The BUILD Health Challenge® (BUILD) aims to support communities that want to move resources, attention, and action upstream to drive sustainable improvement in community health. We are not alone – this movement towards systems change and prevention has picked up stream across the country over the last five years. We know the value – aligning resources, streamlininprograms, addressing the root causes of increasing chronic disease prevalence, increasing efficiency, and most of all, keeping our communities healthy and thriving.  

So why do we continue to live in a culture that allocates the vast majority of attention and resources to healthcare? One reason may be the instant visibility of a doctor’s prescription or surgical intervention. They can treat a patient’s symptoms effectively and efficiently, while policy change and cultural shifts may take much longer to demonstrate health outcomes, even as they reach many more people.  

Most BUILD communities take a “both/and” approach – connect community members with the services they need, whether that is an inhaler, legal services, or access to fresh food, while simultaneously working to change the systems that left them with a dangerous home or a neighborhood food desert to begin with. One provides immediate relief, while the other ensures that future generations will not have to face the same health crises. However, the latter requires a much more complexmulti-pronged intervention. 

BUILD worked with our evaluation partners at Equal Measure to create two frameworks. The first, the Outcomes Framework (p. 28-29), looks at how BUILD communities progress towards the attainment of a healthy community. While this works takes time, the team identified core systems changes that can create a healthier, more equitable community – as well as precursors that indicate that they are likely on track to achieve those systems changes. This helps set the work of systems change in the context of a measurable, manageable time frame.  

The second framework, the Progress Continua, allows communities to assess their implementation of the BUILD pillars. What does it mean to be “bold”? Is the approach community-led, or could community members be more integrated in the decision-making process at more stages of the work? How can we measure health equity?  

The Progress Continua identifies factors that indicate a community is being Bold, Upstream, Integrated, Local, Data-Driven, and equitable in approach. Within each factor, the framework provides multiple stages of implementation, from early stages to advanced. This framework not only provides structure for measuring progress on complex practices, but allows communities to identify their strengths and opportunities for growth as they move forward with their work.  

Read the report. 

Both of these frameworks are powerful tools for communities that plan to adopt elements of BUILD. The Progress Continua, in particular, is an innovative approach that has been adapted by others in the field as a model of how to assess progress in areas that are typically unmeasurable. These frameworks allow us to understand progress on undervalued but vital practices in a way that is meaningful and compelling.  

The “Getting BUILD Ready Guide” is intended to provide this capacity to others in the field. By sharing our frameworks, community examples, and a key resource list, we aim to make these practices more accessible and better understood. Ultimately, we see the opportunity for more communities – beyond the 55 who have been part of BUILD – to embark on partnerships that will move resources, attention, and action upstream.