Communities working to improve their health, thanks to challenge: Changing behaviors
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* Lindsey Wahowiak

Now that its 50 grantees have been named and awarded, the Healthiest Cities & Counties Challenge is moving forward at full tilt, with new and existing programs beginning to thrive in communities across the country.

A collaboration among APHA, the Aetna Foundation, National Association of Counties and CEOs for Cities, the Healthiest Cities & Counties Challenge is an initiative to award the programs and people making a difference and working across sectors to build healthier communities. With more than 100 cities, counties, tribal communities, universities and organizations applying for grant funding, 50 communities were chosen to receive $10,000 seed grants to fund their proposed programs in October. The communities span the country and cover everything from helping kids form healthy habits to building home-based asthma intervention programs to pushing residents to walk or bike more.

As the challenge continues, the grantees will be evaluated for their effectiveness, sustainability and replicability through a partnership with Rand. The National Partnership for Women and Families will provide support for community engagement, said JeVonna Ephraim, project manager for the Healthiest Cities & Counties Challenge at APHA. At the end of the challenge, in late 2018, grand prizes of $500,000 and $250,000 will be awarded to large and small communities, respectively. Four runners-up in each ranking will receive smaller supplemental grants of $50,000 and $25,000.

Seed grant funding can have a big impact in communities, such as Sandoval County, New Mexico. There, the Sandoval Health Collaborative used its seed money to print a pilot brochure for first-graders, reaching out to students across the county to teach them about healthy habits to set for a lifetime. The booklets also have portions for parents, and leaders hope that the students can model healthy behaviors that motivate their whole family to pursue good health, said Richard Draper, JD, program director for the collaborative.

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A supporter gives her endorsement to healthy homes in Des Moines, Iowa. Des Moines is one of the 50 communities selected for healthy programming seed money in the ongoing Healthiest Cities & Counties Challenge.

Photo courtesy Aetna Foundation

In Sandoval County, which has both urban pockets and rural communities where internet bandwidth is limited, the booklets help ensure parents and kids interact with a learning tool together. But there is an online component: A scannable code on the booklet allows parents to learn more about local parks and walking trails. Signing up for a program encourages families to get active to win healthy prizes.

The data pulled from the sign-ups will show how many families stay engaged with the program after the 10-week education course is over in the grade schools, Draper said. But it will also show if people are getting more active.

“It’s very difficult to change behaviors in general, but health behaviors in particular. A lot of it just doesn’t take,” he told *The Nation’s Health.* “(But) if their 8-year-old says, ‘Come on, let’s go outside, take a walk or play,’ hopefully there’s a little pull at the heartstrings there. Maybe with all of that, over time you can nudge behaviors.”

Draper said that the collaborative hopes that if the program is successful, it can be scaled up or down for other communities across New Mexico to use.

The Healthiest Cities & Counties Challenge is designed to improve public health nationwide, starting on small levels. Ephraim said the challenge, even now in its early stages, can serve as an example to other communities on how small steps and investments can make a big difference.

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Faith communities in North Carolina are helping to promote health through the Mecklenburg County Village HeartBEAT program, shown here raising awareness. The program is an awardee in the Healthiest Cities & Counties Challenge.

Photo courtesy Lauren Woods

“We’re really excited to build those connections between communities, and (help them) use each other as resources,” she told *The Nation’s Health.* “We are eager to highlight local initiatives that can be replicated to make changes in public health using this multi-sector, collaborative approach.”

Setting a good example is just what Mississippi State University had in mind with its Feed the Seed Challenge. Working to change the built environment, partners in the challenge are hoping to eventually influence how people in Gulfport, Mississippi, eat their fruits and vegetables. That might sound like a stretch, but with a diverse team of stakeholders involved, promoting school and community gardens will become an entry point to improving healthy eating habits, said Tracy Wyman, ASLA, a landscape architect and healthy communities liaison at Gulf Coast Community Design Studio, part of the Feed the Seed Challenge.

Wyman said that a program within one elementary school in the Gaston Point neighborhood is teaching fourth- and fifth-graders about the life cycle of plants, from the secrets of soil to the importance of food systems, including illustrating how the neighborhood is part of a food desert. The students will work in their school garden — which project leaders hope will eventually harvest vegetables to serve for school lunches and snacks — but have also contributed signage for, and taken a field trip to, a community garden several blocks away. Wyman said the community garden is open for anyone to work in, or harvest fruits and vegetables from — and she believes the message is getting out, from the fourth- and fifth-graders setting good examples for their fellow students, to their parents and neighbors getting involved.

“The schoolchildren took a field trip to the community garden, and that was the first time they had been there,” Wyman told *The Nation’s Health.* “They were able to see the sign, plant some plants and vegetables and begin to see the opportunity for them to have a greater impact on their own community.”

As the 50 challenge communities grow their initiatives, so, too, might their needs. The challenge’s online learning network offers resources, articles, toolkits and outreach materials to not just those who received the initial $10,000 grant funding, but all applicants to the challenge. Ephraim noted that the Healthiest Cities & Counties Challenge webinar series, held the second Thursday of every month, also explores how applicants across all sectors can secure funding, engage their communities, build partnerships and pursue policies that will improve public health.

The learning network also offers blogging opportunities, launched in February, for community leaders to upload their own articles and progress reports, sharing what they have learned.

Sharing lessons learned is a vital part of the Village HeartBEAT program, one of the 50 challenge communities. An effort of Mecklenburg County, North Carolina, backed with the support of County Commissioner Vilma Leake, the program, which stands for Building Education and Accountability Together, is an effort to help faith communities in six high-risk ZIP codes address health disparities locally.

Village HeartBEAT efforts include a leadership academy to teach and train health ambassadors from different congregations, including teaching them how to set up a health ministry and making sure faith communities have “tangible resources” to address key public health behaviors, including healthy eating, smoking cessation and increased physical activity.

Cheryl Emanuel, MS, senior health manager for Mecklenburg County and an APHA member, said the county has always been good at collecting and interpreting data. But by sharing that information, what it means and how to make positive changes with faith leaders who are already active in places with poorer health outcomes, public health programs can be even more successful. Such partnerships can have major results, she said. And Emanuel’s team noted that they are already seeing results in weight loss and lowered A1C levels, a measure of average blood glucose used to diagnose diabetes, in congregations in the high-risk zones.

“Public health is something we do not have to try and reinvent,” Emanuel told *The Nation’s Health.* “(But) when you have the board of county commissioners invested in what you’re doing, it makes all the difference. We must do more within our ZIP codes if the health is going to get better for all people. It needs to be block by block and community by community.”

More announcements will be made about the Healthiest Cities & Counties Challenge over its two-year course. To learn more, visit [www.healthiestcities.org](http://www.healthiestcities.org).

*Want to weigh in? Visit The Nation’s Health website starting May 1 at [www.thenationshealth.org](http://www.thenationshealth.org) to comment.*

*   Copyright The Nation’s Health, American Public Health Association