How can the collective impact approach put anti-racism at the center of its work?  How can collective impact work authentically center Black and Pacific Islander families, as it focuses on improving infant and maternal health? In this podcast interview, FSG Senior Consultant Miya Cain explores these questions and more with the Executive Director of Expecting Justice, Dr. Zea Malawa, building on their time working together on the early stages of the initiative. This interview is an unbridged version of an article shared in the Stanford Social Innovation Review titled Bringing an Anti-Racist Approach to Collective Impact.

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Please find a transcript of this podcast lower down this page

Resources and Footnotes


Music

The Intro music, entitled “Running,” was composed by Rafael Krux, and can be found here and is licensed under CC: By 4.0. The outro music, entitled “Deliberate Thought,” was composed by Kevin Macleod. Licensed under CC: By.

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Podcast Transcript

Welcome to the Collective Impact Forum podcast, here to share resources to support social change makers working on cross-sector collaboration.

The Collective Impact Forum is a nonprofit field-building initiative and online community that is co-hosted in partnership by the nonprofit consulting firm FSG and the Aspen Institute Forum for Community Solutions. 

In this episode, we feature an unabridged interview with Dr. Zea Malawa of the collective impact initiative Expecting Justice. This interview is part of an online series in the Stanford Social Innovation Review that explores the collective impact movement 10 years after the original article was published in SSIR. In this interview, we learn about Dr. Malawa’s work with Expecting Justice, a collective impact initiative that supports maternal and newborn health in San Francisco, California. Dr. Malawa describes how Expecting Justice has embedded anti-racism measures throughout their work, and what they have learned through the process. Interviewing Dr. Malawa is FSG senior consultant Miya Cain, who supported the work of Expecting Justice in the early stages of the initiative.

Miya Cain: Hi everyone. Thanks for joining us today. My name is Miya Cain and I am senior consultant with FSG, one of the host organizations for the Collective Impact Forum. I am delighted to be here today hosting a conversation with Dr. Zea Malawa, an incredible, extraordinary physician, leader, and devoted advocate for children and families in San Francisco. Today’s conversation is part of a series of pieces marking the 10-year anniversary of the original article, Collective Impact. In this series, we are looking at how the practice of collective impact has evolved over the past 10 years and elevating important learning and experiences from folks across the field, like Zea. One key theme throughout the series is how equity can be included as an essential component of collective impact work. I believe that there is truly no one better to talk about doing this work, collective impact with antiracism at the center, than Dr. Malawa. Actually, because we have had the chance to work together, I may just drop the formalities if that’s OK and call you Zea throughout the conversation.

Zea Malawa: I would prefer that. Thanks, Miya.

Miya Cain: With that, could you just tell us a little about yourself, Zea, and what brought you to this work?

Zea Malawa: Sure. I am Zea Malawa. I've been a pediatrician for over a decade and my practice has always been in safety net clinic studies. That was always my intention when I went to medical school. I’ll say probably like eight or nine years into practicing medicine, I started to feel really heartbroken all the time because it was really clear that what I could bring to my patients in the clinical setting was not getting at what the problem was that was ailing them. I was working with a lot of Black and Brown families and many of them were really experiencing the social and health consequences of racism and what is very frustrating is that vaccines have no impact on discrimination in schools and telling parents to keep their kids’ car seats facing backwards until age two does nothing to help parents protect their kids from police violence, for instance. Bearing witness to systemic racism and the toll that it was taking on kids no less and seeing parents who were so helpless to be able to protect their kids from this racism, it really started to impact I think my health and wellbeing, especially being a Black mom myself and being able to relate so closely to these parents. I quit my practice and I went to school for a year and got a master’s in public health and when I came out, I was really clear that I wanted to try to produce great health for kids of color by trying to use policy leaders and really trying to center systems change as a mechanism for creating a healthier future for the kids of San Francisco. That’s kind of how I got here. 

Miya Cain: That’s awesome, Zea. Thank you so much for sharing how you moved from clinical practice to really thinking about the broader system. Could you just tell us a little bit more about Expecting Justice?

Zea Malawa: I love talking about Expecting Justice. Expecting Justice is our collective impact effort. We started in 2017, in the fall of 2017, the idea that we wanted to address racial disparities in preterm or premature births within the city of San Francisco. For people who don’t know, rates of preterm birth which is when a baby is born before 37 weeks of pregnancy. Those rates are very disparate depending on your racial background. In fact, maternal health outcomes in general are some of our most shameful and upsetting health disparities because they are some our widest health disparities in this country, some of our most persistent health disparities in this country, but also some of our most devastating because they're impacting newborns and brand-new mamas. So it’s really important that we figure out how to ensure that everybody in this country has the opportunity to have healthy, safe pregnancies. That was really kind of what the impetus was behind the launching of this call to do that. I knew that, when I was interviewing for the job of leading the backbone, I was really explicit that if I got this job, I wanted to address racism as a root cause of these disparities. Although I'm a physician, I didn’t want to talk about clinical interventions. I didn’t even want to talk about how we could help people get to prenatal care earlier. I really wanted to talk about some of the racialized experiences that I know Black birthing people were having that was creating stress, which was leading to the adverse maternal health outcomes. I wanted to talk about things like economic exclusion and high rates of racialized unemployment in this country. I wanted to talk about the criminal justice system and gentrification. That’s what I wanted to talk about if we were going to create birth justice. Needless to say, they offered me the job and I've been true to my word and we’ve been really trying to think about how we can operationalize this idea that racism is at the root of these birth disparities when we’re trying to address the issue. 

