However, much of this health-focused capital is traditionally invested in projects and programs driven by institutions’ own priorities, rather than into community-led solutions that successfully advance health equity. Accordingly, the tool places particular emphasis on how institutions share decision-making authority over various forms of capital—including grants, investments, endowments, and operating budgets—recognizing that financial governance is a critical indicator of genuine power-sharing necessary to achieve health equity.

When health institutions shift from traditional top-down resource allocation to participatory models where communities have meaningful control over financial resources, they address historical power imbalances that have undermined trust and deepened inequities.

A foundational input for this assessment is the recently launched Bio360 Trust Framework, which draws on biomimicry to understand how trust-like dynamics emerge in living systems across eight domains: Willingness, Discovery, Familiarity, Honesty, Cooperation, Reliability, Boundaries, and Feedback Loops. Shift Health Accelerator has adapted these insights specifically for health institutions making commitments to health equity work, translating biological principles into practical approaches for reshaping resource governance between health institutions and communities. The Bio360 framework reveals deep and broad insights about creating conditions for trust to emerge—findings directly applicable to health institutions seeking to build authentic partnerships with communities.