Cynthia Bethel-Jaiteh and her son, Khalil Jaiteh, 3, enjoy Louisville’s African Heritage Festival.

24:1 Community, Missouri

Twenty-four municipalities, united for change

Samijah Robinson, 3, cools down during “Beyond the Backpack,” a back-to-school event at Normandy High School. The 24 municipalities of the community share a single school district and a single vision for how to improve their neighborhoods, their schools, and the lives of their citizens: "Collaborate.” “At the end of the day, housing alone won't fix our community,” says Chris Krehmeyer, CEO of the neighborhood development organization Beyond Housing. “Education alone won't fix our community. Jobs alone, health alone, economic development alone won't help our community.” Some of their solutions follow.
Beyond Housing is working to boost home ownership in 24:1 in a number of ways. Its nonprofit Community Land Trust uses a variety of subsidies to make home ownership affordable. Residents own their homes but lease the land, which is owned by the trust. The houses stay affordable because the trust controls the price owners receive when they sell. Buyers receive financial and home-ownership counseling before they buy and support services after they sign the contract.
James McGee, mayor of the City of Vinita Park, talks with officer Patricia Ash at “Beyond the Backpack.” For 24:1’s municipalities, which range from fewer than 200 people to about 5,000, every dollar and efficiency counts. The cities share contracts, best practices, and monthly conversations in the quest to bring better services, health, and well-being to residents. Six of the municipalities also share a police department.
Jaylen Davis, 9, tries on his new backpack during “Beyond the Backpack,” at which backpacks and school supplies were distributed to hundreds of students. The 24:1 community was shocked to its core four years ago when the state of Missouri stripped its school district of provisional accreditation. To regain accreditation, the schools are revamping training for principals so they can better support teachers, and they meet regularly to look at performance data for every child. The school district also reopened a formerly closed school to create a “Kindergarten Center.” Every child at the center receives a college savings account funded by Beyond Housing.
One of the 24 municipalities, the City of Pagedale, has seen a flurry of economic development, starting with the opening of a discount supermarket in 2010. “Everybody agreed that a grocery store they could walk to and get fresh fruits and vegetables and get healthy meals was one of the first things they wanted,” says Pagedale Mayor Mary Louise Carter. Other development projects aimed at making Pagedale more livable and walkable have included senior housing, a bank, and a cinema.
Daycare provider Tina Mosley reads to Londyn Kennell, 2, at Our Daycare, in St. Louis. Open 24 hours a day, seven days a week, Mosley’s preschool caters to parents who juggle two jobs or work and school. Programs Achieving Quality, or PAQ, run by the St. Louis nonprofit United 4 Children for the 24:1 community, gives Mosley and other child care providers the resources to create the best learning environment possible for young children.

On a map, the 24 contiguous municipalities just northwest of St. Louis resemble nothing more than a crazy quilt. And for decades, their governance and services were a patchwork, too. Each municipality—from the tiny, two-street Village of Glen Echo Park, population 160, to the neighborhood-sized City of Normandy, population 5,008—has its own government. But more than five years ago, city leaders rose above their individual municipal identities and city charters, embracing an “all-for-one” approach. Calling themselves “24:1,” they first came together in the midst of the nationwide mortgage foreclosure crisis that threatened the health of individuals, families, neighborhoods, and entire communities. Today, the municipalities strive to realize a unified vision: strong communities, engaged families, and successful children. “To start healing the community, you have to have everybody involved,” says James W. McGee, mayor of the City of Vinita Park. “If everybody takes ownership, then you’re going to have a healthier community.” For this unique spirit of collaboration and healing, the 24:1 Community has been honored with the RWJF Culture of Health Prize.

Photos: Copyright 2016 Tracie Van Auken. Courtesy of the Robert Wood Johnson Foundation.

