The BUILD Health Challenge is contributing to the creation of a new norm in the U.S., by putting multi-sector, community-driven partnerships at the center of health to reduce health disparities caused by system-based or social inequity.


In the United States, more than 95 percent of health care spending is dedicated to the provision of direct medical services. However, medical care accounts for only a fraction of population health status in the nation. A far greater share of health outcomes, as much as 70 percent, can be attributed to the interplay and influence of social, physical, and economic environments on health behaviors. BUILD awardees work to improve communities that are adversely affected by these factors, which are often referred to as the social determinants of health.

This national program strengthens partnerships between community-based organizations, hospitals and health systems, local health departments, and others, to cultivate a shared commitment to moving resources, attention, and action upstream to drive sustainable improvements in community health.

BUILD Stands For:


Partnerships that aspire towards a fundamental shift beyond short-term programmatic work toward longer-term influences over policy, regulation and systems-level change


Partnerships that focus on the social, environmental and economic factors that have the greatest influence on the health of a community, rather than on access or care delivery


Partnerships that align the practices and perspectives of communities, health systems and public health under a shared vision, establishing new roles while continuing to draw upon the strengths of each partner


Partnerships that engage neighborhood residents and community leaders as key voices and thought leaders throughout all stages of planning and implementation


Partnerships that use data from both clinical and community sources as a tool to identify key needs, measure meaningful change, and facilitate transparency amongst stakeholders to generate actionable insights

BUILD and its communities apply bold, upstream, integrated, local, and data-driven (BUILD) approaches to improve health in communities that are adversely affected by upstream factors, such as transportation, food availability, and employment opportunities. In total, BUILD has supported 37 projects from across the country. Many of these projects have already yielded highly promising approaches that focused on issues such as home remediation to address childhood asthma; code enforcement at the local level to reduce housing hazards; and access to healthy foods in response to food insecurity and obesity.

BUILD Leadership

A unique coalition of national and regional organizations fund BUILD, including: The Blue Cross and Blue Shield of North Carolina Foundation, The Colorado Health Foundation, The de Beaumont Foundation, The Episcopal Health Foundation, Interact for Health, The Kresge Foundation, Mid-Iowa Health Foundation, New Jersey Health Initiatives, The Robert Wood Johnson Foundation, Telligen Community Initiative, and The W.K. Kellogg Foundation. Learn More

BUILD is based in the Washington, DC, metro area and is led by executive director, Emily Yu. (Bio) (Headshot) (Contact)

Defining the Issues:

Here's how BUILD defines key areas impacting community health.
Social Determinants of Health

The social determinants of health are all the environmental factors that influence your health, including early childhood development, employment opportunities, food insecurity, air and water quality, transportation, educational attainment, public safety, and housing.

Examples of social determinants that would impact your health include:

  • Is your home free of lead, mold, or other hazards?
  • Do you have access to affordable, nutritious food?
  • Do you have opportunities to exercise, either outside or at a exercise facility?

Income, education, housing, transportation, the built environment, and other “social” factors are the true “determinants” of your health – or as the Robert Wood Johnson Foundation (RWJF) has described it, “Where you live, work, learn, and play.” In collaboration with RWJF, the Virginia Commonwealth University has created life expectancy maps that illustrate the impact of the social determinants of health as you move through different neighborhoods of major US cities.

Health Disparities

The BUILD Health Challenge defines health disparities as the differences in health outcomes based on race, ethnicity, sexual orientation, and socio-economic status. For example, minorities experience a higher prevalence of adverse health outcomes from chronic disease to mental illness to mortality rates than their white counterparts.

As a New York Times analysis declared in 2015, “Income Inequality: It’s Also Bad for Your Health.” The County Health Rankings & Roadmaps project also provides detailed breakdowns of county-by-county health disparities in data, maps, and more.

Health Equity

Health equity is achieved when immutable characteristics such as race, gender, sexual identity, and more are not correlated to higher rates of adverse health outcomes; i.e. that historically marginalized groups are no longer bearing a disproportionate burden of disease.

One of the goals of the BUILD Health Challenge is to promote health equity by creating the conditions to allow people to meet their optimal level of health.


An upstream approach addresses the community factors that shape health before any clinical intervention is necessary (also known as social determinants of health). These factors can include fields as diverse as affordable housing, public safety, access to healthy food and economic opportunity.

The de Beaumont Foundation’s Brian Castrucci discusses how public health ties into moving upstream to improve health and cut healthcare costs in the Huffington Post’s “Rowing Together: How Public Health Supports the ‘Upstream’ Doctor.”