Racism is embedded deep within America’s public health infrastructure as it is in so many systems in our county.

COVID-19 was an introduction to this fact for many white Americans. They saw—in some cases for the first time—how the inequities in our health systems are deadly for people of color. But for Black and Brown Americans, this was just the latest manifestation of the structural racism within a system allegedly designed to keep all Americans healthy and safe—a system in desperate need of change. And it is up to us in philanthropy to make that change possible.

Look back through American history, and you’ll see how our modern public health system was built with racism deeply rooted in its foundation. Whether it was the Hill-Burton Act of 1946 permitting Southern states to use federal funds to build “separate-but-equal” hospitals, or the exclusion of service and agricultural employees from the National Labor Relations Act of 1935, which kept Americans of color from unionizing and gaining health benefits, a racist system was built, brick-by-brick. And as each brick was added, a structure of severe inequity became calcified.

That history built the system we have today: one where Black, Latinx, and Indigenous Americans are more likely to suffer from chronic diseases like diabetes and heart disease, and more likely to die from cancer. A system where Black, Latinx and Indigenous women have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care. A system where nonelderly Indigenous and Latinx people are more than twice as likely as their white counterparts to be uninsured.

For those of us in philanthropy, the question is how we can use the resources at our disposal to change this racial injustice. This presents both challenges and opportunities. Challenges, because the healthcare system is so vast, opaque, and full of bureaucracy. We at the New Commonwealth Fund for Racial Equity and Social Justice have a significant opportunity, because we are not bound by endless red tape and decades of doing things the same way. We have the power to disrupt the system at its core by starting fresh and showing the healthcare industry what an anti-racist health system looks like.

In my work with the New Commonwealth Fund for Racial Equity and Social Justice, health equity is one of the five pillars of our grantmaking. And while we are far from the end of our journey, we have learned some valuable lessons about how to effectively fund work in this space. Here are a few takeaways:

Trust leaders of color to know the needs of their communities. This is, frankly, a lesson that should be applied across all types of grantmaking. The philanthropic system has its own issues with racism and needs to evolve accordingly. This means investing in founders of color with bold visions to disrupt systemic racism and co-creating metrics and measurements together. It means distributing responsive and strategic and deeply impactful grants to ensure giving is aligned with the needs of the organizations being supported, allowing organizations like The Neighborhood Birth Center—Boston’s first birth center—to secure a 5,000-square-foot building in the heart of the city’s communities of color. As funders, we can either create a culture based on distrust—one where nonprofit leaders are constantly working to back up metrics that we have imposed upon them—or we can choose to respect those leaders and foster mutual trust by giving them the space to execute their vision and co-create metrics.

Invest in new models of healthcare delivery with the potential to scale. Disrupting health inequity means demonstrating that alternatives are not only possible, but worthy of broader investment. In Massachusetts, 99 percent of babies are delivered in hospitals. Investing in a program that delivers safe, midwife-assisted births would result in fewer C-sections, lower rates of preterm birth, and fewer babies born with a low birthweight—all issues that disproportionately affect moms and babies of color. The Neighborhood Birth Center is Boston’s first midwife-run birth center, but with continued success, it will certainly not be its last. Another example is Vital CxNs, led by an organization taking a grassroots approach to improving Boston’s community health ecosystem by tackling the city’s persistent and pervasive health inequities and fostering collaborations.

Invest in organizations and coalitions that can leverage system-wide change. Rebuilding our system of healthcare delivery will be a long, hard road. Making the current system more equitable is in some ways more challenging, but just as necessary, to create change with the urgency that’s needed. This means investing in organizations—like the statewide Health Equity Compact—that were created with the expressed purpose of changing health systems from within, either through legislation or public-private partnership. These organizations need the financial and institutional support to grow and thrive, and build power and credibility in their respective spaces.

Changing America’s health system is daunting work. There will be days when–as nonprofit leaders, funders, and advocates–we feel like “the little train that could.” But this is a fight that needs to be won if we are to become the just, equitable, healthy society that we all deserve.

Dr. Makeeba McCreary is president of the New Commonwealth Fund for Racial Equity and Social Justice. She lives in Boston.