Before Hamilton County Public Health (HCPH) launched the WeTHRIVE! initiative, it had received three national grants that supported healthier communities by addressing policies, systems, environments, and social determinants of health: Healthy Kids, Healthy Communities (HKHC) from the Robert Wood Johnson Foundation, Communities Putting Prevention to Work and the Strategic Alliance for Health, both from the Centers for Disease Control and Prevention.
HCPH quickly realized that it needed to coordinate those efforts in order to effectively manage resources, align goals and improve the lives of a population at risk for diabetes, health disease, stroke and high infant mortality. An enduring success of WeTHRIVE!’s coordinated, sustainable approach is the county-wide systems change that it has achieved. What began as a focus on healthy eating and active living grew into a focused method of implementing a broader culture of health in Hamilton County.
With support from HKHC and the Active Living By Design (ALBD) [now known as Healthy Places by Design]* team, HCPH formed strategic partnerships with other organizations to expand WeTHRIVE!, a grassroots-level health movement designed to involve communities in the process of change. The initiative works with community partners, schools, businesses, churches, elected officials, and residents, extending partnership efforts throughout the community. WeTHRIVE! also reset the frame around community health, allowing partners and stakeholders to more easily see their roles and to select strategies that would be sustainable for the county.
Some early strategies included:
Early in the launch of WeTHRIVE!, HCPH and the YMCA of Greater Cincinnati partnered to host a luncheon as a forum for local, state, and federal legislators, along with leaders from local sectors, including government, planning, transportation, recreation, education, business, and community-based organizations. The broader community was urged to join the WeTHRIVE! movement, and afterward, partners conducted follow-up activities to increase engagement and community capacity, reaching approximately 500 stakeholders.
As WeTHRIVE! continued to engage community members and diverse partners over the years, it increased capacity for local leaders, mobilized community members, built credibility, and eventually began to be institutionalized within HCPH. The initiative also reached out to other partners with similar or overlapping missions—for example, the environmental services department, which includes waste management, water quality, and housing issues. Through collaboration with other agencies, WeTHRIVE! was able to get broad buy-in to its mission.
Preparation is not limited to the early stages of a community-change initiative, and WeTHRIVE! took the time to assess, re-assess, and evaluate throughout its work while thinking about the initiative’s sustainability. As the three large grant initiatives that led to WeTHRIVE’s creation ended, budgets shrank and staff transitioned to new opportunities. HCPH staff took that time as an opportunity to brainstorm together and set a new direction for WeTHRIVE!. Rebecca Stowe, Director of Health Promotion & Education at HCPH and former Project Director for HKHC, explained, “We were trying to figure out how to build on the momentum we had created and use the expertise we had in-house.”
That brainstorming led to a new structure for the WeTHRIVE! initiative in 2014 that would focus on engaging and developing community members who could shape and drive tailored strategies within their own communities. In this voluntary system, community councils within Hamilton County’s 49 jurisdictions could adopt an overall resolution, pledge that they would support the WeTHRIVE! initiative, and develop a committee responsible for health and wellness, which must include:
The inclusion of two residents on each committee was strategic: “We wanted to make sure that there was buy-in from the community and resident voices,” Stowe said.
WeTHRIVE! carries its own weight in the community. Partly because it is voluntary and tied to the public health department, trust has been built up. WeTHRIVE! has sought to authentically engage community members throughout its growth, whether through open conversations early on or by building systems that work community engagement into standardized processes within the agency.
“We encourage our teams to invite the community in, and they’ve done that. Some community councils have stronger representation than others, but we do try to make it multi-sectoral. With our organizational partners, we continuously provide education about message framing and overview. It’s encouraging to see that communities are also taking ownership and doing recruitment through word of mouth.”
—Rebecca Stowe
One result of this authentic connection with community members has been a deeper understanding of local barriers to healthy living. As communities adopted WeTHRIVE! Overall Resolutions, many of them made it clear that they felt they needed to solve issues around substance abuse, injury prevention, and social health in addition to the early focus on healthy eating and active living. HKHC had provided the structure and direction necessary for WeTHRIVE! to learn how to navigate the policy, systems, and environmental change process, and that foundation allowed the initiative to expand and address other social determinants of health.
