“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has,” goes the quotation usually attributed to the late anthropologist Margaret Mead. Today, huddled around conference tablesand hatching ambitious plans, relatively small groups of committed leaders are trying to improve health and transform health care in their communities.
Consider these examples:
- In California, Live Well San Diegois attacking a tidal wave of chronic diseases and rising costs, and is halfway through a 10-year plan to improve the health and well-being of county residents. More than 100 partnering organizations, including the county health department, are working to halt tobacco use, increase healthy eating, improve access to quality health care, and even make the area more resilient in the event of natural disasters or other emergencies.
- In Georgia, the Atlanta Regional Collaborative for Health Improvementhas brought together local government officials, philanthropies, health care systems, public health authorities, and others to chart a strategy that could lead to lasting improvements in the community’s health. ARCHI aims to improve quality and save money in health care, and reinvest those savings to raise local citizens’ education and incomes, which are fundamental determinants of community health.
- In Colorado, the Pueblo Triple Aim Corporation, a nonprofit organization, has worked for the past five years to make Pueblo County the state’s healthiest based on theircounty health ranking(Pueblo ranked among the bottom 5 of the state’s 64 counties when the effort began). The local health department, hospitals, federally qualified health centers, the Pueblo Latino Chamber of Commerce, and other organizations have banded together to fight obesity and unintended pregnancy, and deter unnecessary emergency department use and avoidable hospital readmissions.
- In Minnesota, Hearts Beat Back: The Heart of New Ulm Project is working to create “a world without heart disease,” starting in the rural communities of New Ulm (population 13,500), Springfield (pop. 2,215) and Sleepy Eye (pop. 3,600). Beginning in 2009, this collaboration of The Minneapolis Heart Institute Foundation and two local health systems launched several initiatives to reduce heart attacks and heart disease. For example,with more than two-thirds of local adults overweight or obese, they launched a media campaign thataims to persuade people to “swap it to drop it” – that is, to exchange sugary sodas for water when shopping in local grocery or convenience stores.
These collaborations are on the leading edge of a national movement of multi-sector collaboratives to improve health, according to a new reportby ReThink Health. An initiative of the Fannie E. Rippel Foundation,and funded by the Robert Wood Johnson Foundation, ReThink Health has guided more than 30 communities in reimagining and transforming regional health. In 2014, the organization conducted an online questionnaire to learnmore about community health partnershipsaround the country. ReThink Health ultimately identified133such groups in 33 states, usually operating at the county or state level, and mostly launched within the past five to 10 years.
The questionnairealso found that these partnerships had a number of aspects in common. More than half brought representatives from at least 10 different sectors tothe table: typically hospitals and other healthcare providers, public health and social service agencies, community organizations, government and elected officials, and academics and researchers. About half seek to improve health across the board for area residents, while most of the rest are focused on a specific condition or risk factor, such as heart disease, or a population, such as teenagers who may unintentionally become pregnant.
Most groups also focus on the underlying social, economic, or educational conditions that contribute to poor health; the accessibility, quality, and costs of the local health care system; and the characteristics of the physical environment, such as walkability of neighborhoods, that either do or don’t contribute to health.
The survey and analysis identified challenges and opportunities for these collaborations. Many have big goals – for example, eliminating all heart attacks locally – but haven’t yet undertaken similarly large measures to accomplish those goals. Most fund activities through grants and contracts, and face considerable difficulty continuing their work when those funds run out. And with many groups pursuing similar goals and strategies, they would probably benefit fromsharing knowledge among themselves, or by having long-lasting partnerships share lessons with newer partnerships.
What’s more, as broad as many of these collaboratives are, they may not always have all the right people at the table. Individual community residents themselves aren’t always involved, nor are certain sectors that stand to gain from health improvement, such as health insurers, or local businesses reliant on having a healthy and productive work force.
A final concern is that it’s hard to find any evidence that these partnerships are truly making a difference, partly because they haven’t existed for very long. It’s plainly hard – and time consuming – to effectuate lasting change in a community or region, and also difficult to measure the impact of a given set of interventions. But of course, given the widespread problems of poor health and costly health care, these aren’t reasons to dodge the need for change.
ReThink Health intends to repeat this questionnaire annually to “produce regular snapshots and examine the progress of regional health transformation efforts,” its report says. That’s great news. As a nation, we have nothing to lose, and everything to gain, from understanding what these dedicated groups of people are learning and accomplishing as they tackle the overwhelming challenge of improving health.
Susan Dentzer is the Senior Policy Adviser to the Robert Wood Johnson Foundation.