“Not everything that counts can be counted.” – Albert Einstein
The release of the 2014 County Health Rankings last week and the expansion of its model and measures underscore the many ways our communities determine our health, the persistence of place-based inequality, and the comprehensive nature of our work to improve health and equity. Many of the national health trends are positive. Whether it’s the apparent leveling off of obesity rates or the declines in smoking and physical inactivity, the healthy communities movement is beginning to see some encouraging bottom line results.
Proud advocates in our movement might also cite trends like increasing rates of active transportation and transit use, the growth in urban agriculture and farmers’ markets and the increasing demand for walkable communities. Still others would highlight the growing number of policies adopted for complete streets, better school nutrition, shared use of facilities, healthy food financing, healthy child care environments, bike share infrastructure or transit-oriented development. These are all measures of progress that can be celebrated! Yet I find myself most interested these days in certain aspects of our collective success that are hard to measure.
My 12 years working at Active Living By Design with community partnerships has given me a close look at the process of healthy community change and the diverse, local heroes who make it happen. And I see emerging from many of these partnerships the kind of deep, consequential and systemic preconditions for building a culture of health.
I’ve witnessed leaders wrestle with the tensions of facilitating true engagement and inclusion, and put forth the consistent intention and effort it takes to forge quality relationships across disciplines and multiple layers of difference. I’ve watched passionate organizers struggle to build the kind of lasting community capacity that can sustain and deepen change regardless of changing circumstance. I’ve seen career bureaucrats with vision summon the patience and quiet courage it takes to steadily shift the values, norms and practices within an institution and build their agency’s ownership of change even while being opposed from inside and out. I’ve noticed more decision makers explicitly raising equity and sustainability in community-level civic discourse. And I’ve encountered community residents, youth and a new generation of connected professionals who give generously of their time to advance the vision of a healthy community for all.
It’s hard to measure, but I know that the participation and learning and leadership I see every day is precisely what will make the growing number of healthy community policies and environments really count. If we can scale this work, I’m convinced we will build the foundation of a broader culture of health. Over time, it won’t matter whether some partnerships choose to focus on childhood obesity, education, asthma, economic development, food security, affordable housing, injury prevention, economic justice, smart growth, community safety, climate change or any shifting combination of them. Under any name, this is how we will develop the leaders, integrate the values and knowledge, create the structures, and sustain the collective will to address community determinants of health and improve health opportunities for all.