[Health Affairs]

We hear much about American health and health care being in crisis. Health care in the United States is increasingly expensive for everyone—consumers and government alike—but it doesn’t make us healthy. Despite that, there are “bright spots” of change where communities are coming together in new ways to solve their most pressing health problems.

These collaborations begin with the premise that the subject of health and wellness isn’t just about health care. Although health care can often heal us, it can’t overcome poverty, substandard housing, lack of transportation, or an unhealthy environment. What happens outside the walls of hospitals—that is, in places where we live, work, and play—matters more than what happens inside the colossus that is our health care system. Our communities still struggle with chronic, seemingly intractable conditions driven by where people live.

There is a way forward, though. In 2015, with support from the Robert Wood Johnson Foundation (RWJF), the Kresge Foundation, the de Beaumont Foundation, the Colorado Health Foundation, and Advisory Board, we launched the BUILD Health Challenge. It’s an unusual mix of funders that have aligned their giving to bring together nonprofits to work with both their local public health departments and their hospitals to identify bold, upstream, innovative, local, data-driven solutions to health problems. BUILD’s innovative approach to addressing issues of poverty and environment will help communities create their own bright spots of change for better health that can be replicated across the country.

For the second round of grant making, we’ve doubled down on this approach and added seven additional funders (including the W.K. Kellogg Foundation, Mid-Iowa Health Foundation, and Telligen Community Initiative with their focus on maternal and child health; the Episcopal Health Foundation, the Blue Cross and Blue Shield of North Carolina Foundation, Interact for Health, and New Jersey Health Initiatives) with particular issue-specific and regional expertise.

The RWJF has always worked toward improving the health and well-being of those living in the United States. Increasingly, that has led us in the direction of addressing the so-called social determinants of health by encouraging communities to find local solutions that work for them and that others may learn from or replicate. That’s the underpinning of the RWJF’s effort to create a Culture of Health in the United States, so that everyone can lead the healthiest life possible.

Our partnership with the BUILD Health Challenge encourages communities to do just that—to think boldly and in an innovative way about the systemic causes of the challenges that they face and to calibrate their response in data-driven, collaborative ways that engage local nonprofit partners, hospitals and health systems, government (including public health departments), and community residents.

In 2016, BUILD funded implementation projects in seventeen cities on a range of subjects from home improvement to transportation to reducing violence, and their work continues today. At the same time, real achievements—that translate into healthier communities and reduced health care spending—have already surfaced.

A Bright Spot

For example, in Des Moines, Iowa, the BUILD Health Challenge project works with local hospitals, schools, and many others to refer low-income families with children who suffer from chronic asthma to a local nonprofit, Healthy Homes Des Moines, which provides home assessments, repairs, and parent education to identify asthma triggers, remove them, and prevent them from coming back. Over a six-month period, in the families they worked with, children had missed an average of six school days because of asthma. Oftentimes this had required parents to miss work, too. Forty-three percent of the families were relying on urgent care facilities and/or emergency department (ED) visits for health care. On average, families had made two asthma-related visits to an ED over the previous six months, representing a total cost of nearly $50,000.

This project’s results speak for themselves: The number of school days missed was cut in half, and parents took less time off. Beyond the school and work results, the project found that children reported five more asthma-free days per month. Overall, parents and children learned more about asthma triggers, and parents felt less stressed and felt empowered to maintain their homes in a way that would prevent future asthma attacks.

Taking a step back to measure the impact of asthma on the families whom Healthy Homes Des Moines works with offers an eye-opening perspective on the scope of opportunity available to address these triggers before they escalate into chronic medical problems.

The work that Healthy Homes Des Moines is doing locally, and the work that BUILD is doing to spearhead its approach in these seventeen communities, continues, and we’re watching closely to see how it develops. Bright spots such as Healthy Homes Des Moines are worth trumpeting.

Most communities don’t yet have everything they need to be healthy places to live, work, and play—but they could. Making that vision a reality won’t be quick or easy, but it will be worth it. It will require local leaders coming together in new ways to find sustainable, systematic ways to address issues before they turn into problems.

I hope you’ll follow the progress in the BUILD Health Challenge cities, think about applying, or even (other grantmakers) join us in cofunding these community partnerships. When we think about those chronic, seemingly intractable health problems and how to address them, my challenge to you comes in the form of a question: What will you help BUILD?