- actions
- In the context of these workshops, the results of narrative change, such as cultural shifts, policy changes, and program changes
- catalytic measures
-
Measures that do one or more of the following actions:
- help set goals (near-term and adaptable versus long-term)
- frame issues (e.g., health and well-being are about more than health care)
- create common terms to help individuals and organizations see a commonality of interests
- shift venues (e.g. change how and where an issue is framed and discussed)
These measures often can be used as sentinel indicators of community health and well-being to map to the community health narrative North Star.
- culture
- Sharing and alignment of beliefs, attitudes, values, and actions across a set of individuals, organizations, and decision environments (e.g., where policies or laws are made)
- data
- Any facts, statistics, or inputs used for analysis that come from multiple sources, including administrative files and records, encounters, interviews, focus groups, social interactions, or social media
- experiences
- Events or encounters related to lived or personal experiences and/or current events or experiences in a community
- indicator
- A specified percentage, number, or amount of something to be measured (e.g., number of people with cancer, percentage of a budget that goes to parks)
- influencers
- Individuals, organizations, or collective leadership that lead or provoke health conversations, shape stories about health, and/or set the priorities for health in a population or community
- investments
- The allocation of community resources, which include financial resources, community policies, and time dedicated by community leaders
- equity
-
Includes
- procedural equity: the perceived fairness of processes and procedures in decisionmaking
- contextual equity: how preexisting social conditions influence equity
- distributive equity: how social welfare and need is balanced
In some community contexts, the word equity might not be useful or desirable. Here are some options for terms that could help keep the conversation going:
- health opportunities
- social contexts around health
- fairness in health
- health for all
- health choices
- frames
- Underlying values and beliefs about what influences outcomes (e.g., health outcomes)
- health equity
- The fair and just access to the opportunity to be healthy for all
- measure
- A way of categorizing something to assess, track, or understand it (e.g., positive mental health, health care investments)
- messages
- The articulation of the narrative frame that serves as the strategic foundation for storytelling
- mindsets
- Ways that individuals and groups think about a topic, such as health and well-being
- narrative
-
The critical frames and resulting stories and messaging that influence and inform the way people and communities see and describe the world
A narrative helps to articulate a way of understanding the world and informs how people then act.
- performance-based measures
-
Measures that are focused on accountability and linked to rewards and punishments
These measures tend to be most useful to track a department’s or organization’s effectiveness.
- stories
-
Accounts of experiences via oral or written tradition
Narratives can represent the aggregation of stories that we see, hear, and experience.
- values
- Individual and community principles or standards of behavior
- well-being
-
The full range of assets and capabilities that people need to thrive and create meaningful futures
Well-being is multifaceted and includes
- individual well-being: the state in which people experience happiness and satisfaction and can realize their full potential
- community well-being: the combination of social, economic, environmental, cultural, and political conditions identified by individuals, families, and their communities as essential for them to flourish and fulfill their potential
- collective well-being: the expression of the connections between individual and community well-being. When communities (e.g., places or cultures) are characterized by a strong collective well-being, they have the collective will and connected experiences that allow community members to work together to address systemic harms and build a future together. For instance, collective well-being can refer to the strength and quality of connections among people, between people and institutions in the community, and between people and nature.
Throughout each module, we include these key features with corresponding icons to enhance your understanding and to guide action.
Module 5 Taking Action
Steps to Connect the Dots in Narrative, Data, and Investments for Health and Well-Being
What Is in This Module?
This module focuses on how your community can act on the concepts that you have explored throughout the toolkit. To review, these concepts focus on
- promoting a cohesive health and well-being narrative that emphasizes health equity and collective well-being
- shaping the measures and data your community uses to track progress in health and well-being
- ensuring that community investments align with your community’s health and well-being narrative to consistently mobilize your community into action.
This module provides a few tools and exercises to help your community synthesize these toolkit concepts, get started on work that centers your community’s health and well-being, and keep up your momentum if conditions in your community change (e.g., interest in health shifts, other priorities arise).
We recommend that you complete this module after reviewing all the prior modules because it builds on the ideas, terms, and actions explained in the rest of the toolkit.
Always keep in mind that this toolkit mainly focuses on advancing two principles in health and well-being: health equity and collective well-being. These terms are defined in the glossary and in prior toolkit modules.
