More than half of Americans—133 million people—live with 1 or more chronic diseases, including cancer, heart disease, hypertension, diabetes, pulmonary conditions, and stroke. These diseases contribute to 7 of 10 deaths every year and result in $1 trillion each year in health care expenditures.1 Moreover, costs are expected to rise to $4.2 trillion over the next 10 years.2 Lifestyle modifications, such as eating healthier foods, increasing physical activity, and reducing tobacco use, that address environmental barriers and community conditions can help reduce the burden of chronic disease on communities nationwide.1
The ACHIEVE National Partnership
To help prevent or manage chronic disease risk factors, the Centers for Disease Control and Prevention (CDC) Healthy Communities Program developed Action Communities for Health, Innovation, and EnVironmental ChangeE (ACHIEVE). Through ACHIEVE, local communities engaged in a 5-phase model for collaboration: coalition building, community assessment, action planning, implementation, and evaluation.
The CDC selected 5 national organizations to provide funding, technical assistance, and training to selected communities. Through this national partnership, ACHIEVE communities capitalized on experience and expertise of national organizations to strengthen community leadership, build capacity, and establish healthier communities.
The funded national organizations developed and disseminated tools, models, and strategies for multisector collaboration directed toward reducing tobacco use and exposure, promoting physical activity and healthy eating, and improving access to preventive health services. The CDC selected organizations in 2 categories: community funding (category A) and translation and dissemination (category B). The National Association of County & City Health Officials (NACCHO), the National Association of Chronic Disease Directors, the National Recreation and Park Association, and the YMCA of the United States served as category A recipients. These organizations selected and funded local communities; provided technical assistance and support to funded communities; assisted development and implementation of population-based health strategies; and supported sustainability efforts.
NACCHO and the Society of Public Health Education served as category B recipients. These organizations developed health promotion tools and resources; provided environmental change strategies to communities, with an emphasis on building leadership; disseminated effective resources and models; promoted electronic communication; provided technical assistance; and created training opportunities.
Each category A national organization selected and funded communities annually:
* In January 2008, 10 initial communities participated in ACHIEVE's pilot year.
* In March 2009, 43 communities joined ACHIEVE.
* In February 2010, 41 more communities joined ACHIEVE.
* In February 2011, 40 more communities participated, bringing the total to 134.
* In January 2012, 15 more communities joined and received additional support and technical assistance from existing ACHIEVE communities serving as mentors.
Since ACHIEVE's beginning, 149 ACHIEVE communities have created more sustainable environments to assist people in making healthy choices where they live, learn, work, and play.
NACCHO's Work With Local Health Departments to Implement ACHIEVE
Through ACHIEVE, NACCHO funded and provided technical assistance to 33 communities. Each year, NACCHO selected local health departments and their non–local health department community partners to lead new or enhanced community coalitions and implement the ACHIEVE model.
Each coalition, consisting of cross-sector community leaders from both health and non–health sectors, attended an “action institute” organized by the national partners to learn effective population-based strategies. Following training, NACCHO assisted coalitions with conducting an annual assessment of community needs using the CDC's CHANGE (Community Health Assessment aNd Group Evaluation) tool.3 On the basis of assessment results, coalitions identified and prioritized goals and objectives to address key chronic disease risk factors.
NACCHO facilitated peer exchange and mentorship through conference calls and webinars, electronic communication, and site visits to share community successes and lessons learned. During ACHIEVE's final year of funding in 2012, NACCHO required new communities to apply in partnership with existing ACHIEVE communities that served as mentors. Mentorship developed or further enhanced intercoalition relationships to continue beyond ACHIEVE.
Examples of Success
The following highlights the work of NACCHO-supported coalitions and its impact on ACHIEVE communities:
* Alexandria, Virginia, promoted nutrition through breast-feeding initiatives and community gardens. They increased acceptance of Supplemental Nutrition Assistance Program benefits at farmers markets, potentially reaching at least 12 800 people. Alexandria secured more than $82 000 from Kaiser Permanente Foundation's HEAL (Healthy Eating Active Living) grant to continue their work.