Miya Cain: So important. I remember just the beginning of that project, starting that work with you and thinking through how could we actually bring racism as a root cause into the work, with the steering committee, really make sure that they were addressing those issues as well. Actually, speaking of the steering committee, maybe we should step back. Could you help people understand how the effort is structured and who is involved in the work?

Zea Malawa: Yes, you know, early on, I guess what was unusual a little bit about our collective impact effort is that the backbone staff kind of got hired as a first step in our collective impact and then by the funder. And then I, as the leader of the backbone, turned around and invited a steering committee. Although that’s a little bit of an unusual sequence, one of the advantages of it is that it gave us the opportunity to be really thoughtful about what sectors we wanted represented in the steering committee. 

Again, I think oftentimes because this is a health-based issue, people want to default to having primarily people in the healthcare sector kind of guiding the work. It gave us the opportunity to really be intentional about bringing people from some of the other areas that might impact birthing people. So we have people from early childhood, that field represented. We have people from social services, including a human services agency. Of course, we have doula agencies and a doula nonprofit represented. We have the Federal Reserve Bank represented, which has been really interesting and amazing because they bring some very outside-the-box ideas. And then of course, we do have some of the major birthing hospitals and the Department of Public Health represented as well. We also have San Francisco Unified because the school district touches so many of our parents and families. It’s really important that they're involved in solutions. 

But maybe most importantly who’s on our steering committee are Black and Pacific Islander mamas who are also the prioritized populations that our collective impact effort is focused on. I say most important because to be antiracist in your intervention means that you have to understand how racism is manifesting for a given community and a lot of times in this country, we’re very simplistic in our understanding of racism and people of color. We assume that if you're a person of color you are probably experiencing racism in the exact same way as any other person of color when in fact, that’s not true. How racism lands on a Vietnamese immigrant is very different than how racism is landing on an urban Native American, which in turn, is very different from how racism might be landing on a middle passage Black person in this country. So if we want to actually create antiracist change, you need to have a deep understanding of the problems so that your solutions can fit. In order to understand the problem and all of its nuances, the best experts are the people who live that life every day. 

So we center these mamas and we never take a vote without hearing from them first and making sure that we understand their perspective on and really center it when we’re making important decisions. We also believe that their expertise is one of the most important expertises—is that a word, expertises—on the steering committee and so we pay accordingly. We pay our mamas on our steering committee $100 an hour. That makes perfect sense to me although I know a lot of people balk. If you were doing a research study and you needed to hire a statistician and they were charging $100 an hour in San Francisco, that would probably not be that surprising and you would probably pay it because you recognize that you need that expertise. Likewise, I just want to push everybody who’s listening to this podcast to think about how essential and valuable is the expertise of folks who have lived this life and then how do you represent that value in the way that you compensate these participants on the committee.

Miya Cain: Yes, Zea, I’m so glad that you said that. It’s so important that we’re really valuing the expertise and the work and the labor of people of color and mothers, people of color, in this country so thank you so much for doing that and naming that for all of us. 

Zea Malawa: Do you remember how uncomfortable people were at first with this idea of paying the mamas? Like do you remember how that was a little bit of a struggle with our administration, which in retrospect, is kind of disappointing but I bet not unique.

Miya Cain: Yes, I think people were like, “A hundred dollars. It’s so much. Can we do 20 or can we do a gift card, things like that?” And we were like, “No. A hundred dollars an hour is what you would pay anyone else. That’s how much it costs for a piano lesson, a voice lesson, a massage, you know, and this is really important work and we’re going to compensate people for the time.”

Zea Malawa: The fact that we even had to have that conversation, in retrospect, there’s so racism in that because we would never consider paying an electrician with a Safeway gift card, with a grocery store gift card. Furthermore, like a $20 grocery gift card. I don’t know why we think that is good enough for people who have this kind of valuable expertise that we need for our collective impact effort. Anyways, if there is somebody who’s listening to this that is having a little bit of an internal reaction to the idea of paying mamas so well, I would just encourage you to really kind of evaluate what kinds of racial biases you might hold and really question whether or not you would have that same kind of reaction if we were talking about paying somebody in a different field or context. 

Miya Cain: Yes. I'm over here snapping, Zea, for all of it. I just wanted to kind of step back a little bit and ask you why collective impact was a helpful framework to start out with for this project. We changed it along the way when we were working together and then you continued to evolve it but why was it a helpful place to start?