Use this module to continue conversations about health and well-being in your community and ensure that you are not losing momentum in your activities to center these issues. Like other modules in this toolkit, this module contains discussion prompts and group exercises. It can be facilitated by a group leader or worked on collaboratively in a group setting.
Facilitator Instructions
- A computer or mobile device (if using the digital toolkit)
- A whiteboard or large easel pad in a central location for group exercises
- Easel pads for each small group
- Markers (enough for each small group)
- Printouts of the resources provided at the end of the toolkit (e.g., Participant Workbook, glossary) to provide as handouts; printouts of module pages for those who do not have a computer or mobile device
- Optional sticky notes or notepads for individual brainstorming
- Pens, markers, and paper for notetaking, if preferred
You will also need printed documentation from a health-related community planning effort, such as your community’s upcoming health needs assessment, and it might be helpful to have copies of your notes and ideas from prior toolkit modules.
Skills Acquired to Take Action
By the end of this module, Taking Action, your community will
- be better prepared to pivot when community conditions change, while still maintaining a focus on health and well-being—particularly health equity and collective well-being
- be able to identify short-term and medium-term steps to advance the concepts in this toolkit.
Organization of This Module
This module proceeds in four sections that build on each other:
Appendix B in the annex to this toolkit explains the orienting principles that inform the design of this module.
Section A Revisiting Toolkit Concepts
Take a moment to revisit a few important toolkit concepts.
Key Terms
As described in Module 1, communities are often challenged in the following three areas when promoting health and well-being:
- making sure that there is a widely understood narrative that motivates different community groups on behalf of health and well-being
- planning for measurement and capturing data that will help users of the information act proactively on behalf of health and well-being
- ensuring that investment choices, as demonstrated in community plans, policies and budgets, line up with the expectations and narrative of the community.
Not addressing these sticking points can slow, impede, or affect the sustainability of a community’s progress toward its health and well-being goals (Robert Wood Johnson Foundation, undated).
Figure Details
A Venn diagram titled "Linking Narrative, Measures and Data, and Investments." It includes three overlapping circles labeled "Narrative," "Investments," and "Measures and Data." Text around the circles explains their connections: "Connecting leadership rhetoric to policy and budget change for health and well-being" near linking Narrative and Investments, "Connecting indicators to action on health equity and well-being" linking Investments and Measures and Data, and "Linking community health values and stories to accountability" linking Measures and Data to Narrative.
Key Terms
As noted in Module 2, it is important to advance this work through perspectives that can account for the forest and the trees.
Section B Readying for Pivots
The only constant in community work is change. Whether that change involves a new mayor or a significant community event (such as a natural disaster or pandemic), there will be inevitable pivots—meaning shifts in community priorities or new frames on health and well-being. The following exercise can help you plan for such changes.
Facilitator Instructions
We advise forming small groups of no more than 12 people. To ensure robust discussion, make sure that the groups reflect different perspectives and community sectors. Take 20 minutes for each scenario. These scenarios are also included in the Participant Workbook. Facilitators should help with timing to ensure that groups move between the scenarios together.
Figure Details
A figure titled "Principles of Equity and Collective Well-Being." The figure is divided into three sections:
- The first section is titled "Centers systems and structures, such as" and lists three points: "historical and cumulative impacts," "upstream factors," and "cross-system thinking."
- The second section is titled "Focuses on strengthening interconnection among:" followed by three points: "people," "people and places," and "people and institutions."
- The third section is titled "Emphasizes building well-being producing assets, such as" which includes two points: "positive health and well-being development" and "intergenerational impacts and benefits."
At the bottom of the figure, there is a question: "How do narrative, data, and investment strategy help us advance these three principles?"
Scenario 1. Community Planning Underway as Usual
Suppose it is November.
The fact that it is fall does not just mean crisp air and the change of leaf color. It is that time of year in Anytown when community planning is consuming government processes. Not only is the Anytown 2030 Plan being put together, but the biannual community health needs assessment, the workforce development plan, and the transportation plan are ready for updating. In all this planning, community thriving is a reoccurring theme that the mayor talks about, but no one really knows what it means.
For many, this planning process is more or less set: update some data on the city’s health, economy, and infrastructure and proceed mostly as usual. For some, the process has improved to include opportunities for more community input and engagement. However, a few years after each planning period, it often does not feel like the community is thriving for all.
There is a small group of people on the planning teams (“changemakers”) who think this is the year to do something different, and the community thriving theme inspires them to push for change.
