Healthiest Cities & Counties Challenge Toolkit

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Blaire Bryant

Legislative Director, Health | Large Urban County Caucus

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Overview

The value of community health cannot be overstated: healthy communities are economically competitive and contribute to an enhanced offering of equitable opportunities for residents. With popular and pragmatic support for improved community health rising, counties and cities require resources to evaluate the factors that contribute to population health. A 2016 Aetna Foundation supported survey highlighted that 94 percent of Americans are willing to take new action to improve the health outcomes of their communities. This Toolkit is designed to support cities and counties in the consideration of opportunities and challenges impacting the collective health outcomes of their communities.

The evidence-based practices and examples in this toolkit equip cities and counties to improve the health of residents through modules that outline planning, implementation and evaluation considerations of community health initiatives. In the first section, users can find resources to learn more about foundational principles in planning health initiatives. The subsequent sections contain practical guidelines and worksheets that can be used to facilitate planning activities, as well as resources to learn more about the described strategies that are contained in the drop down tabs. As an online resource, this Toolkit will serve as a dynamic and evolving resource to improve community health programming in counties and cities.

Foundations for Planning Health Initiatives

At the foundation of every successful health initiative is the support and participation of a diverse representation of community members, organizations, and perspectives, and a commitment to improve the structural determinants that impact health, in order to ensure equitable health outcomes for all constituents. The below three strategies and corresponding resources provide insight on these foundational principles to guide you in your planning process.

 

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  1. Overview
  2. Foundations for Planning Health Initiatives
  3. Evaluate Community Needs and Resources
  4. Create and Maintain Effective Partnerships
  5. Use and Assess Data
  6. Engage Local Elected Officials and Key Stakeholders
  7. County Examples

Include Community Voices

Early engagement of community leaders and stakeholders is important, strengthening interest for a community health initiative. Research suggests early community engagement can improve user satisfaction and lead to more appropriate programming.

Soliciting an array of stakeholder perspectives to weigh in on development of a new health program can be the difference between strong community support for the initiative and community resistance. Strong stakeholder engagement also harnesses the skills and talents of a communities most important resource: its people. Community involvement fosters trust, investment, and can ultimately sustain a project.

Resources

Advance Health Equity

The Centers for Disease Control and Prevention (CDC) defines health equity as the attainment of the highest level of health for all people regardless of skin color, education level, gender identity, sexual orientation, employment status, location, or disability. Improved health equity also contributes to more efficient health programming, better use of limited county resources, and improved public health outcomes.

Resources

Address Social Determinants of Health

Individual and community health is determined by an array of social determinants of health, which are defined by the Kaiser Family Foundation as “the structural determinants and conditions in which people are born, grow, live, work and age.”

The role that any specific social determinant serves to directly advance a health outcome varies by individual, but when aggregated these factors correlate to health-related behaviors and accompanying health outcomes for communities. Any new community health program should propose improving upon at least one individual social determinant to health:

  • Economic Stability
  • Social and Community Support
  • Healthcare Access
  • Neighborhood and Built Environment
  • Education
  • Food and Nutrition

Resources

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Evaluate Community Needs and Resources

Before investing resources into a new community health initiative, it is important to understand the community’s specific health needs. A community need or resource assessment can assume different forms. Health priorities should come from both a formal and informal assessment of a county’s existing health needs. Having a good understanding of community needs directs the goals and strategies of the initiative.

Guidelines & Practical Worksheets

Identifying the Problem

Map County Assets

Develop a Strategic Plan

Identify the Problem

Community Health Needs Assessment

Community health assessments (CHAs) are an evaluative model to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address areas meriting improvement.

Health Impact Assessments

A health impact assessment evaluates potential health effects of a proposed policy, plan, program or project before it is built or implemented.Findings from health impact assessments provide practical recommendations to increase positive health effects and minimize negative health effects.

Resources

Map County Assets

A county should map its assets and identify gaps impacting a proposed community health policy initiative before undertaking any programmatic implementation. Mapping assets can offer information on strengths and existing resources in the county. A strong understanding of available resources will help to leverage existing assets.

Read More about County Asset Mapping

Develop a Strategic Plan

A strategic plan should succinctly capture the vision, mission, objectives and strategies to be enacted. Developing a strategic plan in a collaborative group setting will build consensus and strengthen buy-in for the initiative. Revisit the plan often while moving into new phases of the initiative. Below are examples of two tools that can aid you in developing a strategic plan for your initiative.

Logic Models

Logic Models provide programmatic roadmap for an initiative, highlighting goal sequence and desired outcomes.

Community Health Improvement Plans

The Centers for Disease Control and Prevention (CDC) define a community health improvement plan (CHIP) as a long-term, systematic effort to address public health problems based on the results of a community health assessment. CHIP is essential to the development of policies and defining targeted actions to promote community health. A robust CHIP should define a vision for the health of the community through a collaborative process, while addressing a range of strengths, weaknesses, challenges and opportunities that exist to improve health in the community.

