In our final post in this blog series, looking across these seven initiatives reveals several key lessons learned for collective impact in a childhood obesity or nutrition and physical activity context. These lessons learned can be helpful for other initiatives looking to take a collective impact approach to address childhood obesity or other public health issues.
Apply policy and systems approaches alongside programmatic work to create sustained change over time
Winning support for policy change can take time and may require re-framing the issue in order to shift the perception that obesity is just an individual-level problem. When policy changes are successful, however, healthy choices become the easy, default, and convenient choices and facilitate healthier behaviors within the community over the long term.
For example, the San Diego County Childhood Obesity Initiative encourages community gardens as one evidence-informed environmental approach to promote healthy eating. As a result, one diverse and under-resourced community identified a plot of land on which they wished to build a garden. When the initiative tried to work with the city to do so, it took over a year and over $40,000 to get the necessary permits. In response, the initiative worked with city planners to modify their zoning regulations to better enable community residents to build gardens in certain areas without all of the previously necessary permitting. As a result of this policy change, future efforts to build gardens will be much more streamlined.
Maren Stewart from LiveWell Colorado also sees the value of collective impact for creating sustainable institutional change: “The collective impact approach is essential to our vision for sustainability. It takes a collective approach with a number of organizations working together in order to weave healthy behaviors into the fabric of the school, the worksite, or the neighborhood for the longterm.”
Pursue a variety of funding sources to allow for flexibility
A variety of funding sources are available for addressing obesity, including government, foundation, corporate, and private philanthropy. For example, the San Diego County Childhood Obesity Initiative receives core financial support from a range of different sources: First 5 San Diego, an organization that promotes the health and wellbeing of young children during their earliest years; the California Endowment; Kaiser Permanente; and the County of San Diego.
Diversity within an effort’s funding portfolio can afford flexibility to modify the approach as time goes on based on what is and is not working. For example, the Communities that Care Coalition relied primarily on state funds which did not allocate money for a planning period. Recognizing the value of and need for a planning period, the initiative was able to use funds from a private grant to support these activities. Through the planning process they strengthened the original state proposal and thus more effectively used those funds.
Let’s Go! Maine is also exploring opportunities to generate its own revenue by disseminating its model and learnings across the state and country. The initiative is working with one of its corporate partners to create a business plan to develop this strategy that will complement their existing collective impact approach.
Identify opportunities to reach vulnerable populations
In many communities, rates of obesity are higher among low-income, racially and ethnically diverse populations, and /or those living in rural communities. In order to avoid increasing disparities, many childhood obesity interventions have decided to include an explicit focus on these vulnerable populations. For example, David Etzwiler from the Minnesota Diabetes Prevention Initiative notes that, “Being evidence based and asking the right questions, the literature pretty quickly told us which populations to work with. For us, those key populations are Native Americans, African Americans, and Hispanics.”
Several practitioners noted that this is an area in which community-based partners can add particular value, by providing advice, and by providing access to at-risk populations and delivering messages and programming to these groups via an already-existing trusted mechanism. For example, in Northeast Iowa, schools were identified as a strong mechanism for reaching low-income children and their families. Pilot schools for programs related to school wellness and a rural model for Safe Routes to School were therefore selected on the basis of community socioeconomic status. From the beginning the initiative has maintained a focus on vulnerable children and families under the assumption that “if we improve the conditions for those families, everyone else would benefit,” according to a stakeholder involved with the effort.
Address the different realities of partners
An effective collective impact approach for childhood obesity will bring together public health, government, business, schools, community-based organizations, and others with the potential for influence. While all partners are critical to the overall success of the effort, each comes to the table with a different set of realities, including time to commit to the work, funding to support their involvement, political challenges, means of conducting business, and end goals. Appropriately supporting each of these partners may require a tailored approach. For example, more than one practitioner noted that their initiatives compensated certain partners for their involvement, including public health officials and community organizations, as funding limitations would have otherwise prohibited their participation. In some cases, initiatives also provided seed funding for new positions within partner organizations to support the work. In interviews, practitioners also cited a strong desire to involve youth, but significant challenges in doing so effectively.
While posing some challenges, these differences among partners ultimately prove to be a strength rather than a limitation. As one practitioner noted, there is a different “process to action ratio” within each sector that leads partners to proceed at a different pace. Public health agencies may tend to proceed more slowly and cautiously, ensuring that action is taken only when data has been consulted and nuances have been considered in order to identify potential issues up-front. Business, on the other hand, may be more action-oriented with a desire to see change and return on investment more quickly. Each perspective adds value to the overall approach and finding a balance between the two will strengthen the initiative overall.
We hope these lessons learned—about policy and systems change, about funding, about vulnerable populations, and about partner realities— will prove useful for other initiatives looking to take a collective impact approach to address not just childhood obesity but a range of other public health issues. We encourage you to share your experiences and thoughts about applying the principles of collective impact in your work to combat obesity and other public health efforts in the comments section of this blog post, or by contacting firstname.lastname@example.org.
Vanessa Lynskey is a Master of Public Health Candidate in the Public Health and Professional Degree Program at the Tufts University School of Medicine.