Sponsored by DTG and the VHA Health Foundation, Inc.,
More than 30 leaders working in the healthy community field across the nation convened in Boulder, CO. August 14, 1999 to explore critical questions and to discuss the future of the healthy communities movement. Participants were invited by the VHA Health Foundation, Inc. and DTG. The VHA Health Foundation, Inc. is a public foundation that promotes leadership and innovative solutions for creating and sustaining healthier communities. DTG is the Denver/Boulder-based partnership of Darvin Ayre, Tyler Norris and Gruffie Clough, whose work has assisted community change efforts in hundreds of communities. The participants represented health care organizations, physicians, foundations, academia, community coalitions and healthy community initiatives.
The term "healthy community" refers to community-based efforts to improve the health and quality of life of residents by embracing a number of innovative methods, including:
- adopting a broad definition of health
- using a broad definition of community
- creating a shared vision built on community values
- addressing quality of life for everyone
- building diverse citizen participation and community ownership
- focusing on systems change
- building capacity using assets and resources
- measuring progress and outcomes
The healthy community movement in the United States began more than a decade ago. During this time health care organizations have played a major role: as funders, catalysts and pioneers. Recent rapid change in the health care industry, however, has made the continued funding support from health care organizations uncertain.
Prior to the conference, participants posed their most pressing questions in writing to the organizers, who then distilled them into four discussion strands. The strands, along with a crux question from each, are as follows.
- National Voice and Connectivity. How can various national-level efforts to improve community health be linked in ways that instill healthy community concepts in all community systems, policies and operations?
- Leadership and Process. Which leadership strategies can most effectively broaden and build the movement, as well as create sustainable processes that reflect the values of diverse communities?
- Outcomes and Funding. How can outcomes be measured to make the business case for a shift in funding priorities and financial incentives to support health and healthy communities?
- Health Care. How can the incentives of health care providers/partners be aligned with improving population health status and community quality of life?
Small group discussions took place for each strand with members cross-pollinating ideas and discussion points between groups.
Common Themes and Concerns
The following common themes emerged across the group discussions. A positive
future for the healthy community movement is contingent on:
- linking with other movements and sectors to find common ground
- using new language that engages those outside health care
- reconsidering the role of leadership
- using new measurements that quantify the value of this work
- creating value in the change process itself (as in relationship building and "process as product")
- making a new case for healthy communities to encourage new investment
Each discussion group reported to the whole group its best ideas and strategies for answering the crux questions After review, the whole group gave its "collective nod" to the best ideas to emerge from the day's work. Many ideas overlap in categories and practical application. Nevertheless, they are arranged here under four categories: system change, policy change, advocacy and accountability.
- System Change
System change concepts need to be at the forefront of the national dialogue and provide the strategic foundation for the future of the healthy community movement. Healthy community leaders have a role to play in educating audiences about change theory and how to make system change happen.
Furthermore, the healthy community principles should be used to guide actions and convey change theory concepts. Toward this end, national organizations need to provide a blueprint and best practices for achieving system change. Several participants expressed both passion and frustration in this regard. One participant commented, "There has been a great deal of talk about system change, but precious little has been done to change systems that are destructive to communities."
Community stakeholders need to assure that their own initiatives promote system changes locally. This involves moving away from short-term projects toward more highly-leveraged activities or bolder projects that result in system changes.
Suggested Action Step:
- Convene a future meeting to discuss system change and community change.
- Policy Change
The principles and concepts of healthy communities need to be a part of public policy dialogue at the local, state and national levels Success can be defined as, "public policy and public spending reflect the principles of healthy communities."
Movement leaders need to pave the way for a future in which citizens challenge elected officials to finance "root cause" work, as well as ask officeholders and office seekers to endorse healthy community principles. Given that the role of local government is changing, a unique opportunity exists to partner with local governments to put into operation (not a word!) healthy community principles and affect change from within the system
Suggested Action Step:
- Identify and engage credible spokespersons to take healthy community principles and ideas to key individuals, politicians and organizations.
Health care organizations have an important and ongoing role to play in healthy
communities, but the stakeholder base needs to be broader. This can be accomplished by inviting representatives of diverse systems to the healthy community table and by becoming active in other efforts. Strong connections can be made with individuals and organizations addressing human rights, mental health, gerontology, the faith community and other national entities such as those engaged in building sustainable and livable futures
Advocacy efforts should extend as well to government and public health agencies in particular "The future of public health is healthy communities," said one participant. Key tools for advocacy include a compendium of best practices from healthy community initiatives and the simple "filter" question of, "How does doing "x" promote the health and well-being of the whole community?"
Suggested Action Steps:
- Identify and engage emerging leaders-those who will create the next vision for
healthy futures-in healthy community efforts.
- Collaborate with diverse systems and shift the focus from charity to investment.
In order to build on healthy community investments made over the last 15 years, it's necessary to employ the principles of system change and think strategically about next steps. Participants agreed that the objective is not to sustain the healthy community movement itself, but rather to embody the principles as a shared vision for local and national groups. "Some day it won't be called a movement," said one participant. "Healthy community principles will uphold the way society and communities work." The coalition of healthy community advocates can work behind the scenes to build bridges within and between communities.
Another key strategy involves repackaging healthy community work so that it can be quickly and easily understood by those outside the field. One person described the healthy community initiative he directs as, "the research and development arm for the community. We do research and development on building stronger, healthier communities.
Those engaged in healthy community efforts need to develop meaningful measures in order to communicate the value of the community capacity "product." Rather than seeking grants from funders, for example, one participant contracts with funders for services that build community capacity in measurable ways. ''It's more powerful to say, 'We trained 300 families in conflict resolution skills,' than 'We built community capacity.'"
Suggested Action Steps:
- Identify and develop accountability data to make the case to business and
- Package and speak about healthy community services and products in ways that
make sense to those in other sectors.
The healthy community (movement) has reached a critical point. After years under the nurturing wing of health care organizations, the time has come to venture outside the nest. As is the case with any emerging field, language is often inadequate to describe the tasks and processes at hand. If this effort is to mature from a movement to become part of the greater social and cultural fabric, then terminology and methods must be found to convey healthy community principles and practices to a broader audience. Even the term "healthy community" is called into question as a possible impediment to wider ownership Conference participants expressed urgency, optimism and a strong sense of conviction about the importance of the work that lay ahead.