Read More about Logic Models and Community Health Improvement Plans

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Create and Maintain Effective Partnerships

A healthy community ensures that appropriate partners collaborate for community improvement. A critical component of partnerships involves engaging residents and organizations that represent different parts of your community. Agencies within a county and organizations and businesses within a community often find that they have overlapping goals and that working together increases financial resources, strengthens the community and helps all to achieve their missions.

Guidelines & Practical Worksheets

 

Network Building and Cross-Sector Collaboration

Read more about Network Building and Cross-Sector Collaboration:

Commit to Shared Goals and Outcomes

A commitment to realizing goals and outcomes is the basis for collaboration. Shared definitions are helpful for determining if a collaboration is achieving its purposes and goals. Collaborators should identify how they will define success and what data indicators will measure success.

Read More about Shared Goals and Outcomes

Formalize Partnerships

Partnerships can assume many forms and reflect varying levels of formality. Community partnerships can be formalized through the creation of a council responsible for ensuring appropriate action is taken to implement programs. A Memorandum of Understanding (MOU) offers another way to formalize a community collaboration. Partnerships can benefit from formalized agreements, although long-standing partners often do not need a formal document to delineate roles. Below are resources and examples of formal partnerships using both MOUs and councils to guide activities.

Read More about Formalizing Partnerships

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Use and Assess Data

Data is an essential component of a community’s plan to implement successful health programming. Data helps identify opportunities, prioritize need, target initiatives, make mid-stream course-corrections and evaluate progress. Effective use of data can increase accountability and ultimately lead to more strategic investments. While data can enhance planning and decision-making processes, communities often find data collection challenging. Many communities are becoming increasingly informed about how to overcome data barriers and challenges, particularly on matters of data sources privacy.

Different communities have different abilities to collect data. While some communities possess sophisticated digital systems, others collect data through hand-distributed paper surveys. All data-collection methods are helpful.

Guidelines & Practical Worksheets

Read More about Data Use & Assessment

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Engage Local Elected Officials and Key Stakeholders

Participation of local elected officials is vital to the success of any municipal initiative, often offering an opportunity for programmatic endorsement, budgetary support, and enhanced public engagement. Elected officials are well positioned to convene key stakeholders and cultivate strategic alliances among them. Developing the early interest and buy-in of an elected official can give rise to a more visible, public champion for a cause, as well as a wider awareness of, and support for, a community effort. Engagement of local elected officials should begin at the planning stage of a community health initiative—the earlier, the better—to permit their ideas, experience, and network to inform development of a new program.

Guidelines & Practical Worksheets

How to Engage Local Elected Officials

Initial opportunities for engagement include writing a pitch for a proposed community health program and sharing it with a lawmaker’s staff for input. Briefing staff through educational emails, calls, and office visits offers an opportunity to foster working relationships with the individuals most likely to be involved in a project on behalf of an elected official.Writing an article or opinion piece for a local newspaper, highlighting key aspects of the initiative, is another effective means to engage policymakers. Social media provides a unique platform to publicly engage a lawmaker in a dialogue about a community health initiative, offering an opportunity to extend open thanks to a lawmaker and demonstrate broad constituent endorsement of an initiative.

Once an initiative is underway, maintaining the engagement of the elected official should include inviting him or her to speak at program events, as well as participate in onsite programmatic visits, particularly if a photo opportunity or news piece can be created.

Read More about How to Engage Elected Officials

How to Improve Constituent Engagement as an Elected Official

An elected official often assumes a visible leadership role in a community health program to lend credibility and public trust to the project. A community health initiative offers more than an opportunity to enhance constituent quality of life; it presents a means by which a municipality can secure additional state and federal resources. Strong, visible leadership for a county health initiative should include: setting a balanced and optimistic tone in local conversations; convening community leaders and key stakeholders throughout all stages of an initiative; educating state and federal partners; advocating to state, federal, and other partners for additional funding resources; serving as a champion of the initiative by attending and speaking at events for the community’s health program.

Read More about Engaging with Your Constituents as an Elected Official

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County Examples

Foundations for Planning Health Initiatives

Include Community Voices

Advance Health Equity

  • Hillsborough County, Fla., Office of Health Equity has developed a Health in All Policies strategy to engage city, county and community-based agencies to incorporate improved health equity strategies into policy and funding decisions.
  • The Harris County, Texas, Public Health Department conducted a Health Equity Assessment in concert with the City of Houston to identify public policies, practices and programs that could be augmented to reduce the extent of health disparities.
  • The Alameda County, Calif., Place Matters team is using policies to address structural and institutional inequalities in health through active and meaningful community engagement in local policymaking.

