcom and Skagit counties. Households, where English was not the primary or first language, became our focus for support last fall, and it has continued throughout the year. Resources were accessible to those who could navigate the complexities of EOCs (Emergency Operations Centers), FEMA (Federal Emergency Management Agency), LTRGs (Long Term Recovery Groups), online website applications, and reporting sites. Our team and community-based partners (who used these same resources during COVID testing and vaccine response), brought people and resources together in Spanish, Mixteco, and other Indigenous languages. We were able to expand our team to include going door-to-door to check on community members in flood-impacted areas. As the weather heads toward wet and cold, those families are definitely top of mind still.

As our team and our partners raise expectations that we will learn ways to become anti-racist, and incorporate that into our actions alongside themes of equity, belonging, and targeted universalism, we must also remember to be kind to each other. To quote one of our partners “there is no blueprint for the work we’re undertaking.” Working across five counties, it’s easy to let our frustration outweigh the power of partnership, and sometimes harder to accept that we need space for learning at all steps along the continuum. We can make this region a space where all feel they belong – and this means focusing in on those who don’t feel that today. That is the heart of our work, intentionally leaning in to support those who are most often left out. 

We’re grateful for all you do, and as this year starts to wind down, we appreciate that we are on this journey together. To quote the curriculum guide for Facing Race in Phoenix, “Justice requires action and the time for action is now. For equity. For everyone. Because we are all this together.”

Filed Under: CEO Update

Working together to uphold Vital Conditions

October 28, 2022 by Liz Baxter Leave a Comment

It has been almost one year since a “greater than” 100-year flood impacted Whatcom, Skagit, and other counties around the state of Washington. Close to 2,000 households were displaced in North Sound, and one year later many of those families are still waiting for repairs or permanent placement. 

Access to affordable housing was already severely limited, and the flooding increased the demands on scarce options, leading to some tough trade-off conversations. Who do you prioritize during an emergency – households who have been waiting in a queue for months or longer, or those impacted by an emergency asking to have their needs met more quickly? These are tough conversations and they will remain tough for some time to come.

I saw a picture (right) this week of the air quality around the Space Needle in Seattle and, even though so many of us have been living with the smoke, this picture posted by Washington’s Emergency Management Division tells an unhealthful story.  

When we see air quality like this, it’s why we have such respect for the Vital Conditions for Well-Being (click here to see our Resource Library, as it calls out a thriving natural environment as being essential to health and well-being). This air quality was not just unhealthy for vulnerable community members – it was unhealthy for all of us. So imagine those among us who didn’t have a safe place to stay inside and wait out the smoke, but because of housing insecurity were forced to stay outside and breathe that air. I know we do heating shelters in the winter, and cooling shelters when it’s too hot. Are we now looking at needing clean-air shelters as well? 

We’re happy to see cooler weather and rain dampen the fires and clear out all the smoke. We’re also aware that community members are anxious about another wet fall, and what is on the way. There is a network of partners who have been meeting to discuss flood response and the next few meetings will focus on preparing for what comes next as the rainy season continues. With this network, we’ll be better prepared than we were 12 months ago. We have lots of partners in Whatcom and Skagit to thank for that, and both counties now have Long Term Recovery Groups set up for households still recovering from last fall.

Our team has also been heading to meetings – yes, in-person meetings. A successful presentation at the WA Public Health Association meeting on the Collaborative Action Network, and a chance to interact and brainstorm with ACH teams from across the state at the HCA/ACH Learning Symposium happened in the same week in October. We’re beginning to plan our first in-person partner convening for January in three years (Save The Date announcement coming soon!). We’re going to take our technology learnings from remote meetings and use them to optimize real-time meetings. Yes, that should be fun!

We also have about 40 people (partners, board, and team members) from across the region heading to Phoenix, AZ to attend the Facing Race Conference; continuing to learn the language that will allow us to identify, mitigate, and dismantle structural barriers is a commitment we have.  We look forward to bringing those learnings back to the region. 

We appreciate the time and energy that you put into learning and planning initiatives with each other and with our team. Thanks for providing those chances to work together and see how far we can go! 

Filed Under: CEO Update

Collaborative Action Network: Aspirations and Actions

October 3, 2022 by Liz Baxter Leave a Comment

I am often asked the rationale behind the common agreements that we have asked all partners to commit to. For those who aren’t familiar with them they are linked here.

Since 2014, when leaders from across five counties and eight tribal nations formed what is now North Sound ACH, the underlying focus on advancing equity has been present. To further that end, in December 2020 the Board of Directors made this even more explicit, adopting a set of goals for the organization to ensure that all people in the region have access to the conditions relied on every day for well-being. Operationally, we incorporated those goals into contracts between us and our partners – the set of common agreements mentioned above. 