Zea Malawa: I think one of the reasons why it was a helpful place to start is because when you think about racism, this organizing principle that has really guided the development of this country for over four centuries, it can feel really huge and it can feel like really overwhelming like where does one begin to dismantle this gigantic deeply integrated problem. So I feel like collective impact provides a framework or a series of steps to be able to figure out how do you take little bite-size pieces of this really giant problem and turn those tiny bites into a meaningful solution that might create something significant for the people that you're working with and for. From the whole perspective even of needing to be intentional and take the time to create a common agenda, if you're doing antiracist work that inevitably is going to force you to not only think, get on the same page around solutions but get on the same page about problems. And when it comes to issues of race and racism, that’s really important work because I have found in this country not very many people have a deep or nuanced understanding of how racism functions. I don’t think that’s an accident. I think in a lot of ways we obfuscate the presence of racism and how it plays out as a means of maintaining the system. When I say we, I'm speaking about the larger we of the United States and the systems that we have in place like our educational and justice systems. 

So having the opportunity to build a common agenda, having an opportunity to think about how we’re going to hold ourselves accountable through shared measurement gives us an opportunity to really kind of unpack maybe some racist assumptions that we have when it comes to doing social service work and also to kind of level-set around what our understanding of the problem is and what our understanding of the solution is. In particular, to be able to do that work with folks who have the lived experience of navigating racism every day and folks who are in charge of major systems and institutions in the locality where you're doing the work. That’s a pretty powerful connection and set of bridges that you're building that can manifest and eventually become something very powerful by connecting those two kinds of spheres of understanding.

Miya Cain: Yes. And the problem of racism is such a huge problem and such a deeply rooted problem and then even the challenge of disproportionate or inequities in birth outcomes is huge. You mentioned taking this really big problem and breaking it down into bite-size pieces. I was wondering if you could explain a little bit more about what the core strategies of Expecting Justice are. What are those pieces that you broke this work down into to start to chip away at this immense problem?

Zea Malawa: I think in order to answer that I think I'm going to kind of talk about how we got there. I'm going to start there because when our steering committee first showed up—in San Francisco, we’re in a funny position because wokeness is very valued in this city and performing wokeness is very essential for most high-level nonprofit jobs in the city. But that doesn’t necessarily mean that people understand it or have fully connected in an empathetic way to the issue. We had to spend eight months with our steering committee of relatively progressive liberal thinking institutional leaders really making sure that people actually understood what racism was, what health equity means, and what it might look like on the ground. 

Part of that work I think was getting up, working up people’s bravery and helping people find their bravery to think about doing something big and ambitious and outside of the box because we don’t yet have a lot of evidence-based solutions for dismantling racism. That is not something where you could just like go to a journal and be like, “OK, I have the funding and I want to do this. What does the evidence say?” 

I think that for the last 20 years so much of the nonprofit world has been pushed to be so data driven that the idea of taking on something that is not evidence based felt really, really scary to many of our steering committee members. We kind of had to make peace with this idea that if we actually wanted to create a meaningful impact we were going to have to go way out on a limb. So we kind of produced a lot of data and information to make the case that we had a few different options ahead of us. We could do something very safe but we could rest assured that the impact would be very small. Or, we could do something that’s kind of middle-level risk and feel reasonably confident that we would have middle-level impact. Or, we could just go big and do something that is hugely risky and untested with the possibility of being able to create a really big impact. So we kind of laid those options out for our steering committee about where do you guys want to be on this range of risk and impact? 

Ultimately, after eight months of sensemaking that we were doing together while building a common agenda people kind of landed on let’s take a chance and do something big because what else is collective impact good for, why else have we been bothering? 

With that being said, what our three initiatives are: Our first initiative is around increasing access to doula care. Part of that is the most straightforward like building an accessible doula program that can offer doula services to birthing people at no cost. So yes, we definitely did that and continue to support it and it’s really exciting. We also do antiracist doula training and this is a little bit more outside of the box because we are funding to train Black and Pacific Islander birthing people and other folks from those communities to support one another through doula work and we’re intentionally bringing critical race theory and antiracist practices into the doula training so that when our doulas come out, they're not only able to support people during birth but they're able to help mamas navigate and respond to racism when it occurs in a clinical setting. 

Even that is not enough so we also have also been working on introducing legislation at the state level and we are really close. We’re just waiting for the governor to sign off on SB65 to have Medicaid cover doulas in California. The governor, frankly, has already—and thank you—put that initiative into the budget that got passed. These are the different kinds of levels of impact that we’re trying to have with doula access. So likewise, we do antiracism skills building work across the city. That’s different from implicit bias training. That is probably even different than a diversity, equity, and inclusion training. What we’re really trying to do is teach the hard skill that people need to do in order to do antiracist behavior and create antiracist policies and practices in our institution. Those are things like how can we teach you to receive feedback about racism? How can we teach you to give feedback about racism? How can we teach you to engage community in a meaningful way so that they can have a say on the budget that you're putting together? These are the kinds of skills that we are building through our second initiative around the skills building. 

