Building Healthy Communities: a 21st Century Community Change Initiative

Photo courtesy of The California Endowment’s Building Healthy Communities Initiative archive

CSSP has a long history of designing, implementing, and evaluating community and system change efforts. One of the most significant challenges in such an undertaking is sustaining the investments and interest of funders over the long term that is needed to  achieve tangible results with and for communities.  A seminal report about community change initiatives, Voices From the Field III, notes, “For the most part, comprehensive community initiatives of the last two decades did not place issues of power imbalance, institutional racism, and social equity front and center in their work”.¹

In Building Healthy Communities, The California Endowment bucked that history.

Over 10 years beginning in 2010, The California Endowment (TCE) invested $1.75 billion, and partnered with 14 communities across California as well as many state-level organizations and alliances, on Building Healthy Communities (BHC), an innovative initiative to achieve more equitable health outcomes. 

In developing and fostering BHC, TCE consciously built on lessons from the past two decades of community change initiatives, both foundation-sponsored and federally funded.² But BHC moved beyond prior efforts in several important ways.³

• TCE focused on investments in grassroots organizing and youth mobilization—termed “people power” by participants—that far exceeded anything seen in prior initiatives.
• TCE deployed communication and narrative change strategies more proactively than prior community change initiatives had done—or been able to do. TCE sought to influence and shape public opinion as a prerequisite for changing state policies and as support for local activism.
• Partners participating in BHC focused their energies on policy and systems change, rather than programmatic development and implementation. Communities participating in BHC insisted on systems transformation as the essential pathway to positively change the range of conditions identified as the social determinants of health.
• TCE came to center racial equity and justice in the work.

While TCE was neither the first nor only California foundation to invest in power building, the size and scope of its investments have helped power building become a more validated target for philanthropic investment.

The BHC legacy includes results for those most affected in historically marginalized communities, new knowledge for the field, and new learning agendas.

Over the course of the decade, the work of BHC partners:⁴

• Cultivated a vibrant and dynamic adult and youth organizing ecosystem that yielded over 1,200 local and state policy wins and tangible benefits to communities.
• Advocated for more equitable funding of California’s schools through the Local Control Funding Formula (LCFF) policy, which resulted in much-needed increased per-pupil spending and lower teacher-to-student ratios.
• Led a powerful campaign to improve school climate, change the public narrative and raise awareness surrounding the “school-to-prison pipeline” and end harsh and overly punitive school discipline policies. The work yielded a 50% decrease in suspensions statewide, contributing to more in-class time for teaching and learning.
• Played a critical role in supporting the implementation of the Affordable Care Act and ensuring communities enrolled in newly expanded Medi-Cal programs.
• Contributed to policies that expanded health care access to children, youth, and undocumented populations.
• Seeded programs in Health Homes and Health Workforce, which resulted in millions of federal and state dollars of investment and will ensure better quality of care for Californians in need.
• Contributed to ending youth incarceration across the state with youth arrests declining by more than 75%.
• Promoted environmental justice that yielded improvements in water access and quality, and equitable development of parks and recreation and active transportation infrastructure.

In the coming months, this blog series will highlight what has been learned and the on-going learning agenda. These installments will describe:

• The California Endowment’s path to power sharing.
• New ways of building evidence for making the case.
• Actionable insights for leading narrative change.
• Challenges to sustainability—finding the right fit.
• Investing in the Future: Building Youth Power Infrastructure
• Power Building Ecosystem
• Cycles of Change: Power Building and Advocacy

¹ Voices from the Field III
² Voices from the Field III
³ An Ecosystem to Build Power and Advance Health and Racial Equity (Full Report)
⁴ An Ecosystem to Build Power and Advance Health and Racial Equity (Executive Summary)