In a recent , questionable billing practices of nonprofit health systems for patients at or near the federal poverty level were explored, and examples were used from one of our health system partners, Providence. (Please also read the response from Providence at this link.)

As a backdrop, the Affordable Care Act set requirements for nonprofit health systems to disclose their charity care, an intention to help the most vulnerable individuals and families in our communities. Some states, including Washington, followed by enacting legislation to identify if and who would be eligible for free or discounted care; you can find a brief description of Washington’s requirements at the Attorney General’s website.  

It is unacceptable when practices leave people at lower income levels to be buried in even more debt when there are programs to mitigate those circumstances. But we cannot jump to condemn the individuals and caregivers who work with those systems, who have been serving patients under some of the most trying conditions our nation has ever faced. When system-level decisions are made, the systems must work to acknowledge and correct those system-level decisions.   

Regionally, we are working to change the conditions that leave people suffering and struggling, and advance strategies where all community members can thrive. It is a worthy goal, and we’re grateful to have a wide array of regional partners on board with us, including strong practitioners from Providence.    

We believe in what our partners have committed to – not just in writing, but in action. We also believe that North Sound ACH can be of support as our partners navigate tough times. As we have done in the past, we will provide a space for anyone to join in advancing equitable well-being across the region, with our partners and even within our own team here at North Sound ACH. This requires that we all are able to point out when we or I stumble and to work together to do better.

Filed Under: Announcements, Board, Cultural Humility, Equity, Partners, CEO Update Tagged With: Liz Baxter, CEO, collaborative action network, board goals

Intersections

July 29, 2022 by Liz Baxter Leave a Comment

When I became an adult, I could not get a credit card unless my father or (if I had) a husband to act as co-signer. I could not have had a jury of my peers because not all states allowed women to serve on juries. There was no protection for women who were raped by their spouses as there is today. 

Laws and policies evolve – not just to ‘match the current prevailing opinions’ – but to recognize that our system of laws are imperfect and don’t always support and protect everyone in the same way. It takes years of advocacy to make the laws read the way they should in a truly democratic society. It does not happen by accident; it happens with intent. 

Most laws were written at a time when women, Tribes, immigrants, and people of color were not considered to be full human beings with full rights under the law. There was an underlying presumption – sometimes explicitly stated, and other times implied – to support and maintain those in power to stay in decision-making positions and protect us from others who were considered inferior. This ironically also meant that those in power were in wealth-generating positions. 

I mention all this because we often think that injustices were/are so far ‘in the past’ and that the arguments today are somehow easier or not as important. 

We all stand on the shoulders of someone who came before us, and we should all be determined to leave this world a better place for future generations – that is the work of creating new legacies. 

So, at risk of being mildly political, it matters who that next judge is, who sits on school and community college boards, who determines water quality, transportation routes and utility/broadband access. We spend so much time on statewide and national candidate races, we might forget that decisions that impact our lives are often much closer at hand. 

Here in Whatcom County, ballots are due on August 1. Please vote, and talk to your families, including teenagers and young adults about running for office, even if it is for a city or community role. One way to change the course of our future is to change who is making decisions on our behalf. 

I was on a national policy call recently about health system transformation and equity, when several men spoke to the need to include gender equity in racial equity dialogs this year because of the backward slides they were seeing in their own states around women, decision-making autonomy, rights, and access to care and services. 

If we want to create a region where all people feel that they belong, where we address systemic and structural barriers to inequity, and leave new legacies for the future, 2022 provides lots of examples for how we can move forward, without giving states the power and authority to diminish the rights of women, to control what happens within our own bodies, or to control how we protect the environment, waterways, air quality, etc.

We are imperfect. We are working to dismantle long held beliefs and structures. And, I have more faith in what we can accomplish when I look at the groups of individuals and organizations coming together to do this tough work. 

Thank you, as always.

Filed Under: CEO Update

Why Do We Focus on Equity?

June 28, 2022 by Liz Baxter Leave a Comment

Since 2018, when we first started contracting with clinical and community providers, we have asked for twice-yearly updates reporting on progress, challenges and how to mitigate them, and what aspects of innovative work can be sustained without Medicaid Transformation Project dollars. The past two years have been challenging for staff and the people they serve. 

Every six months one partner or another will raise the question of why we focus so much on equity when we could be looking for administrative or legislative fixes for reimbursement or access issues. I get an email from one of my staff, each reporting period, asking “what should I say to this partner in response?” I usually have a long-winded answer, but the crux of the matter is this – we cannot create a culture of belonging without advancing our understanding of communities around us, their history, and the structural barriers that have disadvantaged them over decades or centuries. We cannot work in true partnership to co-design or co-create new initiatives or projects unless we understand who gets left behind by common ‘one-size-fits-all’ approaches. 

