Some see rejection as a sign of failure. Not in Louisville. After being denied a Steps to a Healthier U.S. award from the Centers for Disease Control and Prevention (CDC), partners rallied and in 2002 submitted a successful proposal to the Robert Wood Johnson Foundation for an Active Living by Design (ALbD) grant. ALbD helped accelerate the momentum generated by the Mayor’s Healthy Hometown Movement (MHHM), which launched with local funds and leadership from the Department of Public Health in 2004.
At the time, Louisville residents—particularly those in inner-city neighborhoods, where poverty was most concentrated—were struggling with significant health challenges. Nearly one in four Louisville adults reported that they had not participated in any physical activity in the last month, and almost two in three were obese or overweight. Efforts to create healthier environments were thwarted by a number of factors. Bourbon and fast food were economic engines for the state, and Yum! Brands, Inc., which owns and franchises KFC, Pizza Hut, and Taco Bell, is headquartered in the city. With myriad drive-thru outlets and an abundance of advertising, unhealthy food was pervasive. Old public housing stock, lack of amenities, and unsafe conditions for walking and biking in low-income areas created additional challenges.
With additional support from the four-year Healthy Kids, Healthy Communities (HKHC) grant, the Louisville Metro Department of Public Health and Wellness (LMDPHW) expanded its partnership and improved access to healthy foods and physical activity in 12 neighborhoods most affected by health disparities.
Momentum had already been building around childhood obesity prevention as a result of the MHHM and the ALbD initiatives. Louisville was already developing walking trails, bike paths, and health promotion programs. The HKHC grant helped partners expand their efforts and advance other improvements, especially in neighborhoods with limited access to fresh, healthy foods and safety and environmental problems that discouraged physical activity.
Led by the LMDPHW, the new diverse partnership included the Louisville Metro Housing Authority, the Transit Authority of River City, the Mayor’s Office, Planning & Design Services and Parks, the Presbyterian Community Center, Shawnee Neighborhood Association, the YMCA of Greater Louisville, the Center for Health Equity, Jefferson County Public Schools, and others.
Although many of these organizations had a track record of successful collaboration, the HKHC partnership engaged in explicit planning and capacity-building activities to lay a stronger foundation for their work. They knew that lasting change would only occur with youth involvement, so HKHC partners launched Louisville Youth Advocates (LYA), a group of 50 young people from 12 neighborhoods.
The group identified neighborhood challenges, explored solutions, and informed the development of policies around active living and healthy eating. Documenting their findings through Photovoice and digital storytelling, youth shared results with city council members and other policy makers at a number of events and gallery showings. LYA participants also surveyed residents in West Louisville neighborhoods and discovered that increased access to fresh, healthy foods was a top priority. Their findings led to the opening of several Healthy in a Hurry corner stores to provide fruits and vegetables in neighborhoods where healthy food was lacking.
From that success, and aided by a U.S. Conference of Mayors grant, partners then worked with the local YMCA to start the Metro Youth Advocates (MYA) program. MYA enabled young people to advocate effectively for policy change at the community level, elevating their voices across the city and engaging youth in issues that affected them. Participants strengthened their advocacy, public speaking, policy solving, and critical thinking skills. They also engaged with public officials, community leaders, and peers from the Louisville metro area around issues ranging from food and agriculture to violence prevention, education, and health.
One young person advocated for a change in the Jefferson County Public Schools garden policy so that it would include a maintenance and sustainability plan and allow shared use of the school gardens during summers. Other youth stayed involved in their communities even after they graduated, with some continuing to advocate for improvements.
In addition to its explicit focus on working with youth, the HKHC partnership also worked to intentionally and authentically engage adult residents. Annual planning retreats included leaders from partner organizations as well as community members. These retreats provided a forum for eliciting broad input about the community’s vision for health and how to achieve it. In addition, by identifying goals that extended beyond the HKHC grant period, the partnership set the stage for important, ongoing conversations about sustainability.
Meaningful community connections were made by collaborating with active, well-established neighborhood associations and community schools with whom the health department had existing relationships. In turn, youth volunteers received valuable training through the Center for Neighborhoods. As a result, many of them went on to lead walkability and food access assessments and participate in advocacy activities that generated visible, tangible improvements in their neighborhoods.
