2016 RWJF Culture of Health Prize Winner

All Together for Health


On a map, 24 contiguous municipalities just northwest of St. Louis resemble nothing more than a crazy quilt. And for decades, their governance and services were a patchwork, too. Each municipality—from the tiny, two-street Village of Glen Echo Park, population 160, to the neighborhood-sized City of Normandy, population 5,008—has its own government. That’s two dozen mayors and city councils and almost as many police departments in an area that spans almost 11 square miles, is home to 36,250 people, and is served by one school district.

More than half a decade ago, city leaders rose above their individual municipal identities and city charters, embracing an “all-for-one” approach. Calling themselves “24:1,” they first came together in the midst of the nationwide mortgage foreclosure crisis that threatened the health of individuals, families, neighborhoods, and entire communities. Today, the 24:1 municipalities strive to realize a unified vision: strong communities, engaged families, and successful children.

 “If one community fails, we all fail,” says James W. McGee, mayor of the City of Vinita Park on the western edge of the 24:1 footprint. “To start healing the community, you have to have everybody involved. If everybody takes ownership, then you’re going to have a healthier community.”

For this unique spirit of collaboration and healing, the 24:1 Community has been honored with the RWJF Culture of Health Prize.

A man shaking hands with a police officer.

Missouri’s 24:1 Community

24:1 embraces an “all-for-one” approach to heal their community.

The 24:1 municipalities, whose total populations are 80 percent black, are tackling deep challenges to health and well-being. More than nine in 10 of their public school students qualify for free or reduced-price lunch. The unemployment rate is three times the county norm. People in the area live, on average, 15 fewer years than residents of Clayton, a more affluent community just three miles away. To cap it all off, four years ago the school district lost its state accreditation after 18 years of struggling under “provisional accreditation.”

Shared concern about the community’s ills brought the municipalities together in 2008, when more than half of their mayors first gathered. They were convened by Beyond Housing, a neighborhood development organization that was already building and maintaining affordable housing with supportive social services in the City of Pagedale. With the foreclosure crisis eroding some of Pagedale’s success in increasing property values and improving children’s school performance, Chris Krehmeyer, Beyond Housing’s president and CEO, wanted to spark a wide-ranging conversation: How do we make the community better? How do we make it whole?

The answer was to collaborate. “At the end of the day, housing alone won't fix our community,” Krehmeyer says. “Education alone won't fix our community.  Jobs alone, health alone, economic development alone won't help our community, but we think having all of them together and intentionally integrating them to make the fabric of a place healthy is going to give us long-term economic success.”

To start healing the community, you have to have everybody involved. If everybody takes ownership, then you’re going to have a healthier community.

James W. McGee, mayor, City of Vinita Park, Mo.

Free Little Library A Free Little Library, part of the Normandy Read Me program, sits in front of Our Daycare in St. Louis, Mo. The program offers free books on loan to any student who wants to borrow one.
Family Walking A family walks home along Natural Bridge Road after picking their son up at school. The wide sidewalk is part of the 24:1 Communities collaborative efforts to create a more walkable environment for its citizens.
Health Event The Beyond Housing's "Beyond the Backpack"event, held at Normandy High School in Northern St. Louis County, provided families in the 24:1 communities with back-to-school resources, including immunizations and haircuts.

So, in 24:1 they’re trying to do it all—together. Superintendent Charles Pearson of the Normandy Schools Collaborative, the reorganized and state-controlled school district, meets regularly with the mayors to update them on the quest for reaccreditation and to enlist their help spreading the word about priorities and accomplishments. The municipalities and Beyond Housing also have taken steps to spur economic development, particularly in Pagedale, and to bring a new health clinic to the community. To keep some of the most devoted residents of 24:1—the older generation—from moving away, Beyond Housing worked with two municipalities to build senior living centers. Residents of one of the two complexes, erected on the site of an abandoned liquor store, will tutor and mentor students at the elementary school across the street.

Other resources meant to improve health for residents of various ages have sprouted up across 24:1, including free fitness classes, a free summer youth softball league, and a planned expansion of the 7-mile St. Vincent’s Greenway walking and biking trail. Once completed, the trail will diagonally connect one corner of 24:1 to the other, from the City of Wellston to the Village of Bel-Ridge. A project to convert many of the area’s potholed, unappealing streets into walkable, well-lit, tree-lined boulevards also is slowly coming to fruition.

