Lessons Learned

HEAL partnerships can be quite effective at delivering a variety of community supports for healthy eating and/or physical activity within a 3-5 year grant period, but it is very costly to evaluate actual changes in behavioral outcomes at neighborhood and larger scales. Appropriate time periods for expecting and measuring such changes remain an open question, but it is widely believed that a few years is probably too short a period of time to reverse population-level behavioral trends that have been underway for decades. As a result of these constraints, it is difficult for partnerships to generate ironclad evidence of a direct effect on community-wide health. Those who wish to see the value of an ecologic approach should adjust their expectations accordingly when investing in such initiatives.

Regardless of the specific measure of success, it is important to support baseline and post data collection and clearly define desired outcomes up front in order to rigorously evaluate complex, community-level initiatives that include policy and environmental change.

When working with groups and agencies under severe resource constraints, modest financial support goes a long way to secure the necessary commitments for quality participation. It is important to support local partners to participate in evaluation.

Policy change is a powerful way to create large-scale incentives for desired behavior or disincentives for unwanted behavior. Workplaces provide effective incentives through flex time and release time, subsidized gym memberships and transit passes, on-site facilities, healthy eating options in workplace cafeterias and vending machines, etc. Municipalities provide effective behavioral incentives through fare free transit service, blue bike programs, commuter choice programs, etc. Policy makers at every level should actively consider the structure of incentives for individual behavior when approving any policy.

Local governments that work hard to embed a vision of active living or healthy eating into their comprehensive plans or master plans often find over time that actual development projects fall short of their intentions. The most common reason is that ordinances, codes, design guidelines and other regulations were not updated or sufficiently improved to ensure the desired result. Regulatory changes are often detail-oriented, time consuming, controversial and less enjoyable than community planning processes. They require sustained focus and commitment by elected officials and staff in an ever-changing environment. For this reason, community leaders pursuing regulatory reform may require a healthy dose of encouragement, models to follow, and material support.

The quality of an environment serves as a powerful incentive for its use. People consistently state that beautiful, peaceful, safe and highly accessible environments contribute to HEAL behavior. Large scale policy efforts sometimes forget what is important to individuals in their routine decisionmaking, such as the lack of a small sidewalk segment in a dangerous area, a missing light, a narrow travel lane in high speed area, a heavy or locked door, an inconvenient stairway, the lack of a bench to rest, or a long wall without windows. HEAL leaders should pay attention to critical design details and be careful not to be satisfied with the mere construction and availability of new facilities.

For public officials and staff, it is often both instructive and motivational to see and experience a problem they are being asked to help solve. Partnerships find that they can sometimes transform a frustrating discussion or relationship by touring an area with their public elected official or taking an engineer on a bike ride or walk through a challenging intersection. Whenever possible, problem solvers should be encouraged and supported to experience problems up-close.

Stories motivate decisionmakers by helping them understand and relate to the human impact of a problem or opportunity. For political decisionmakers, stories from constituents help them link a proposal more strongly to their public service and base of support.

Large built environment projects or policies often take many years regardless of whether the setting is a school playground, a greenway or a city streetscape. In order to build and sustain the necessary momentum, leaders need to be persistent and partnerships may need occasional regeneration. Some common methods for building the stamina of a partnership include: recruitment of new members, infusion of new funds, regular celebration of shorter-term achievements and group retreats.

Partnerships find over time that a coalition and a champion are a potent and synergistic combination. Successful policy initiatives, even when they begin at the grassroots, almost always involve a strong mayor, other elected official and/or department head (e.g. planning, parks, public works/transportation), an enthusiastic school principal or a visionary business leader. And these leaders are almost always more successful at promoting change when they have consistent backing of constituents. Emerging coalitions and champions should seek each other, help each other, and keep each other on task until their objective is achieved.

Lead agencies frequently remark about the importance of ongoing funding that allows them to free more attention to focus on partnership and project development, expand and deepen their networks and overall presence in the community, develop a sustainable base of support for longer-term initiatives, train staff and build experience. They also state that multi-year funding allows them to take risks, learn from mistakes and make necessary adjustments without be punished within an annual grant cycle. For accountable leaders who are pursuing complex initiatives with a wide diversity of partners in situations where change is constant, the reliability provided by a multi-year grant is considered a great asset.

