The evolution of the Fund for Public Health NYC with Sara Gardner

Sara Gardner is heading into her 15th year as the executive director at the Fund for Public Health NYC, and it is no surprise that she has such longevity. Prior to being ED at FPHNYC, she was at EngenderHealth for two decades working to advance sexual and reproductive rights and gender equality. That made her no stranger to crisis response, leading FPHNYC since 2008 through a recession at the time and later through COVID-19.

Gardner has worked with six Department of Health and Mental Hygiene commissioners during her tenure and used the FPHNYC’s unique model of public-private partnership to mobilize the philanthropic community and support the DOHMH’s endeavors. That included during Hurricane Sandy and the ongoing opioid and substance misuse crisis. Her expertise on the evolution of FPHNYC throughout the years, the ever changing relationships between the public-private sector and the challenge of advancing public interest while balancing the evolving priorities set by new mayors and their administrations is knowledge that sets Gardner apart from many ED’s. 

She was also included in City & State’s Responsible 100 last year.

This conversation has been edited for length and clarity.  

You were at EngenderHealth for two decades and then decided to move on to FPHNYC. What led you there?

During college I traveled to Africa. I spent a semester there and it ignited a passion in me for international work and public health. I decided to leave college and I joined the Peace Corps. When I came back, I moved to New York to go to graduate school and I ended up working with an international nonprofit organization that focused on women's health, sexual and reproductive health. But as things go, I was there for almost two decades, and my kids were young and I wanted to be around. 

I decided I wanted to stay in public health and in the nonprofit sector. When I started looking around I realized what a great Department of Health we have here in New York City. It was a wonderful time for public health in the city with Mayor Bloomberg and Dr. [Tom] Frieden at the helm of the Health Department. I interviewed and got the job, and it was kind of a perfect next step for me having been 20 years, with my first career in international health. Now, moving to public health work in a premiere health department in the country, if not the world, I get to work in a city that I love, with such tremendous diversity. There's so many different cultures and languages and neighborhoods in New York City. It was a great next step for me.

You became the ED of the Fund for Public Health in 2008 and have led the Fund through many crises, including the 2008 recession and later COVID-19. What advice do you have for other leaders when leading an organization through multiple crises?

My main piece of advice would be transparency and communication. I think we saw this particularly hit home with COVID-19. There's been other crises during my tenure that didn't impact my team or my office as COVID-19 has. COVID-19 transformed the way we work in New York City, even nationally. It's just been a seismic change. We work in such close partnership with the health department, to help them expedite critical initiatives and leverage private philanthropy, and the volume of work increased so much overnight. I think over time with the increased volume of work, our systems and our staff capacity were maxed out pretty quickly. Like a lot of other nonprofits, we had to go 100% remote, and navigating a crisis, an all-hands on deck moment when you're 100% remote was very challenging. I found that staying in touch with staff during this period was particularly important, and that's hard to do when you're not seeing them on a daily basis. It's about really rolling up your sleeves, getting into the trenches, trying to understand the perspective of employees from all areas of your organization, and being very constant and clear with your communication. That's my biggest take home.

We saw how things unfolded under the pandemic and that clear communications so you know where you are at the moment in time– letting people know that things are going to change, and that we're going to roll with the change, and make decisions as things move along. That to me was my biggest learning experience as a leader. And I have to say, this has probably been the hardest years of my entire career. It’s very, very challenging, but I do think that clear and consistent and honest transparent communications are key.

COVID-19 was such an unprecedented time for many New Yorkers. What are the strengths of the FPHNYC’s structure and how did you utilize that structure of the organization to formulate a path to recovery during such a critical time?

We were founded right after September 11th to manage a large federal grant. It focused on supporting the healthcare system to prepare for future emergencies, and future emergency responses, by building their infrastructure and developing emergency scenarios and plans. We were really the fund that was really built for moments like this. The team at the Fund is composed of experts in project management, administration fundraising, and communications. We have many experts in public health and nonprofit management, so that we can expedite and scale programs quickly.

In partnership with our primary partner, the DOH, and through our long-standing relationships with the philanthropic community in New York City, these partnerships have built trust over time. In peacetime we work with them to create opportunities for private philanthropy to partner with the government for innovation. In times of crisis, we can leverage additional resources quickly as a bridge to public dollars, or to enhance publicly supported programs, for greater impact. A great example of this was during COVID-19, we worked with the DOH to launch a very successful vaccine initiative, across the city. It targeted the neighborhoods that were hardest hit, where there are historically greatest health disparities. Part of what we did was expedite implementation, by bridging private philanthropic dollars to help jumpstart the initiative, while waiting for public funding to come in.

There are so many issues to tackle and balance when it comes to the health and safety of all New Yorkers. For example, while we were facing the coronavirus pandemic, issues related to birth equity and overdose equity were exacerbated. How do you balance the fund’s response to so many competing priorities while also advancing equity?