Columbia Gorge Region, Oregon and Washington

Where well-being is the common currency

Hood River, Oregon, is among the towns that dot the Columbia Gorge region. The conversation on health here includes all voices, and counts on the community to work together. When Oregon changed the way it handles Medicaid spending, it mandated the creation of a Community Advisory Council. In Columbia Gorge, its members are the people affected. By law, half of the seats must be held by people on Medicaid, and Columbia Gorge’s 15-member council includes three Latino members, three people with disabilities, and the parent of a disabled child.
Lauren Kraemer (left) and Julia Sanchez (right) enjoy a community cooking class at One Community Health, a federally qualified health center. Despite miles of apple and pear orchards and other agriculture, a 2015 survey found that 34 percent of the region’s citizens worry about running out of food. Through the “Veggie Rx” program, clinics and social service agencies identify people at risk of hunger and give them a fruit and vegetable prescription. With a monthly prescription, participants receive $30 worth of fruits and vegetables from local farmers' markets. Not surprisingly, recipients have embraced the idea wholeheartedly. At senior centers, the redemption rate has been as high as 98 percent.
Community health worker Vitalina Rodrignez interacts with Dalia Castillo and her baby, Altana Delgado. The action plan for the Columbia Gorge Region includes expanding the long-standing use of community health workers. Employed at clinics, schools, or government agencies, these certified professionals, such as Rodrignez, meet with people in their homes and connect them to services in all aspects of their lives, including health, housing, education, food, and finances. They also serve as the eyes and ears of policymakers and report back on problems or trends they observe in the field.
Finn, Liam, and Evie Woodward enjoy a sunny day. The Columbia Gorge Region boasts ideal conditions for kite surfing, sailing, and other outdoor activities. To boost fitness opportunities for all, the health department in The Dalles, Oregon, the county seat of Wasco County, started walking groups to educate people on health, exercise, and nutrition. By design, the routes will run past corner stores that the Gorge Grown Food Network is working to supply with more locally grown produce. When walkers get to the stores, they can use Veggie Rx vouchers to buy snacks.
Carmen Vaeza, her mother, Maria, and her father, Lazaro, pick apples and pears on the Kiyokawa Orchard. Agricultural workers are among the Columbia Gorge region’s expanding Latino population. Leticia Valle (not pictured), who was born in Hood River and returned after college to work as a community health worker, is a key member of the Latino community working to affect change and influence decision-making. An elected member of Hood River County’s transportation board, she says, “I can make sure they don’t forget about the Latino voice.”

A vast rural area larger than the state of Connecticut with only 75,000 people, the Columbia Gorge is characterized by extremes. Not far from the coffeehouses and boutiques of Hood River, Oregon, White Salmon, Washington, and The Dalles, Oregon, are remote towns where some residents live in poverty. The nearest doctor’s office may be an hour away. Orchards throughout the region produce a bounty of pears, apples, and cherries, yet one out of five people reports running out of food on a regular basis. To address those disparities, the people of the Columbia Gorge region turned an ordinary requirement from Oregon lawmakers—to assess the well-being of residents and come up with an action plan for improvements—into an extraordinary opportunity to give all residents the chance to thrive. The 2016 RWJF Culture of Health Prize recognizes the spirit of collaboration in the Columbia Gorge. “It’s a wonderful acknowledgement of what the community has been trying to do and continues to try to do,” says David Edwards, CEO of One Community Health, a federally qualified health center.

Photos: Copyright 2016 Josh Kohanek. Courtesy of the Robert Wood Johnson Foundation.

Louisville, Kentucky

Stats and data feed innovation in this community.

This former liquor store in the Smoketown neighborhood has been rehabilitated and transformed into a free after-school arts program called Steam Exchange. Other initiatives that harness the power of artists include Project H.E.A.L., a five-year effort that will employ the arts to help residents look for solutions to community health needs, and Roots & Wings, a performing arts group that addresses community violence, black identity, and other issues.
Cynthia Bethel-Jaiteh and her son, Khalil Jaiteh, 3, enjoy Louisville’s African Heritage Festival. Their city’s agenda for bringing the community together and solving for disparities was born out of the city’s 2003 merger with surrounding Jefferson County, a voter-backed move meant to increase government efficiency and spur economic development. The year of the merger, 13 foundations planted the seeds of change by creating the Greater Louisville Project, which aims to improve education, jobs, and health of the community. Among its initiatives is an effort to boost the number of residents who have advanced degrees.
Louisville Metro Police Department Chief Steve Conrad talks with community leaders during the West Louisville Peace Walk. One of the most sobering inequities in Louisville may be that its most dangerous neighborhoods have violent crime rates 35 times higher than the safest ones. The city is working to change that with a comprehensive prevention approach that includes weekly neighborhood Peace Walks with residents and police. Another initiative pairs youth who have been in trouble with the law with mentors and case managers to help them set and achieve academic goals.
Mohammed Arwan (left) and Jonathan Clement (right) participate in Louisville’s YouthBuild program, based on a national model with the dual mission of training young people in construction and building affordable housing. Through the program, participants—many of whom are young parents—earn high school diplomas and acquire the skills to work in one of four career tracks: construction, environmental design, nursing assistant, and culinary arts. They also learn valuable skills—such as showing up on time, being a team player, and solving problems—that translate to any field.
Community health workers Mary Squire and Rhonda Whooten pay a visit to Martin Trice in his Louisville home. In Louisville, KentuckyOne Health is using data to identify “familiar faces”—those who often use emergency and hospital services because they can’t afford preventive care—and keep them from coming back. Today, when those patients are discharged, they are connected to in-home preventive health services such as nutrition and exercise counseling.

