Challenge to tackle health determinants in nation’s cities, tribes, counties: Call for proposals ================================================================================================== * Kim Krisberg As public health workers turn their attention to tackling the social determinants of health, establishing cross-sector partnerships is paramount to long-term success and sustainability. Now, a new effort has joined the movement — and it comes with more than $1.5 million in prize money. Officially rolled out during National Public Health Week on April 4, the Healthiest Cities & Counties Challenge is a collaboration between APHA, the Aetna Foundation and the National Association of Counties and is designed to encourage small and mid-size U.S. cities, counties and federally recognized tribes to convene multisector partners toward creating positive health changes. A primary goal of the challenge, which is being administered by CEOs for Cities, is to elevate a health-in-all-policies philosophy among city, county and tribal stakeholders and eventually capture best practices and lessons that other communities can tailor and replicate. To drive momentum and excitement, the challenge will award prizes to cities, counties and federally recognized tribes that demonstrate the most measurable changes during the multi-year challenge period. Proposals are being accepted through May 31 from cities, counties and tribes. “The challenge aligns perfectly with APHA’s efforts to create the healthiest nation in one generation because we know that it has to happen from the community level on up,” said Susan Polan, PhD, APHA’s associate executive director for public affairs and advocacy. The challenge defines a healthy city, county or tribe as one that is “economically competitive, inclusive and equitable.” In fact, proposals to participate in the new challenge must address issues of health equity as well as the social determinants of health. Participating cities, counties and tribes can choose from a handful of health-related domains on which to focus — such as healthy behaviors, social and economic factors, and the built environment — and will be assessed using metrics such as tobacco use, walkability, housing affordability, living wages and food quality. Cities, counties and tribes participating in the challenge will be judged on their own merit and progress, as participants will not be competing against each other. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/46/4/1.1/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/46/4/1.1/F1) A new challenge is calling on cities, counties and tribes to focus on behaviors, the built environment and other health factors. Photo by KatarzynaBialasiewicz, courtesy iStockphoto Challenge organizers realize that just a few years is a short amount of time to affect measurable changes in health outcomes and social determinants. As such, participants will also be judged on their ability to build effective cross-sector coalitions and partnerships that can tackle long-term health challenges. Garth Graham, MD, MPH, president of the Aetna Foundation, said that while public health professionals may serve as a “central hub in the wheel” of challenge activities, it is critical that challenge participants engage partners outside the traditional public health sphere. “We know that cities and counties are looking to actively solve these problems…and we want them to know how the social determinants fit in,” Graham told *The Nation’s Health.* “From our perspective, when we think about health and health care, we think that where you live matters more than your genetics — that where you live is a very powerful determinant in how long you live and how healthy you live.” Unlike some health improvement efforts in which lessons are shared at the end of a project, challenge participants will share best practices and experiences via an ongoing learning network. In addition to the learning network, challenge organizers will offer technical assistance, subject matter expertise and online educational opportunities. Cities, counties and tribes chosen to participate in the challenge will receive a $10,000 seed grant to support project implementation. Maeghan Gilmore, MPH, program director for health, human services and justice at the National Association of Counties, noted that counties have substantial “convening power” and are particularly well-suited to creating inclusive collaborations. Not surprisingly, she said that while there is no “standard blueprint” for improving community health at the county level, she expects that counties will be excited to learn from the experiences of their peers. “It’s tough to move the needle…but we see from our members a real appetite for this,” Gilmore told *The Nation’s Health.* “They view it as a way to make better policy and program decisions.” In general, Gilmore said counties are often concerned with larger systemic and financial issues. For example, having the capacity to care for and keep an aging population healthy is a common concern at the county level, she said. “Counties are still grappling with issues like chronic disease and substance abuse, but we also know they want to learn how to create an environment that people want to live in and where they can be healthy,” Gilmore said. “And that takes all forms and functions.” Helping to guide, pick and judge Healthiest Cities & Counties Challenge participants will be an advisory council of subject matter experts in the fields of public health, urban planning and performance improvement. Denise Koo, MD, MPH, advisor to the associate director for policy at the Centers for Disease Control and Prevention and an advisory council member, described the challenge as the culmination of years of education and awareness-raising around the social, economic and environmental factors that play a critical role in the health of people and communities. Koo, an APHA member, said one of the more unique aspects of the challenge will be the ability to follow and collect data on projects as they are happening as well as measure ongoing progress against city, county and tribal baseline metrics. “This convenes many of the sectors that are going to be necessary to improve health, and it’s always helpful to have an incentive or prize to bring people together because (cross-sector) collaborations are not our natural state,” Koo told *The Nation’s Health.* “What I like about this challenge is that it’s also working on some softer metrics of collaboration, which can be a difficult sell…but it’s critical to long-term success. Hopefully, partnerships will simply become the way of doing things.” The challenge has two tiers of participation: cities, counties and federally recognized tribes with populations between 65,000 and 250,000 as well as cities, counties and federally recognized tribes with populations between 250,001 and 600,000. However, cities, counties and federally recognized tribes with very small populations can join up with another city, county or tribe to meet eligibility requirements. Also, cities larger than 600,000 can focus on a particular community home to at least 65,000 residents. At the end of the challenge, a grand prize of $250,000 will be awarded to the winning participant in the 65,000-250,000 tier as well as four prizes of $25,000 each for runners-up. In the 250,001-600,000 tier, the grand prize winner will receive $500,000 and four prizes of $50,000 each will be awarded to four runners-up. Participants will be announced July 31. For more information and application materials, visit [www.healthiestcities.org](http://www.healthiestcities.org). *Editor’s note: This article was corrected post-publication.* * Copyright The Nation’s Health, American Public Health Association