Build Healthy Places Network (BHPN) and National Association of Chronic Disease Directors (NACDD) held a thought leader roundtable gathering national, state, and local leaders to bridge a way for public health and community development sectors to work together advancing health and racial equity through upstream partnerships. This primer shares the recommendations emerging from our roundtable and illustrates opportunities for public health to advance racial equity goals through engagement with those responsible for helping to shape the built environment. Support for 'Public Health Primer: Engaging Community Development for Health Equity' was provided by NACDD and the Robert Wood Johnson Foundation.
This primer seeks both to create a starting point for the work and to challenge our perspectives of where race, health, and place intersect, and who are our partners in addressing the drivers of health.
We employ the vital conditions for health and well-being (see below) as an organizing framework through which we can see the multisector nature of these drivers of health and a role for the community development sector as a partner in influencing health at the community-wide level.
What is your organization’s definition of equity? Health equity? Racial equity?
Which of the vital conditions does your organization work to address?
In what ways does “place” impact the health of the communities you serve?
Many public health practitioners wonder how the community development sector differs from the community development activities that are more familiar and common in the public health field. The community development sector is a multi-billion-dollar sector investing in persistently disinvested communities through the development and financing of affordable housing, schools, grocery stores, health clinics, small businesses, job training programs, and services to support children, youth, and families. Broadly, one can break down the major players into two groups: community development corporations, or CDCs (not to be confused with the Centers for Disease Control and Prevention) and community development financial institutions (CDFIs)
State health departments are responsible for assessing the needs of local populations and advising local health departments on actions to meet those needs. A state health department is a centralized unit of state government with overarching responsibility for protecting, assuring, and improving the health of the state’s citizens. They typically act as conveners, supporters, and distributors of data, information, funding opportunities, and support for local and county health departments. Local and county health departments are responsible for assessing the needs of local populations and more often provide direct services, resources, and information to citizens in local areas. Health departments traditionally work in concert with other agencies and nongovernmental organizations.
The roles, responsibilities, and scope of public health authority depend on state policy and the governing relationship between state, local, and county health departments. Below are the most common governance structures:
Since the factors impacting health rest in the social, political, historical, and economical spheres of our country, it is unrealistic to think public health can solve health disparities and inequities in a silo.
Public health can play an essential role in multisector collaborations, as a convener to distribute information, uncover common priorities, and work with a broad range of partners to develop upstream and downstream strategies to protect and promote health. Multisector collaboration between public health departments and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health (or vital conditions for health and well-being), and reducing health inequalities.
Generally, this ecosystem of partners should serve as a way to include all interested individuals, entities, and organizations as it will take all of us to combat the generations of disinvestment, harm, and mistrust done to disinvested communities. More specifically, it is important to identify and name which sectors, government entities, community members, and community-based organizations need to have their voices and perspectives included in the work to advance racial and health equity.
Encourage communities to share their stories. This will help strengthen data and center the human experience.”
—Roundtable Participant
In your own region, is your organization similar in mission, practice, or approach to organizations operating in other sectors but within the same communities?
What are some initial steps your organization can take to establish partnerships with the community development sector?
What would your commitment to equity look like to ensure it is applied as an intentional design decision and practiced across the partnership process? How are you centering the community in your partnerships?
ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. Territories, and the District of Columbia, and over 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, formulate and influence sound public health policy and ensure excellence in state-based public health practice.
ASTHO membership includes public health agencies serving rural areas and small cities. The organization’s website also features blogs covering public health topics relevant to rural communities.
There are 58 chronic disease directors representing states and territories of the US. In addressing chronic diseases which is long-term by nature, NACDD employs a broad focal view on disease prevention and promotion of health, making them excellent partners for projects addressing social determinants of health. Their mission is to protect the health of the public through primary and secondary prevention efforts and work “upstream” on root causes of chronic conditions.
The National Association of County and City Health Official’s (NACCHO) tool to search for local health departments in your area.
Learn more about NACCHO’s Rural Health Section, composed of NACCHO members and partners working together on specific rural public health issues across multidisciplinary and programmatic expertise in support of NACCHO’s mission.
The National Network of Public Health Institute’s (NNPHI) directory of member institutes. Public health institutes are nonprofit public health organizations dedicated to advancing public health practice and making systematic improvements to population health.
Enterprise Community Partners is a national nonprofit that exists to make a good home possible for the millions of families without one.
The National Alliance of Community Economic Development Associations (NACEDA) is an alliance of state and regional community development associations who are champions, stewards and thought leaders for community development.
NeighborWork’s members are community development organizations building strong and resilient communities, providing people with opportunities to live in safe, healthy and affordable housing.
Learn about NeighborWorks America’s Rural Initiative. An initiative dedicated to creating vibrant rural communities by delivering a range of essential services, including capital, training, and peer learning.