The last couple of months have been brutal. People are struggling, suffering, and dying – violence, extreme heat and flooding, and limited or no access to basic needs. Our region’s two northern counties still have thousands who are displaced by flooding in the fall, looking for permanent housing and that is on top of those who were looking for housing already. This impacts all of us, which is why we all have to understand and see our roles in what happens next.

We have the contradictions of close to 20 mass shootings over Memorial Day weekend, coupled with the knowledge that Congress has been deadlocked on gun legislation for close to 30 years. While they are stymied, children were being killed on the streets and in school buildings. I wonder if Congress would be deadlocked if they were debating the best ways to nourish, feed, and educate children. I want to believe that well-intentioned, smart people represent us in Congress and I want to help them focus on the questions and issues that will make communities safer and healthier, and allow people to thrive. 

I collect photos of my family – we are a diverse collection of people connected by love. Perhaps for that reason, I also am moved by images that others create and share during these tough times and I want to share some with you. Not because I am trying to influence your point of view or politics, but because they are all asking questions that point to what I call ‘the creative tension’ in most decisions. Rarely is there a decision made where one solution benefits everyone; typically the choice made will advantage some and might disadvantage others, especially if we aren’t paying close attention to intended and unintended impacts.

I know that I gravitate toward images that affirm my viewpoint, but sometimes they challenge my thinking too, which I appreciate. I would also appreciate you sharing images or thoughts that have moved you and that you’d like to share. North Sound ACH has tried to stay in a nonpartisan space, which I also appreciate, but addressing gun violence and the public’s safety is a debate that will occur in many settings over the coming years. I have to believe that we will come out on the other side with a brighter future ahead, but it won’t happen if we stay within a debate designed by lobbyists from any side. We need to come at this as community members who actually care about the people in our communities – all the people, leaving no one behind. I hope you will join in those dialogues with an open heart and an understanding of our history of laws and policies that have left legacies of structural and systemic exclusion in many communities. 

We emphasize equity so that our team, board, and partners understand the past and present, and find ways together to make the North Sound region a place where all people feel a sense of belonging and find ways to thrive, leaving no one left behind. We believe we can craft new legacies to leave for future generations.

Washington Post Article to Link: More than 311,000 students have experienced gun violence at school since Columbine.

Filed Under: CEO Update

Find and strive for our ‘universal goal’

May 27, 2022 by Liz Baxter 1 Comment

Liz’s Note, May 2022 newsletter

Such tumultuous emotions this week …

I happen to live one block uphill from an elementary school, and every morning I hear the background noise of children arriving and entering the school building. On Wednesday morning I stood and intentionally listened to those sounds instead of leaving them in the background of a busy morning. After another unimaginable night for families, my heart continues to break for them, thinking of the thousands of times that I dropped off my sons at school, never fearing what could happen to them before the end of the day. Our children should be safe, allowed to live without fear of violence, especially in places meant to nurture them and help them grow. That is part of our obligation to them, and the people who surround them.

I spent time talking with partners this week about what targeted universalism is and how much setting the ‘universal goal’ matters, as opposed to identifying a universal strategy. I asked them to imagine how different it would be if our goal was to keep all children safe from violence and harm. Gun control and safety is one of many strategies but it is not the only needed strategy. We also have to think of all the elements that result in young people targeting other young people for death in such horrific ways. Young people are hurting, facing trauma and don’t have the needed support around them to make their way through alone.

I refuse to believe that we are powerless to make these circumstances change. 

Two events come to mind for me – I joined many at Skagit Valley College last weekend for the Spring Powwow. In the wake of Buffalo and California, I was moved to tears watching four generations of dancers from one family as part of the Grand Entry in the afternoon, knowing that for too long, tribes were forbidden from practicing these traditions. Seeing young people as part of rebuilding these traditions is so impactful.

And on Wednesday evening I traveled to Shoreline to watch my grandson compete in a district track meet. I again found myself battling my own anxieties of having so many children gathered together, wondering whether some circumstance would put them in danger, and I felt I needed to be there, to make sure they do not feel alone. They are our future and worth every minute of our time to assure they have every opportunity to thrive. 

I mentioned to one of my team that I remember the day when each of my boys began to understand that they could feel two conflicting emotions at the same time. Happiness and pain, fear and gratitude, hope and anxiety. That is where I am when each of these events rips through a community. I realize that while Buffalo and Uvalde seem far away from Northwest Washington, we had our own experience in Marysville not so long ago. Every community is just like ours, and what happens there happens to all of us too. 

Hug your loved ones, and please wake up each day with a desire to change this world for the better, because we can do that work if we act together. 

Be well,

Filed Under: CEO Update

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PO Box 4256, Bellingham, WA 98227
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