Mobilizing Communities Toward Better Health, Income and Education: Q&A With United Way's Brian Gallagher
United Way Worldwide has evolved from its roots as a fundraising organization to a critical community convener that mobilizes local partners, including businesses, community leaders, public officials and community residents, to expand opportunities for people to live healthy, quality lives. United Way focuses on three key building blocks: a quality education that leads to a stable job, enough income to support a family through retirement, and good health. With support from United Way Worldwide, 12 United Ways across the country have formed the United Way network’s first Health Mobilization Group. This peer-learning community will use the County Health Rankings framework to work with the residents, external experts and stakeholders to drive systems change to improve health and health equity in their communities.
NewPublicHealth will conduct an in-depth series on the work of United Way on the ground to improve health, education and income. The series will include Q&As with thought leaders as well as those advancing initiatives at the community level: the leaders in local United Way organizations and their communities. We kick off this series with a conversation with United Way Worldwide President and CEO, Brian Gallagher, MBA, about the organization’s priorities, key partners and methods for mobilizing communities for social change.
NewPublicHealth: United Way focuses on three key issues: education, income and health. Why are these the most critical issues, and how do they work together to impact quality of life?
Brian Gallagher: We actually began by focusing on the idea that we’re in business to advance the common good in communities. When we started asking ourselves how we would do that, we quickly understood that our focus must be on creating opportunities for a better life. We talked to experts in human development and conducted polling across the U.S. to ask ordinary people what they believe they have to have in terms of opportunities for a better life. The answers came back the same—education, financial stability and being healthy and having access to quality care. We consider them the building blocks of life.
We know that young people who are healthy and have good nutrition and physical activity actually do better in school. The facts are pretty compelling. And the opposite is true, too. The more education you achieve, the healthier you are. And again, the more financially stable you are, the better access you have to nutritional food, better lifestyle choices and healthier outcomes. They all work together to create a quality life.
NPH: What is United Way’s strategy for helping more people live healthy lives?
Brian Gallagher: We really focus in a couple of areas. One is improving conditions that support healthy eating, physical activity, and avoiding risky behaviors. The other is access to health care. For instance, we were very involved in helping to get the SCHIP legislation passed in the 111th Congress. Even more important now, if you think of the nearly 1,200 local United Ways across the country, we’re actually an information and content distribution channel. We can connect federal government, corporations and foundations with local communities because we have a unique reach. United Ways cover 95 percent of the country. The outreach efforts around SCHIP eligibility have been key for us following passage of the legislation. It’s not just what we focus on in terms of healthy lifestyles, but it’s actually making the connections between information and programs and services with people, and the policies, systems and environments in communities.
NPH: How does United Way go about mobilizing people and communities across sectors for social change?
Brian Gallagher: The strategy for us is grounded in the idea that if conditions are to change, normative behaviors also have to change. If you think about smoking in public places, for instance, before cities could pass ordinances to ban smoking in public places, there had to be a majority of people who lived in those communities who wanted that change. The mobilization effort is really the idea of how do you get individuals back involved in their communities and in their own life again.
Too often what’s missing is that institutions and systems work independently of each other. Mobilization brings institutions and individuals—businesses, local public sector leaders, local non-profits and other citizen’s groups—together to set collective goals and develop collective strategies. That’s where you see progress.
NPH: What are some interesting examples of the mobilization work?
Brian Gallagher: A good example is in Birmingham, Alabama. A community group there is focused on what city-wide conditions and resources must change to promote healthier lifestyles. Sixty different voluntary organizations came together—public sector, businesses, citizen’s groups—and they’re working on things like promoting bike lanes, vending machine policies in stores and in schools, working with local farmers and faith-based organizations to place community gardens in under-served areas. The content is important, but it’s also the idea of putting different people with seemingly different interests together for a common purpose.
Another great example is in Milwaukee. They’re focused on teen pregnancy rates. And they’re making a tremendous collective impact. Public health departments, the Mayor’s office, the hospitals, local non-profits, school systems, and others set a bold goal of dropping teen pregnancy rates by 46 percent by 2015. In October 2011, the City of Milwaukee and United Way announced a fourth consecutive drop in the teen birth rate to its lowest level in decades. The current trend indicates that the partners are on track to reach their goal of 30 births per 1,000 (a 46 percent drop) by 2015.
NPH: How do they decide what to focus on? Does it typically come from the people in the community, or the outside experts?
