With nearly 700,000 residents, Jefferson is Alabama’s largest county. Home to the city of Birmingham, the county has a rich history of tremendous prosperity linked to iron and coal production. It also has progressive funders, government agencies, and non-profit organizations, such as the United Way of Central Alabama (UWCA), the Community Foundation of Greater Birmingham (CFGB), and the Jefferson County Department of Health (JCDH).
At the same time, 26 percent of Jefferson County children live in poverty and more than one-third of Birmingham families live in food deserts. And, like the rest of the state, residents have high rates of obesity, food insecurity, and physical inactivity—particularly people of color and low-income community members.
In response, a multidisciplinary collaborative, Jefferson County Health Action Partnership, (HAP), received a Healthy Kids, Healthy Communities (HKHC) grant in 2009 to address these challenges. The grant helped HAP expand its membership to include more than 100 partners and to broaden its work to address policies, systems, and environmental change strategies.
Soon after, Jefferson County experienced a series of setbacks. The county declared bankruptcy in 2011 due to the mismanagement of its debt. That spring, an EF-4 tornado devastated the region, killing 64 people, causing $2.4 billion of property damage throughout the area, and leaving dozens of communities reeling from the loss of life and property. And in 2012, the State Board of Education assumed control of Birmingham City Schools, which serves over 24,000 students, because of a severe financial shortfall.
Despite these challenges, HAP served as an inclusive and effective force for healthy community change during lean and unsteady times.
From 2009 to 2013, UWCA served as lead agency for the HKHC partnership as it adapted to rapidly-evolving opportunities and threats. For example, in 2010 the JCDH received a $13.5 million Communities Putting Prevention to Work (CPPW) grant from the Centers for Disease Control and Prevention (CDC). While it was a welcome windfall, the grant generated an urgency to hire new staff and dramatically increased HAP’s scope of work. “To make large scale change happen, you have to be willing to take the first step and create something people can get behind. It’s exciting to see where it has led us,” says Kadie Peters, Vice President of Community Impact in Health at United Way of Central Alabama and former HKHC Project Director.
With this grant, HAP built upon many of HKHC’s elements, adding partners and intentionally overlapping in some areas to provide additional support. But this, too, was not without challenges. For example, Jefferson County leaders recognized the need to form a joint task force when partners like the school system and child care centers were inundated with requests from leaders associated with HKHC, CPPW, and other initiatives.
The joint task force also helped consolidate many different meetings with similar agendas. Later, in response to the addition of other community partners who were better equipped to lead implementation activities, HAP adopted Articles of Collaboration to formalize member roles and increase transparency; identified anchor organizations (UWCA, JCDH, and CFGB), each of which provided staff support; and restructured its work around four priority areas to ensure partners were pursuing the same strategic directions.
Amanda Storey, Executive Director of Jones Valley Teaching Farm and former HKHC Project Director reflects, “HKHC was a blueprint for the CPPW application and thinking. . . a game plan was already in place.”
At the beginning of HKHC, HAP comprised mostly large organizations. As part of the partnership’s assessment and planning activities, HAP identified smaller grassroots organizations, initiatives, and community members with complementary interests and invited them to collaborate alongside the larger organizations.
For example, in 2010, HAP and Freshwater Land Trust initiated Our One Mile, a community engagement planning process to create a greenway master plan for the region. The 18-month visioning process gathered community input on trails, sidewalks, and parks to develop routes for the master plan. Three thousand Jefferson County residents participated in the process, which included an online forum and 40 meetings. The campaign resulted in the development of the Red Rock Ridge & Valley Trail System Master Plan, which proposed over 200 miles of shared use greenways and trails and over 600 miles of street-based bicycle and pedestrian pathways.
Similarly, the HKHC partnership’s staff met with members of Greater Birmingham Community Food Partners (GBCFP) to advocate for and educate members about the benefits of a Birmingham-Jefferson County Food Policy Council. The open forum allowed participants to discuss the local food system and ways to be more involved in the process. With support from HAP, GBCFP reorganized as a Food Policy Council and expanded membership to include community gardeners, students, and residents. The new members identified local food policies, while the council established a formal structure and created a charter which defined its vision for a healthy food system in Jefferson County. The Food Policy Council went on to host annual Food Summits that increased awareness of and support for the local food system. The summits also supported HAP efforts, including the development of an urban agriculture ordinance.
The length of the HKHC grant provided time for the partnership to build new relationships and expand collaboration with community members. Community engagement played a vital role in the partnership’s success and, ultimately, paved the way for the achievement of tangible impacts. Many of these are still developing. “Even though HKHC has been over for a few years, we had the time and space to work with community members and decision makers on projects that are now just being built,” Peters says.
Intentional assessment activities ensured that HAP was poised to address the community’s most pressing concerns. The partnership conducted a Community Healthy Living Index (CHLI) in three of its target neighborhoods, engaging more than 300 residents to assess the availability of and access to opportunities for active living and healthy eating. These assessments highlighted challenges and needs around the implementation of policy, systems, and environmental changes; helped HAP identify perception gaps between partner organizations and residents; and identified specific projects for future work.
Residents indicated that they wanted safe places that provided access to physical activity. In response, HAP pursued Safe Routes to School, a Walking School Bus program, Complete Streets policies, and the development of a greenway master plan. Similarly, community members identified the lack of affordable healthy food as a concern. In turn, HAP advocated for a food policy council, an urban agriculture ordinance, and after-school and mobile markets.
