A New Power Grid: Reflections on 'Building Healthy Communities' at Year 5

Systems change, policy change, narrative change, and people power are terms we use often at the California Endowment.

Together, they represent what's happening in fourteen geographically diverse communities across the state thanks to our Building Healthy Communities (BHC) initiative. Just as important is the state-level systems and policy change work we've supported to help strengthen local efforts. Taken together, they represent the comprehensive vision behind BHC, a ten-year, $1 billion initiative launched in 2010 to advance statewide policy, change the narrative, and transform communities in California that have been devastated by health inequities into places where all people have an opportunity to thrive.

As 2015 came to a close and we reached the halfway point of BHC, we thought it important to look back at the first five years of the initiative and document what we've learned to date. And because transparency in philanthropy is critical to the growth and effectiveness of the field, we want to share those insights with others.

A significant portion of the BHC plan involves a "place-based" focus on fourteen communities. Of equal importance is how the collective learning and energy generated by those communities help promote health, health equity, and health justice for all Californians. In other words, BHC is a place-based strategy with a broader goal of effecting statewide change.

So, what we have learned? It starts with this: BHC will be successful when three things happen to benefit the health of young people in lower-income communities:

• 100 percent coverage of and access to health-promoting health services for young people is the norm;
• 100 percent of California schools have wellness and school climate policies and practices; and
• 100 percent of California cities and counties have established local health-promoting policies.

The thinking behind these three targets is simple: the wellness of young people is optimized when the "systems" they encounter on a regular basis — the healthcare system, their schools, their neighborhoods — support what families want and need for their children's health and well-being. And while those targets are critical to the success of BHC, the ultimate goal is for the power dynamics in the fourteen communities to shift to such an extent that families are able to hold local officials accountable for full ongoing implementation of family- and youth-friendly policies.

That's not to say we haven't made progress on accountability. Residents of the fourteen communities are working hard to hold local officials accountable across a wide range of issues, including access to safe, clean water; parks equity; living wage laws; common sense school discipline that keeps kids in school; fair school funding practices; and access to health care and coverage for all Californians regardless of immigration status.

Already, thousands of residents from BHC communities, young and old, are standing shoulder to shoulder to address these challenges. They are demonstrating courageous leadership. What they are accomplishing in their neighborhoods and at the state level exceeds all our initial expectations. They are the heroes of the unfolding story that is Building Healthy Communities.

In the five years since we first launched the BHC initiative at an event in City Heights with First Lady Michelle Obama, our board, staff, and community partners have been working hard to catalyze the kind of change needed to bring us closer to the goal of health and justice for all. We also commissioned three independent reviews of our progress, lessons, and mistakes. Over this past year, we reviewed the reports with our board and staff; we listened to and learned from our community partners; and then we got busy making needed adjustments.

In the spirit of transparency and accountability, we share what we've learned with our colleagues in philanthropy. The report, A New Power Grid: Building Healthy Communities at Year 5 (28 pages, PDF; or Executive Summary, 8 pages, PDF), documents our progress, lessons learned, and key changes we are making at the midpoint of the initiative. I welcome and encourage your feedback. Email us at [email protected].

Robert K. Ross, M.D., is president and CEO of the California Endowment.