Healthy Places by Design recommends a community change process that is intentional about partnership, preparation, and strategic progress to change policies, systems, and environments for improved community health. Leaders of healthy community change initiatives can determine their own communities’ strengths and weaknesses within each step and address any gaps accordingly.
Partner with others to address complex issues. While positive community changes are often championed by strong and passionate individuals and lead organizations, sustained and impactful efforts require broader multi-disciplinary and cross-sector coalitions that set collective priorities and act in concert. Each participant brings a valued perspective. The Partner step involves the development—and dedicated maintenance—of a cohesive coalition with residents as authentic partners; meets and communicates regularly; creates a structure and organization that makes sense for the participants and the group’s mission; driven by the needs of the community; and enables the group to achieve its goals and objectives. Successful coalitions comprise:
Prepare continuously to succeed. Preparation is not limited to the early stages of a community-change initiative. Rather, it is the ongoing and deliberate process of collecting relevant assessment data to inform program planning, prioritizing, and specifying action steps, identifying measures of success, providing appropriate training for partners, and pursuing financial and in-kind resources to build capacity. Success should be determined by routine assessments of the partnership’s processes (for example, partner engagement and satisfaction), impacts in the community (for example, improved health-promoting environments), impacts on individuals (like changes in health status), and other outcomes, depending on available expertise and resources.
Progress by identifying and implementing practical strategies. Just as each community exists in its own unique context, placed-based community change initiatives may not all follow the same formula for change, and some strategies will result in varying levels of impact and sustainability. Healthy community strategies must be practical within the context of each community. In a robust and sustainable community change initiative, the following strategies work to mutually reinforce each other by including a mix of "quick wins," mid-term milestones, and those with the potential for long-term support from organizations and systems. This strengthens aspects of each strategy to create impacts that are greater than the sum of their parts.
Promotions typically reach individuals to change their behavior through awareness-building appeals. Programs directly serve individuals in smaller group settings by providing education or opportunities for healthy behaviors. Examples include cooking classes and walking clubs. While these strategies alone do not lead to sustainable community change, they can build public interest and support and can help mobilize the residents. Ideally, programs and promotions are implemented in a way that complements more sustainable policy, systems, and environmental change strategies, and can help ensure activation and sustainability of new or improved spaces.
A focus on changing policies and environments is a longer-term strategy to support individuals’ personal choices by ensuring that communities are places where healthy behaviors are convenient, safe, and routine. Policy change strategies typically target government ordinances, regulations, and protocols. Changes in informal policies, like organizational practices, processes, or protocols, can also be impactful. Environmental change strategies strive to make the physical spaces in our organizations, neighborhoods, and communities more conducive to healthy lifestyles. As with promotions and programs, policy and environmental changes alone may not lead to sustainable community change, and often require integrated promotions and programs for improved health outcomes. These strategies typically lead to longer-term impacts and can be initially implemented as pilot projects, which are valuable for testing new procedures or projects on a small scale.
Strategies that emphasize changing larger systems can lead to sustainable impacts. When communities have an integrated web of supports—including mutually reinforcing policies, programs, environments, funding, and organizational practices—healthy change strategies are institutionalized. “Health in All Policies” is one systems approach for governments to address existing norms or establish new ones, and align indicators, accountability measures, and fiscal decisions around prioritizing the health of the community in everyday decisions.