文章基本信息

标题：Place-Based Initiatives to Improve Health in Disadvantaged Communities: Cross-Sector Characteristics and Networks of Local Actors in North Carolina
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作者：Matthew E. Dupre ; James Moody ; Alicia Nelson 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2016
卷号：106
期号：9
页码：1548-1555
DOI：10.2105/AJPH.2016.303265
语种：English
出版社：American Public Health Association
摘要：Objectives. To examine the leadership attributes and collaborative connections of local actors from the health sector and those outside the health sector in a major place-based health initiative. Methods. We used survey data from 340 individuals in 4 Healthy Places North Carolina counties from 2014 to assess the leadership attributes (awareness, attitudes, and capacity) and network connections of local actors by their organizational sector. Results. Respondents’ leadership attributes—scored on 5-point Likert scales—were similar across Healthy Places North Carolina counties. Although local actors reported high levels of awareness and collaboration around community health improvement, we found lower levels of capacity for connecting diversity, identifying barriers, and using resources in new ways to improve community health. Actors outside the health sector had generally lower levels of capacity than actors in the health sector. Those in the health sector exhibited the majority of network ties in their community; however, they were also the most segregated from actors in other sectors. Conclusions. More capacity building around strategic action—particularly in nonhealth sectors—is needed to support efforts in making widespread changes to community health. Improving the health of disadvantaged and underserved populations is the cornerstone of public health policies and initiatives. A sizeable body of literature now demonstrates that achieving widespread and sustainable health improvement for these populations requires moving beyond a focus on individual health behaviors to a focus on the underlying social conditions, health care system, and built environment that have an impact on health. 1–3 Place-based initiatives are designed to promote change around these fundamental determinants of health in local communities. 4,5 Although their approaches vary in significant ways, place-based health initiatives share a theoretical and strategic emphasis on concentrated investments in social, economic, and human capital within local settings to achieve measureable health improvements. 6–10 The June 2014 issue of the American Journal of Public Health highlighted the need for more research and discourse on place-based initiatives. 11 Although there is now a small literature describing these initiatives—and their successes and failures from the “30,000 ft. level” 7,12 —there is a lack of empirical research on the work involved in place-based initiatives and the challenges they face. 13 Launched in May 2012, Healthy Places North Carolina (HPNC) is a $100-million place-based initiative of the Kate B. Reynolds Charitable Trust designed to improve health outcomes in the most rural and socioeconomically disadvantaged communities across North Carolina over the next 10 years. 14,15 The approach of HPNC builds on previous place-based initiatives (e.g., utilizing local residents, building capacity), 16–18 while emphasizing the activation of actors outside the health sector and encouraging upstream efforts that are emergent and iterative within the community—rather than determined by a funder or predefined strategy. 14,19,20 Central to the health-improvement paradigm for HPNC, and place-based approaches in general, are the local actors whom these initiatives are designed to empower and mobilize. 17,21,22 These actors are the agents of change in the community and are vital to the effectiveness of place-based interventions. However, few studies have examined the capacity of and relationships among these actors to understand their individual and collective strengths to effect change in their community. 21,23 Even less is known about the levels of leadership attributes and connectedness that exist among actors across different organizational sectors, particularly among those in organizations outside the health sector (e.g., education, social welfare, and business and development). In this study, we used data from 4 HPNC counties to provide insights into the actors at the core of a major place-based health initiative. The following sections describe the methods used to identify and examine the local actors from this initiative and provide early evidence on a set of questions that are fundamental to the place-based enterprise: First, what are the general levels of leadership attributes (defined here as their awareness, attitudes, and capacity) of local actors as they relate to improving the health of their community? Second, how well-connected are the actors across organizational sectors? Third, how do actors from the health sector and those outside the health sector compare across leadership attributes? The results are discussed in the context of advancing place-based initiatives and highlighting the greatest areas of need for building capacity among actors in rural communities.