In Louisville, tackling health inequity is high on the agenda. Civic leaders and health institutions here have recognized that in the face of generations-deep disparities, proximity to health-care services is only part of the story. Good health for all citizens requires so much more—such as having a job, a safe place to live and walk, a place to buy healthy affordable food, a good education, clean air to breathe, and a strong social network. Collaboration, data-driven decision-making, and a shared commitment to health have led to Louisville’s recognition as a 2016 RWJF Culture of Health Prize winner. The city’s arts, business, health, education, law enforcement, and social-service sectors have come together, turning statistics and data into tools to rectify health inequity, respond to neighborhood violence, and make the city’s impressive health resources available to everyone.

Photos: Copyright 2016 Tyrone Turner. Courtesy of the Robert Wood Johnson Foundation.

Manchester, New Hampshire

Transforming a city—and the health of its citizens

The largest city in a rural and affluent state—and in all of Northern New England—Manchester faces challenges similar to those of larger urban communities. When Manchester rolled out a new health strategy two years ago, the Granite United Way took the controversial step of aligning its grants with the city’s goals. That meant funding fewer programs and focusing on collaborative, multi-year strategies. One of these was the Manchester Community Schools Project, through which schools provide a wide range of social services and education support to children and families.
Lenny Bradford shops for greens at the farmers' market in Manchester’s Victory Park. The city’s health-promotion efforts focus on building and bolstering neighborhoods, an approach that harkens back to a time when the city’s earlier immigrants created tight-knit communities and strong support networks. In this context, block parties, schools, community centers, homes, and fire stations have become tools for growing trust and delivering services while boosting health and well-being.
Curtis Bouchard, 6, reads in the library at Gossler Park Elementary School in Manchester. Gossler Park is one of several schools that have become new safe havens and hubs for community-building in neighborhoods facing poverty, crime, and violence. In 2012, with seed money from the Robert Wood Johnson Foundation and others, Manchester set up two such community schools. Partners bring health care, social services, family support, and community-building activities such as block parties and health fairs right to the schoolhouses. Work at two more schools began last year.
The nation’s opioid epidemic has fueled a spike in drug-overdose deaths in Manchester. “You have people of all backgrounds, of all ages who are all overdosing,” says paramedic Chris Hickey. In May, Hickey proposed and helped launch an initiative called Safe Station, which turns fire stations into intake centers where people can go without fear of being arrested. Within the first four months, more than 420 people had sought help and been referred to treatment.
Romaldo Rivera, 14, and 1-year-old Roman Alexander stand on a platform in Manchester Street Park that overlooks the Spicket River. Manchester partners are working to make it easy for residents to be active, wherever they are. The city’s industrial past has provided a valuable resource in the form of abandoned railway beds and trestles, some of which have been transformed into walking and biking trails and bridges using a combination of public and private funding. The city and such nonprofit groups as Manchester Moves are working toward the completion of a network of trails that will connect the city’s downtown and nearby towns.

Founded along the Merrimack River in the early 19th century, Manchester sprang from a utopian vision: to create an industrial center to rival its English namesake, complete with sprawling, red-brick textile mills, workers’ quarters, schools, libraries, theaters, and parks for all who lived and worked there. But as manufacturing sagged in the latter half of the 20th century, the city lagged as well. Today, in a transformation that has spanned several decades, the city’s business community has repositioned itself for the 21st century. Manchester has evolved into a mid-sized city, and Elm Street—its main thoroughfare—has become a thriving urban hub with trendy restaurants and coffee shops. A few blocks away, long-vacant mill buildings are now home to tech startups, loft condos, and two universities. Now this city of 110,000 is applying the same resilience and determination that sparked the mill-yard comeback to what may be an even tougher challenge: revitalizing health and well-being throughout Manchester’s neighborhoods.

Photos: Copyright 2016 Tracie Van Auken. Courtesy of the Robert Wood Johnson Foundation.

Miami-Dade County, Florida

This multicultural destination takes a diverse view of health.

