Building Healthy Communities

Overview

Building Healthy Communities (BHC) is a 10 year, $1 billion comprehensive community initiative launched by The California Endowment in 2010 to advance statewide policy, change the narrative, and transform 14 of California’s communities devastated by health inequities into places where all people and neighborhoods thrive.

Where you live shouldn’t determine how long you live, but it does.

THE ODDS ARE STACKED AGAINST LOW-INCOME COMMUNITIES AND COMMUNITIES OF COLOR.

In fact, health has more to do with place than doctors’ visits. The odds are stacked against low- income communities and communities of color. Because of a legacy of racial and economic segregation, anti-immigrant policy and a host of other historical “isms,” there are many communities in California where the neighborhood environment conspires to harm residents. These environments lack basic health protective amenities like parks, grocery stores, decent schools, jobs, housing, and the list goes on. These neighborhood and community environments are not natural; they are manmade, and can be unmade.

OUR GOAL AND HOW TO GET THERE.

Our goal is healthy, fair, and just communities for all people who call California home. Our theory for how to get there is simple: We are strengthening the fabric of our democracy by investing in the social, economic, and political power of the very residents who have been the targets of exclusion, stigma, and discrimination. Transformative and sustained change also takes youth leadership, strong partnerships, and a compelling new story about how health happens—or should happen—in all communities. Youth and adult residents are harnessing this power and voice to change the rules at the local and state levels so that everyone is valued and has access to the resources and opportunities essential for health. Over time, these changes will lead to better health outcomes for all.

 

Framework for Health Equity

To be healthy, we need opportunities to make healthy choices; to afford food and housing; to have good jobs that sustain a family; to attend quality schools for better education and careers; to live in safe neighborhoods, breathe air free of pollution, and so on. No amount of health care coverage will compensate for people who don’t have access to these essential
opportunities for health.

The Framework for Health Equity, developed by the Bay Area Regional Health Inequities Initiative (BARHII), helps to explain these manmade health inequities, and how they can be unmade. The right side of the framework – the Medical Model – shows that our health is influenced by a combination of our access to health care, genetics, and personal choices. Research shows that the medical model is responsible for less than 30% of our health outcomes. The other 70 percent or more — the socio-ecological model on the left side — lies within our social, political, and economic environments. These systems — and the rules and practices they enact and promote — determine the distribution of resource and opportunities; and who has access to them. By employing our 5 drivers of change, Building Healthy Communities, works with residents, the public sector, and other stakeholders make place-based investments and transform 14 communities by changing the policies and systems that shape them.

Why Place? 

When most people think of health, they think of the doctor. The truth is, your zip is more important than your genetic code when it comes to health. Zip code is shorthand for neighborhoods and it is there that chronic stress-inducing conditions shape the present and future of the residents. Research shows that in many areas nationwide, a mile can mean 15 more years of life for someone living in an affluent neighborhood as compared with someone living in a poorer underserved community, just several blocks away.

• Learn more about our 14 places
• Check out our interactive map

The BHC Theory of Change 

To create sustained and transformative change, it is vital to build community capacity by increasing social, political and economic power and by changing the narrative about health. We need to change policy and systems so we can create healthy environments that will, over time, improve health status.

The “What” of BHC – Priority Policy Changes

At the outset of BHC, sites were asked to identify the policy and systems changes most critical to improving health in their community. The policy priorities being pursued in the sites and across the state are as diverse as the communities themselves—from salad bars to skate parks—and are organized into Twelve Transformative Policy and Systems Change Priorities, outlined in the chart below. Taken together, we believe the Transformative Twelve comprise the activities necessary to move the needle toward health equity.

Transformative Twelve

The “Who” of BHC 

Dynamic, ongoing engagement and dialogue among partners within the 14 selected BHC places and across the state is fundamental to the BHC model. Collective success depends on trusting and vibrant relationships throughout key stakeholder groups, including residents, grassroots organizations, youth, government leaders, and others who share the goals of policy and systems changes to improve health for all.

While all stakeholders have a role to play, BHC emphasizes the authentic development and expression of adult and youth resident voices in the 14 communities. This means meaningful engagement and robust participation of a broad segment of residents, particularly those that have been traditionally excluded, including undocumented immigrants, LGBTQ, formerly incarcerated, and boys and men of color. BHC values the creation of a new ethos of inclusion and a new narrative about health that includes the voice of all.

As partners in working towards social change, foundations, along with government and system leaders, must listen to and strive to be co-leaders and co-learners with adult and youth residents.

The “How” of BHC

Drivers of Change

• Resident & Youth Power builds capacity and understanding of how civic participation is key to changing policies and systems that will improve community health and hold institutions accountable for advancing health equity.
• Narrative Change focuses on reshaping the norms and beliefs about who matters in our society and how to invest in community health for all.
• Collaborative efficacy for policy innovation emphasizes strengthening the capacity of systems leaders, community organizations, and residents to work together to advance social change is sustainable and healthy for everyone.
• Leveraging Partnerships is critical to ensuring that private and public capital aligns towards investments that create healthy places and people.