health equity

Growing Well Connected Communities

More than two years ago, leaders across America’s Cooperative Extension System (CES) and National 4-H Council (4-H) began imagining how they could expand their collaborative efforts to amplify and accelerate a culture of health across the nation. They are building upon rich agency histories of youth and adult partnerships, translational science, expert volunteer programs, and expansive research. With support from the Robert Wood Johnson Foundation and the engagement of 13 first wave Land-Grant Universities (LGUs), the Well Connected Communities initiative launched its first year in August 2017.

The LGUs, from a mix of rural and urban areas, have each partnered with three communities within their state to build or grow locally representative health councils, identify community needs and interests and strengthen practices for young people to work alongside adults to help create change for cultivating wellness.

The work is rooted in a series of guiding values and principles including:

  • Commitment to transforming place through genuine partnership
  • Focus on equity and inclusion
  • An intergenerational emphasis—with hope and action
  • Balancing what works (evidence) and innovation (creating new pathways)
  • Learning and growing together—a results oriented movement

In December 2018, state and local teams convened to kick-off the initiative, get rooted in evidence-based practices, and begin to build a peer-learning network that will continue to grow with the initiative.

As local work advanced, several youth and adult teams also participated in the National Youth Summit on Healthy Living in February 2018. One of the activity tracts focused on supporting Well Connected Communities teams in exploring local health needs using County Health Rankings and Roadmaps, developing a draft action plan, and presenting their plans to fellow attendees.

Over the next year, communities will connect with at least 150 volunteers to mentor youth leaders, build local capacity, and ensure successful implementation of an action plan. Communities are focusing on a wide range of health issues that reflect local needs and interests ranging from the expansion of safe walking routes and trails, opioid use and misuse prevention, mental health, and other healthy lifestyle supports. For example, Utah State University with its partner community, Davis County, has prioritized mental health in response to the high rates of suicide mortality and limited support services across many of its largest counties.


Suicide Mortality, Age-Adjusted Rate by Year, 2003 through 2014 (Utah: Well Connected Communities Community Assessment, powered by CARES)

Quality of Life, Suicide Mortality for Utah, Davis County, UT and the USA (Davis County, UT: Well Connected Communities Community Assessment, powered by CARES)

Well Connected Communities Map Room powered by CARES


Well Connected Communities is taking the long view and in the short term is focused on engaging 1,000 communities over the next 10 years! LGUs and communities in this first wave of the work are excited about the initiative because it is:

  • Community driven
  • Holding a broad definition of what creates and supports health
  • Focusing on system’s approaches
  • Committed to working with communities who are at all different stages of healthy communities work


Participating Land-Grant Universities

Over the coming months, the Well Connected Communities’ leadership and professional development teams will be hosting a series of webinars to connect with and support CES leaders, LGUs, and their communities as applications are made to join the next wave of the initiative.

Together, they will show how young people working with adults can lead the way in spurring community change with a focus on promoting health and wellness where they live with the resources they have.

Resident-Centered Approach Grows Healthy Babies and Local Economy

This article was written by Megan Calpin and Jessica Luginbuhl. It was originally published in the Building Healthy Places blog on July 25, 2017.

Can a community market improve infant health? Can developing a local entrepreneurship culture reduce the number of babies born prematurely?

The Life Course Theory suggests that the answer is yes. In the US, African American babies are twice as likely to die in their first year of life compared to white babies. Despite years of investment in improving access to prenatal care and high quality services, racial inequities in birth outcomes persist. The Life Course Theory proposes that exposure to healthy environments early and throughout life can increase the likelihood of healthy birth outcomes from one generation to the next.

Map of predominant race and child mortality

Click the map to zoom to your area.

That’s why the UC Berkeley School of Public Health launched the Best Babies Zone (BBZ) Initiative in 2012, with funding from the W.K. Kellogg Foundation. The BBZ Initiative works to implement Life Course Theory at the crossroads of public health  and community development  practice. Because health is shaped by where we live, work, and play, the BBZ Initiative identified three small geographic areas to implementation of BBZ’s place-based, community-driven, multi-sector approach to reducing racial inequities in birth outcomes.

A place-based approach to improving infant health

BBZ Castlemont is one of the original three Zones, located in Oakland, CA. The effort there is led by the Building Blocks for Health Equity (BB4HE) Unit at the Alameda County Public Health Department (ACPHD). ACPHD has long valued resident leadership and vision. And the BB4HE Unit has a track record of working on cross-sector social determinants of health issues since its inception in 2009. Their work is presently sustained through funding from an anonymous donor and The San Francisco Foundation, The California Wellness Foundation, and Kaiser Permanente Community Benefit program.