Though challenges remain, Krehmeyer says one of the biggest transformations in 24:1 is an invisible one: a shift from resignation to hope.

“I think people now have a sense of ‘Wow, we really may have a community that's going to be exciting, that’s going to be vibrant,’” he says. “‘And it's going to be ours, and we can feel proud about where we live day in and day out.’”

If one community fails, we all fail.

James W. McGee, mayor, City of Vinita Park, Mo.

A young boy sits in a theatre seat enjoying a bag of popcorn.

Now Showing in Pagedale: Hope

24:1 Cinema Moviegoers buy tickets at the 24:1 Cinema on Page Ave. in Pagedale, which was constructed with the assistance of Beyond Housing to revitalize commerce downtown. The cinema offers tickets at lower prices than many other movie theaters, and a portion of the proceeds returns to the 24:1 communities to fund new initiatives.

With just four screens and an unassuming Art Deco marquee, the 24:1 Cinema in Pagedale, Mo., may not seem like much to an outside observer. But to Alderwoman Marla Smith, the one-year-old movie theater’s lights are “eye candy” and a herald of the renaissance she fervently wants for her city.

“When I was a little girl, Pagedale was popping,” says the 44-year-old mother of three. People owned their homes and lived in them, she says. Big employers such as the Lever Brothers soap factory and the Stix, Baer and Fuller department-store warehouse anchored the community.

But by the mid-1980s, many Pagedale businesses were in decline or had shuttered. Unemployment rose, and X-rated movies were showing at the Olympic Drive-in. There hadn’t been a grocery store since the 1960s. Houses went dark when homeowners lost their jobs and mortgages.

In the 1990s, Mayor Mary Louise Carter and the neighborhood development group Beyond Housing began working together to replace dilapidated homes and vacant lots with affordable housing. Then about 10 years ago, they began meeting with residents to ask what else would make their lives better.

“Everybody agreed that a grocery store they could walk to and get fresh fruits and vegetables and get healthy meals was one of the first things they wanted,” Carter says.

It seemed a simple enough wish, but enticing a developer to build a store in a low-income community proved challenging. In the end, Beyond Housing financed construction with local taxes, and discount supermarket chain Save-A-Lot agreed to run the store, which opened in 2010.

A flurry of other development projects aimed at making Pagedale more livable and walkable has since brought in senior housing, a bank, and the cinema—all within a few blocks of each other. The city has used grant funding to repave the formerly uneven, unlit sidewalks near the theater and supermarket and has added streetlamps. A barbershop, health clinic, and county social services center will open next to the theater this year.

Because the cinema and supermarket are owned by a community land trust, their profits fund neighborhood development, which is a boon for Pagedale and the surrounding municipalities.

Though it might take some time, one of Smith’s biggest hopes is to attract a family restaurant to downtown Pagedale.

“Who wouldn’t want to go have dinner and go to a movie?” she says.

Everybody agreed that a grocery store they could walk to and get fresh fruits and vegetables and get healthy meals was one of the first things they wanted.

Mary Louise Carter, mayor of the City of Pagedale, Mo.

Community Gardening Community volunteer and activist Deborah Vincent works in the community garden in St. Vincent Park, Mo. The garden is one of the initiatives within the 24:1 communities designed to create access to healthier food sources.
Save a Lot A Save-a-Lot store sits on Page Ave. in Pagedale, Mo. The store opened in 2010, bringing the first grocery store to the town in 40 years, which helps contribute to the revitilization of housing and commerce in Pagedale.

How to Be a Good Mayor

Over homemade turkey ribs and peach cobbler, a dozen North St. Louis County mayors and city representatives discuss matters large and small at their monthly gathering: their struggling school district, whether they should jointly bid on computer networking and security services, the cost of road salt.

A mayor’s job isn’t always exciting. But for 24:1’s tiny municipalities, which range from fewer than 200 people to about 5,000, every dollar and efficiency counts. The cities share contracts, best practices, and monthly conversations in the quest to bring better services, health, and well-being to residents. Six of the municipalities now also share a police department, the North County Police Cooperative.

Viola Murphy, mayor of the City of Cool Valley, says 24:1’s collaborative governance started when one of the other mayors asked what she paid for salt. “I told her what we paid and she was like, ‘I pay much more than that,’” she says. “So we started to look at how could we save money for our communities and get things done.” 