Additional assessment activities helped confirm the need for active transportation and higher-quality childcare centers. Participants of the Walking School Bus program conducted a Photovoice assessment to identify barriers and assets along their routes to school, documenting vacant and blighted homes and trash and crumbling infrastructure on local properties. They used the photos to create a video and brochure to advocate for policy and environmental changes like increased funding for Safe Routes to School programs, a Complete Streets policy, and street maintenance. The partnership also combined resources with other stakeholders and conducted 100 assessments of local childcare centers using the Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC) tool. After completing the assessments, participants set goals for improving their physical activity and nutrition environments.
Peters reflects on the value of these intentional assessment activities, noting, “[After] all of the things that were brought up in those initial meetings [with residents]…we’ve been able to see some pretty dramatic changes. HKHC was an intense time commitment, but we were able to see a lot of wonderful changes happening because we had the time and the space to be there and build relationships. And that’s still one of the most valuable things about the HKHC grant: we had so much time to work on projects that really take three years to be built out, and to see the finished product.”
“Some of the pilot projects and policies that we were able to fund through HKHC were really valuable. In some cases, they’ve led to the growth of things that came out of those projects, or we were able to learn from them and shift our priorities,” observes Peters. For example, HAP collaborated with school wellness coordinators, the Children’s Policy Council of Jefferson County, and Jones Valley Urban Farms to create new wellness policies in six of the county’s 12 school systems. Many of these policies reengaged school-based wellness committees, which began implementing Safe Routes to School programs and other elements of the policies that worked best for individual schools.
This work continues today. Now coordinators are better equipped to address new requirements from the federal government. Dedicated state and local funding is supporting their work, Safe Routes to Schools efforts are expanding, and there is an intentional effort to improve traffic conditions in neighborhoods around schools that are most impacted by health disparities.
Similarly, HAP and other partners joined forces to enhance support for childcare centers, including advocating for nutrition and physical activity standards. Ultimately, this focused attention led to the adoption of new regulations for more than 200 childcare providers caring for over 17,600 children in Jefferson County as well as technical assistance and training to support their implementation. More recently, JCHD began implementing a scoring system, and childcare centers are required to post the results of their inspections. “So now when you walk into one of those centers,” Peters says, “you’ll be able to see whether they’ve had some violations. It’s supposed to be much easier for parents to understand.”
HAP also influenced the adoption of a Birmingham Urban Agriculture Ordinance and the creation of markets in the partnership’s target neighborhoods. Partners supported programs to promote healthy eating and established farmers’ markets, mobile markets, farm stands, and after-school markets throughout the county. Outgrowths of the ordinance have led to land banking, which has established tracts of up to 30 acres that could eventually support small urban farms. The ordinance also laid the groundwork for the development of farm labs at elementary, middle, and high schools. Sustainable food production lessons and working markets run by students are integrated into state curriculum requirements.
Each of these efforts, and others like them, helped pave the way for the adaptation, scaling, and spread of healthy community strategies throughout the county. In some cases, Jefferson County has become a model for peer communities. For example, in 2012, the National Complete Streets Coalition’s nationwide analysis recognized the Birmingham Complete Streets Policy for its safe, smart transportation language.
HAP designed its initiatives to be scaled and replicated in order to ensure sustainability. JCDH, CFGB, and UWCA all committed to providing ongoing staff support to ensure the partnership continues. And HAP and its partners are supporting many of the HKHC projects and initiatives several years after the grant has ended. These include implementation of the Red Rock Ridge & Valley Rail System Master Plan, Safe Routes to School of Central Alabama, implementation of the Birmingham Comprehensive Plan, Complete Streets implementation, before- and after-school wellness policies, and urban agriculture outreach.
HAP also secured over $85 million in small and large grants as well as in-kind support from a range of sources during HKHC. These include a $10 million TIGER grant from the federal government to fund economic recovery efforts as a result of the 2012 tornado; more than $500,000 from the Alabama Department of Transportation to support Safe Routes to School infrastructure and programming activities; and grants from local partners to support community engagement and healthy lifestyle programs. However, consistent external funding has been much harder to secure since HKHC ended. This has required partners to be more resourceful.
Kadie reflects, “We don’t have big, ongoing grant dollars to support some of this work. And so we’re thinking a little more strategically about how we can leverage funds. We’re being more thoughtful about pulling organizations together and working on projects that are going to be beneficial and very low cost, and determining how we can collaboratively support them.”
Jefferson County and its leaders continue to be recognized for their outstanding efforts to improve community health.
In 2015, HAP began investing deeply in health equity work to address the stark health disparities and pervasive, negative consequences of systemic racism in its community. That year, a Roadmaps to Health Action Award from the Robert Wood Johnson Foundation’s (RWJF) County Health Rankings & Roadmaps national program enabled the partnership to develop guiding principles, support educational efforts, and begin embedding health equity principles and practices into its work. And in 2016, a small cadre of HAP representatives were selected from hundreds of applicants to join RWJF’s inaugural class of Culture of Health Leaders. This program engages people from diverse sectors who want to become even more effective leaders in creating healthier, more equitable communities.
HAP recently reorganized to improve its effectiveness and enhance sustainability. With enhanced priority areas that now include mental health and health equity, and aligned metrics and action plans, the partnership has renewed energy and accountability. Peters reflects on this change, sharing, “We’re able to bring a lot more partners to the table than we had in the past. And we’re exploring how we can really engage our leadership team to take action, and how we can think through the sustainability piece to include more than just the three anchor institutions that provide ongoing support.” She adds, “We’re spending significant time on it.”
*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.
With thanks to Transtria, LLC, which led the evaluation of the Healthy Kids, Healthy Communities national program.
Donaldson K, Stachecki J, Brennan LK. Health Action Partnership Case Report. St. Louis, MO: Transtria LLC; 2014. http://www.transtria.com/hkhc. Accessed July 31, 2017.
August 2017