I think that what happened during COVID-19 provides compelling proof that we need good public health programming, and a strong public health infrastructure, all the time. Not just during emergencies. Of the $4 trillion that the United States spends on health, only 5% goes toward public health. Yet when you think about health, what creates health and supports health, 70% is from the social and environmental determinants and only 10% to 20% is from clinical care. We spend more money than any other nation in the world on our healthcare. Our results don't support that kind of spending. In fact, a lot of our primary indicators are not as good as other industrial nations. I think our maternal mortality and morbidity rates are proof. 

The COVID-19 emergency was unprecedented in our lifetime, and it was an all hands on deck moment. Health department staff across the agency were activated to work on the COVID-19 response. The aftermath of COVID-19 includes things like increased mental health issues. We certainly lost a lot of ground in some key areas where we've been making progress. The prevalence of substance abuse disorders and suicide increased under COVID-19, and not just the use of opioids. People are also delaying seeing their doctors for normal preventative care and screenings. I think, my first point about needing to have robust investment in public health systems is that we could have been better prepared when first responding to COVID-19; the infrastructure in place was not up to par, and if they had been, maybe we would have been in a better place to continue our work on these other critical issues. I think this is the time when we really need to continue investing in public health, and not go back to where we were before.

FPHNYC connects the public and private sector to the philanthropic community to advance public health for all New Yorkers. How have the partnerships between the public and private sector evolved throughout the years?

When we were launched 20 years ago, we were new on the scene and it took a while to establish our model. The public-private model has an emphasis on creating opportunities for private philanthropy, to partner with the government, particularly around innovation. This predates me, but in my first years as the second executive director at FPHNYC there was some skepticism in the philanthropy community about the potential of private-public partnerships.  But over time we were able to convince these foundations to support innovative projects and now we have a track record of success.

Today, we have a long-standing partnership across  New York City’s philanthropic community, which is really built on a foundation of trust. We are good stewards of their resources, we're accountable, and we get stuff done. It's really a great way for private philanthropy to work with government programs, essential for innovation, and a powerful way to join resources for greater impacts. 

You’ve worked with several city health commissioners during your tenure. How do you respond to the challenge of advancing long-term public-interest goals while also responding to the evolving priorities set by new mayors and their administrations?

It's been six health commissioners. I started under the Bloomberg administration, worked through the De Blasio administration and now I'm working with the Adams administration. The main issue we're dealing with is that the priorities don't change with the administration. The continuity comes into play when private foundations, who have worked with us on specific initiatives, can be assured that as one administration ends and a new one begins, our programs remain. The fact that we have a program focused on maternal mortality and morbidity, and trying to change the fact that black women are eight times more likely to die in childbirth than a white woman, isn't going to change. It's not a political issue. It's a human and a public health issue. It's an issue that continues to be very concerning, and we strive towards making change. I have to say, with six commissioners, I think the secret to my success is that I've been able to work with each one and all of them have just been wonderful. All of the people at the health department are incredible public health practitioners, and very dedicated to the work, and that's made it easy to transition with each new commissioner. The commissioner is actually the chair of my board. It's been easy to find common ground to work together, because our missions are aligned, and we believe in the same end goals. With different administrations, they may be reworked and renamed, but at the end of the day they are addressing the core public health problems.

What are the DOHMH’s priorities now and how will it support the DOH’ priorities moving forward?

Under the new administration, the commissioner has been in his role formally since March, and we actually just had a board meeting this week where he layed out some of his key priorities moving forward. A big one is mental health, and particularly mental health of our youth. As we've seen during Covid, there's been a real increase in anxiety and depression, the opioid overdose epidemic, and suicide rates, so those are certainly priorities for this administration. We will also continue the work on the backsliding in our progress that we've been making on maternal health and addressing the disparities in maternal mortality and morbidity. We're really doubling down to continue and expand on the work that we've been doing prior to Covid. 

We will continue, of course, to work on Covid response. It's under control and the numbers are stable, but it's still spreading throughout the city. So we're still continuing the work and the focus on vaccinating those who are still not vaccinated, particularly kids, and also to give booster shots. Also some people neglected preventive care for a number of reasons. It was hard to get to the doctor's office. People were afraid to venture out of their homes. Two and a half years went by without normal preventive screenings for many people. So it's a high priority to provide access to healthy foods and get people to think about their diet and exercise.

Now we're at a point where we really want to shed light on some of these issues that are still very prevalent. In our society, health equity is also a major concern. Our work on anti-racism and addressing long-standing disparities in health care are going to continue to be a focus in our work.

What values do you always want the FPHNYC to keep as it continues to create a healthy and safe New York?

I'm a big believer in this public-private model. I've been here for 15 years, I've seen it all, I've seen the results of this work and they're very powerful. With the DOH, I think that we're recommitting to the issue of health equity at the Fund, just like at the health department. We believe that every person has the right to a healthy life and that health is foundational to everything. That underpins our whole philosophy and our commitment to our work. So we strive to make access to good health care, and access to all that is required to have a healthy life more equitable throughout the city.

I think if we've learned anything during COVID, we've learned the importance of clear and transparent communications. I think public health really needs to communicate to people that what we know now might change, and it's very complicated in a crisis situation. We've learned that clear and consistent communication across all levels of government and the nonprofit sector is really critical to helping people.