A commitment to healthy living is contagious. That’s what the city of Buffalo, New York has learned. In 2003, Buffalo Niagara Medical Campus Inc. received an Active Living by Design and Healthy Eating by Design grant from the Robert Wood Johnson Foundation to build healthier communities. As the work continued through Healthy Kids, Healthy Communities (HKHC), the HKHC Buffalo partnership addressed policies, systems, environments, and social determinants of health.
The initiative’s staff recognized that forging partnerships—both within and outside the city—was critical for success. The effort would require buy-in from community leaders and city and state officials, and expertise on a number of fronts would need to be leveraged. Perhaps most importantly, the initiative would be difficult to sustain without genuine grassroots engagement.
“Every time I turn around, there’s a new partner working with a new partner working with a new partner.”
The partnership has been successful in each regard. “Every time I turn around, there’s a new partner working with a new partner working with a new partner,” says Samina Raja, an HKHC steering committee member. “So much goodwill has been created here.”
“One of the things that I learned quickly was how tired of the talk the community was, in terms of an organization or the city, or anyone, coming in and saying, ‘I’m going to do this for you,’ and then not following through,” says former HKHC project coordinator Jessie Hersher Gouck. “They’d say, ‘We’ve been here before, and the needle didn’t move.’”
Going in and saying “It’s important to be healthy” was not the right approach. "We had to reframe our message within a larger context."
Step one was building trust. Coming into a community, a home, and saying “It’s important to be healthy” was not the right approach, Gouck says. “That was a non-starter.”
Parents would say, “Look, I understand that fruit is healthier for my kids than candy. And I get that wheat bread is better than white bread.” But what do you do when the only option is a convenience store that doesn’t offer those options?
“That was the reality that we were confronted with over and over again,” Gouck attests. “So we had to take a different approach, both with the community and in working with our elected officials. We had to reframe our message within this larger context.” The team needed to address root causes and engage a multidisciplinary team of partners.
That meant, for example, having conversations with city officials and community leaders about public safety and transportation. City staff appreciated the interaction, Gouck says. “It felt like they wanted to try to carry out these new types of engagement with the community because they were being very well received.”
The HKHC team also reached out to the public school system. “The Buffalo school district has come on board fully as a partner,” Raja says. The district already had a mandated wellness policy, and the HKHC partnership encouraged the administration to update it to include community partners and look into what else could be done beyond the school day. Young people were brought to the table to express their concerns and offer solutions.
The partnership created eight policy briefs based on comprehensive healthy eating and active living community assessments. These briefs laid the foundation for a series of summits, roundtables, and tours, each tailored for audiences with which the partnership sought to strengthen community engagement.
“I don’t think I quite realized at the outset how powerful it could be to have multiple organizations working together.”
“I don’t think I quite realized at the outset how powerful it could be to have multiple organizations working together,” Raja says. “It sounds silly now, looking at it in hindsight, but at the time, in 2002, I was only thinking of one partner at a time. I didn’t fully appreciate the power of a broader network of partners.” Raja believes that the individual partners are now thinking more deeply about their work and the changes they can affect.
“Ultimately, we all ended up learning from each other,” Gouck affirms. “And I think that’s taken our HKHC goals in different directions than we had originally anticipated.”
“The HKHC partnership infused this kind of energy in the community,” Raja says. “There’s energy and spirit dispersed within the partnership to lift the community.”
“Every time I came to the table,” Gouck adds, “I asked myself, ‘What can I bring to this partner?’ That was our approach to everything.”
To create lasting community change, the HKHC Buffalo partnership knew that an important step was to have meaningful engagement from young people. The Buffalo Youth Advisory Committee (YAC) was formed, comprising high school students from across the city. Youth seats were also created on the Food Policy Council of Buffalo and Erie County, the Buffalo City Bicycle and Pedestrian Board, and the Buffalo Public Schools Wellness Committee.
YAC members participated in the city’s zoning and land-use change process and hosted a training session to teach high school students about land-use planning and effective participation in public meetings. Another successful YAC effort resulted in a policy change that will remove unhealthy vending machines throughout the school district. Buffalo YAC now includes representatives from nine Buffalo schools, who continue to advocate for healthy changes in their community. In the 2010-11 school year, YAC was renamed HYPE (Healthy Youth, Positive Energy). HYPE continues to offer Buffalo’s young people an ongoing platform to express their concerns about health issues within their schools.
Another youth-oriented program, Growing Green, is a summer garden initiative run by the Massachusetts Avenue Project that was designed to promote healthy eating, increase access to healthy food, and give youth a fun learning opportunity through the summer.