The Consortium for a Healthier Miami-Dade County addresses health in ways that resonate with each of the area’s unique cultures and communities. For example, the historically underserved Little Havana has been lifted by the local nonprofit ConnectFamilias. The organization offers a range of educational, employment, and enrichment services for people of all ages, and it helped the community plan and build a safe park—an amenity Little Havana previously lacked.
In Liberty City, home to one of the oldest black communities in Florida, Miami Children’s Initiative aims to transform the neighborhood block by block. The organization has started with an “impact zone” of 29 blocks, and particularly the three blocks adjacent to two schools that serve more than 600 children. There are early-learning centers, after-school and summer programs, and workshops for parents. Many kids describe a community center opened by the initiative as their “safe haven.”
Fifteen percent of Miami-Dade County’s population is 65 and older. Recognizing seniors’ increased risk of poverty, isolation, and poor health, the Miami mayor's office joined forces with the Consortium for a Healthier Miami-Dade County in 2006. Their Initiative on aging provides resources and information on senior needs, such as assisted living and transportation, and organizes free cultural events. In the Age-Friendly Business District in Little Havana, businesses provide weekly coupons to older adults living nearby to encourage them to walk to their stores.
Pierre Kennedy, a homeless man who stays in the downtown area of Miami, speaks with an outreach worker from Camillus House, a full-service homeless center. More than 600 homeless people—many with mental health problems—sleep outdoors in Miami every night. Camillus House’s Lazarus Project aims to keep them from having to go back and forth between the psychiatric ward and the sidewalks. Staff members go out night after night to provide medication and health treatments and advise them of shelter and other services.
A drive through some of the county’s underserved neighborhoods reveals a surprising void for a place renowned for its sun and beaches: There aren’t enough safe parks and playgrounds. To change that, the Consortium for a Healthier Miami-Dade County is creating “pop-up parks” in urban neighborhoods that have little green space, while the county is building nature trails and bike lanes and adding playgrounds. Next year will bring the city’s most ambitious project: The Underline, a 10-mile, 100-acre park to be built on unused land below Miami’s Metrorail.

Miami is like no other place in North America, or possibly the world. Famously welcoming, Miami-Dade County—also known as the “Gateway to the Americas"—has served as a haven for generations of refugees from Cuba, Colombia, Nicaragua, and other Latin American countries. But below the high-energy surface, Miami is grappling with pressing social and health risks. In 2003, the Consortium for a Healthier Miami-Dade County was formed to address the county’s overall health. Determined from its creation to be as inclusive as possible, the consortium has grown from 160 to 300 partner organizations focused on prevention and on the social factors that impact health. Successes over the past decade include putting healthy menus in place for the county’s public schools, which serve 340,000 children; installing fitness equipment that is free to all in 16 parks, with seven more teed up; reducing the homeless population; and offering routine HIV testing in all health facilities. Because of its long-term focus on collaboration, inclusion and outreach, Miami-Dade County has been honored with the 2016 RWJF Culture of Health Prize.

Photos: Copyright 2016 Tyrone Turner. Courtesy of the Robert Wood Johnson Foundation.

Santa Monica, California

Where health and wellness are always on the agenda

The view from Santa Monica Pier. Maintaining economic diversity, especially through a focus on keeping housing affordable, has been a longstanding goal of Santa Monica, where 70 percent of residents are renters and the median household income is about $69,000. Developers must set aside a percentage of newly constructed units for affordable housing. By doing so, says Durinda Abraham, a property manager, “You will give families the opportunity to thrive who otherwise wouldn’t have that opportunity.”
Tiana Binns, foreground, and, from left, Lauryn French, Demisary Pacheco, Jacquelince Yapkowitz, and Willow Cheng MacIntire celebrate the end of the year at Rosie’s Girls, a Santa Monica camp for middle-school girls. The city’s 2014 Youth Wellbeing Report Card found high rates of substance abuse, social isolation, bullying, and symptoms of depression among young people. Part of the city’s Wellbeing Project, the report card also found that only one-third of 5-year-olds were prepared socially to enter kindergarten. Santa Monica took decisive action, investing funds not only in early childhood development but also mental health services in schools.
Grace Seto shops at the farmers’ market in Santa Monica’s Virginia Avenue Park. Once ruled by gangs and described by residents as “scary,” today the park is a hub for neighbors. Improvements over the past decade or so include the addition of a library, teen center, fitness center, and meeting spaces for after-school enrichment classes and birthday parties. The park’s transformation reflects the city’s commitment to create a safe space for people to play, learn, and interact.
Darius Popenhagen commutes to his job at a local bike shop. Nearby Los Angeles is synonymous with cars and gridlock. But Santa Monica is working to expand and improve options for how its residents and visitors get around. In August 2015, the city council held a townhall-style meeting to consider new policy initiatives and adopted improved mobility for residents as one of five goals. Santa Monica has added 107 miles of new bike lanes in recent years, and as of last fall, bikers can access 80 bike-share stations. The city also changed 12 intersections downtown so that pedestrians can cross in all directions.
Staff member Jennifer Zapata (left) helps client Cheri Armstrong (right) at the Annenberg Access Center. A network of Santa Monica partners collaborates to find innovative ways to help the homeless. A guiding principle is the “housing first” philosophy, which houses people as quickly as possible and then makes sure they receive services to resume stable lives. Santa Monica was one of the first cities in the nation to develop a registry of the most vulnerable individuals experiencing chronic homelessness. And in 2007, it introduced the Homeless Community Court so that people cited for trespassing or public intoxication, for example, can get help and clear their records.