Brian Gallagher: It’s a little of both—but it doesn't work unless the local community commits to it and believes it. You can come from a national or statewide perspective. What’s important is that you have the data and strategies that have worked in other places to influence what a community might be working on. However, at the end of the day, they have to decide to work on it. If you don’t have local buy-in and local leaders moving toward a common goal, it doesn’t matter how smart you are in Washington.
NPH: Who are the partners United Way considers to be critical?
Brian Gallagher: The first point I would make about the critical nature of partnerships is that it has to be a diverse, comprehensive set of partners. United Way is 125 years old this year. We have a 100-year history of partnering with major corporations and organized labor in America. You need both. Business and labor are critical to us because they both have influence in terms of policy as well as access to information. Local government officials and organizations are also critical because if you’re going to focus on issues like nutrition and vending policies in schools, or smoking policies or physical changes in a city, you’ll need the support of those leaders. You also need content expert partners—academics, foundations, community health advocates and others. We have a national partnership with CDC because we want access to their expertise and we can help put that to work on the ground. Obviously we also need health care, health care systems, hospitals and community clinics. Those are our natural partners in health across the country.
The one thing that is surprising to many people is that we need partnerships with individuals in communities. You can partner with communities in different ways, but most organize themselves in groups—through faith-based organizations, neighborhood organizations and through the use of technology. Increasingly, we’re finding that we have to have partners that are vehicles for getting individuals together because that’s one of the ways to create normative change.
NPH: Why is the business sector so critical as a partner?
Brian Gallagher: Quite honestly, sometimes what people need in terms of opportunity is a job. Maybe the most forward-leaning force in America is the marketplace. Businesses move to opportunity faster than government does and faster than most non-profits do. If you can get businesses involved in an issue like healthy lifestyles and normative change, you take advantage of this huge momentum, which is jobs and job creation in the marketplace. In addition, increasingly businesses that are socially aware want their people involved in this kind of work, so it gives us access to human capital.
If we can put these different kinds of partners together to say, “how do you create a marketplace for healthy products?” in terms of vending policies and other methods, in a way that a business could get behind, because it’s both a market opportunity and creates a healthier environment, that’s the win-win we’re looking for.
NPH: Many local United Ways are using the County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute that provides a standard way for counties to see where they are doing well and where they are not so they can make changes to improve health. Can you talk about the work that these United Ways are doing to make policies, systems and environmental changes in underlying conditions that affect health?
Brian Gallagher: What’s really important about that is one of the foundational components that have to be in place for system’s level change—you have to have data. In order to get players to the table in local communities, it helps to be able to compare communities to each other. If you can get a consistent set of data so, for example, Cincinnati can look at what Milwaukie’s doing in teen pregnancies, and you can look at the data and clinically proven strategies, you’re much further along in the conversation.
Having the County Health Rankings & Roadmaps levels the playing field. I’ve worked for United Ways in five local communities, and I’ve been in many conversations where supposed experts will essentially make assumptions about data and what strategies work. United Ways are using the Rankings’ comprehensive framework about inter-connected factors that affect health because it is a core, foundational base that gives confidence to this system’s change process.
It’s been, for instance, one of the big missing pieces in the area of education, because there are huge arguments on what actually is the graduation rate because there are differences in measuring it. Until you have an agreed-upon, consistent set of data, you argue about assumptions that no one can prove.
NPH: Can you also tell us about the Health Mobilization Group?
Brian Gallagher: It’s a group of local United Ways that, with the help of the Robert Wood Johnson Foundation and others, are a learning cohort. It’s everything that I just described in terms of how you create systems change—that’s not the way we grew up institutionally in the United Way network. We grew up as a fundraising organization. We have to learn what it takes to bring these different interests together, and how you create strategies and measure progress together.
We bring together 12 United Ways, including their volunteer and professional leadership, and put them into a learning cohort. We bring in content experts such as the Prevention Institute and mobilization experts such as the Harwood Institute, and we train the local United Ways on how to actually do this work. Then they go back into their communities to share the learning and put it into practice. We find that an 18-month period allows for a much more in-depth method for learning and competency development than what you can get at a conference or individual training exercise. It’s an accelerated, intense development process.
NPH: How is it going so far?
Brian Gallagher: We’re very encouraged by it. We’ve got mobilization groups in health, education and income now. If you look at all the performance metrics that matter to us—showing progress on education or health issues at a community level, revenue generated for the organization, trust levels—we’re making tremendous progress.