How a Foundation's Winning Programs Are Creating a Culture of Community Health

From jails to factories to streets to schools, the winning programs in a foundation's competition stretch the boundaries of what we normally think of as public health.
by | May 13, 2013 AT 11:00 AM
Karen DeSalvo

Karen DeSalvo, New Orleans' health commissioner, is thrilled, of course, that her city was one of the six winners of the Robert Wood Johnson Foundation's inaugural Roadmaps to Health Prizes. But even if New Orleans hadn't received one of the foundation's $25,000 no-strings-attached grants, she says, the city still would have been a winner.

That's because the site visit by the RWJF team generated even more momentum for what the city was trying to accomplish. "Those two days," she says, "were a validation of the fact that we have strong civic and community involvement. It was a real motivator to keep going no matter what."

The other winners, announced in February, were Cambridge and Fall River, Mass.; Manistique, Mich.; Minneapolis; and Santa Cruz County, Calif. The deadline to apply for the 2013-14 prizes is May 23, just 10 days away, and community leaders interested in applying ought to take a look at the descriptions of the programs that won for last year. The winning programs, selected from among 160 applicants, were seen as using innovative strategies to create a culture of health in their communities.

Some of the things the winning programs are doing stretch the boundaries of what we normally think of as public health. For example, in Santa Cruz County, the folks guiding the effort believe that a community is both healthier and safer when people who've committed minor offenses have access to support and help to keep from going back again and again to a jail cell, and so they've created a Custody Alternatives Program in partnership with law enforcement to reduce unnecessary incarceration.

Another key feature of the winning strategies is partnership. Manistique's approach is built on a multi-faceted collaboration between the town and the Sault Ste. Marie Tribe of Chippewa Indians. Because unemployment and poverty are among the many factors that have an impact on community health, they worked together to find a new buyer to keep a paper mill that is one of the area's largest employers from closing. They also have a partnership agreement that allows veterans to get vision services at the Manistique Tribal Health Center.

Finally, the objective of these strategies is to try to improve health indicators for the entire community and across the socio-economic spectrum. "One of the things that we've been able to do here," says Wendy Garf-Lipp, one of the leaders of the effort in Fall River, "is bring together a coalition that doesn't look at just one problem, but looks at the whole plethora of problems--be it poverty, lack of education, lack of community support, good housing, a job."

DeSalvo, a Tulane University medical-school faculty member, became involved in rebuilding New Orleans' health system after Hurricane Katrina. When Mitch Landrieu was elected mayor, he asked her to co-chair his health-care transition team and, eventually, to head the city's health department. DeSalvo's work has centered on moving the department from simply providing health care to marginalized populations to a broader focus on public health and the larger community.

Part of that involves using the modern tools of a better built-environment. For example, the city has adopted a "complete streets" policy that includes increasing the number of bike lanes fivefold over three years. And the health department is working with the schools to implement a recently passed law requiring students to get 30 minutes of daily physical activity.

DeSalvo says there is still real work to do in areas ranging from reducing violence to increasing economic opportunity, but that the work that has been done is moving the dial. In the end, she says, creating a culture of health in a community is like making gumbo: You want to have all the ingredients, but even if you don't "if everybody puts something in the pot the results can be magical."