Collective Impact for Health and Wellbeing

UCLA students, staff, and faculty enjoy a 15-minute “fit break” for stretching and movement.

The “healthy campus” movement has taken off at universities across the United States. Traditionally, these efforts have focused on students and targeted specific subject areas, such as alcohol use and sexual health. Since 2007, the City University of New York’s Healthy CUNY initiative has been promoting student health by increasing healthy food access, promoting emotional wellbeing, and creating a tobacco-free campus. At the University of California Los Angeles (UCLA), we laid the groundwork for the Healthy Campus Initiative (HCI) in 2012 to create a social movement. Our efforts engage the entire campus population of students, staff, and faculty in building health and wellbeing into university culture. Statewide and national efforts, such as the Partnership for a Healthier America’s Healthier Campus Initiative (2014) and the University of California’s Healthy Campus Network (2016), are also taking hold. 

What unites these healthy campus efforts is the recognition that universities have the capacity and responsibility not only to conduct education, research, and service, but also to infuse health and wellbeing into campus culture. Of course, this comes with challenges. Senior administrators and faculty at many campuses think devoting scarce academic resources to wellbeing activities is a form of mission drift. Moreover, health and wellbeing initiatives often exist in silos, and programmatic, opt-in types of activities often have difficulty engaging stakeholders and reaching intended audiences.

To combat these and other challenges, some large organizations are beginning to prioritize broader, more collective efforts. The Robert Wood Johnson Foundation, for example, is engaging diverse sectors to foster what it calls “a national Culture of Health,” in which all Americans can live a healthier life. This shift provides an opportunity to rethink traditional health promotion strategies and consider newer, cross-sector, collaborative approaches such as collective impact.

We believe HCI, the program we are leading at UCLA, offers insights for leaders working to launch or sustain their own wellbeing movements in universities, worksites, pre-K to 12 schools, and city communities. Indeed we continue to glean inspiration from other successful initiatives that have utilized the collective impact approach, including the Los Angeles Food Policy Council, the Greater Cincinnati Foundation, and Menus of Change, an academic-industry collaborative to advance healthy, sustainable, socially responsible food.

Prioritizing a culture of wellbeing

In 2013, UCLA Chancellor Gene Block announced HCI—the vision of Jane and Terry Semel and supported by them. Originating at The Semel Institute for Neuroscience and Human Behavior, HCI is fostering a culture of physical, emotional, and social well-being for more than 85,000 UCLA students, staff, and faculty. HCI is a multi-pronged, campus-wide effort led by faculty and senior administrators that prioritizes health and wellbeing in seven major areas (called “pods”): BEWell (built environment), BreatheWell (tobacco-free campus), EatWell (food and nutrition), EngageWell (social wellbeing), MindWell (mind-brain health), MoveWell (movement and physical activity), and ResearchWell (support for the initiative’s research and evaluation activities). The initiative draws on UCLA’s research and teaching to develop new academic, research-based, experiential, policy, and physical-structural approaches to wellbeing, with the idea that emotional, physical, and social wellbeing are integral to individual and institutional success. To guide this culture change, HCI embraced a social movement that follows community-organizing principles and uses the five conditions for collective impact.

Collective impact: five conditions of success

In a nutshell, collective impact comes about when a group of stakeholders from different sectors commit to a common agenda to address a broad, complex social challenge. In the case of HCI, “sectors” include campus units represented by students, staff, and faculty, and the common agenda is to create a culture of health and wellbeing by “making the healthy choice the easy choice.” Here’s a look at how the effort embraced each of the five conditions.

1. Share a common agenda.

Challenges:

• Health is often considered solely the domain of health professionals.
• High-level initiatives can be overly prescriptive.
• Faculty may be resistant to top-down initiatives.

The first step to uniting the campus was to define health in a way that would be useful for all the individuals and units that make up our diverse community. We started at the heart of our institution: UCLA’s principles of community and tenets of being a “True Bruin.” Building on these core values, we developed themes for HCI and determined that a healthy campus does the following: fosters high-level wellness; encourages personal responsibility; respects diversity; strives to reduce inequalities in health; and recognizes the interrelationship between, social, physical, and emotional wellbeing.

We also made sure that HCI would be supported at the highest institutional level. Today, the chancellor’s office serves as the program’s administrative home, signaling to the entire campus community that a building culture of health and wellbeing is a priority. The initiative encourages senior leadership to consider “health in all decisions” (for example, in designing a new building or opening a new dining hall) but does not prescribe a process to achieve specific goals. For instance, promoting HCI is now a line item on job descriptions for some senior administrators.

In addition, HCI has been successful in engaging faculty around the idea of implementing evidence-based solutions in our own backyard and linking a healthy campus to academic excellence. This means not only attracting the best students through perks like healthy dining options, but also providing opportunities for students to develop mindfulness and other healthy habits for success. A survey conducted by the Partnership for a Healthier America found that nearly one in four students prioritize access to wellness opportunities when deciding where to apply for college. We have also worked to create and support academic courses and degree programs that complement HCI themes, such as an interdisciplinary undergraduate food studies minor.

2. Provide a coordinating structure.

Challenges:

• Broad initiatives may lack stable funding.
• Getting buy-in from the university community can be slow, often comes in waves, and requires a variety of strategies.
• The roles and expectations of participating groups can be unclear.

HCI benefits from the funding, support, participation, and long-term vision of philanthropists Jane and Terry Semel, who provide flexible, ongoing support and creative insights as the initiative matures.

Michael Goldstein, former Associate Vice Provost (AVP) of HCI and longstanding UCLA faculty member, used his deep understanding of the university’s culture of shared governance to help garner campuswide support and frame HCI as a collaborative (rather than top-down) endeavor. In the first two years, Goldstein’s team produced presentations and sponsored events for more than 140 student, staff, and faculty organizations. Now well established, HCI hosts annual community-wide celebrations; its most recent attracted an estimated 2,500 people.

