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By BETSY TAYLOR

Trinity Health has launched a new multimillion dollar effort to encourage policy, systematic and environmental changes to promote healthy behaviors and reduce tobacco use and obesity, beginning with six community collaborations over the next five years. Trinity Health leaders say they are focusing on combatting tobacco use and curbing obesity because they are leading drivers of preventable chronic disease and high health care costs in the United States.

Choucair

The Livonia, Mich.-based health care system on Feb. 29 announced its first grant recipients for its Transforming Communities Initiative. (See box, below.) Dr. Bechara Choucair, Trinity Health's senior vice president for safety net and community health, said the initiative builds on Trinity Health's previous work with community partners to create healthy communities. He said the collaborative nature of the community coalitions will be key to the work to bring about systematic change. "The reality is that addressing upstream interventions and the root causes of poor health requires the full village. Hospitals and local public health agencies can't do it alone."

Collaboration, not competition
The health care system asked communities where it has a clinical presence to work together on one grant application, involving area Trinity Health hospitals, community organizations and coalitions, and area public health departments and officials. In some regions, partners also included other hospitals that could be considered market competitors. More than 20 grant applications were received, with a half dozen selected.

While the work of each coalition will vary based on specific needs in its region, the initiative includes strategies that will be a focus across each community. These strategies include:

• Advocating for Tobacco 21 policies to make 21 the minimum age to buy tobacco.
• Developing and implementing "complete street" plans to support transportation projects to improve street networks for drivers, pedestrians, transit users and bicyclists.
• Establishing nutrition and beverage standards and policies in Head Start programs, day care centers and schools.
• Encouraging breast-feeding by working to achieve the World Health Organization and UNICEF's "Baby-Friendly Hospital" designation, supporting workplace policies like flexible scheduling and designating private space for breast-feeding mothers and on-site or nearby day care.
• Expanding physical activities in schools.

Moore

As an example of how one community tailored its programs to meet local needs, Proviso Partners for Health in Maywood, Ill., supports green economy jobs through a community garden project that includes training in sustainable agriculture, healthy catering, culinary arts and food service.

Ongoing support
The six collaborations receiving the first Transforming Communities Initiative grants will receive up to $500,000 a year for five years. Each community that receives a grant has agreed to match a portion of grant funds, with a total of $5 million in matching funds pledged by communities, Choucair said.

Grant funds will be awarded through a Trinity Health regional health system or a Trinity Health medical center that is a part of each community collaboration; and the grant is administered by each coalition.

Quentin Moore, Trinity Health's director for population health and disparities prevention, said the system evaluated grant applications based on need, the coalition members' abilities to support the programming, and the demonstrated ability of partners to collaborate with others outside of the coalition and to engage new community partners.

One organization applied for the grant on behalf of each coalition, Moore said. The funding requires a full-time liaison to support the efforts. Some applicants identified a potential new hire for this role, while others identified a current staff member who will serve in the role, Moore explained.

Workers prepare a community garden for planting as part of Live Well Springfield, a coalition in Massachusetts that promotes healthy living. Trinity Health’s Mercy Medical Center and Live Well Springfield are among the partners working together through the Transforming Communities Initiative to combat poor diet and inactivity and to improve health.

Trinity Health has committed to more than just funding, the system leaders said. The system will provide expertise and technical support to help the community partnerships evaluate the effectiveness of their work. Baseline measurements will be recorded related to the health of the geographic area served by each coalition. Part of the initiative includes plans to evaluate outcomes, such as smoking rates and obesity rates, quarterly, at least in the early stages of the initiative, Moore said.

Systematic change takes time, Choucair noted, so Trinity Health also planned the initiative to last at least five years. The initiative will include $40 million in low-interest investment loans to support interventions related to social determinants of health. The loans will fund efforts for improvements related to specific issues, such as food access, housing and early childhood issues.

Trinity Health puts the overall amount of investment in the initiative at $80 million. Choucair noted that figure includes the grants, matching funds from communities, Trinity Health's technical support and the low-interest loans, which will be offered during a later phase of the initiative, after the coalitions' work has progressed.

Moore said the initiative is a clear reflection of Trinity Health's Catholic mission. Each community partnership identified the areas of greatest need in its community, and its work will directly help poor and underserved populations. In addition to reducing smoking and obesity rates, coalitions will take other steps to improve health in their communities.