The Local Initiatives Support Corporation (LISC), a national Community Development Financial Institution (CDFI), has urban offices around the country that work to equip struggling neighborhoods with the capital, strategy and know-how to become places where people can thrive.
How do you and your organization recognize historical and persistent harms of structural racism and build trust toward healing?
How can you co-create an inclusive community process that centers community voice?
How can communities play a central role in analysis and use of data, to reflect their unique lived experiences, historical context and inform needs through a community-rooted vision?
The CDC is an operating agency of the Department of Health and Human Services that serves as the nation’s leading public health institution. The CDC’s primary mission is to protect public health and safety through the control and prevention of diseases, injury, and disability. Through its Community Transformation Grant (CTG) program, the CDC has invested more than $200 million annually in programs to promote safe and healthy neighborhood environments since 2011. As of 2015, the CTG program has been reorganized and reassigned to the Prevention and Public Health Fund, established through the Affordable Care Act. This program continues to be the primary funding source for local initiatives that address social determinants of health.
Community development is a multi-billion-dollar sector of the American economy that invests in low- and moderate-income communities through the development and financing of affordable housing, businesses, community centers, health clinics, job training programs, and services to support children, youth, and families. The sector has its roots in the urban revitalization efforts of the late 19th century but expanded as a result of the War on Poverty programs of the 1960s. Today, the community development sector invests more than $200 billion annually in low-income communities.
While community development is not a discrete academic discipline or an accredited field like public health, it is more than an activity. It is best viewed as a self-defined sector involving organizations from multiple fields that share a common focus on improving low-income communities. These organizations come from fields including real estate, city planning, law, social work, public policy, public health, affordable housing, and finance, and generally identify themselves as being part of the community development industry. Neighborhood-level Community Development Corporations (CDCs) and Community Development Financial Institutions (CDFIs), working at both local and national levels, provide leadership in the sector, often working alongside neighborhood residents, real estate developers, philanthropic organizations, city agencies, investors, and social-service providers.
By improving well-being in disadvantaged neighborhoods, community development affects the “upstream” causes of poor health, like poverty, unstable housing, and limited access to fresh food markets and other services. At its best, community development achieves health equity by addressing many of the factors, or social determinants, that affect public health.
For more read Demystifying Community Development
CDFIs are “private financial institutions dedicated to delivering responsible, affordable lending to help low-income, low-wealth and other disadvantaged people and communities join the economic mainstream” (see the Opportunity Finance Network). CDFIs include both for-profit and nonprofit institutions like community development banks, credit unions, loan funds, and venture capital funds. These institutions invest in communities by financing small businesses, microenterprises, nonprofit organizations, and commercial real estate and affordable housing. As of 2018, there were more than 1,100 CDFIs serving cities, rural areas, and Native American reservations.
CDFIs also serve as intermediaries that help commercial banks invest in low-income communities to meet their Community Reinvestment Act (CRA) requirements. Some Community Development Corporations and affordable housing developers operate CDFIs as part of their work (for example, the affordable housing developer Mercy Housing has an associated CDFI, Mercy Loan Fund).
Leading CDFI resources include the Opportunity Finance Network, the nation’s leading CDFI trade association, and the United States Treasury’s CDFI Fund, the federal government’s designated funding source for CDFIs. Established in 1994, the CDFI Fund provides financial and technical-assistance grants to certified CDFIs, and manages the New Markets Tax Credit program, among others. CDFIs must be certified through the CDFI Fund to access these programs. In 2013, the CDFI Fund distributed $172.6 million to CDFIs nationwide.
For more information on CDFI’s, check out this great video from the Opportunity Finance Network:
Vital conditions are properties of places and institutions that all people need for health and well-being. They include a thriving natural world, basic needs for health and safety, humane housing, meaningful work and wealth, lifelong learning, reliable transportation, and, central to all of these, belonging and civic muscle.
Investments in these conditions are necessary to create an equitable, thriving future for ourselves and for generations to come.
Source: ReThink Health
Upstream services focus on macro level factors such as structures that impact health whereas downstream services focus on providing equitable access to care. For example, addressing income from an upstream initiative is to advocate for living wage policies, wage capping, and progressive taxation whereas a downstream imitative would be to address income to ensure that chronic disease prevention programs are accessible to people who have low income.
Resource: Loma Linda University Health
The Network adopts the Department of Health and Human Services definition of health equity: “The attainment of the highest level of health for all people.” Others describe health equity as the “the absence of systematic disparities in health or in the major social determinants of health.” Community development provides a pathway to achieving health equity by serving as a mechanism to address many of the root causes of poor health.
