“The analysis of health narratives in Sentinel Communities reveals important insights about what ideas and values are influencing and framing the positioning and priority of health in community discussions.”
—RAND Corporation
Culture of Health Sentinel Community Insights: What Frames and Influences Narrative
Brief Feb-01-2022 3-min read
Report Publish Date: February 2022
This issue brief describes how community health narratives are framed in places participating in RWJF’s Sentinel Communities Surveillance project.
Primary Takeaways
The authors found the following frames in Sentinel Community health narratives:
- “Health is an individual responsibility.”
- “We should reverse alarming health trends through intensive, focused action.”
- “Strengthening the economy is a top priority, and if there are health benefits, that is a bonus.”
- “Healthy people need healthy environments.”
- “It’s time to address health equity and systemic racism.”
The authors also found the following changes over the five years of their study:
- Changes in leadership led organizations to shift priorities.
- Evolving narratives led to new ways of allocating and using funding.
- New or reimagined programs and policies reflected shifts in the health narrative.
Overview and Objectives
Begun in 2016, RWJF’s Sentinel Communities Surveillance project tracks how a Culture of Health is developing in 29 communities across the country. The authors wanted to know whether changing health narratives led to improvements in health.
Hypothesis or Approach
The authors gathered information from phone interviews with Sentinel Community leaders; online, published, and local materials and media about the communities; and data sources including the Census Bureau’s American Community Survey, the CDC’s Behavioral Risk Factor Surveillance System, County Health Rankings, and state and local data collection systems.
The authors used examples from Allegheny County, Penn.; Baltimore, Md.; Butte, Mont,; Finney County, Kan.; Granville County, N.C.; Harris County, Texas; Louisville, Ky.; Maricopa County, Ariz.; Milwaukee, Wis.; Mobile, Ala.; Monona County, Iowa; San Juan County, N.M.; Sanilac County, Mich.; Tacoma, Wash.; Tampa, Fla,; Toledo, Ohio; and White Plains, N.Y.
How This Influences Change
“[T]he frames and supporting influencers to advance a health narrative can be a powerful tool in how government and civil society leadership makes its case and
seizes opportunities, such as COVID-19, to accelerate new health initiatives,” the authors write. “It is important to consistently monitor and evaluate the evolution of these health frames, who is advancing those frames, and how the fuller narratives move across influencers.”
Research: Go Deeper
How a community views and prioritizes health, well-being, and health equity matters to the strategy, policy, and investment choices the community makes to improve health outcomes. In the Sentinel Communities, how leaders and organizations define and discuss health issues, including the consideration of issues such as the legacy of systemic racism, has evolved over the past five years. At the same time, these health narratives were influenced by social and political changes, expanded awareness of community health needs, and new conversations in government and in civil society. The question now is whether health narratives, which might have changed or expanded to adopt new perspectives (e.g., a greater appreciation of systemic racism), will endure and lead to practical improvements in health, or shift again based on emerging priorities within communities and society more broadly. This report describes aspects of community health narratives, with specific focus on the ways in which community health narratives are framed, what and who influences and impedes those narratives, and what appear to be linkages between narratives and community action. This report provides an initial look at predominant narratives related to health, well-being, and health equity through the environmental scan and stakeholder interviews conducted for the Sentinel Communities Surveillance Project. As such, the report offers a foundational analysis of what may be driving health narratives and outlines a path for subsequent, in-depth exploration of those factors.
Robert Wood Johnson Foundation, February 2022
Figure 1B: Components of how narratives manifest in communities: Intersection of frames, influencers, and actions
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Research Team
This study and report was conducted and created by the following people.
- RAND Corporation
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