Revitalizing Newark

An effort in New Jersey helped a long-struggling city in ways that promote not only economic growth, but also health and wellness. 

When they opened the senior housing over in Pine Lawn, I was over there to support them. That’s what we do.

Mary Louise Carter, mayor of the City of Pagedale

Less money spent on basic services like salt and garbage removal has meant more money for community policing, neighborhood sports leagues, biking and walking trails, and other initiatives that boost health and quality of life, the mayors say. Banding together has also enabled the cities to secure federal and state grants to begin widening streets, building sidewalks, and planting and trimming trees—efforts that make 24:1 safer, healthier, and more attractive for residents.

To hold themselves accountable to their communities, the mayors wrote a set of 10 best practices, including having an annual budget, an annual audit, and police coverage. In a state that has come under intense scrutiny following the death two years ago of 18-year-old Michael Brown in a police shooting in Ferguson, a suburb just outside of 24:1, they were ahead of the curve. Last year, Missouri passed a statute that put in place 12 similar standards for municipalities across the state.

Mayor Mary Louise Carter of the City of Pagedale says helping each other live up to the best practices is just one way the mayors pitch in for all of the communities.

“When I have a ribbon-cutting ceremony, mayors from all around 24:1 come to support me,” she says. “When they opened the senior housing over in Pine Lawn, I was over there to support them. That’s what we do.”

View of road entrance to a high school.

Righting Normandy's Schools

Students writing during class.

A Collective Impact on Health and Education

It’s no exaggeration to say the 24:1 community was shocked to its core four years ago when Missouri stripped its school district of provisional accreditation, citing years of stagnant test scores and poor performance. Alumna Pamela Westbrooks-Hodge, now a state-appointed member of the Joint Executive Governing Board that runs the schools, says hearing news of the de-accreditation was “like experiencing death.”

In 2014, the state created a new governing body for the district, the Normandy Schools Collaborative, with a mandate to meet accreditation standards by 2017. The community moved swiftly to action. “It wasn’t just the state that said, ‘Make it right,’” says Superintendent Charles Pearson. “Community members said, ‘Make it right, and we’ll work with you.’”

Normandy’s path forward has not been easy. A state law enabling students to transfer from a de-accredited school to one with accreditation has drained millions of dollars in tuition and transportation fees paid to other, more affluent districts with higher costs. Meanwhile, nearly every Normandy student qualifies for free or reduced-price lunch.

“Our families are struggling around literacy, family structure, employment, and housing,” Pearson says. “When students come from poverty, they need a ton of wraparound services.”

To regain accreditation, the schools are boosting training for principals so they can better support teachers, meeting regularly to look at performance data for every child, using a standards-based curriculum, and implementing classroom practices that have been shown to help children learn.

The collaborative also reopened a formerly closed school to create a “Kindergarten Center” for all children in their first year of school, and every kindergartner receives a college savings account funded by Beyond Housing, a nonprofit community-development organization. Sixth-graders have been moved back to the elementary schools, to help deal with discipline problems at Normandy 7th & 8th Grade Center. And Normandy High School now has four academic tracks: global entrepreneurship, performing arts, biomedical sciences, and engineering.

Accreditation is a short-term goal, but the long-term goal is great schools for these children.

Charles Pearson, superintendent, Normandy Schools Collaborative

Pride A graduate from Normandy High School stands in front of a mural painted by Beyond Housing across from the school.
School Greenhouse A teacher points out the properties of particular plants in the school's garden to sixth grade students at Lucas Crossing Elementary School in Normandy, Mo.
Guinea Pig Fun Students in the sixth grade hold their classroom guinea pigs at Lucas Crossing Elementary School in St. Louis County, Mo.

Pearson says the district is also revamping how its many nonprofit partners provide wraparound services, such as tutoring, mentoring, case management, mental health, and services for families experiencing homelessness. “There had been wraparound services, but now we’re connecting them to academic goals,” he says. “If an organization is providing mentoring, let’s make sure those kids are attending 90% of the time.”

Those kinds of connections are all-important, Pearson says, because the district’s success will not be measured by accreditation alone.

“Accreditation is a short-term goal,” he says. “But the long-term goal is great schools for these children.”

Street view of a row of houses.

