Melinda French Gates and MacKenzie Scott Pitch in for Student Health

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Earlier this month, two of the most powerful women in philanthropy stepped up to support healthcare for American students. Melinda French Gates’ Pivotal Ventures and MacKenzie Scott provided a combined $23 million to the School-Based Health Alliance (SBHA), which works to support and expand school-based health centers across the United States. Though the philanthropists’ commitments were made separately, SBHA announced them together.

School-based health centers provide students with primary care, and most provide mental and behavioral healthcare. Many offer oral and vision care, as well. Access to school-based healthcare has been shown to improve both academic and health outcomes, particularly for students from low-income families who often lack healthcare access. But despite the effectiveness of this approach, it reaches only a small number of students. There are about 3,900 school-based health centers around the country, serving a small fraction of the more than 25,000 Title 1 schools (schools with a high percentage of low-income students). 

“Our goal is to establish health centers in every one of those schools,” said Robert Boyd, president and CEO of the School-Based Health Alliance, in a recent interview. 

Support for school-based health centers is an obvious fit for MacKenzie Scott, whose firehose of philanthropy has included gifts to an array of community health centers around the country, as IP reported recently. Scott has also provided grants to health conversion foundations that increase health access in underserved rural areas of the country. 

Pivotal Ventures, created and backed by Melinda French Gates, is best known for its support of women and girls — it has committed $1 billion to “expanding women’s power and influence in the United States,” according to its website. Women and girls of color are a particular priority, as Ada Williams Prince, the organization’s director of program strategy and investment, wrote in an IP guest post last year.

In addition, Pivotal Ventures backs mental health for young people, caregiving, paid family and medical leave and more. Along with the Susan Crown Exchange, Pivotal Ventures was also a founding funder of the Center for Digital Thriving, which was established recently at Harvard.

The $23 million in total support from Pivotal Ventures and MacKenzie Scott will allow the School Based Health Alliance to broaden its reach. “These investments acknowledge the urgency of addressing youth health today and will help us expand healthcare in schools through a mix of innovative services, training, and advocacy for policies that make sense for communities and families,” Boyd said when the new funding was announced.

Healthcare on campus

Why school-based healthcare? Robert Boyd put it simply: “Because kids are in school — that's the easiest place to catch them. And when you start talking about the schools we're serving — primarily Title 1 schools with 80% of the kids on free and reduced lunch — parents often can't get away to take their kids to see the doctor. Or if they do, not only do parents miss work, their kids miss school. School-based centers provide care right on site.” 

It shouldn’t come as much of a surprise that access to healthcare isn’t distributed equally among America’s children — abundant evidence attests to those gaps. The Community Preventive Services Task Force, which was established by the U.S. Department of Health and Human Services, found that “Children from low-income and racial and ethnic minority populations in the United States commonly experience worse health, are less likely to have a usual place of healthcare, and miss more days of school because of illness than do children from the less economically and socially disadvantaged populations.” 

Pointing out that access to school-based healthcare boosts both educational and health outcomes, the task force recommended “the implementation and maintenance of school-based health centers (SBHCs) in low-income communities to improve educational and health outcomes.” 

The School-Based Health Alliance has been working to fulfill that goal for more than a quarter-century. SBHA provides support to existing school-based health centers and technical assistance to local healthcare organizations that want to open centers in schools; it also advocates at the state and federal level.  

SBHA’s board is made up of people with prominent positions in health policy, education, nursing, mental and behavioral health, social work and care coordination. It also incorporates the perspectives of students themselves, with members of SBHA’s Youth Advisory Council serving as voting members. “We're an all-embracing alliance of everybody who is focused on getting kids the healthcare that they need now,” Boyd said.

Two funders, two funding styles

This isn’t the first time Melinda French Gates and MacKenzie Scott have backed the same causes. For instance, they partnered to fund the $40 million Equality Can’t Wait Challenge, which sought ways to expand women’s power and influence in the U.S. and wrapped up in 2021 with awards for four winning initiatives.

In 2022, both joined other philanthropists in supporting the Gender Fund, which aims to raise $1 billion to promote equality and women’s leadership in Africa, Asia and Latin America. And just last summer, the two pitched in, along with the Diller-von Furstenberg Family Foundation and Expedia Group, on a $45 million project to renovate the Seattle waterfront. According to the Seattle Times, French Gates personally reached out to MacKenzie Scott to ask her to support the project.

In the case of SBHA, the simultaneous donations from Pivotal Ventures and MacKenzie Scott were the result of coincidence, not coordination. Pivotal Ventures and the School Based Health Alliance have been in discussions since 2019. There was a lull during the pandemic, after which the conversations continued in earnest, with Pivotal Ventures exploring how best to support young people. “What they wanted to do was focus on coordinating care for students in schools, to make sure that students and their families had access to healthcare, mental healthcare, and the resources they need,” Boyd said.

The funding from Pivotal Ventures — it committed $16 million — will help launch care coordination initiatives in Atlanta, Chicago, Houston and Miami. Boyd believes the initiatives will help SBHA develop a model that can be used in other areas of the country. This plan was already in the works last fall when Boyd got word that MacKenzie Scott was giving his organization $7 million. The funding from Scott will allow SBHA to expand its work still further.

While Melinda French Gates and her team reportedly advised MacKenzie Scott when she began formulating her approach to philanthropy, the two women manage their giving very differently.

“It is interesting to consider the different styles of these two funders,” Boyd said. “MacKenzie Scott has her people out there finding out what is what, they do their due diligence and determine how much they're going to give you. It's no strings. She's basically taking the attitude of a venture capitalist: ‘Hey, you're a great organization with great people and a great mission and a great reputation, I'm going to give you additional resources to go ahead and do what you think you need to do.’” 

In response to philanthropy watchers who fret about Scott’s approach and the potential risk of giving big, unrestricted gifts to small nonprofits, Boyd was dismissive. “Those people don’t understand that nonprofits like SBHA have been managing with nothing for years,” he said. “When someone comes along and offers this kind of support, we’re not going to screw it up. That’s just not going to happen.” 

Pivotal Ventures, on the other hand, worked closely with SBHA to develop a relationship over a sustained period, according to Boyd. “They’ve got an amazing team,” he said. “I’ve worked with many people in philanthropy who don’t listen. They listen. Over the years, we’ve built a level of trust, and they know that whatever they ask us, they are going to get an honest answer. Our goal is to make sure that all kids have access to healthcare, because healthy kids learn better. It’s really that simple.”