In addition, the dedicated HCI leadership positions that compose the initiative’s coordinating structure, or “backbone,” help clarify roles and expectations, and have been central to the success of HCI. These positions include a full-time senior faculty member (the associate vice provost), who leads the steering committee and reports to the executive vice chancellor and provost; a full-time administrative coordinator; a team of paid undergraduate students and graduate student researchers; and faculty and senior administrator content experts who lead the pods and invite people to attend recurring pod meetings, where all are welcome.

3. Engage in mutually reinforcing activities.

Challenges:

• Concerns exist over “turf” and resources.
• Competing priorities can look like barriers to action.
• Common goals do not necessarily use common strategies.

At UCLA, we recognized there were already numerous ongoing health-related efforts pre-dating HCI. Through asset mapping and mobilization, identifying and adopting evidence-based practices, holding regular stakeholder meetings, and finding grant support for HCI-related projects, the initiative has demonstrated its value to individual units. For example, the BEWell pod assisted a preexisting, student-led effort to redesign a stairwell so that taking the stairs was more appealing. BEWell connected the students to the campus architect and others to facilitate buy-in and permissions, and matched the funding that students had received from their school’s dean. Results from the project demonstrated not only an increase in stairwell use, but also an increase in school pride.

With support from HCI, PhD Candidate Tyler Watson led a stairwell activation project at the Fielding School of Public Health. Similar efforts are now rolling out across campus and the University of California system.

Acknowledging and working to address competing priorities is also important to successful efforts. For instance, the EatWell pod members collaboratively launched a healthy vending pilot study that successfully improved the nutritional quality of product offerings without impacting the bottom line. The pilot worked because of the diverse expertise of the team, HCI funding, and trust that developed between different groups during EatWell pod meetings. Now, healthy vending machines are available across the campus.

Finally, leadership must be open to different strategies to meet goals. For example, promoting healthy eating for undergraduates was a common goal for HCI, but campus dietitians did not welcome the original strategy of placing calorie counts on the dining hall menus; they were concerned it would distract the students from focusing on health and more on weight, potentially triggering eating disorders. HCI eventually moved forward with the dietitians’ strategy to use smaller serving bowls and encourage a tray-free environment in the dining halls to help moderate portion sizes and reduce food waste.

4. Participate in continuous communication.

Challenges:

• The diverse constituents of universities are not accustomed to working together and often lack an understanding of each other’s priorities.
• Participants are often predisposed to status quo.

As we mentioned above, regular, in-person pod and steering-committee meetings facilitate team building and trust, which often leads to creative discussions, as well as expertise and resource sharing. HCI’s steering committee is composed of executives (including deans from the medical and nursing schools) and vice chancellors (including the executive, student affairs, and administrative vice chancellors). In addition, ongoing, in-person and web-based communication breaks down silos and infuses the HCI vision into day-to-day campus life.

These strategies have exposed different sectors of the UCLA community to evidence-based and best practices that have accelerated positive changes. For example, as members of the BEWell pod, the campus architect and transportation director now consider “the healthy choice as the easy choice” in the development of new campus projects. This has resulted in changes in the campus environment, such as improved bicycle infrastructure, no new parking development, and additional stairwell activation projects. The transportation director identifies HCI as a win-win: Charged with meeting the University of California-wide carbon neutrality goal by 2025, she has found that behavior change around active transport is more likely when the motivator is health rather than the environment.

5. Agree on shared measurement systems to evaluate and boost progress.

Challenges:

• Different units employ different methods and benchmarks for measuring success.
• The difficulty of measuring culture change can limit evaluation.

Initially, HCI’s measurement consisted of taking an inventory of campus assets— including people, policies, courses, student groups, and campus departments—and connecting these assets through events and pod meetings. These two steps allowed each pod to gather people with similar subject area interests and, in turn, allow them to agree on methods and benchmarks to measure success. For example, all HCI-sponsored events track attendance and include participant surveys to measure knowledge and skills gained, and satisfaction. HCI also identified existing data sources related to the wellbeing of the UCLA community (for example, the University of California Undergraduate Experience Survey) and succeeded in adding questions about emerging campus priorities, including food access and emotional health.

To capture culture change, all HCI pods contribute to an annual progress report that includes videos, photos, and reflections, as well as more-traditional progress data. Furthermore, we are currently building a dashboard to measure benchmarks for each pod subject area, such as sugar-sweetened beverage consumption in dining halls, student food security, and employee perception of support for health in their workplace. Finally, we are learning from others like the Robert Wood Johnson Foundation and the CDC NIOSH Total Worker Health Program that are working toward defining measurement around the culture of health.

HCI also supports original research to inform pod-specific efforts and inspire larger health-related research projects and health policy. For example, following the success of the BEWell stairwell redesign, several other stairwell activation projects have been initiated on campus, and HCI is overseeing a stairwell activation project and evaluation across the 10-campus University of California system through the Healthy Campus Network. In addition, a study conducted by HCI graduate student researchers on student food insecurity and food literacy has helped inform campus, University of California, and statewide solutions to help students struggling with food.  

The collective impact framework can be an effective tool for guiding the next generation of social change initiatives. As John Kania and Mark Kramer pointed out in their 2011 collective impact article, large-scale initiatives often fail by assuming collaboration can occur without infrastructure. While no two communities or initiatives will be the same, we hope these examples and lessons will help others think through challenges that may emerge as they work toward building their own culture of wellbeing.

Read more stories by Wendelin M. Slusser, Hannah Malan, Tyler Watson & Michael S. Goldstein.