The HKHC partners approached the change process from multiple levels simultaneously. Youth and resident engagement in assessment and advocacy activities built demand for neighborhood improvements which, in turn, helped inform city-level policy and environmental changes.
Early partnership successes included expanding the city’s bicycle lanes, creating an Active Living committee within city government, and producing an educational rap about how to put bikes on buses that quickly went viral. During the development of Liberty Green, a HUD HOPE VI project, partners added pocket parks and a walkable streetscape, ensuring that pedestrian safety was addressed. They created a pedestrian safety action plan and a neighborhood planning process that engages citizens in walking audits to identity and prioritize changes. They also helped establish connections from 12 priority neighborhoods to the Louisville Loop, a 25-mile shared-use path that will eventually become a 100-mile loop around the city.
Additional grant funding helped establish new partnerships between the YMCA of Greater Louisville and more than half a dozen corner store owners to install Healthy in a Hurry Sections of fresh produce in areas lacking full-service grocery stores. As a result of the initiative, store owners received refrigeration, signage, marketing, start-up inventory, ongoing technical assistance, and money to renovate facilities to make them more attractive and to make it easier to sell fresh produce. Some owners replaced beer advertising with Healthy in a Hurry signage.
Due in part to local advocacy, Mayor Greg Fischer also initiated a Food Policy Advisory Council. Its charge was to develop policies in support of a just, sustainable food system to improve public health, spur economic development, and increase access to healthy food for all Louisville Metro citizens. Finally, political will to support healthy community change increased significantly thanks to a health-in-all-policies perspective that has helped align agendas, streamline communication, and expedite action among key decision makers.
The Mayor’s Healthy Hometown Movement has evolved and continued under Mayor Fischer, and the impact of Louisville’s passion for and ongoing commitment to health is undeniable. The city has leveraged a range of private and public resources to support downtown revitalization, including significant improvements in previously distressed public housing developments.
Pocket parks exist throughout the downtown area, and marked walking paths connect to key destinations across the city. There are now hundreds of miles of bike lanes, an accomplishment that netted the city a bronze-level Bicycle Friendly Communities designation from the League of American Bicyclists. In addition, the Louisville Loop is nearly complete, and the city is working with residents to determine where stations for the new bike share program should be located.
More residents can access fresh produce through Healthy in a Hurry corner stores. New community and school gardens are in place and thriving because of resident engagement. Funding from a variety of private and public sources, such as the Centers for Disease Control and Prevention (CDC), the U.S. Department of Housing and Urban Development (HUD), the National Convergence Partnership, and the U.S. Conference of Mayors provided resources to supplement the HKHC grant and to take its work to the next level.
Metro Youth Advocates also continued to create a diverse cohort of young leaders with the knowledge, skills, experience, network, and confidence to spark positive change in their communities. In 2016, the organization brought together 100 students from 28 different zip codes and 24 different high schools. These leaders will form the backbone of the next generation of community leaders in Louisville.
And conversations about health equity, once initiated primarily by the LMDPHW and the Center for Health Equity, are embraced by partner organizations and residents alike. They now have a deeper understanding of how social determinants such as housing, transportation, employment, and education can affect health—and they’re doing something about it.
Louisville has embraced cross-sector collaboration. The Mayor’s Healthy Hometown Movement promotes a culture of health by sharing information and education about the work of several collective impact groups: the Louisville Health Advisory Board, Healthy Babies Louisville, and the Louisville (Opiod) Treatment Advisory Group. Health in all policies and health equity have been embedded in each of these multi-sectorial alliances and within Metro Government.
Today, Louisville is often cited as a national leader for its efforts to address equity and improve community health. In 2016, it was one of just seven recipients of the national Culture of Health Prize awarded by the Robert Wood Johnson Foundation.
And, true to its history of persistent commitment, the city’s dedication to embracing a broad definition of health to improve the lives of all of its residents shows no signs of waning.
*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.
Bildner M and Brennan LK. Louisville’s Healthy Kids, Healthy Communities Case Report. St. Louis, MO: Transtria LLC; 2014. http://www.transtria.com/hkhc. Accessed July 25, 2017.
August 2017