Report Publish Date: November 2022
This brief report describes how communities are changing their systems to advance health, wellbeing, and equity in places participating in RWJF’s Sentinel Communities Surveillance project.
The authors say many of the Sentinel Communities were in the “transitional” phase of systems change, in which they are having new conversations, acknowledging the need to do things differently, creating new collaborations focused on particular issues or needs, and changing the way they deliver services.
The researchers also found that some communities had taken on structural change, with established coalitions and shared goals, new government structures to take on health and equity, data and resource sharing, and new policies.
Least common, the researchers say, was evidence of transformative change, with systems aligned around a “north star”; more efficient working arrangements, decisionmaking, and investments; and integrated data that allowed everyone to make decisions using the same information.
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 how much systems-change approaches were taking hold in these places.
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 systems change theory to create a framework for understanding systems-level changes in the communities and describe how transformative they are.
Themes of the brief come from all 29 communities, with examples from Butte, Mont.; Milwaukee, Wisconsin.; Tacoma, Wash.; Tennessee; Toledo, Ohio; and San Diego County, Calif.
“Systems change is a critical part of building a Culture of Health and advancing health equity because systems evolutions can fundamentally reform the policies and processes that have posed structural barriers and driven persistent inequities.”
—RAND Corporation
Understanding how systems change for better health and wellbeing happens in communities can help policymakers, advocates, researchers, and community members reimagine their communities’ systems and how they work together.
“Systems change” is a critical part of building a Culture of Health and advancing health equity because evolution within systems can fundamentally reform the policies and processes that have posed structural barriers and driven persistent inequities. Over the past five years, communities have been grappling with the best ways to foster positive, sustainable action to improve the health of their residents—whether it means having consistent access to quality healthcare, mitigating the negative impacts of social factors on health, or addressing the inequities and role of systemic racism exposed by disproportionately rising rates of chronic disease and the COVID-19 pandemic. However, changes that reposition how a community promotes health and wellbeing are not simple and are often plagued by a lack of long-term commitment among community leaders
and residents faced with competing priorities and limited resources for sustainability. True systems change helps to address these challenges by institutionalizing changes in how “work gets done,” whether through new ways of working together, financing, or sharing of data or information. This report provides an initial look at systemic changes to advance health, wellbeing, and health equity through the environmental scan and stakeholder interviews conducted for the Sentinel Communities Surveillance project. As such, the report provides a foundational analysis of what changes are happening in the systems that support health in a community and not simply change at the level of individual organization or within a particular sector. While the initial Sentinel Communities Surveillance project posed questions about systems change, it was not geared to be a systems change analysis. As such, this report should be viewed in the context of that limitation—these are early insights to be further examined in subsequent phases of this work.
Robert Wood Johnson Foundation, November 2022
This study and report was conducted and created by:
Research
Browse the profiles of a diverse group of 30 communities who are committed to improving the health and wellbeing of their residents.