Address Social Determinants of Health

  • Polk County, Iowa, conducted a series of discussions on the impact of social determinants of health, including access to care, affordable housing, education, emotional wellbeing, nutrition, safety and transportation in the county.
  • Cowlitz County, Wash., produces the Cowlitz County Community Report Card, which provides county residents the health data and trends that are impacting county health.
  • To increase awareness of social determinants of health Napa County, Calif., developed the Healthy Bodies Coalition Worksite Wellness Toolkit.

Evaluate Community Needs and Resources

Identify the Problem

  • Adams and York County, Penn., conducted a Community Health Needs Assessment which focuses on health risks that contribute to the county’s leading causes of death, disability and how those are unevenly distributed among demographics.
  • Anne Arundel County, Md., used its Community Health Needs Assessment to obtain a stronger sense of its population growth, senior populations, and leading causes of death.
  • Wicomico County, Md. –The health department conducted a health impact assessment on concentrated animal feeding operations (CAFOs) in the county and explored if there is a relationship between CAFO emissions and an increase in asthma triggers. Findings from the county’s assessment informed policy recommendations related to respiratory disease and illness.

Map County Assets

  • Fairfax County, Va. –Fairfax county employed Mobilizing for Action through Planning and Partnerships (MAPP) to inform development of its Community Health Improvement Plan. The county developed a six phase MAPP process, including phases such as the development of vision and values statements, as well as formulating goals and strategies.
  • Bergen County, N.J. –The New Jersey county uses Mobilizing for Action through Planning and Partnerships (MAPP) to engage community partners and create a collective vision for improving its residents’ access to integrated primary and behavioral health services.

Develop a Strategic Plan

  • Kent County, Mich. –After the county conducted a health needs assessment, it then developed a community health improvement plan (CHIP) titled Healthy Kent. The plan leveraged the findings of the health needs assessment to develop county-wide health priorities that addressed mental health, obesity and poor nutrition, substance use disorders and violence.
  • Martin County, Fla. –The Martin County Advisory Committee formed to improve the quality of life and health outcomes of its residents. The committee developed a Community Health Improvement Plan (CHIP) to augment awareness of existing health and human services.
  • Kittitas County, Wash. –The Youth Services Mentor Program administered by Kittitas County provides community-based after school mentors for children. The program employed a Logic Model from its onset, assessing five key areas: needs, program inputs, program activities, program outputs and program outcomes. By mapping the developed program, Youth Services Mentor Program found that long term mentees experience fewer health disparities, develop full potential as strong, confident, successful adults and eventually become civically engaged members of community.
  • Marathon County, Wisc. –The county health department developed a Strategic Plan to offer renewed organizational focus leading to improved efficiency and effectiveness in addressing public health needs.

Create and Maintain Effective Partnerships

Commit to Shared Goals and Outcomes

Formalize Partnerships

Use and Assess Data
  • Prince George’s County, Maryland –Prince George’s County collects and maintains current health data on the county’s website for all to access on a range of health-related issues from air quality to infant mortality rates.]
  • Tioga County, Pennsylvania –Tioga County conducts the Pennsylvania Youth Survey (PAYS) every other year. The PAYS Survey is administered in individual school buildings at the school’s discretion. The PAYS tool is a data driven approach which gathers information changes in patterns of the use and abuse of harmful substances and behaviors and risk factors that are related to those behaviors. County partners are then able to use those results to direct prevention resources to areas where they are likely to have the greatest impact.
  • Ramsey County, Minnesota –The county administers Metro SHAPE (Survey of the Health of All the Population and the Environment) as a joint project by eight metro public health departments to identify local health issues such as access to health care and social-environmental factors. Participating health agencies include the City of Bloomington, Carver County, Dakota County, Hennepin County, City of Minneapolis, Scott County, Saint Paul-Ramsey County and Washington County.
  • Clackamas, Multnomah, and Washington Counties, Oregon –This county consortium developed theTri-County Opioid Safety Coalitionto decrease opioid misuse and harms by coordinating the efforts of public health, medical, behavioral health, payer and patient communities. The coalition has focused on three data-driven strategies to combat the regions local opioid epidemic, including assessment of overdose risks, increasing community awareness in high-risk areas of opioid risks, prescribing safer substance use medication and monitoring opioid prescribing trends. The coalition uses data to tailor its policy and programmatic interventions in the region.

Engage Local Elected Officials and Key Stakeholders

How to Engage Local Elected Officials

How to Improve Constituent Engagement as an Elected Official

  • The Wake County, N.C., Board of Commissioners created a Population Health Taskforce, which is comprised of 25 residents, to initiate a strategic health plan for the county.
  • In Ravalli County, Mont. county commissioners wrote a letter in support of the Sapphire Community Health Inc., to receive a grant.

 

 

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