Beyond Charity: Systems-Change Philanthropy for Structural Health Equity in Oral Health

Health philanthropy has traditionally emphasized downstream service delivery rather than addressing structural and policy-level determinants of health. In light of widening health disparities and increasing political threats to public health and civil rights, there is a pressing need for philanthropy to evolve. This commentary introduces and explores an equity-centered philanthropic model as a framework for driving systems change, building community power, and advancing long-term transformation in oral health.

CareQuest Institute's philanthropic approach is grounded in the lived realities of racial, economic, and geographic oral health disparities, and the historical exclusion of oral health from broader equity agendas. The model prioritizes funding community-led organizations, centering lived experience, supporting multi-year partnerships, and embedding oral health within cross-sector health justice movements. Two grantee case studies are used to illustrate this approach.

The case examples include: 1) Families USA's grassroots-informed federal policy advocacy and 2) Community Catalyst's capacity-building for BIPOC-led and community-rooted health justice campaigns. These examples demonstrate how equity-centered philanthropy can support structural change and amplify community leadership.

Equity-focused philanthropy faces practical challenges, including the need for new evaluation frameworks, sustainable capacity-building, and resisting extractive or paternalistic dynamics. To truly advance health equity, philanthropy must move beyond transactional funding and become an active partner in redistributing power, elevating community voice, and sustaining systemic transformation across the oral health ecosystem.