Our last initiative and the one that is maybe most ambitious and untested is called the Abundant Birth Project. What that is is the first in the United States basic income for pregnant people. Through that program we are giving Black and Pacific Islander pregnant people $1,000 a month starting as early in pregnancy as we can find you and lasting through six months postpartum. Again, because we know that programs are not enough to solve systemic problems, we’re looking at what we can do to connect systems change to that work. Also, as part of SB65 which we call our California Momnibus Bill we introduced legislation that would have a basic income for all pregnant people who are low income in California and we’ll be piloting that over three years. Also, at the local level, we have a basic income working group and we’re really pushing the working group to consider in particular how we can support pregnant people who are Black and who are Pacific Islander since that population is most at risk for adverse outcomes. So we’re pursuing multiple routes of sustainability while simultaneously piloting this outside-the-box intervention and that to me is what it looks like to do antiracist systems change work through collective impact. 

Miya Cain: Wow. This is amazing. It’s just so incredible to hear how you’re thinking at every level how can we support mothers, how can we bring in mothers’ voices, and then how can we change the system along the way and make it something that’s sustainable. I love the Momnibus bill that you named it. So let’s just talk a little bit more about the five conditions of collective impact because I think it will help us to really try to break down how you got here, how you were able to bring antiracism into this work in such a clear and intentional way. So we started out by talking about the common agenda, and you were starting to tell us about how it took a lot of work to get the steering committee on the same page around solutions, and also on the same page about the problems that the committee is facing so I’m wondering if you can share a little bit more about how you made those problems real for the steering committee and how you moved people who were hesitant to do something big to, you know, doing work that’s never been done and piloting a project that is the first in the country.

Zea Malawa: Thank you for asking. It was a journey. I’m not going to lie like after our first steering committee meeting, I was a little bit worried because I had heard so many perspectives that were clearly based in a racist standpoint, and I was like, “Oh, no. These are the people that we just signed up to dictate how this effort is going to move forward.” We clearly have a lot of work to do. I guess one of the first things was to just kind of acknowledge the way that I myself had been socialized to approach this problem from a very racist place. I personally feel like my years in medical school really kind of embedded in me a lot of kind of racist notions about how you take care of people of color, paternalistic notions, this kind of idea that people of color are having such a hard time in society because there’s something inherently wrong with them. They’re not smart enough. They’re not educated enough. They don’t work hard enough. So much of that I feel like is propagated through many professional schools, and people who end up going into helping professions, and so I think one of the first steps was just kind of acknowledging that so many of us have kind of been taught that these are individual-level problems created by individual-level behaviors and individual-level choices, and therefore our solutions need to be fixing these problematic individuals, and so just kind of starting with the acknowledgement that that’s probably where we all are coming from, and recognizing the ways in which that’s problematic. 

We also really wanted to kind of activate people’s empathy around this issue because many people understand racism in an intellectual way but they may not understand what it’s like to live it. So in order to do that, what we did was we created a series of case studies that were parallel case studies. There would be two kinds of personas. One of the personas was racially privileged and the other persona was somebody who was experiencing racism but they’d be up against similar barriers. 

For example, we have two moms and they both smoke and they both have nutrition challenges. They are taking in too many calories and it’s impacting the baby. However, one mom, the racially privileged mom, was able to connect with a physician that she related to, and that physician was able to give her suggestions around nutrition that made sense to her and so she was able to kind of change her diet. That physician also was able to talk to her about her smoking in a way that made her feel empowered and able to change her smoking so she was able to quit. That mom also happens to live in a neighborhood with a lot of really wonderful grocery stores and beautiful parks, and so doing exercise regularly or accessing groceries is really easy for her even though she has a full-time job. 

Then you take this other mom who is also contending with poor nutrition and smoking, and this mom is Black, and she was unable to connect with a doctor that is racially concordant with her, and when she did connect with a doctor, the doctor ended up shaming her very much for being both overweight and for smoking, and so she didn’t feel inspired or empowered to make changes in her lifestyle but even if she did, she lives in a neighborhood with very few grocery stores and a lot of convenience stores and fast food restaurants so it’s difficult for her to access healthy food. She also has a very long commute on public transportation to get to and from her full-time job, and lastly, it’s not safe to exercise after work in her neighborhood, and so it takes a lot of effort for her to be able to engage in the exercise that the doctor recommended. 

So we presented two cases like this where you can see that two moms might be up against the same barriers but because of the structures around them, their choices in how to address the barriers are very, very different. I mean the range of choices are available. 

So we made four cases like that, and after we kind of presented each case to the steering committee, we did a sensemaking activity, either the iceberg of understanding so people could kind of think about it at different levels or we did empathy mapping which is a tool from Design Thinking so that people could really kind of think about what it might be like to be the mom who is experiencing racism in those circumstances. 

Then after they did their sensemaking, we actually created infographics that show some of the statistics to show that these are not just kind of random hypothetical cases but in fact the majority of Black pregnant people live in neighborhoods where there isn’t access to groceries. The majority of Black pregnant people live in neighborhoods where there is an overabundance of tobacco advertising, and so those kinds of activities I think started to help our steering committee understand that they may not have as strong of a grasp on this issue as they had thought coming in. 

Going forward like I said, we also used a fair amount of data because I think many people who are skeptical need to see data in order to know that it’s real, which is frustrating because if you live in a city and your eyes are open, you probably can be clear that structural racism is happening because it is very easily observed and yet very often, we have to convince people additionally with numbers and data. So we did a lot of that also. 

