In early November, nearly 13,000 public health leaders and researchers from across the country gathered in Boston to learn from one another at the American Public Health Association’s (APHA) annual conference. After spending more than two years contending with the largest public health crisis of our lifetime, attendees were excited to reflect on lessons learned. Prioritizing health equity and data-informed approaches emerged as themes at the conference. Across those themes, collaborating to align systems emerged as a common thread, key to preparing for the next public health crisis. Diverse, multi-sector collaboration is vital for short-term initiatives to stop the spread of infection and long-term initiatives to build systems and environments promoting lifelong health.
The Duke Endowment funds a community coalition-building initiative called Healthy People, Healthy Carolinas (HPHC), which accelerates diverse, multi-sector collaboration to improve population health. The community health improvement work of HPHC was among the collaborative approaches featured at the APHA conference. To date, 24 HPHC coalitions across North and South Carolina bring together partners from schools, health care systems, businesses and other sectors, using the Collective Impact Model. The Collective Impact Model was first described in 2011 in the Stanford Social Innovation Review as a way for cross-sector partners to solve complex social problems. The key components of the model include: (1) a common agenda, (2) shared measurement, (3) mutually reinforcing activities, (4) continuous communication and (5) a strong backbone organization.
The APHA conference provided an opportunity to highlight the work of four HPHC coalitions working in Henderson, Wilkes, Robeson, and Rowan counties. Case studies from those counties illustrated how using Collect Impact can facilitate improving public spaces for recreation, building healthier workplaces and increasing activity in schools. Ultimately, we hope to reduce health disparities.
Questions and discussion prompted by APHA attendees from across the country affirmed the promising implications of Collective Impact well beyond the Carolinas. Visitors reviewing our HPHC poster presentation inquired about how they could use the model in rural versus urban settings. The decision to use a shared measurement system — a Collective Impact principle — that prioritizes communities of greatest need also resonated with visitors as a logical way to ensure under-resourced communities are targeted and an active part of decision-making. APHA presenters and participants highlighted similar findings in their communities, noting that having policy makers, such as county commissioners, engaged early on in discussions with diverse partners from the community was key to successful local policy change. Shifting power dynamics from an individual toward a Collective Impact approach to decision-making creates a leadership structure that holds everyone accountable and is more likely to be sustained. The HPHC case studies reinforced for APHA visitors how Collective Impact helps coalitions promote sustained, equitable health outcomes by grounding their work in local data and community feedback.
The HPHC initiative continues to grow and drive change in communities. The Endowment has been flexible in its approach to this work, expanding the focus since its introduction in 2015 from interventions targeting individual behavior change to those targeting policy, systems and environmental reform. Additionally, the importance of building a foundation for Collective Impact and ensuring that the coalition is reflective of the diversity of the local community prompted a new funding timeline. This includes a 1‑year planning grant followed by the opportunity to apply for a 5‑year implementation grant. The structure is more accessible for coalitions focused on communities with high poverty levels as well as historic and often racialized under-investment in public infrastructure, such as sidewalks, farmers markets and green space.
Working together and increasing the diversity of perspectives at the decision-making table is a critical element of public health practice. HPHC coalitions exemplify the reality that diverse, multi-sector collaboration is the only way to foster equitable access to health.
Miriam Tardif-Douglin and Emily Roland are Senior Research & Policy Analyst and State Director, N.C. Implementation Team, respectively, at CaroNova, an incubator working to align leaders across the Carolinas in pursuit of a better, more equitable, system of care.