The Network adopts the Center for Assessment and Policy Development definition of racial equity as “the condition that would be achieved if one’s racial identity no longer predicted, in a statistical sense, how one fares. When we use the term, we are thinking about racial equity as one part of racial justice, and thus we also include work to address root causes of inequities, not just their manifestation. This includes elimination of policies, practices, attitudes and cultural messages that reinforce differential outcomes by race or fail to eliminate them.”
The distribution of power and resources within and between places needed to establish racial equity.
Read more about spatial justice in the Frameworks Institute’s new report: Navigating Cultural Mindsets of Race and Place in the United States
A framework for conducting research and generating knowledge centered on the belief that those who are most impacted by research should be the ones taking the lead in framing the questions, the design, methods, and the modes of analysis of such research projects. The framework is rooted in the belief that there is value in both traditionally recognized knowledge, such as scholarship generated by university-based researchers, and historically de-legitimized knowledge, such as knowledge generated within marginalized communities.
For more read from the Participatory Action Research website as part of a university-community participatory action research (PAR) collaboration between Carleton College and community members and institutions in Faribault, MN.
Design that is trauma-informed centers healing as an integral part of the design process and prioritizes it as an observable outcome in the built environment. It is good for everyone because spaces are purpose built and empower individuals and communities to steward the design of homes, schools, neighborhoods, etc. It goes beyond tactical interventions when a trauma-informed design process offers an opportunity to disrupt the structural systems that perpetuate trauma.
Resource: Trauma-Informed Housing
Enterprise’s Health Action Plan fosters the relationship between affordable housing developers and public health practitioners to analyze health data, engage with residents, and co-develop a plan that prioritizes community health and well-being in affordable housing. The Health Action Plan offers seven steps that guide affordable housing developers to embed evidence-based public health practices that align with residents’ and community members’ health needs into the design of their construction projects. This upstream multisector collaboration approach has led to the adoption of over 42 health-promoting strategies that center belonging and civic muscle by connecting residents with resources, creating community murals, and enhancing community gathering areas.
Forging Lasting Bonds: Creating Healthy Housing through the Health Action Plan
In this video snapshot, Build Healthy Places Network’s Alexis Sims speaks with two leaders from East Bay Asian Local Development Corporation (EBALDC) Annie Ledbury, the Associate Director of Creative Community Development, and Ener Chiu, the Executive Vice President of Community Building.
During this interview, Annie and Ener dive deeper into the Healthy Neighborhoods Approach to community development and how the research on the social determinants of health from the Alameda County Public Health Department led their organization to expand on the nonmedical factors that directly influenced residents’ health. This approach fosters multisector partnerships within EBALDC’s priority neighborhoods, where residents are at the heart of their work. Annie and Ener discuss how the collective impact model is used within community development to advance racial healing and foster a sense of belonging to improve the community spaces. Trusted partnerships between public health agencies and community organizations are essential for public health practitioners who are looking to collaborate further upstream to advance health and racial equity efforts and should be nurtured not only during urgent situations but also in nonemergent times.
Hennepin County Public Health Department in Minnesota was one of ten grantees as part of a cross-sector innovative initiative in 2020-2022 to advance health equity through multisector partnerships and improve population health by responding to community needs. The public health department shared that nearly 12% of the population lived below the poverty level in the past 12 months at the beginning of the project. In addition, according to a health survey conducted in 2018, BIPOC residents experienced a higher rate of mental distress compared with White Americans. The department recognized the need to address complex issues, such as racism, as a public health crisis.
The Community Health Improvement Partnership (CHIP) of Hennepin County focused on community mental well-being and housing stability through partnerships with communities of color and Indigenous populations. The coalition included partners from public, private, and nonprofit sectors along with representation from public health and healthcare leaders. Subject matter experts in mental health, housing, and education also partnered with these communities to address historical trauma and racial disparities through equitable policies and practices. Equitable screening criteria were implemented to help vulnerable populations with housing options, and spiritual, faith, and cultural leaders and healers worked with residents to increase social connectedness practices in rental housing and reduce barriers.
CHIP partners used a collaborative financial approach that directed funding to community organizations that would allow them to create meaningful change in their communities. This approach increased community-led solutions to address the unique challenges that BIPOC communities often face. Health and racial equity were prioritized by the community, and partners ensured the community’s voice was heard throughout the program. Furthermore, this approach heightened the importance of community engagement and involvement when planning and implementing programs to advance health and racial equity efforts. Learn more
Healthier Together is a community coalition formed across Pierce and St. Croix counties in Wisconsin to address the unique socioeconomic challenges faced by residents of these predominantly rural communities. The coalition, spearheaded by United Way of St. Croix and the public health departments of Pierce and St. Croix counties in collaboration with numerous local community development corporations, secured funding through the Wisconsin Department of Health Services’ Mobilizing Communities for a Just Response program to support a bi-county housing assessment and policy scan. This work explores the unique and evolving housing needs of their communities, and develops holistic policy recommendations to advance community-led efforts to build healthy, opportunity-promoting environments.