But I think the critical turning point for our steering committee was actually probably about eight months in, right before we got to deciding what our first focus area was going to be. One of the mamas on our steering committee who had been there since the beginning, she hadn’t talked very much about things that were personal to her. She would share perspectives about what she thought needed to happen but she hadn’t spoken much about things that were personal to her, which made sense because none of us were. 

But an article in April 2018 came out in The New York Times about America’s black maternal health crisis, and most of our steering committee read it, and it really just kind of contextualized I think what we were talking about for our steering committee. So this mom felt moved to share her birth story, and it was a terrible birth story, and she was treated horribly by the providers. I think for our steering committee who had gotten to know this mom very deeply over those months, and they understood what an incredible woman she is, how capable she is in expressing what she needs and what she wants, and to see that even this woman was treated this poorly by San Francisco physicians who are generally so liberal and progressive, that even she was having this experience I think it activated our steering committee in a different kind of way because it became personal. This mom who we had all become friends with over the last nine months was treated so unfairly and her experience was not unique. This is no longer just her problem or a problem for them over there, this is all of our problem. So once it became all of our problem, then it became a question of what will we do to solve it, and that really freed us up to do some wild stuff.

Miya Cain: Thank you for that, for combining the importance of data with also the importance of stories, and I also like that you pointed out that this mom that was on the steering committee didn’t share her story until eight months in so she wasn’t just there as a token mom to have her story paraded around. She was actually a decision maker as part of the steering committee, and she was sharing as a colleague and a friend of the steering committee members, and not just as a mom, you know, as a mom. I think that’s really important to point out for people who are listening, that the stories that people share can be really powerful but that we shouldn’t be only tapping into people for their stories.

Zea Malawa: Thank you, because I also again think that the ways that all of us have kind of been taught to think about community, community engagement, and people of color more broadly is that our perspectives are valuable but only in certain ways, not universally, and to have an antiracist collective impact is to allow the folks who are there representing community, the full breadth and range of dignity and community that you give the other steering committee members so thank you for naming that.

Miya Cain: Thanks, Zea. So let’s move to the second condition of collective impact, shared measurement. I was wondering if you could talk a little bit about how we actually hold the steering committee accountable for the outcomes that we want to see, and particularly for antiracist outcomes that we want to see in the city.

Zea Malawa: I’m going to be really honest. This is a place where we have really struggled. I guess one of the things I will say is that data, how we typically use it as a form of evaluation, is not usually constructed in a way that is particularly accessible for folks who don’t deal in data. 

So one struggle is just even how do we get the entire steering committee to a level of understanding around data and evaluation such that everybody can participate meaningfully in the conversation around what metrics will we choose, and so we had to really invest, I think maybe like four or five meetings really just all of us getting on the same page around what metrics are available, what metrics are useful, etc. 

But even after we did that and we came to a place where we were kind of clear on what metrics we wanted to evaluate ourselves on, it turns out that data is not often collected because what we generally collect data on are individual-level outcomes, and what we generally don’t collect data on is systems change. In fact, this many years into the effort I still can’t tell you how one measures systems change and I’ve been really trying to find out. So as a result of that, you kind of run the risk of kind of pigeonholing your collective impact solutions into individual-level efforts because that’s the only kind of data that you can collect so that kind of works against trying to create antiracism systems change when you can only evaluate yourself on individual-level change. 

So we’ve been really struggling around that. We’ve been kind of thinking this through using a results-based accountability framework, and results-based accountability really demands that we ask not only like how much should we do but is anybody better off as a result of us doing it, and when you start to try and think about measuring is anybody better off, it gets very tricky because we might collect data, for instance, on who got to prenatal care and when but what we’re not collecting data on is did they have a positive, affirming, dignified experience but that positive, dignified, affirming experience is what is going to make or break prenatal care, is what is going to make or break whether or not prenatal care is actually contributing to a healthy birth outcome. 

So I feel like what’s really challenging is that because in general the field of data science and evaluation is very much rooted in a perspective that does not consider race or racism. It’s really hard to use those tools as they exist right now to measure antiracist effort. I want to be clear. That’s not to say that we shouldn’t be held accountable for creating antiracist effort. On the contrary, fighting racism is so hard, you need extra layers of accountability to make sure you’re actually doing it and not chickening out or shying away or etc. But it can be really difficult. 

I guess one of the other things that we use in addition to certain data points and trying to cultivate more valuable data is we use community accountability. Can you show your face in this community? We don’t just have like one or two community members on our steering committee. We are at a place where nearly half of our steering committee members are community members and so there’s an accountability in that because they show up and they have to face off with mamas who maybe didn’t get their needs met when they go home from the meeting. I mean now they’re always home because it’s Zoom so maybe the mama is like right there in the background during the meeting. 

Anyways, I guess what I’m offering is that shared measures is one way to create accountability but it may not allow you to create accountability around antiracism and dismantling racism so what would it look like to incorporate other layers of accountability while also pushing the data scientists in our midst to collect data around systems change and structural change as opposed to just individual-level change?