Click the diamonds to explore a Best Baby Zone.

Oakland’s Castlemont neighborhood has a long history of resident leadership, community organizing, and local enterprising. It was also the site of early community development efforts in the 1960s and continues to be a hub of strong community organizations. These assets—paired with recognized social, economic, and health inequities—made Castlemont an ideal location for the BBZ approach.

Putting resident priorities at the center

After gathering initial concerns from zone residents through community events and forums—such as the Castlemont Community Cafés—a few social determinants of health emerged as top concerns: safety and violence; local economy; community building; and education. To turn these issues into actions, BBZ Castlemont relied on the human-centered design approach taught to them by Gobee Group.

According to Gobee Group, human-centered design—sometimes called design thinking—supports “reframing problems in order to explore underlying assumptions” and consists of three phases: inspiration, ideation, and implementation.

  1. The inspiration phase is all about building empathy for the recipients of a program or process.
  2. Ideation is a time for wild brainstorming to explore all possible solutions.
  3. Implementation encourages rapid testing to refine carrying out ideas.

BBZ Castlemont’s work is guided by these phases. Staff focuses on starting small and getting to scale over time.

Building the local economy to improve community health

BBZ Castlemont’s team began considering local economic development strategies that would build on the history of arts and entrepreneurship in East Oakland.

For existing resident entrepreneurs who needed a place to sell their goods in the Zone, the Castlemont Community Market (CCM) provides a launching pad for small businesses and a monthly, all-ages gathering space to support community building. The CCM is held on the first Saturday of the month outside Youth UpRising, a key partner in BBZ Castlemont’s collaborative work and one of Castlemont’s anchor institutions. Leadership within the CCM has evolved with a burgeoning vendors association, comprised of six vendors who either live or work in the neighborhood and create natural skin and hair care, jewelry, or clothing products.

A way to further build entrepreneurship capacity in the zone was a nine-week entrepreneurship training program on business development. Through a partnership with the Oakland-based Mandela MarketPlace, East Bay Asian Local Development Corporation, and Centro Community Partners, this program began in 2016 out of an identified need for business incubator programs for those with little to no business experience or start-up capital. Staff always seek to link direct services to upstream programs, so they recruited some participants through ACPHD’s perinatal and infant home visiting programs as well as the CCM vendor community.

Lastly, a mini-grant program provides seed-funds to residents and partner organizations to conduct community-driven projects aligning with resident priorities. An advisory body with residents, local organizations, and BBZ staff select the awardees and advise on the implementation of the projects, building the capacity of local residents to fulfill their natural role as leaders. Former projects include the East Oakland Swim Club and the Castlemont Community Play-Time. Both projects are examples of drawing on local resident knowledge to improve community well-being. Both projects are now supported by other entities, such as Oakland Parks and Recreation Foundation and First 5 Alameda County, respectively.

What’s Next?

BBZ Castlemont’s approach to health equity and community development continues to be a shining example of what is possible when programs keep local residents at the center while putting the Life Course Theory into practice. Zone residents have become ACPHD staff and BBZ Castlemont staff have become leaders and advisors in the BBZ National Learning Community, providing technical assistance to a new set of three BBZs launched in January 2017. As this Zone moves into its seventh year, the staff continue to engage new community and economic development partners in the work to improve birth outcomes through addressing health across the life course.

To learn more about each of the BBZs, visit Three new BBZs will be enrolled in a new cohort starting January 2018. To learn more, visit Start a BBZ.

Salud America! Launches New Report for Members

SA-logoCommunity Commons and its partner Salud America! are excited to announce the release of a new, custom tool: The Salud Report Card!

This new tool is designed to help identify and communicate what health issues are important to you and your community. The report can be downloaded, printed and shared online making it easy to provide vital information to key figures like local and state PTA, health departments, city leaders, friends, and family.

Know the Issues, Start a Change

Want to begin to address and help solve health issues facing Latinos and their children? Learn more about Salud America! by watching our recent webinar where we first announced the Salud Report Card.

The Salud America! Hub provides comprehensive content, resources, and research; which suggests lots of achievable healthy changes. You can also view some of the many posts about policy changes happening now, or follow the footsteps of the many Salud Heroes making an impact in their communities. For example, building a fitness trail!

Create a Report in Your Area

The Salud Report Card highlights key health issues in your county with data, policy solutions, research, and stories so you can start and support healthy changes for Latino kids. One of the largest hubs on the site, members of Salud America! are able to create these geo-located reports, using mapping and data tools on the provided by Community Commons.