* Cook County, Illinois, addressed nutrition and physical activity through mixed land use agreements and farmers markets, potentially reaching 2.5 million people. The county received $16 million from Communities Putting Prevention to Work to sustain these efforts.
* New London, Connecticut, implemented chronic disease management programs, decreased tobacco advertising in the community, and promoted access to healthy food through urban agriculture and corner stores. New London received almost $84 000 through a Community Transformation Grant.
* Putnam County, Missouri, adopted Complete Streets plans, enhanced parks and trails, and created tobacco-free outdoor places for more than 4000 people. Through the SIM (Social Innovations for Missouri) grant, Putnam County raised $550 000 for tobacco and environmental interventions.
* Yellowstone County, Montana, adopted Complete Streets plans and addressed adult nutrition in workplaces, potentially reaching 100 000 people. They received a 5-year grant for $1.5 million from the Office of Women's Health and $30 000 from the Health Resources and Services Administration for a healthy weight collaborative.
Although ACHIEVE funding ended in September 2012, communities continue to lead efforts nationwide to improve community environments.
Sustaining Their Efforts
Many NACCHO-supported coalitions have found their coalitions to be effective and plan to continue their work through these entities. They report having visibility and structures in place to support their work, such as shared vision, defined roles and responsibilities, and mechanisms for effective communication and productivity. Some communities are finding that infrastructure support is necessary to plan coalition meetings, develop agendas, reach out to partners, and coordinate activities. Most often, local health departments assume these responsibilities; some have demonstrated significant commitments by supporting staff time and expanding their role on chronic disease prevention.
In some cases, communities continue ACHIEVE-specific coalitions; in other cases, they are affiliating with other coalitions or initiatives. Some communities have broadened their focus to include other health areas, such as drug and alcohol abuse. For example, members of New London's coalition will continue their tobacco work with another coalition and funding from the Substance Abuse and Mental Health Services Agency. Some are strategically looking to state initiatives to help determine their priorities.
Most coalitions have identified partnerships as important for sustainability. They have collaborated on funding opportunities and looked to partners to assume ownership over initiatives started under ACHIEVE. In Yellowstone County, community partner Agency on Aging oversees a chronic disease management program initiated by its ACHIEVE coalition, and other partners have allocated staff resources to support coalition work. The city recreation department in North Charleston, South Carolina, has allocated funds for community gardens. The coalition in Ingham County, Michigan, identified an established alliance interested in continuing work started under ACHIEVE. This alliance uses the ACHIEVE model by working with organizations to conduct assessments and implement supporting policy and environmental changes.
Investment in Community Health
NACCHO's ACHIEVE communities' vast impact on community health has promising implications for sustainability and future healthy communities initiatives. Evaluation conducted by Altarum Institute found that NACCHO's 33 ACHIEVE communities have accomplished the following successes:
* Recruited 401 coalition members, including 309 representatives from non–health sectors.
* Implemented or are in process of implementing at least 154 goals and strategies in support of healthy living in schools, workplaces, community institutions, health care settings, and in the community-at-large.
* Potentially reached more than 2.5 million people nationwide.
* Secured almost $24 million in additional funding to continue the ACHIEVE work.
Altarum Institute's evaluation has also revealed the following about collaboration, community mobilization, and other factors in ACHIEVE communities:
* Almost all communities (92%) reported moderate or significant increase in coalition members' understanding of population-based strategies and skills to support implementation.
* More than half of communities (55%) reported significant increase, and a third (33%) reported increase in leadership strength among coalition members.
* Sixty percent of communities reported a significant increase, and a third (33%) reported a moderate increase in collaboration with community partners; 90% reported a significant or moderate increase in coordination among ACHIEVE and other community initiatives.
* More than half (59%) reported significant or moderate change in community norms around nutrition, physical activity, or tobacco use.
* Nearly a quarter of respondents reported significant increase, and almost 40% reported moderate increase in the amount of new resources they obtained.
For more information, visit the ACHIEVE Web site at www.achievecommunities.org and read NACCHO's compendium of ACHIEVE success stories, Building Healthier Communities: Local Health Departments Implement the ACHIEVE Initiative, at bit.ly/WmGyfj.