Miya Cain: I really liked your point that the traditional data methods that we have may not be enough, they may not be sufficient for actually measuring antiracism and the kind of systems change that we want to do, and that community accountability is so important as well. Earlier, Zea, you shared the three strategic pillars of your work, the increasing access to doula care, the skills building around antiracism, and also the Abundant Birth Project. So I was just wondering if there’s anything else you wanted to add for people who are listening about the importance of mutually reinforcing activities.

Zea Malawa: Yes. I mean one challenge sometimes is that if you don’t bring your entire steering committee along on the antiracism journey, then they’re not going to be able to mutually reinforce your antiracism activities. So again, it’s why everybody kind of has to get on the same page because if some people are talking about race-neutral interventions, that actually might be undermining those people who are trying to get racially specific with their interventions recognizing that, you know, racism is at the root. 

So that has been hard, and furthermore I guess another thing is that in the United States, our laws are not set up for antiracist, and so there is varying levels of risk aversion that one might find on their steering committee in terms of people who are willing to say the word racism or acknowledge that racism is the root cause or maybe even just acknowledge that maybe some of your service providers in your agency are biased. So I feel like as far as antiracist work and mutually reinforcing activities, if people are not all on the same page about antiracism, then some of their activities might in fact be racist, and then instead of being mutually reinforcing, they might be cross-canceling, and so when it comes to racism, one might feel a sense of urgency understandably because especially if you’re working with kids and families, you can feel the window closing for a given kid. It closes so fast. We don’t have six years to waste to make an impact on a kid’s life, and so on the one hand you might feel a sense of urgency, and on the other hand if you rush this work, you’re going to end up with unsatisfying results and cross-canceling activities so you have to put in the investment to bring your steering committee along.

Miya Cain: Thank you. The fourth pillar of collective impact is continuous communication. I’m wondering if you have any advice for listeners on continuous communication. You had just started to say the importance of having these difficult conversations around antiracism and even getting people comfortable saying the word racism. Are there other aspects of communication that you work on through your work?

Zea Malawa: Yes, I mean two important aspects. I think the first piece is around narrative like when we think about why have we so comfortably sustained such deeply racist systems in this country for so long when most Americans would probably don’t agree with racism? Like that’s really important to think about, and I think the reason why we’ve been able to maintain it so long in large part is because of narratives. When you take my issue around Black moms, think about what are the narratives around Black moms. Think about the welfare queens that politicians from Nixon up to Mitt Romney and Trump have been operationalizing to galvanize their conservative voters. That narrative piece is part of what continues to make it difficult to work safely in this country, and so we’re really, really thoughtful when we’re engaging with the media in particular but in any space about how we can push the narrative around the larger societal narrative around our issue whenever we’re communicating about it. 

I think that the other piece around continuous communication is just recognizing who you’re communicating with because different folks in different spheres use different mechanisms to communicate, and if, for instance, you’re pushing out an email newsletter regularly as one of your mechanisms for continuous communication, think about who is likely to see and read an email newsletter, and who’s going to miss that. For us, we think about publications, for instance. When we get a little bit less busy, we have so much that we need to publish about but who is going to read what very much depends on where you publish. So in a way to be inclusive, we’re trying to think about publishing in both academic journals and in the popular press, and what would it look like to even put an even shorter, more bite-sized version of whatever we publish on our social media so that we can be continuously communicating with not just our steering committee members that are leaders of institutions but also with the community and also with folks from all walks of life. So I think that to be antiracist in your communications to just really make sure that you been thoughtful about who accesses what forms of communication, and once you’ve thought about that, that you’re inclusive in your communication to reach as many folks as possible.

Miya Cain: The fifth element of collective impact is the backbone, and I know that you play a really strong backbone role. Could you talk a little bit more about the importance of a backbone and what a backbone actually does to make an initiative like this run?

Zea Malawa: I don’t know if I can talk too much about the importance of a backbone in general because I don’t know too many. I mostly know my collective impact effort, and I can say we are very important. I would imagine that they’re generally super important for keeping everything together but I will say that when I was first brought on to lead our backbone, I had the pleasure of kind of having a collective impact coach because I wasn’t familiar with the framework when I first got hired into the role. She taught me a lot about what it was going to take to run a successful collective impact and when we were kind of talking about the role of the backbone, I feel like—I’m trying to remember the right analogies that were used but it was something like you’re the coach but not the quarterback. It’s some kind of football analogy. It’s this idea that you kind of support the effort but you are not the decider or the leader but rather you’re just kind of like hold it up. 

But the problem is that if you’re trying to do antiracism work at least, not a lot of people have a strong antiracist vision, and in particular people who are established in their field, maybe leaders of their institution, it’s hard to become a leader of your institution if you’re deeply antiracist. Those two things it turns out, being deeply antiracist is generally not compatible with promotions I have found, and so we can’t just assume that institutional leaders are going to be able to lead an antiracist collective impact effort because presumably if they could, we wouldn’t have so much racism in our institutions. So part of the job of the backbone actually is to push people out of their comfort zones, is to help people I think consider things that they haven’t considered. 