SA! Report Highlights

Simply select your state and county and the Report Card will specifically exam the following in your county:

  • Obesity
  • Food Access
  • Physical Activity Issues
  • Health Equity
  • Vulnerable Populations

The Report Card can help you quickly get data and research in to the hands of those who need it most, and can be used to justify and advocate for grant funding and policy change. Which of the topics in the Report Card stand out in your county? Comment below and tell us what you think of this new tool.

Need Help?

Email Salud America! digital curators, Eric, Lisa, and Amanda at They can answer questions and help you access information and data/maps on many other topics.

MDs Now Prescribe Walking as a Boost to Health

The following was originally published at and written by Jay Walljasper. 

A compelling reason to keep your New Year’s resolution to be more active.

Everyone knows walking is good for you.

It’s plain common sense, backed by a wealth of recent medical research. In fact, a major new study found that lack of physical activity is twice as deadly for us as obesity.   

Health data shows that as little as 30 minutes of walking a day cuts the incidence of Alzheimer’s Disease in half, lowers the likelihood of diabetes by 60 percent, limits colon cancer by 31 percent for women and reduces risk of dementia, heart disease, depression, osteoporosis, glaucoma and catching a cold.  

This kind of evidence prompted US Surgeon General Vivek Murthy to issue a call for Americans to walk more . “Physical activity – such as brisk walking – can significantly reduce the risk of heart disease and diabetes,” Murthy explains. “Even a small first effort can make a big difference in improving the personal health of an individual and the public health of the nation.”

“Walking is the most common form of physical activity across incomes and ages and education levels,” adds Thomas Schmid of the federal Centers for Disease Control and Prevention (CDC). That’s because it’s free, easy, relaxing, available right out your front door and easily incorporated into daily schedules.  Plus it’s fun. The CDC’s most recent research shows the number of Americans who take a walk at least once a week rose six percent in the last decade.

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Click on the interactive map to see what this data looks like for your own community or visit our Map Room to create your own maps.

Still less than half of all adults meet the minimum recommended guidelines for walking, rolling in a wheelchair or other physical activity  (30 minutes a day five days a week), according to the federal Centers for Disease Control and Prevention.  Even worse, only a quarter of high school students today reach the mark (an hour a day seven days a week), according to the Surgeon General’s report.

What can be done to ensure the health of our country?  The Surgeon General encourages everyone to walk and work to make their hometowns more safe and inviting for people on foot.  He lauds the new walking movement that’s emerged over the past few years for getting Americans moving again.

Health care professionals are on the frontlines of this effort, and many are bringing the message back to their clinics by including physical activity as one of the vital signs—like blood pressure and tobacco use—they check on with patients. Some MDs even write prescriptions for walking. Several health care systems track physical activity in their health care records, including Greenville Health in South Carolina, Intermountain Healthcare in Utah and Idaho, and Kaiser Permanente, an integrated health care delivery system, in California and seven other states.

If Walking Were A New Drug, it Would Make Headlines

“What if there was a pill you took one day that lowered your blood pressure, prevented diabetes, improved your mood and protected against depression, increased bone density and prevented fractures, helped you remain independent as an older adult, enhanced your ability to think, and gave you more energy?” ask Dr. Robert Sallis and Dr. Karen J. Coleman in Sports Medicine Bulletin.

“Would you be asking your doctor to prescribe it for you?”

Such a drug already exists, Sallis notes, it’s called walking. “If walking was a pill or surgical procedure, it would be on 60 Minutes.”

Sallis, a family practitioner at a Kaiser Permanente clinic in Fontana, California, keeps special walking RX prescription pads in his exam rooms, which he fills out for some patients saying, “This is what I want you to do to treat your high blood pressure or depression or diabetes etc.  If it’s not enough, then we will consider using a medication.”

What are patients’ reactions?  “They respond very well to this message,” Sallis says. “This approach really frames for them how important exercise is to their health and treating their disease.”  

Sallis first spoke up about walking and other physical activity being recognized as a vital sign in 2007, when serving as president of the American College of Sports Medicine and helping launch the Exercise is Medicine initiative with the American Medical Association.  The aim of that project is to highlight the mounting research proving that physical activity should be seen as essential to health and the treatment of disease.  It’s obvious that doctors, nurses and other clinicians should raise the idea of walking during medical exams, when people are paying particularly close attention to their health and how to maintain it.

Putting the Plan Into Action

In 2009, physical activity was designated as a vital sign for Kaiser Permanente facilities in Southern California and the idea was quickly adopted throughout the rest of the non-profit organization—the nation’s largest integrated care health system with 10.2 million members, seventeen thousand physicians, fifty thousand nurses, 620 clinics and 38 medical centers on the West Coast, the Mid-Atlantic region, Colorado, Hawaii, and Georgia.