Partnerships that rely on staff for their primary leadership can be particularly vulnerable to turnover. The incidence of staff turnover tends to be high when the position is part-time and/or poorly paid or when the division of labor suffers from an extreme imbalance leading to burnout. Staffed partnerships should be careful to plan for possible turnover, ensure that leadership, labor and institutional memory are distributed throughout the partnership and that staff positions are funded at a level necessary to attract and retain people with the appropriate skills and experience. Partnerships are also less vulnerable to turnover when they have well developed committee structures, solid and up-to-date orientation materials and systems, clear internal communications that enable all partners to stay abreast of the whole initiative (not just their piece), volunteers who are familiar with systems such as databases and files, and flexible arrangements that allow funds to be redirected when appropriate. Funders can help by designing their programs to encourage all these items, but especially by providing significant and reliable resources for qualified staff.

Active living and healthy eating partnerships can be successfully led by a variety of community institutions, including health departments and health care organizations, local governments, community development organizations, environmental advocacy groups, academic institutions, youth and educational agencies, and trails organizations. Individual champions can be found in a similar variety of fields and settings as well as in the community at large. It is important to recognize the leadership potential that exists in non-traditional places within a community, and learn how it can best be put to use. Understanding the unique spheres in which leaders operate helps anticipate key issues that may later surface as these organizations or individuals attempt to partner with others.

Lead agencies that engage in partnership(s) as a primary method of community problem solving or that expand their own agenda to support ambitious goals set by the partnership often require internal capacity building and staff development in order to exercise good stewardship over a project, especially as a partnership grows and succeeds. Lack of support or static capacity can hinder the lead agency or lead to internal crises that affect partnership outcomes.

Leaders of long-term partnerships often find that opportunities arise outside of an existing workplan or during the course of a multi-year project. Those who remain observant and open minded and who retain the capacity and flexibility within their partnership to make mid-course corrections and take on new projects find they are in a better position to respond to key opportunities as they arise.

It is important for leaders to maintain a sense of fun and fulfillment within a partnership in order to maintain engagement, motivation and commitment. Partnerships rely on volunteerism and teamwork, and often require unusual demands of busy people. Leaders who help make the work fun and rewarding, and who encourage others to do the same are appreciated and tend to enjoy stable, productive relationships with partners over time. Leaders often need to be reminded and encouraged to celebrate accomplishments and encourage playfulness along the way.

Learning networks have direct and indirect effects on community outcomes, and are often considered by community leaders to be key to the success of partnerships and projects. Learning networks most often influence outcomes by affecting work plan content, policy and program decisions, composition and effectiveness of partnerships, performance of leaders, and resource development and allocation. Collaborative, multi-strategic approaches to behavior change are complex, burdensome and new to most people. Leaders of ALbD community partnerships have emphasized the importance of training and technical assistance, opportunities to discuss the work openly with their colleagues, experts and partners, and opportunities to learn about new tools, resources, opportunities and best practices.

In order to secure broad-based ownership of an active living or healthy eating agenda in low-income and otherwise disadvantaged communities, it is important for a partnership to develop a structure that builds that ownership. Resident organizing, community-based coalitions and other form of grassroots leadership development are important to sustaining long-term efforts in communities that have many other challenges, histories of conflict with outside institutions, and low trust of top-down processes. Communities with strong existing coalitions and organizing infrastructure have an advantage in building and sustaining the kind of shared ownership that can outlast resistance to change.

Resident involvement and community organizing do not guarantee that a given policy priority will be sustained until it is achieved. Resident leaders and organizers have limited resources and occasionally shift their focus according to circumstances and changing priorities. It is important to establish community ownership for long-term change, but equally important to recognize that active living and healthy eating are part of a larger prioritizing process in communities.

Community-based organizations in low-income communities and communities of color do not always represent the community or even a key constituency within it. Well-established community development organizations sometimes do not invest in community organizing or reach out to new or growing groups as community demographics change, but rather conduct distinct projects that require little community involvement. Well established leaders with solid external reputations sometimes have a poor or mixed history of collaboration within the neighborhood and even within their own racial or ethnic group. It is valuable to understand the actual history and constituency of key organizations and leaders, and the quality of connections within a neighborhood, before investing in a particular partnership arrangement or advocacy initiative.