I think the backbone, if you’re going to have an antiracist collective impact needs to be really experienced and really well versed in antiracism so that they can know when the steering committee is adequately wrestling with the issue, when the steering committee is, you know, adequately creating solutions, and sometimes that involved me doing some one-on-one with steering committee members to kind of check in on where they’re at and what’s been hard for them. It’s required all of us in the steering committee to have some uncomfortable conversations on a regular basis, and for me as the lead of the backbone, it’s required me to actually put a pause or a break or disagree with some of the decisions that are made, and while I would never—I don’t empower myself to unilaterally veto things. I will sometimes put a pause after we’ve taken a vote to name what might be some of the impacts of the decision we make and make sure that everybody still wants to co-sign on those impacts but in order to be able to do that, I need to be able to understand potentially what are those racist impacts. 

I will say for folks who are trying to build that expertise, there is a tool in the interwebs called the Racial Impact Assessment Tool. It’s free and it’s put out by Race Forward so that can be a really good place to start if you’re trying to understand whether or not the work that you’re doing is going to have a racist impact or not but I feel like that idea of a kind of more passive backbone probably won’t work if you’re trying to create an antiracist collective impact unless you’re dealing with institutional leaders who are extraordinarily well along on their antiracism journey. 

I wanted to say as somebody who grew up in this country my entire life, I can say it’s virtually impossible to get to the age I am, the mid 40s, and not be racist. All of the TV we consume, all of the radio, all of the books, all of the education is all based in a very White supremacist perspective, and so whether we notice it or not, we’re being socialized to be racist constantly. So when I’m saying that our institutional leaders probably don’t yet have the skillset, I’m not saying that our institutional leaders are all racists and just trying to make things terrible for people of color but I am saying that we in this country have not made that a requirement for our institutional leaders, that they’ve done this intensive dismantling of racism that they’ve socialized prior to taking on these critical roles, and so somebody needs to have that expertise and so ideally that will show up in the backbone.

Miya Cain: I’m really hearing the importance of the backbone having antiracist expertise and also the backbone not being neutral. It’s important for the backbone to have a strong vision and a strong perspective, and not just continue—keep the work moving forward on the track but actually be steering towards a north star.

Zea Malawa: Exactly. As a leader I was agnostic on the specific solutions that we came up with but I was very, very opinionated on whether or not we were going to be having antiracist impact. So as we were trying to identify solutions, if it felt like we were identifying a solution that was not going to have the impact that we had stated in our common agenda we were hoping to have, it was my job to name it but it was not my job to automatically throw out this or that solution. I can be agnostic about the specific solutions as long as I am clear and driven on the impact we’re trying to have.

Miya Cain: So important. Zea, we’ve just talked about the five elements of collective impact, and when we’re walking through these five conditions, it can kind of make the work feel technical or formulaic but we all know that in practice this is not how things go. It’s not how change happens. Change is messy, and I’m curious how you’ve thought about the cultural and relational parts of this work.

Zea Malawa: I mean again, one thing that I will name is that you have to be in relationships in order to be able to grow your empathy around issues of race and racism, and that can be sometimes hard because in general what professional culture looks like in the United States is that you maintain a certain level of distance in your work relationships, and that you don’t bring too much emotion and emotional nuance into the work. So it can be confusing, hard, and frankly it can feel uncomfortable for a lot of people to show up to the collective impact in that space in a different kind of way and so we’ve tried to use tools to help people. 

One of the things that you brought, Miya, to our very first collective impact meeting with our steering committee was that you thought about bringing in elders from the community. So if you recall on the very first meeting, we brought these four elders, Black women who live in San Francisco, and we had asked them ahead of time to write something, to write us a little something about what brought them to San Francisco when they were girls and what dream did they have for themselves, and then to write about what dream do they have for their great grandchildren. Starting the whole steering committee grounded in the dreams of these Black matriarchs of our community already it was like a very different tone than any other Department of Public Health meeting that I’ve ever attended. And then when we still met in person, you know how important food was to me. I really felt like it was important that we provided lunch, and like it was a really delicious lunch, and that furthermore we paid someone from our prioritized communities to make that lunch, and so we were always catering from the Black and Pacific Islander communities which was amazing because then it just gave our steering committee one more way to build a connection that isn’t just distanced and sterile to these communities. 

So I think by having deep check-in questions, we asked in our most recent steering committee a couple of days ago, we asked who raised you? Take 60 seconds to tell us who raised you. Tell us three things about them, and having something so personal like that can be so important to build those relationships. In general I think taking the time to get to know one another on a more personal level and actually building things into your meeting that would encourage that kind of connection will ultimately make the work richer. 

You know, there is a wonderful article by somebody named Tema Okun where she kind of describes White supremacy culture at work, and one of the things that she kind of describes in this White supremacy culture is kind of these transactional interactions. I guess what I would say is that there is definitely a time and place for transactional interactions but I don’t know if that time and place is in the steering committee. So when you take the time to build those personal relationships, you’re not only setting the stage for deeper and richer work, but you’re also introducing people to a different way of being in a professional work space that frankly is often much more pleasant and comfortable for people. So in doing that, that’s like a different kind of systems fitness and systems change that you’re introducing through the work also.