If you’ve visited Santa Monica, you might think the city begins and ends with the iconic Santa Monica Pier and Third Street Promenade of shops. But for the 93,000 people who call it home, Santa Monica is a complex city wrestling with the same complicated issues as its bigger neighbor, Los Angeles. Four years ago, Santa Monica set out to measure what was helping or hampering the well-being of residents. The results led to the Wellbeing Index, the first attempt by a city to produce a data-based guide for steering policy. Combining existing information gleaned from city departments and fresh input from surveys, the index sets a framework for priorities and shapes initiatives on health and wellness. For example, the city’s Cradle to Career initiative brings parents, educators, and service providers together to help children thrive. Santa Monica’s strong call to action, grounded in data, is one reason it was selected for the 2016 RWJF Culture of Health Prize.

Photos: Copyright 2016 Josh Kohanek. Courtesy of the Robert Wood Johnson Foundation.

Shoalwater Bay Indian Tribe, Washington

Spiritual health drives a holistic approach to living.

For Charlene Nelson (pictured), the Shoalwater Bay Indian Tribe’s chair, nothing is more important than the health and safety of her fellow tribe members. For the small tribe, located on one square mile in a rural floodplain and tsunami zone, safety is a top concern. The tribe also considers neighboring towns in its emergency planning. The shelter and emergency command center was designed to accommodate the entire region, not just those on the reservation.
From left to right, Alyssa Auvinen, Mechele Johnson, Jamie Judkins, Jan Ulmstead, James Kissee, and Charlene Nelson are members of the tribe’s Pulling Together for Wellness group, which meets under a symbol of their cultural heritage, a century-old wood canoe suspended by wire from the ceiling. Here, they discuss ideas on how to improve the tribe’s health and well-being, tackling everything from food sovereignty to better streets to tobacco prevention. The wellness coalition also enlisted teens to conduct a health survey and share their findings at a community dinner.
The tribe sharpened its focus on community health after tribal women experienced a perplexing increase in the frequency of miscarriages and infant deaths about 25 years ago. With its very future in jeopardy and the closest tribal clinic 70 miles away, the tribe started a full-service wellness center that has offered medical, dental, behavioral health, and substance abuse services for more than a decade and continues to expand. Evidence of the tribe’s improved well-being is measured in the number of young people on the reservation today: 40 percent of residents are under 18.
In Shoalwater, the current generation is shaped by the experience of three generations before and tasked with setting the course for generations to come. To ensure that traditions are passed on to future generations, Earl Davis (left) teaches tribal youth, including Aiden Davis, the traditional Salish style of woodcraft and how to shape logs and planks into carvings.
Siblings Sam (left), Maybelle (center), and Ferril Johnson take part in a “tsunami and health walk” organized to provide an opportunity for fitness while teaching participants, from toddlers to seniors, what to do and where to go in the event of an earthquake-triggered tsunami. The Shoalwater tribe has purchased land on higher ground and is setting its gaze on moving the reservation out of harm’s way.

The will to survive and thrive propels the Shoalwater Bay Indian Tribe. The federally recognized tribe has 373 members, 84 of whom live on the remote reservation in Pacific County, Washington, 150 miles southwest of Seattle. Although small in size, the tribe has big goals to improve and maintain the physical, social, emotional, and spiritual health of its people. The community promotes healthy behavior and active living, invests in the lives and well-being of its youth, and tends to all residents’ medical, dental, and mental health needs with its wellness center. The tribe’s approach to life, fed by its rich and deep history, reflects the core values of the RWJF Culture of Health Prize. “Our elders and our ancestors taught us that health is a holistic thing,” explains tribe member Earl Davis. “It’s not just whether you get up and exercise and eat right. It’s taking care of your mind, taking care of your body, taking care of your spirit, and taking care of everything around you.”

Photos: Copyright 2016 Josh Kohanek. Courtesy of the Robert Wood Johnson Foundation.