By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“No one has ever become poor by giving.”

-Anne Frank

Twenty years ago when I was the Medical Director of Community Health Clinic Ole in Napa, someone I still don’t know placed one hundred $50 gift cards to a grocery store in my home mailbox, with a note, saying that I should distribute them to needy patients of our Health Center. Our outreach team mobilized and distributed them to 50 particularly needy individual patients and families. The same thing happened the following year. The anonymous donor trusted me to make sure that their charity would go to a person who needed it; that person would never know who gave this gift, because even I did not know who it was. The charity was given without the desire or expectation of being recognized publicly, or even privately.

Eight years ago, a retired businessman –who came to the United States from India to build a business selling medical supplies—lent a 17 year old young man from his hometown in India the money to be able to attend UC Davis where he was accepted as an undergraduate aerospace engineering student. The young man’s family was of modest means; they could not afford to send him abroad to be educated. The retired businessman was not related to the family, but he made this high-risk personal loan to help him achieve his dream to be a high-tech engineer, and to support his family in the process. This young man met my daughter and is now my son-in-law.

Around this time of year, many people call local homeless shelters offering to help. Thanksgiving dinner at the Napa homeless shelter was purchased, cooked, and served by the local painters union. They called and volunteered to do this, without being asked.
All of these are examples of the highest level of charity. About 950 years ago, a physician-philosopher named Maimonides identified eight levels of charity. Paraphrasing them in order from highest to lowest:

1. The greatest level: Support a member of your community with a gift, a loan, or helping find employment to strengthen his hand so that he will not need to be dependent on others. This is the charity provided by the Indian businessman.
2. Give to the poor without knowing to whom one gives, and without the recipient knowing from whom he received it. It is given in secret to a trustworthy intermediary. This is the charity of my unknown neighbor, who provided the gift cards for my patients. Leaving a generous tip for the low-income housekeeping staff at a hotel could fit in this category, as well.
3. Give to someone that is known to the donor, but the recipient does not know who gave the gift.
4. Provide a donation when the donor does not know who they are helping, but the recipient does know.
5. Give directly to someone, with both the donor and recipient knowing each other, but the gift is given without being asked. The painters who prepared and served Thanksgiving dinner to the homeless of Napa would fit in one of these three levels (3, 4, or 5); although the donor and recipient could see each other, they did not know each other’s names.
6. Giving to a poor person after being asked.
7. Giving inadequately, but gladly and with a smile.
8. The lowest level of charity is to give unwillingly.

In the progressively lower levels of charity, much of the purpose of the charity is to be seen by others as being charitable (called virtue signaling by psychologists). This charity is still very important, as many U.S. charitable organizations rely on these lower levels to gather donations. In the higher levels, the charity is not intended to improve one’s social capital but rather aims to increase the opportunities of others and positively impact communities.

Here are three takeaways for each of us:

1. Contemplate these eight levels of charity; talk them over with your family and friends.
2. This holiday season think about ways you can give at one of the higher levels.
3. Let humility guide your giving practices. Celebrate those who quietly, give without expecting recognition.