Miya Cain: I remember that first meeting after the mothers wrote letters. I think it was like a letter to their great grandmother and then they told their birth story, and then a letter to their future great granddaughter. I remember that there wasn’t a dry eye in the house after that, and it really signaled to me that this was something different, and to others that this was going to be a different kind of work. I think I just want to share that this has been a transformational relationship, and even being part of this early work has changed the way that I approach my work at FSG now. I try to bring music. I try to bring stories. I try to make sure that we’re building relationships with each other as a team, with our clients, with communities, with whoever we’re in contact with, that we’re living our values through every aspect of our work so thank you for that.

Zea Malawa: I love that, and you know it’s so important to us that we do that well, that we ask about that in our end of the meeting evaluations regularly, and if we don’t like the numbers we’re getting back, then it means that we need to be more intentional about building relationships. Similarly, we ask, “Are you comfortable talking about racism in this space?” and at first people were not, and so we intentionally did things to grow the percentage of people who did feel comfortable talking about racism. I mean nobody’s ever going to feel 100% comfortable but I don’t want people to feel so uncomfortable that it’s shutting down the conversations.

Miya Cain: I know we’re coming to the end of our time together, and I was just wondering what most surprised you about this work? What was most unexpected?

Zea Malawa: I mean one thing I will say that was unexpected is how ill-equipped collective impact framework was, at least at the time to create equitable solutions. I think it was a little bit surprising how many blind spots the initial framework had. I mean even just when putting together the steering committee, the initial charge was to find institutional leaders which makes sense because they are the decision makers but when you think about how institutional racism works, inevitably you’re mostly recruiting people of racially privileged backgrounds. So just the fact that there wasn’t like an acknowledgment of those kinds of challenges, I think that was surprising in like a not good way. 

I think on the other side, something that has been surprising in a really good way is how excited people have been about this work. I mean I would imagine this is probably true in all cities but in San Francisco there are just so many people convening so many different initiatives and there are so many meetings that you have to go to, and it is tiresome and confusing to know where to put the energy in, and I myself attend a lot of meetings that just have no impact but we are this many years in and so many of our original steering committee members continue to come back and continue to feel excited because I think that they are feeling the changes that we’re making and they can see that we’re having an impact. So I guess it’s a little bit surprising that we’ve been able to make an impact on racism because that’s always surprising but I think it’s also pleasantly surprising that this experience has been meaningful not just for me and for the communities that we prioritize but also for a number of the institutional leaders who have so many meetings that they could choose from every month and they still continue to choose us.

Miya Cain: I think that goes back to what you were saying about this not just being transactional. It’s transformational relationships and that really helps people stay connected to the work and to each other, and the community accountability that you were sharing earlier as well. I think people really see themselves as responsible to the community and as part of the community. So, Zea, we are at time. I could talk to you for hours. Is there anything else that I should have asked you that I didn’t or anything else that you would like to share for people who are really trying to incorporate antiracism into their work.

Zea Malawa: I guess one of the most important things to share is I think you just—you have to stick with it. It’s going to be so hard. As a backbone leader I had to believe in it hard enough for all of us in order to bring this to life. There were so many times when it felt like it wasn’t going to happen or maybe would be easier to pivot, and there is this way that I have to hold the vision and believe in it so hard that nobody else could even doubt it, and that takes so much energy I guess I would say to keep the cynicism at bay but I guess I just want to remind people why we need to invest that kind of emotional labor, and that is simply that as a Black mom, I can say that I cannot alone keep my son safe. I literally need everybody else’s help. When one in 1,000 Black men in this country die because of police violence, every single Black mom, we need your help. I wish there was a way that I could know that my son was going to be safe and I wish that I had full control over it on my own but I don’t. So this is a genuine plea from me to everybody who might be listening to this podcast. On behalf of myself and all of the other moms of color out there who just want their kids to have their fair share of the daylight, and grow up to be the happy, wonderful, healthy human beings they were always meant to be, on all of our behalf I’m just requesting that everybody don’t just do the easy thing but dig into the hard work because our kids are worth it. We can’t do it alone so I think that’s what I want to say.

Miya Cain: Thank you so much, Zea. I’m not a mom yet but I’m going to be a Black mom someday, and I have a Black mom, and I just would echo your plea to all of our listeners to really do the work. Do the work to change the system so that all of us, all of our kids, all of our children’s children have a chance to thrive. Thank you so much for your time today.

Zea Malawa: Miya, thank you so much for hearing all of my ideas and making space for them. It’s always a pleasure to be able to work with you.

And this closes out this episode of the Collective Impact Forum podcast. If you are interested in learning more about what was discussed, you can find links to resources in the footnotes of this podcast, including a links to the SSIR series Collective Impact: 10 Years Later where this interview is featured.

We would like to acknowledge that this episode was produced and edited on the unceded, traditional lands of the Coast Salish people, including the Duwamish, Suquamish, Stillaguamish, and Muckleshoot tribes. We honor with gratitude the land itself and the past, present, and futures of these tribes.

The Intro music for this episode was composed by Rafael Krux and our outro music is composed by Kevin Macleod.

This is Tracy Timmons-Gray, Associate Director here at the Collective Impact Forum, and your podcast host. I want to say thank you so much for listening, and we look forward to connecting with you more in our next episode. Until next time, we hope you are safe and well.

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