Stowe explained, “To go and talk to [highly disadvantaged communities] and say, ‘You need to adopt policies that help folks eat healthier and be active’—that was great, and it was a step toward creating environments for people to do those things, but there were bigger issues at play. For them, it was violence. It was poverty. That’s where we kept coming back to.”
To meet communities where they were, WeTHRIVE! re-structured its Pathways to Health to include Social Health, which addressed many of the concerns that residents voiced.
WeTHRIVE! released its first health equity report in August 2015. During a quarterly learning collaborative meeting for WeTHRIVE! communities, an epidemiology team presented on the topic, generating interest in continuing to have dialogue and to bring in additional training.
The focus on health equity has been strengthened by collaboration with the public health advisory council, including the hospital system and other partners, which have agreed to share their data. Based on that data and internal assessments, WeTHRIVE! changed its initial approach for at-risk communities. In the 2015 health equity report, the initiative was able to rank all communities based on the shared data, noting whether they fell into the “highly-concentrated disadvantage” category, based on:
WeTHRIVE! is taking a deeper dive with the communities that fell into that category. Five of those communities had already adopted a WeTHRIVE! overall resolution, but there were five others which still needed assistance. The initiative is now in the process of doing a community assets and opportunity audit, including collecting photos and observations that they will combine with community health data in order to make community profiles. Meanwhile, a contractor will be out doing grassroots work in tandem with the health education team.
WeTHRIVE! hopes to return to the communities prepared for a two-way dialogue about each community’s challenges and data, while sharing that there are partners who’ve committed resources and people ready to help them through the process of becoming involved with WeTHRIVE!.
In addition to increased community capacity and collaboration, an enduring success of WeTHRIVE! is the county-wide systems change that it has achieved. What began as a focus on healthy eating and active living grew into a method of implementing those strategies in neighborhoods. That model was then institutionalized across the agency in a way that addresses a broader culture of health in Hamilton County.
“With the agency-wide implementation, the vernacular here has become ‘Everybody has a role,’” Stowe shared. “If a community wants to work on environmental or social health issues, and housing is related, you might be called in.” To account for this involvement, the initiative overhauled its Ambassador Program, a volunteer leadership program for community members (Ambassadors) who work locally to build healthy communities, to focus on policy, systems, and environmental change; health equity; and cultural competency. This updated program was re-launched in January 2016.
In early 2014, shortly after HKHC had ended, Hamilton County’s Board of Health committed to adding two additional health educators to its budget to support WeTHRIVE!. It then hired a part-time contractor to help with outreach to at-risk communities, capacity-building, and facilitating an implementation team of internal and external staff. A meeting in February 2016 included partners from hospitals, the grant-making agency Interact for Health, and departments of planning and development, emergency management, developmental disabilities, solid waste management, and air quality. The initiative is also included in the Community Health Improvement Plan and Strategic Plan being used for accreditation from the Public Health Accreditation Board.
“Our health commissioner was not going to let this go,” Stowe said. “The level of support from county leadership has made decision-making go much more quickly. They’re invested in improving community health, and they look to us as the experts and ask, ‘What’s your recommendation?’ Now, they ask how they can support us.”
WeTHRIVE!’s sustainable thinking, community engagement and focus on health equity have continued to grow the movement.
By 2015, 19 of Hamilton County’s 49 jurisdictions had adopted WeTHRIVE!’s Overall Resolution, and 122 of Hamilton County’s child care centers and after school program providers adopted its Child Care or After School Wellness Resolution.
*Throughout this story, references are 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 Hamilton County Public Health and WeTHRIVE! implemented principles within Healthy Places by Design’s Community Action Model, please contact Rebecca Stowe at rebecca.stowe@hamilton-co.org or Joanne Lee at joannel@healthyplacesbydesign.org.
June 2016