Patients are asked how many days a week on average they engage in moderate or strenuous physical exercise, like a brisk walk, and for how many minutes? These two simple questions frequently spark conversation about the value of walking (or yoga, Zumba classes, bicycling, gardening and other physical activity) in treating and preventing disease.

A follow-up study published in the journal Medicine and Science in Sports and Exercise found that 18 months after Kaiser Permanente adopted physical activity as a vital sign in Southern California, 86 percent of all adult patients had a record of their activity levels included in electronic medical records. In 2013, Kaiser Permanente’s Exercise as a Vital Sign program was honored with an Innovation Award by the National Business Coalition on Health.  

“Asking an individual about their daily physical activity helps our providers learn what matters to our patients and prompts our patients to think about healthier habits,” explains Lisa Schilling, vice president for Healthcare Performance Improvement with Kaiser Permanente’s Care Management Institute.  “It also allows us to connect the individual to resources and habits that promote better health.”

Even health care professionals sometimes need encouragement to live more healthy. Zendi Solano, a research assistant for Kaiser Permanente in Pasadena, California, admits that she knew the importance of exercise but “really didn’t take it seriously” until her doctor asked about it during a check up.  Diabetes runs in Solano’s family, and she was obese with elevated blood sugar. Right then and there, she decided to take up running. At her next physical, Solano had lost 30 pounds and her blood sugar levels were normal. Being asked about exercise as a vital sign, she says, “is a great reminder.”

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Click on the interactive map to see what this data looks like for your own community or visit our Map Room to create your own maps.

About 2/3 of Sallis’s patients fall below the minimum federal guidelines for exercise, and half of those report no moderate physical activity at all during an average week, he says.  “Talking about physical activity can have an impact on everyone,” he says, especially high risk patients with diabetes, lung disease, heart disease, hypertension, arthritis or other chronic diseases.

“Anyone who is at risk for chronic disease should consider exercise an essential vaccine to greatly lower risk of illness and…extend life,” he wrote in a guest editorial for The British Journal of Sports Medicine.  

The power of exercise to heal really hit home for Sallis after meeting Valerie, a 68-year-old patient with Parkinson’s Disease who hobbled into his office with a walker.  She was desperate and depressed because her medication was no longer working. He recommended she visit a fitness professional to walk on a treadmill at one mile-per-hour speed along with some resistance training and stretches.  

“In a month-and-a half, she came back to my office without the walker, and telling me she had more energy and a more positive outlook,” he remembers. This convinced him, “if something so simple and inexpensive as exercise can have such a profound effect, shouldn’t we try to prescribe this powerful medicine to all of our patients?”

Something You Can Say ‘Yes’ to For Better Health

For Liz Joy, Medical Director for Community Health at Intermountain Healthcare based in Utah, the “a-ha” moment about physical activity as a vital sign came in 2008 at a meeting focused on preventing obesity among youth.  “It was a roomful of physicians, health care directors, scientists and coaches,” she remembers, “and one speaker got up and asked: ‘What is health care doing about this crisis?’  That’s when it came to me that physical activity needs to become a vital sign.”

Intermountain adopted the idea in 2013 in its electronic health record for use by clinicians in Utah and Idaho. “It’s a way to bring discussion of physical activity into the exam room,” Joy explains.  “Even if it’s just a brief conversation about how important it is to your overall health. I can let patients know it’s as important as blood pressure, and more important than obesity and cholesterol to your overall health.”

“I generally start by talking about walking, because it’s free and everyone knows how to walk,” she adds. “I’ll tell them just start with 10 minutes at a time—and no one has ever said they can’t do that.  Do that three times a day, and you have your 30 minute daily minimum.”

Joy notes that doctors have been charting people’s weight for generations, telling them to lose weight while watching the national obesity rate continue to rise.  “Talking about physical activity is a positive conversation–something people can do to improve their health. And when they take that first step, sometimes their eating habits begin to change too. You’ve helped enhance their self-efficacy.”

Some of her patients don’t consider walking real exercise, so the conversation can offer new motivation to get back on their feet.  “I saw a patient and was surprised his records showed that his physical activity was zero. I knew he had a dog, and I asked if he walked the dog? Yes, he said 30-60 minutes a day. But he didn’t think of it as exercise.”

“The physical activity vital sign is a great prompt to have a conversation with patients about activity and exercise— to them things like gardening and dog walking count,” she adds.  

Joy points out that health care systems have a strong incentive for adding physical activity to their lists of vital signs.  “Physical activity is stressed in Medicare reimbursements as one of the HEDIS (Healthcare Effectiveness Data and Information Set) measures, which Medicare and others use to assess the quality of health care delivery to determine level of payments.  It’s a huge financial driver.”

