In 2017, the BUILD Health Challenge® (BUILD) set out to support 19 cross-sector, community-driven partnerships dedicated to advancing sustainable improvements in community health. BUILD’s support for these communities wrapped up in August 2019; based on evaluation and reporting activities, we can report that the awardees made progress implementing the BUILD model—moving resources, action, and attention upstream in their communities on long-standing, difficult health issues ranging from asthma and lead poisoning to obesity and early childhood development. (Read the 19 Community Stories to learn more about the focus of each BUILD community.)

Equal Measure and Spark Policy Institute, BUILD’s learning and evaluation partners, explored four questions as the award period closed:

  1. What does it mean for communities to implement the BUILD principles and advance equity?
  2. To what extent are systems changing in BUILD communities?
  3. In what ways are funders experiencing the impact of participating in BUILD?
  4. What are the future implications for BUILD?

The findings proved to be encouraging and offered BUILD stakeholders a few unexpected insights as well.

Question 1: What does it mean for sites to implement the BUILD principles and advance equity?

BUILD communities made progress on each of the five BUILD principles in their final year of support, according to evaluation evidence (See Chart 1). On average, they moved from early phase implementation (score of 1) to gaining momentum and reaching the advanced stages of work (scores 2 and 3). In other words, partners began their second year of the BUILD award still developing an understanding and implementation plan for the five principles and ended with new norms taking hold. In some places, the BUILD principles now represent partners’ default ways of working.

What does growth in these BUILD principles mean on the ground? Below is a summary of findings from the evaluation of how BUILD communities shifted their work and where challenges still lie:

Question 2: To what extent are systems changing in BUILD communities?

Taken together, the implementation of the BUILD principles has led the 19 BUILD sites in the second cohort to enact a total of 58 new systems-level changes in their communities between 2017 and 2019, creating new conditions that over time can benefit residents at a population level.

Percentage of 2017-2019 BUILD Sites Reporting Three Types of Systems Change

Of the three types of systems change outcomes expected in BUILD communities:

  • The most progress was made in re-allocating or finding new sources support for the BUILD work; nearly all BUILD awardees have resources to continue some aspects of their work.
  • The majority of BUILD awardees achieved shifts and scaling of organizational practices and policies important to health, including 1) improved enforcement of existing policies; 2) new policies reflective of the BUILD model; and 3) approaches that engage residents in design and decision-making opportunities. Organizational policy and practice changes are critical to create and sustain systems change efforts.
  • Several BUILD partnerships helped to pass new regulatory and legislative policies, primarily at a municipal or city level. These have the potential to positively impact health and equity beyond the BUILD community and at a population level.

“These newly formed partnerships between organizations are a sign of systemic change. These partners become community allies who protect, educate, and address unmet needs together and not individually. This has created synergy, increased efficiency, and additional resources for individual efforts and initiatives.”

Houston, TX

The BUILD Compendium to Systems Change guides readers through how BUILD communities have approached and achieved systems change outcomes and offers ideas and examples for what communities may look at in their own work to derive systems level changes.

Question 3: In what ways are funders experiencing the impact of participating in BUILD?

The BUILD Health Challenge is supported by a funding collaborative of national and regional funders. During the second cohort of BUILD, we learned about the funders:

  • Funders’ relationships mirror the progress seen in BUILD partnerships – strengthened relationships, increased knowledge, and efforts accelerated via collaboration.
  • Regional funders internally advance more ambitious and broadened approaches to health by joining BUILD, enabling them to confidently lead efforts targeting the social determinants of health.
  • BUILD’s unique model of national and regional funder collaboration is a critical element, combining the broad experiences and perspectives of national funders with the deep, local expertise of regional funders.
  • Funders aspire to individually and collectively enhance and amplify the impact of BUILD even more.

“BUILD has brought together funders who otherwise might not cross paths, providing a platform from which to engage, learn, and co-create.”

BUILD Funder

Question 4: What are the future implications for BUILD?

BUILD is continuing strong with a new cohort of 18 communities announced in November 2019, and a celebration of the program’s five-year anniversary in 2020. As efforts move into the next phase, which includes completion of the third cohort award cycle, there are strategic opportunities for BUILD to:

  • Further impact the field to encourage more multi-sector, upstream, equitable health efforts. Providing tools and frameworks that articulate how the BUILD model works can help expand the work to new communities and funders.
  • Accelerate success for the newest cohort of BUILD; new communities will benefit from an expanded set of resources, knowledge, and experiences at the outset of their BUILD work as they plan for systems change, apply an upstream lens, and position for a continuous focus on equity.
  • Advance equity more deeply than in the past. Equity is embedded throughout the BUILD model: as a core value, as a principle for implementation, and as a measure of success. Identifying how BUILD defines, embeds, and takes action on equity is essential framing for the partners and the field.

We will continue to document and share the accomplishments and challenges experienced by BUILD communities. The BUILD team is already diving back in to support a new cohort of 18 communities and advance our learning agenda. Improving population health and health equity requires many years of effort under a shared, clear vision and with new, blended, and re-allocated resources. Just as vital to the success of this work is inspiring new mindsets and new norms among a cadre of champions who will grow this work in communities throughout the country.


Equal Measure is a nonprofit organization that works to advance social change through design, evaluation, capacity building, technical assistance, and communications, helping clarify program goals, support implementation, facilitate learning, frame impactful narratives, and share learning with the field.

Spark Policy Institute is a national organization with a mission of helping communities, non-profit, and for-profit organizations and policymakers solve complex social problems that often cross multiple sectors, by collaborating with change agents at all levels to create, evaluate, and improve innovative, dynamic solutions to today’s most pressing challenges.