Communities Creating Health Communities Creating Health Communities Creating Health, presented in partnership with Creating Health Collaborative, is a series on how the design, implementation, and evaluation of interventions in health can align more closely with what communities value. #creatinghealth

Imagine that it is five years from now, and your neighborhood is a measurably healthier place to live—kids start life with the support they needed to succeed, and when people experience life challenges, neighbors make themselves available to help. As community members celebrate what they have achieved together, people from surrounding areas clamor to know how it happened, especially since your neighborhood did not receive any special concessions. When they visit, they see the same things they have in their own neighborhood: schools, social services, hospitals and clinics, banks, businesses, housing developments, and places of worship. They see that the political leadership is competent, but no more so than their own. However, they also notice that people and organizations have completely different beliefs about and intuitions for effectively interacting with each other.

So, what changed, and is it sustainable?

The secret behind your neighborhood’s transformation was, in some ways, simple. Five years ago, your neighborhood was many things, including an informal organization that held the pieces of everyone’s health. Except, when you looked at it, you saw the pieces were scattered and needed assembly. Posed this way, it was clear that the quality of connections between parts of the neighborhood made a difference. Homeless services, housing support, and job-training programs were not linked, for example, and there was no support for caregivers when they felt overwhelmed. Where connections were poor, health suffered and healthcare spending was higher. And yet, there was no mechanism or sense of accountability to help establish better connections, and it was impossible to see how the neighborhood might improve the health of its people.    

So you set about envisioning a future together. You identified kindred citizens— neighborhood leaders, and people from local healthcare systems and community development institutions—who also saw the neighborhood as a health-producing organization, and asked how health would change under different circumstances. Using tools to model future scenarios, you all saw that acting collectively to confront tensions that were holding you back could lead to better outcomes for everyone. To move forward, you needed a common set of aims, including ones that could help healthcare systems shift toward more neighborhood-based care. In the past decade, the positive feedback loop between better health and community development had been getting stronger, but you needed to organize your neighborhood to understand how to assemble a healthy environment from their perspective.

As your neighborhood meetings yielded new relationships and opportunities, they also revealed gaps in infrastructure. For example, your growing group didn’t realize how challenging it was to get help from a scatter of organizations after being sick and how this could worsen chronic cycles of illness. The health care system shared this challenge, so you pooled together a small amount of money designated for community benefit so that neighbors could dedicate themselves to making sure that people didn’t get lost on the pathway out of illness.

You also recognized that some neighbors had a much harder time than others and that the health care system was concerned about many of the same people, given their focus on high-need patients. So you to made the case for neighborhood organizations to participate in the value chain of improving health. This helped redirect some of the financial incentives created for the health care system and establish the neighborhood’s voice and expertise as an integral, rather than ad hoc, part of the system.

As you worked together, your neighborhood’s modest achievements instilled confidence in aiming higher. Some business-savvy neighbors realized that if the community invested in revitalizing dilapidated housing and cleared a nearby junkyard to build a new park, the value of that area and areas surrounding it might rise. It would also be safer and more walkable. Together, the experience of planning small projects enabled you to adaptively design more complex ones. As the projects became more complex, local business leaders and regional planners took note of your progress, as they did in places like Atlanta. Because you communicated your successes, the local healthcare system became more active, recognizing that their independent community benefit programs could be better spent on the neighborhood’s work.

As more people in the neighborhood heard about the success of your growing group, they wanted to join, because:

  1. You recognized that people assemble health where they live, which means that healthcare organizations and neighborhood-based services need to work together.
  2. Through shared experiences, people trusted each other more and felt capable of confronting tensions that previously pulled the neighborhood apart.
  3. Your local healthcare organizations started to shift their center of gravity away from hospitals into neighborhoods.
  4. Your entire community embraced adaptive problem solving, which brought new skillsets to hard problems.

As your neighborhood’s reputation grew, more opportunities came its way, and you had the confidence to make bolder investments in your shared future.

Imagining a healthier future doesn’t start with how to pay for it. What comes first is the neighborhood developing an understanding of what is happening right now, including understanding the connections that matter and developing a shared view of what a healthier life could be. Only then can communities know how to get the most from every dollar spent to improve health. What’s important is imagining it out loud.

Today health care systems command the lion’s share of health spending, because we can see their devotion to evidence, efficiency, and improvement. Tomorrow, local experience, efficacy at the neighborhood level, and intrinsic motivation will make for a better value proposition—one that attracts social investors, regional planners, and politicians, who play an integral role in ensuring that the benefits are equitably shared.

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