Building Wealth and Neighborhoods

Chris Krehmeyer, president and CEO of the neighborhood development group Beyond Housing, estimates that the 24:1 community lost 6 or 7 percent of its 15,000 households during the 2008 foreclosure crisis. And eight years later, he says, “We’re still struggling.”

Property values haven’t rebounded, and 24:1 now has more renters than ever, he says. “That doesn’t have to be bad, but there’s strength in homeownership.” Homeowners create stability in a neighborhood because they generally move less than renters, and often they are more invested in the property and the community. Their children are more likely to stay in the same school, and that continuity can benefit students academically and socially.

One can see the decline in homeownership on the street where Pagedale Alderwoman Marla Smith lives. Seven houses on her block are Beyond Housing subsidized rental homes. Three belong to the Housing Authority of St. Louis County. Six houses are vacant. Two have been torn down by the city.

“That leaves maybe six homeowners,” Smith says.

Excel Center The Excel Center, which offers financial planning services, sits on Page Ave. in Pagedale.

We help people be aware of what they’re doing with their money, and pave the way to saving so they can have a family legacy.

Evette Baker, financial education specialist, Prosperity Connection

Beyond Housing is working to boost homeownership in 24:1 in a number of ways. Its nonprofit 24:1 Community Land Trust uses a variety of subsidies to make homeownership affordable for people who would otherwise be locked out of the market. Residents own their homes, but lease the land, which is owned by the trust. The houses stay affordable because the trust controls the price owners receive when they sell. Buyers receive financial and homeownership counseling before they buy, and supportive services after they sign the contract.

With its partners Prosperity Connection, a nonprofit financial education provider, and Red Dough, a lender that offers lower-interest alternatives to predatory payday loans, Beyond Housing has established a “Wealth Accumulation Center” in downtown Pagedale. The center offers free financial coaching and classes on home-buying, credit repair, college and retirement savings, and other topics.

“We help people be aware of what they’re doing with their money,” says financial education specialist Evette Baker, “and pave the way to saving so they can have a family legacy.”

A toddler boy in a daycare setting.

A Quality Start for Children

A boy hula hoops during a block party.

The Culture of Health Prize

The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.

For Tina Mosley, owner and director of Our Daycare and Learning Center, caring for children and enriching their lives is a round-the-clock job. Open 24 hours a day, seven days a week, her preschool caters to parents who juggle two jobs or work and school. Most of the families can’t pay much, if anything, for childcare, but their children get high-quality care nonetheless.

That’s the goal of Programs Achieving Quality, or PAQ, run by the St. Louis nonprofit United 4 Children in the 24:1 footprint: give childcare providers, whether center- or home-based, the resources to create the best learning environment possible for young children.

Because Our Daycare and Learning Center and the three-dozen other preschools PAQ works with serve mainly families who receive childcare subsidies, the schools are unable to raise tuition rates, says Director Alleta Kyd. They can’t afford to pay their staff more than $10 to $10.50 an hour, let alone invest in professional development or new playground equipment. Some of the owners are so strapped they can’t even buy toys, Kyd says.

The better quality services we can provide to children at a younger age, the better life outcomes they will have.

Lindsey Noblot, 5ByAge5 program coordinator

Programs Achieving Quality Daycare provider Tina Mosley leads a sensory activity at Our Daycare in St. Louis. Mosley is a participant in Beyond Housing's "Programs Achieving Quality."

Preschools that become part of PAQ benefit from monthly coaching on how to motivate staff, run a shipshape business, and market their services to parents. They receive grants for things like renovating a sunroom for all-weather play or giving teachers bonuses. And they get free professional development, certification classes, and CPR training for their staff.

“For young children, being in a consistent, quality early childhood facility gives them the ability to move forward in the first stages of development,” Kyd says. “It allows them to really learn what is expected in school, and that allows them [eventually] to learn what’s expected in a career.”

PAQ fits into a larger initiative in 24:1 to ensure all local children are prepared for school by age 5. Called 5ByAge5, the project engages more than 30 partners that provide five building blocks to children ages 0 to 5 and their families: health care services, developmental screening, parenting support, community connections, and early learning.

“Everybody deserves a chance at a great start,” says Beyond Housing’s Lindsey Noblot, who coordinates 5ByAge5 on behalf of the partners. “The better quality services we can provide to children at a younger age, the better life outcomes they will have.”