The coalition centers affordable housing as a key focus of their policy and advocacy goals, and the assessment addresses four priority areas related to housing: senior housing, workforce housing, wraparound services, and community engagement. Through a partnership with Build Healthy Places Network, Healthier Together produced a report providing a framework for designing inclusive and holistic policies that center community voice and set forth innovative policy recommendations aimed at improving access to affordable and healthy housing for individuals and families.
The assessment involved meaningful participation of local residents through focus groups and key informant interviews to identify priority areas, as well as strategies to improve alignment between community development and public health through affordable housing initiatives. The report notes that “by bringing together a wide range of individuals with varied backgrounds, specialized knowledge, and lived experience, these interviews allowed the workgroup to better understand the multifaceted challenges and opportunities related to healthy and affordable housing” (p. 4). The assessment also integrated the vital conditions framework, with the perspective that human housing or safe, affordable, stable, and quality places to live are critical to the health of residents. Access the report here.
Where do you see opportunities within your work to try strategies similar to the ones highlighted in this primer? And where do you anticipate there being barriers?
The following materials offer frameworks, guidance, and strategies for centering health and racial equity in partnerships across public health and community development.
BHPN
The REPAIR framework, developed by Build Healthy Places Network, lays the groundwork for how institutions can work with BIPOC communities to implement long-term, sustainable, community-institution solidarity for racial healing. This tool shares actionable steps to heal the impact of systemic racism by building relationships, trust, and collective community power.
Read More
NACDD
In public health, equity is both a pathway to achieving and an outcome of social justice. In this report, NACDD partnered with Think Equity, LLC, to present a social justice framework for public health professionals at all levels to strengthen public health practice and improve health outcomes among historically disinvested communities in the U.S.
Read More
BHPN
This resource, produced by Build Healthy Places Network, provides coalitions working to create healthier communities with strategies to embed equity at every stage of the policymaking process. The tool offers practical steps to support collaborators who are interested in building capacity for equitable and sustainable policy solutions and surfaces key steps that coalitions can take to co-create an inclusive community process.
Read More
Third Space Report
In this document, ThirdSpace Action Lab provides a high-level overview of their research findings on why focusing on racism in community development matters; what dominant narratives are underpinning racism in the sector; how structural racism specifically manifests; and what a more explicit, more affirmative anti-racist approach might look like within the community development sector.
Read More
Purpose Built Communities
When working with communities and across sectors, it is important to find what binds different groups together. Purpose Built Communities and FrameWorks Institute developed guidance to help foster value-based conversations and shift cultural mindsets about how we think and talk about fairness, prosperity, and working together across sectors and neighborhoods.
Read More
NACDD
NACDD created the Moving to Institutional Equity tool to help users recognize institutional racism by moving through a series of worksheets that give step-by-step directions to identify potentially racist policies and/or procedures and then to explore opportunities to change the outcomes.
Read More
Stanford
“Collective impact is a network of community members, organizations, and institutions that advance equity by learning together, aligning, and integrating their actions to achieve population and systems-level change.” This resource from Stanford Social Innovation Review explores the global field of collective impact, which has blossomed in recent years, and offers a set of actions to lead equity-centered collective impact work to ensure these initiatives’ efforts do not fall short.
Read More
FrameWorks Institute
Rooted in an understanding of how racism shapes and is built into places, this report, produced by FrameWorks Institute, maps the existing cultural mindsets of place, race, and their relationship and describes how they can enable or inhibit transformative work for spatial justice.
Read More
In what ways does your organization create spaces that allow you to express your emotions and encourage storytelling with your colleagues?
What are some initial steps your organization can take to establish partnerships with the community development sector to further advance health and racial equity?
There is much alignment in the focus and shared values of these two sectors but still work to do on mutual learning and understanding of each other’s work. Both sectors need to adopt approaches that recognize intergenerational trauma and are grounded in the history of place and communities to advance equity.
Our hope is that practitioners can lift up the ideas highlighted by this primer, to advocate for multisector collaboration to focus on community-driven and anti-racist approaches that advance health equity in communities across the country.
Build Healthy Places Network wants to hear from you! We would love it if you could take a few moments to complete the survey below. This helps us create effective tools and resources for cross-sector partners that are advancing health and racial equity.
BHPN is looking for organizations that find the new Public Health Primer valuable in their efforts to achieve racial and health equity. By sharing information, the Network can create effective tools and resources that support cross-sector partnerships to build community power, promote health and racial equity, and revitalize neighborhoods.
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