The program had been successful for years, but a community assessment determined that more was needed to keep young people engaged during the school year as well. To address this, the Massachusetts Avenue Project teamed up with the Buffalo Healthy Eating by Design partnership to make the Growing Green program available year-round. Young people involved in the program later joined with HKHC partners to organize a youth advisory council focused on food policy and to advocate within their schools.
The HKHC Buffalo partnership also planned, marketed, and executed a three‐part charette series to create a community‐wide vision for a healthier Buffalo. In acknowledging the importance of youth buy-in, they worked closely with their partners to determine the best ways to get Buffalo youth to attend the meetings. More than 125 people participated in the visioning events, including more than 40 young people in independent youth sessions.
Other youth-led projects included participation in the Erie County’s Agriculture and Farmland Protection planning process and neighborhood assessments of food availability and walking and biking conditions.
As the HKHC Buffalo initiative built momentum, so too did a desire to participate. City staff began to engage community members who had never before been involved in civic activity. For example, 10 training sessions were organized to prepare community members to participate in the city’s Green Code process, which looked at revising 60-year-old land-use plans and zoning codes.
In a flat city where more than a third of households don’t own a car, policies that improve the safety and convenience of bicycling were considered a priority.
In a flat city where more than a third of households don’t own a car, policies that improve the safety and convenience of bicycling were considered a priority. Buffalo had been an early adopter of Complete Streets legislation, which ensures that roadways are designed to be safe for all users, including pedestrians, bicyclists, and those of different ages and abilities. In response to these priorities, GObike Buffalo emerged from the work of the HKHC partnership, promoting biking, alternative transportation options, and improved streetscapes to create positive impacts on health, the environment, and overall quality of life. GObike Buffalo leveraged this history to increase support for alternative transportation advocacy.
And in 2013, the Food Policy Council of Buffalo and Erie County was formed. The council advises public agencies and policymakers, and its goals include reforming policies to increase the amount of locally grown food served in public facilities and increasing the number of farmers’ markets in the county. The Department of Health has fully embraced the council, and many county staff members are now active participants on both the Food Policy Council and the Complete Streets Coalition, setting the stage for longer-term systems change.
On April 3, 2017, the Buffalo Green Code, a form-based Unified Development Ordinance, became effective citywide. This success didn’t happen overnight; it involved convening 242 public meetings and enlisting the support of thousands of community members from throughout the city. This was also the first major overhaul of city zoning laws since 1953, and the ordinance serves as an ambitious blueprint for zoning and development in the future.
The work around healthy eating and active living has also expanded to address broader social determinants of health. Food policy summits focused on health equity have been held, addressing some of the root causes of health inequities.
“When we held the first food policy summit, it was about raising awareness of food,” Raja says. “When we held the second summit, it was about economic development and food. The third one was very much about justice.”
Raja says the school district’s commitment to community health concerns has been “tremendous.” There’s now a district-run farm-to-school program.
Raja says the school district’s commitment to community health concerns has been “tremendous.” There’s now a district-run farm-to-school program. “We didn’t have any school-based community gardens when we started,” she says, “but some of the conversations and activities that took place in the neighborhoods led to Grassroots Gardens, which is going really well.”
Buffalo has also been recognized as a Bronze Level bicycle-friendly city by the League of American Bicyclists, and the work has only just begun. There are 300 miles in the city’s bicycle master plan, explains Justin Booth, executive director of GObike Buffalo and a year-round bike commuter who has lived in downtown Buffalo since 1996. As work to complete those miles continues, Booth points to a number of notable “wins.” For example, 500 permanent bike racks have been installed around the city and all new and rehabilitated buildings are required through the Green Code to include bicycle parking. Impacts like this make him confident the upward trend in bicycle ridership will continue, giving residents more access to active living opportunities and less exposure to pollution.
The partnership developed a relationship with ChangeLab Solutions that expanded into a collaboration on webinar presentations, grant proposals, and formal reviews of local policies. The HKHC partnership also hosted visits from members of HKHC programs in Georgia and North Carolina, sharing its work on Complete Streets, environmental change, and more.
“There are so many activities and new alliances being built and new players stepping in,” leading to the “tipping point in health equity and other community engagement work that we’re seeing today.”
“There are so many activities and new alliances being built and new players stepping in,” Raja attests. Without the depth of partnerships through the HKHC initiative, she says, the community could never have reached the “tipping point in health equity and other community engagement work that we’re seeing today.”
*Throughout this story, references may be made to Active Living By Design. In April 2018, the organization adopted its new name, Healthy Places by Design.
If you’d like to learn more about how Buffalo implemented principles within Healthy Places by Design’s Community Action Model, please contact Joanne Lee at firstname.lastname@example.org.