The blog of the Urban Institute
November 7, 2014

Guiding principles for community investments that promote health

November 7, 2014

Thankfully, the profound connections between healthy human development and the social and economic conditions of our daily lives are starting to gain more widespread recognition and attention. The November issue of Health Affairs is devoted to how social services and community supports improve people's health. One intriguing article examines measures of neighborhood opportunities that are conducive to healthy child development: things like quality early-childhood education, proximity to parks and healthy food, and a low-poverty environment.

It’s clear that our country has a growing "health disadvantage" relative to other wealthy democracies—that is, Americans have been dying at younger ages than people in almost all other high-income countries. But we are still grappling with explanations and solutions.

The Robert Wood Johnson Foundation has been at the forefront of these issues for several decades, from its Commission to Build a Healthier America to its current efforts to infuse a "culture of health" throughout the country. This culture promotes individual and community well-being, creates physical and social environments that prioritize health, and supports access to opportunities for healthier lifestyles and high-quality healthcare for everyone. The Kresge and Annie E. Casey foundations are also leading major efforts on these fronts.

New and exciting signs of progress are appearing in communities across the country: from the Building Healthy Places Network, to Purpose Built Communities, to Magnolia Place in Los Angeles and the ReFresh Project in New Orleans. The Federal Reserve banks of San Francisco and Dallas are also focusing on the intersections of health and community development.

Earlier this year, I attended a financial innovations roundtable hosted by the Federal Reserve Board of Governors. The meeting was devoted to health-related community investments and I used many of the promising ideas shared that day to create a set of principles that can guide community-based health-oriented investments.

All other things equal:

  • Invest early in life, ideally in early childhood
  • Invest for the long term (for life-long, even multi-generational, benefits)
  • Invest in efforts that are preventive rather than remedial
  • Invest in efforts that are evidence-based or contribute to an evidence base
  • Invest in efforts that respect and advance a community’s own priorities
  • Invest in people or places or systems that have been traditionally underserved or unattended
  • Invest in ways that foster stability and continuity (at neighborhood, community, state, or federal levels)
  • Invest in ways that can transform and/or bridge major service systems, including and especially non-health systems

These principles are grounded in the growing body of research on the social determinants of health (see this and this and this). I hope others can refine them in the future.

In many ways these principles reflect, at the local level, a "health in all policies" approach that other countries have long embraced. It is very encouraging that the community development field is attending to the health and well-being of residents. Making wise investments along the way should help ensure that this attention pays off.

Photo: Children in California participate in a public school-based early-morning running program aimed at combating childhood obesity. (AP Photo/Gregory Bull)


As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.


It is not all that complicated. Having a for profit healthcare system with for profit insurance companies combined with lack of education funding and little job expansion relates to poorer health outcomes. The data keeps repeating itself over and over and we lack the will to fix these things. Social darwinism has taken hold in this country and we will pay the price of that shift for many generations to come.
The principles Laudy sets out are right on. If we had room for three more that should guide implementation as much as choice, I recommend: Invest with others to leverage what you each are doing; Invest to connect people and communities to the broader polity (i.e., don't build new ghettos); and Remember that the context of your investment matters: advocate for policies that make implementation of the principles more likely and powerful Some practitioners shy away from getting involved in the policy arena, and certainly each of us needs to play to our strength, but trying to accomplish good things in an unfriendly policy environment not only requires far more effort, it also limits reach to the immediate client, problem or neighborhood at hand. Conversely, a good policy environment can multiply impact. Thanks for the really thoughtful piece!