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A Flexible Model for Investing in Healthy Community Transformation

July 2017

Joanne Lee, Collaborative Learning Director, Active Living By Design
Jaime Love, Program Officer, Interact for Health
Bronwyn Starr, Program Officer, New York State Health Foundation
Risa Wilkerson, Executive Director, Active Living By Design

Following the success of community-led initiatives that took place as a result 200 partnerships across 35 states, Washington, DC, and Puerto Rico, Active Living By Design (ALBD) developed a deep understanding of the community change process.

The organization synthesized lessons learned from more than 15 years to develop an evidence-informed and practice-tested framework for creating healthier communities through comprehensive, integrated strategies. This framework, the Community Action Model (CAM), is relevant for a variety of health goals, and has served as the basis for ALBD’s work with communities and funders. In turn, the framework has helped funders implement bold new approaches to creating healthier policies and environments. The New York State Health Foundation and Interact for Health, for example, have utilized components of the CAM to inform their regional approaches to grantmaking, and to create lasting community change in neighborhood initiatives.

The CAM is grounded in the importance of Community Context. Every community has its own culture, assets, history of achievement, and opportunities from which to build—and when funders, local leaders, and partnerships fully recognize unique community settings, they are better able to tailor strategies to align with and leverage various dynamics at play, thereby maximizing impact. The CAM identifies six Essential Practices that are critical for meaningful and sustained change in communities:

  • a health equity focus,
  • community engagement,
  • facilitative leadership,
  • a culture of learning,
  • sustainable thinking, and
  • strategic communication.

Community Context and the Essential Practices are interwoven throughout the CAM’s 3P Action Steps: partner, prepare, and progress. These steps lead to early, intermediate, and sustainable impact, ultimately creating a culture of health.

The CAM approach has proven to lead to healthy and sustainable community change. In Hamilton County, Ohio, ALBD served as the National Program Office for the Healthy Kids, Healthy Communities (HKHC) initiative, a program supported by the Robert Wood Johnson Foundation, which included 49 communities across the country. Hamilton County Public Health coordinated the local HKHC project, which utilized the CAM Essential Practices of “community engagement” and “facilitative leadership” through a resident-led process in various neighborhoods throughout the county.

First, a community coalition was formed in each focus neighborhood. While health department staff initially launched these coalitions, the goal was for community leaders to ultimately sustain them. Staff built community knowledge and capacity around health issues that were being addressed, while ensuring that the problems and solutions were being identified by the residents themselves. Listening and allowing the community to lead the work was imperative to success. Seven years after the HKHC grant started, community coalitions continue to thrive, while steadily expanding to fit the needs of their neighborhoods.

Hamilton County HKHC Project Coordinator Jaime Love worked directly with the community coalitions and—towards the end of the HKHC grant period—transitioned into her current role at Interact for Health. As a public health professional and now funder, Ms. Love understood that support was needed for strategies that produced long-lasting health improvements in communities—so she integrated the CAM Action Steps and Essential Practices of “community engagement” and “facilitative leadership” into her foundation’s grantmaking approach. Ms. Love’s experience as a grantee and community leader motivated her to harness the privilege of philanthropy to allow time and opportunity for long-term strategies (policy change, built environment modifications, and changing systems), ensuring the greatest impact and sustainability.

In 2014, Interact for Health engaged ALBD to share the CAM approach for community transformation with their staff and board. This helped shape a health promotion frame around all of the foundation’s investments, and sparked conversation with grantees about how to think beyond one-time programs in the community—to sustainable, long-term solutions. The CAM provided Interact for Health a framework that included needed programs, while connecting those efforts to broader policy and environmental change strategies for greater progress in the foundation’s service area throughout Ohio, Kentucky, and Indiana.

NYSHealth first partnered with ALBD in 2015, and has since found the CAM to be a flexible and impactful model for their investments. A core tenet of NYSHealth’s Building Healthy Communities priority area is to be flexible and responsive to community change over time (i.e. community context). To achieve this, NYSHealth staff listen to resident voices, honor community priorities before addressing foundation priorities, and value the payoff of investing first in relationships. For example, when the following key themes for creating healthy change emerged from Building Healthy Communities grantees, NYSHealth took action with the CAM in mind:

  • Access to safe spaces is key. The availability of safe spaces presented a challenge for many neighborhoods attempting to promote opportunities for physical activity. While funding for safety issues had not previously been considered, the foundation realized that safety is a necessary precursor to use of public and open spaces and should be part of their investment.
  • Direct and sustained resident engagement is critical for overcoming skepticism that has built up over time in many of New York neighborhoods. NYSHealth supported the Niagara Falls grantee partnership in establishing a Resident Engagement Council, a cadre of community-based planners and advocates leading healthy food and healthy activity initiatives informed by their lived experiences.
  • Grantees and community leaders want policy and advocacy training, because they recognize how stronger capacity in this area leads to sustainable policy, systems, and environmental change—so NYSHealth is supporting it. For example, the East Harlem, New York partnership responded to community requests to have a greater voice in neighborhood changes. A series of workshops then influenced the East Harlem Neighborhood Plan, which will inform New York City’s rezoning process. After several public meetings, a report was issued which documented the top objectives, with health as a crosscutting theme.

NYSHealth has also embraced the Essential Practice of “developing a culture of learning” to inform investments and support community capacity. ALBD coordinates the foundation’s Building Healthy Communities learning collaborative, through which grantees are provided opportunities to share experience and knowledge, engage in peer-to-peer learning, identify promising practices, discover new funding opportunities, and guide future policy, both locally and statewide. The learning collaborative offers a safe environment where grantees can speak openly and freely about their work, and ALBD has been a valuable partner in facilitating these conversations and helping create an environment of trust.

The experiences of Interact for Health and NYSHealth illustrate the importance of intentionally integrating specific strategies, actions, and essential practices to achieve comprehensive and long-term impact in communities. Using the CAM as a guide, community coalitions and leaders can work collaboratively to build healthier communities, and funders can tailor their investments utilizing a tested approach, resulting in lasting change.