“Time- and resource-intensive.” “Unsustainable.” “Limited to individual responsibility.” These phrases have been used to describe concerns about programmatic strategies for improving population health, particularly when public health began emphasizing policy, systems, and environmental change strategies as longer-term approaches. This shift in focus seemed necessary to pivot from a history of over-reliance on programs and promotions. But, in efforts to counter this history of practice, have we swung too far and lost the impact of programs on people’s lives?
I have been guilty of it. I recently worked with a coalition that wanted to increase physical activity in West Philadelphia. They asked me to help the group explore environmental and policy change strategies, knowing that they may be more sustainable. I asked about existing efforts from which they could build or to which they could link. They mentioned dance and basketball programs. In ALBD’s Sustainability Framework, we highlight how programs can be sustained by institutionalizing them within existing organizations or systems. However, the sports and dance programs in West Philadelphia were run by small non-profits rather than government agencies. In that case, the community’s context required embracing a different view of programs.
Read literally and at first blush, Shoot Basketballs Not People (SBNP) sounds like a program that engages individuals in physical activity and away from violence. But as I listened to Garry Mills, Founder and Executive Director of the organization, I realized that what he has built is more than a program; it is a community ministry. Garry is in his 30s and has attended almost as many funerals as his age. Compelled to do something, Garry hosted a basketball game specifically dedicated to non-violence at the local playground. When more than 500 people showed up, Garry realized that his community could rally to create positive change.
It’s been eight years since that first neighborhood basketball game. Since then, SBNP has grown to provide a range of opportunities for youth to build life skills. While the game of basketball is used as a vehicle to engage youth in healthy behavior, SBNP also prepares them for academic success, careers, and long productive lives through education and new experiences. “I’m straight with kids and tell them they aren’t all going to be LeBron James,” says Garry, “but I take them to talk to the athletic trainer and the business manager so they start to think about other possibilities.” He also forms relationships with parents in the community, and this role modeling serves as a bridge for youth to strengthen bonds with adults. Program youth also give back through a variety of volunteer community service activities. SBNP is an example of a successful and sustained program with positive outcomes, including improved graduation rates and job placements.
While programs like SBNP work to change individuals’ behavior, I’m also reminded that they highlight the importance of community responsibility. Another way to think about it is community culture. Ideally, we’d like to see formal systems and institutions such as schools, health care, justice, and others provide sustainable programs and services. But in some communities, the reality is that youth and residents feel that those systems or institutions have failed them. Instead, programs led by residents and grassroots organizations serve as trusted “informal systems” for opportunities and positive change. The negative impacts of disconnection to formal systems affects communities across the country, and is so essential to community health that a measure of disconnected youth was added to the annual County Health Rankings this year.
As is usually the case, I needed to spend time in communities and with residents to obtain perspective and renewed equilibrium. When exploring sustainable policy, systems, and environmental change approaches in the future, I’ll be more intentional about examining successful programs in order to uncover the informal systems that are truly transforming our neighborhoods.