In November 2019, The BUILD Health Challenge (BUILD) launched the third BUILD cohort, supporting 18 cross-sector, community-centered partnerships for 30 months. Guided by the BUILD principles – Bold, Upstream, Integrated, Local, and Data-driven, each grounded in health equity – BUILD partnerships across the country worked closely with residents to identify and address a public health priority. Awardees implemented upstream projects to improve the social determinants of health in housing, food access and systems, maternal and child health, community safety, and more.
Over the course of the two-and-a-half-year award period, Equal Measure, BUILD’s learning and evaluation partner, explored three questions:
- To what extent did BUILD communities implement the five BUILD principles?
- How did BUILD communities advance health equity?
- In what ways did implementation in BUILD communities lead to short- and long-term system change outcomes?
A note on COVID-19 and the racial justice movement
The first reports of COVID-19 began surfacing in the United States in January 2020 with devastating health impacts and social distancing practices emerging soon after — just as BUILD awardees were establishing and refining their work. The health and economic crisis precipitated by COVID-19 and the intensified racial justice movement following the murder of George Floyd underscored the pervasive systemic racism and inequitable health and economic systems in our society – challenges that BUILD communities were uniquely suited to address. Awardees needed to quickly pivot to respond to the crises, as well as redesign plans and community engagement strategies.
Now, as the third cohort of BUILD awards comes to a close, we recognize the work in communities has inevitably changed in ways that could not have been anticipated at the start of the cohort. It is critical to consider the broader context surrounding the data and results detailed here and the implications of the ongoing pandemic, using caution and reason in making comparisons to past or future cohorts of awardees. For further insights about how BUILD partners are carrying forward the lessons of the pandemic to sustain their work, see “BUILD Communities after 2020: What We Carry with Us.”
To what extent did BUILD communities implement the five BUILD principles?
BUILD communities completed two assessments during the award cycle, in 2020 and 2022 in an effort to understand if and how collaboratives made progress against the BUILD principles. Ultimately, BUILD awardees advanced work across each of the BUILD principles– moving from early phases of implementation (score of 1) to gaining momentum and making progress towards advanced stages (scores 2 and 3). Communities gained momentum especially in their Upstream and Local approaches – focusing on the social, environmental, and economic factors that influence health and on resident-driven and led strategies for change, as illustrated in Figure 1. (Learn more about the progress continua evaluation framework.)
Figure 1: BUILD Principles, Progress toward Implementation Change, 2020 to 2022
What did change look like in BUILD communities?
The findings table below illustrates implementation in each principle across BUILD communities and how the pandemic impacted some of the work in BUILD communities.
How did BUILD communities advance health equity?
Health equity is embedded in each of the BUILD principles and drives the long-term vision of the initiative. Given the centrality of health equity, our assessment explored the ways and extent to which BUILD communities advanced health equity. We learned that communities:
- Used of an explicit equity lens throughout their work, with a focus on community engagement and power-building.
- Prioritized residents. Many partners centered resident voices and decision making in their work. Engaging with community residents was a critical element of approaches to defining issues, generating solutions, and setting goals.
- Implemented equitable data practices. Equity also showed up in using asset framing, examining local resources, disaggregating data, centering the voices of those most impacted, and increasing access to resources and removing barriers.
- Deepened their understanding of racism as a root cause of health inequities and the need to redress racism to achieve health equity.
- Named racism. A growing number of partners began reflecting on their role in racial justice work and started to explicitly name redressing structural racism as focus areas of their BUILD work.
- Got more proximate to community. Other partners, recognizing that their members and locations were not representative of the community, sought collaboration with grassroots organizations, particularly those led by BIPOC leaders.
In what ways did implementation in BUILD communities lead to short-and long-term, and system change outcomes?
Since BUILD is a catalyzing award, BUILD tracks system-level outcomes as well as short-term outcomes – early signs of progress and change that lay the foundation for broader change. More information can be found on the current BUILD Outcomes Framework.
Most BUILD partnerships reported moderate or significant changes across four short-term outcomes.
More than half of BUILD partnerships reported moderate or significant changes for three types of systems changes.
Future implications
Lessons from the third cohort will inform the strategic direction and supports for BUILD and its future communities. Below are considerations for BUILD that may also be helpful for other community health leaders, funders, and practitioners in the field.
- Equip awardees and local leaders to build power with residents in their growing role as partners in the work
- Rethink what it means to be “data-driven” and the role of community-centered evaluation practices and resident-informed data
- Support awardees to address and measure their progress on sustainable systems change and equitable outcomes
- Enhance BUILD’s learning and evaluation agenda in the future by drawing on findings from the full network of 55 communities and increasing participatory and equitable evaluation approaches.
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Learn more about who applied for the BUILD’s fourth cohort and what we’ve learned so far.