Spreading the Message into Exam Rooms Everywhere

The American College of Sports Medicine (ACSM) has joined with other groups in the walking movement to alert health care professionals about the promise of adding physical activity to their list of vital signs.  

“One strategy is to get influential medical organizations to formally adopt physical activity as a vital sign, and then activate their individual members,” says ACSM CEO Jim Whitehead.  They’re already working toward that goal with 10 medical societies, including the American Medical Association, the American Hospital Association, American Academy of Pediatrics, American College of Cardiology and the Preventive Cardiovascular Nurses Association.

“This is for all health care providers, not just physicians.  Nurses can often make a greater impact because they typically spend more time with you, ” notes Brenda Chamness, ACSM Strategic Health Program’s Senior Director.

Working with Kaiser Permanente and the Every Body Walk! Collaborative— a coalition of organizations ranging from the CDC to AARP to NAACP to the PTA—ACSM hosted a two-day scientific roundtable on the subject last April, which detailed recent research and presented best practices used by working physicians, including Robert Sallis and Liz Joy.  In October, several hundred health professionals around the country took part in a webinar on “Making Physical Activity a Vital Sign.”

“All this can have a major impact by showing people that they all don’t have to go to the gym to be healthy,” says Adrian Hutber, Vice President of Exercise is Medicine at ACSM. “They can just go out and take a walk.”
Jay Walljasper writes regularly about public health and healthy communities.  The former editor of Utne Reader, he is author of The Great Neighborhood Book. His website is

Four Maps of American Health You Need to See

This post was originally published by Samantha MacDonald on December 4, 2015 on the ESRI Insider Blog.

Eat your fruits and veggies. Drink plenty of water. Exercise 30 minutes a day. That’s the perfect recipe for good health, right? Well, not quite.

The truth is, your health depends on much more. Thanks to advances in mapping technology, today’s health professionals know that where you live, work, learn, and play has an incredible impact on your well-being.

Interactive maps paint the picture of community health, showing the spatial relationship between disparities, illness, and location—like visualizing how a neighborhood with no playgrounds influences childhood obesity. Maps offer rich insights that can help drive positive change in Americans’ lives.

Check out these four maps to explore the health challenges that permeate the United States and how place plays a pivotal role.

Education and Health

According to the Centers for Disease Control and Prevention (CDC), “education is one of the strongest predictors of health; the more schooling people have, the better their health is likely to be.”

Understanding and communicating the health benefits of an education may help increase graduation rates. This interactive map explores the spatial relationship between high school completion and health quality.

ESRI Map 1

Access to Health Care

Access to basic health care varies radically from place to place across the country and is inadequate in many parts of the nation. These county-level maps present two ways of examining a fundamental community health challenge: to the left of the slider bar is a look at doctors’ offices relative to population: to the right, primary health providers.ESRI Map 2

Linking Obesity and Diabetes

Fact 1: Close to one-third of US adults are obese.

Fact 2: Almost 90 percent of people with newly diagnosed type 2 diabetes are overweight.

These county-level maps reflect the close links between these key community health challenges.

ESRI Map 3

Poverty and Health

Poverty can have a significant impact on health. Poverty among school-age children (5 to 17 years old and living with families) increased in more than a quarter of US counties during 2007–2011. This map shows how poverty in school-age children in the United States has changed during 2005–2011 by school district.ESRI Map 4

Explore Similar Maps on Community Commons


Population with Only a High School Diploma

Medically Underserved Area:Population

Medically Underserved Areas

Diabetes Incidence, New Cases by County

Diabetes Incidence, New Cases

Population Below the Poverty Level, Children (age 0-17), Total by County

Population of Children Below the Poverty Level

Obese Adults (Age 20+) Percent by County

Obese Adults (Age 20+)

Data Viz of the Week: Veterans Data

Veterans face a number of health issues often relating to their time of service. Search the Community Commons data list to see the various veterans data that are available.

Non-map visualizations can be created in—and downloaded from—the demographic section of a Community Health Needs Assessment report. To see the map data for your own area, click on the map image to visit the interactive map room and zoom to your location.

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Veterans Hawaii 3

New Maps of DC Health Data: Not Yet One Culture of Health

Our good friend Ted Eytan from the Kaiser Permanente Center for Total Health writes an excellent blog chronicling his life and work in Washington D.C. We’re proud that his postings often including one or more Community Commons maps that he uses to help tell his story. He gave us permission to share one of his latest with you, modified a bit to fit our audience and format. Read more