Strengthening Community Relationships as the Foundation for Change

Every day, the CDC Foundation witnesses communities coming together to ensure all residents are thriving. Businesses, nonprofits, health departments, community coalitions and others are forming meaningful partnerships to support healthier communities.

Governmental public health plays a key role in ensuring the community is at the forefront of public health decisions and that, through cross-sector partnerships and equitable practices, everyone has a voice in the growth of their community.

Based on an unprecedented increase in public health funding and an extraordinary focus on stark, persistent differences in health outcomes during the COVID-19 pandemic, governmental public health and its partners have a once-in-a-generation opportunity to amplify a vision for vibrant communities where everyone can lead their healthiest life.

With this new funding, many state public health agencies faced workforce and process challenges to dispersing the funds in a timely, strategic way that would optimize equitable outcomes. The temporary nature of the funds also sparked concerns about the sustainability of projects since public health has historically been subject to bursts of funding followed by periods of underinvestment. Public health practitioners questioned whether there could actually be harm done to community partnerships if projects were cut short once the funding was gone.

The Strategies to Repair Equity and Transform Community Health (STRETCH) initiative aimed to help states strengthen their cross-sector and cross-agency coordination to build a culture of health that would allow state health agencies to effectively and equitably invest the public health funding they were receiving. 

The STRETCH initiative took a systems change approach, guiding states through three levels of change to analyze current policies and procedures, relationships and power dynamics and prevailing narratives on health. By guiding project development through a systems change approach, building sustainable equity practices was woven into the fabric of community partnerships.

Ten state health agencies participated in STRETCH with team members from their internal agencies as well as external partners, such as local public health officials, community-based organizations, universities and religious institutions. The 10 participating state public health agencies were located across the United States, had various team structures and different political contexts.

Though it seemed as though the 10 states were all different, thematically, many of the same challenges arose throughout STRETCH: limited workforce capacity, complicated funding systems and limited experience in how to put equitable approaches into practice.

With support from the project partners—the CDC Foundation, Association of State and Territorial State Officials (ASTHO) and MPHI—the STRETCH teams worked on innovative solutions to these challenges.

These similarities strengthened the peer learning community component of STRETCH. “It's kind of refreshing to know that... we're all doing the same work… we have similar challenges. We have similar successes, too, because this work comes with successes, too, right?” says Abigail Merced, health equity program manager, Kansas Department of Health and Environment.

STRETCH participant looks over the project overview at the STRETCH Summit, an in-person conference and networking event for participants

ASTHO team members, partners with MPHI and the CDC Foundation on the STRETCH Initiative, collaborate on presentations.

Connecticut STRETCH team members gather during an in-person conference.

Relationship building and strengthening is central to the success of public health work; the STRETCH initiative serves as a reminder that relationships happen internally, across departments and teams, as well as externally with other industries and organizations.

Many of the participating state teams realized that to create long-term change in their communities, they would first have to create change within their agencies. Internal structures, policies and practices sometimes hindered their ability to partner with community organizations.

Five of the 10 states focused on developing staff trainings on the foundational concepts of health equity to ensure their departments apply an equity lens when creating and implementing strategies and pursuing partnerships. By starting with the why behind the work, they created a shared vision and purpose.

Nevada Department of Health and Human Services Division of Public and Behavioral Health was one of the state teams to develop an agency-wide training. Godwin Nwando, health equity manager, Nevada Department of Health and Human Services, emphasized, “Whether it's working with the different academic institutions, working with different local agencies or different local community-based organizations, we're all trying to grow in the same direction…[to] be able to work together and row in the same direction in order to reduce health disparities.”

Other state agencies had already laid the foundation of equitable approaches internally and were ready to strengthen their community partnerships. Mississippi and Maryland, for instance, both worked to improve their request for proposal (RFP) processes to help fund non-traditional partners, specifically smaller community-based organizations. Typically, these smaller organizations struggled to navigate the application process set by the state agency. By addressing the language included in the application, the requirements of the funding agreement and providing additional support throughout the process, the state could develop more diverse and inclusive community partners.

What we did was just really look at, what are all of the different areas that can be a challenge for community-based organizations and then work backwards and see, what can we do as a state agency. What can we do to change that to make it a little easier?

Pamela Williams, director, Cancer and Chronic Disease Bureau, Maryland Department of Health

Communities, including state health agencies and community-based organizations, have been working toward everyone having fair and just opportunities to access health care, clean air, parks, childcare, transportation options and the many other aspects of our lives that impact our overall health long before the STRETCH initiative—and this work will continue on after.

STRETCH hoped to strengthen the foundational relationships imperative to ensuring all members of the community can thrive and improve the structures and processes needed to consistently move this work forward. Overall, the STRETCH initiative demonstrates it takes a combination of collaboration, tailored technical assistance support and strategies that address systemic barriers to make true strides in closing health gaps to ensure everyone has the opportunity to live their healthiest life.

The Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative is a partnership between the CDC Foundation, Association of State and Territorial Health Officials (ASTHO) and Michigan Public Health Institute (MPHI) with support from Robert Wood Johnson Foundation. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, the Robert Wood Johnson Foundation.

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