The Building Healthy Communities Legacy
Building Healthy Communities (BHC) was an innovative 10-year, 14-community initiative of the California Endowment (TCE) to achieve more equitable health outcomes in California. Over a decade, from 2010 to 2020, TCE invested $1.75 billion and partnered with the 14 communities across California and many state-level organizations and alliances
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. But BHC moved beyond prior efforts in several important ways:
- TCE investments in grassroots organizing and youth mobilization—termed “people power” by participants—far exceeded anything seen in prior initiatives.
- Partners participating in BHC focused their organizing and advocacy 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 deployed communication and narrative change strategies more proactively than prior community change initiatives had done—or been able to. TCE sought to influence and shape public opinion as a prerequisite for changing state policies and as support for local activism.
What was the impact of this decade of work, and what lessons were generated by the thousands of people working in 14 communities and statewide?
Research and evaluative studies are answering these questions. Studies include (1) a comprehensive catalogue of BHC’s contributions to state and local policy changes; (2) case examples of how grassroots organizations and statewide non-profits operated as a power building ecosystem to achieve policy change; (3) analysis of the investments fueling the local work and leveraging far larger philanthropic, state, and local investments; (4) examination of how TCE’s board kept a risky, decade-long and continually evolving initiative on track; and (5) documentation of local leaders’ views about the actions and ingredients needed to sustain and evolve what BHC put in motion. This research by independent evaluators has been supported by TCE both to assess impact and to distill BHC’s lessons.