Facilitator Instructions
After reading the scenario together, have the groups address the questions that appear in Figure 5.3.
Figure Details
- A visual presentation with three sections labeled "Centers addressing systems and structures," "Focuses on strengthening interconnections" and "Emphasizes building well-being producing assets." The top of the image includes a prompt encouraging participants to consider their role during the planning season and how they can incorporate community thriving themes and principles into their strategies: “Consider yourself part of the changemaker group. How might you consider health equity and collective well-being during planning season? What can the community thriving theme inspire both within and across plans? How can you convince others of the importance of health equity and community well-being? Use the sample questions to discuss how your planning would address the three principles of equity and collective well-being.”.
- Each section contains bulleted questions aimed at guiding discussion
for changemaker groups on planning for equity and collective
well-being, with a label “sample questions” on the far left of the
visual.
- Centers addressing systems and structures
- What data might help you in the planning process to get to community thriving?
- What information would you need to understand how the systems described in the plans could motivate changes that improve collective well-being?
- Focuses on strengthening interconnections
- How might the plans demonstrate the importance of collective well-being? What would they say and/or do?
- How can the planning process identify strategies that foster connections among people? Between people and institutions? Between people and nature?
- Emphasizes building well-being producing assets
- What about the planning process can elevate action that builds assets for collective well-being in the community?
- What should be included in the plans to aid decisions that focus on impacts to future generations?
- Centers addressing systems and structures
- The graphic includes a box indicating a time commitment of 20 minutes for discussion.
Scenario 2. The Community Redirects
Now it is June of the following year.
It has been an active few months as the community planning process got off to a strong start. Initially, the small group of changemakers inspired others involved in the planning process. Government agencies asked tough questions of each other about what it means to thrive, and there were some pilot efforts to improve coordination among the health, workforce, and transportation plans to at least work across sectors and systems. This resulted in a few shared measures of thriving and well-being across the three plans, and these measures emphasized how investment choices would improve community connection and positive health. Additionally, a campaign called “Connect Today. Stronger Tomorrow” was imagined with grand plans for neighborhood pilot programs to bring people together. The idea of a well-being impact assessment was even considered in the Anytown 2030 Plan to review how city investment choices would either help or hurt community thriving.
But by June, new leadership in the mayor’s office has stalled progress. Community thriving and well-being now seem like a “nice to have” by those in charge. New leaders are saying things like, “Well-being has nothing to do with jobs and growth. We are only about jobs in Anytown.”
Health, transportation, and workforce plan leaders do not feel that they have the same support to advance measures as before. Disillusioned, they look to what can be salvaged.
Facilitator Instructions
After reading the scenario together, have the groups address the questions that appear in Figure 5.4.
Figure Details
A structured graphic with three columns titled "Narrative," "Data," and "Investment Alignment", with a label “sample questions” on the far left of the visual.
Text above the three columns reads: "Keeping in mind the approaches of changing narrative, data, and investments, consider the following questions. What happens to the plans developed in Scenario 1 without political support from the mayor? How can Anytown keep its focus on community thriving and collective well-being in the context of a “jobs-only” agenda?
Use the sample questions to discuss how you, the changemakers, can continue your work despite administrative and political changes in Anytown."
- Under "Narrative," questions include how to rally the community and
identify key advocates for collective well-being. These questions
read:
- In light of the changes described in the scenario, how can leaders in the community rally the cause of collective well-being and continue to center its importance?
- Who should be brought in to advance the importance of collective well-being and link that concept to jobs?
- In the "Data" column, questions focus on sharing information with
the new mayor and the role of nongovernmental organizations in
maintaining focus on community well-being. These questions read:
- What information can be shared to make the case to the new mayor?
- If the momentum in the government slows down, what types of data could nongovernmental organizations gather to help keep the focus on collective well-being?
- The "Investment Alignment" section contains questions about actions
that can support collective well-being within a "jobs-only" focus
and how to align planning efforts from the previous year with this
focus. These questions read:
- Are there potential actions that continue to advance the cause of collective well-being that also have a “jobs-only” focus?
- What parts of the planning from last year can align with the “jobs-only” focus and still advance collective well-being?
The overall theme explores strategies for maintaining community thriving amidst changing political dynamics. The graphic includes a box indicating a time commitment of 20 minutes for engagement with the content.
Scenario 3: A Community Disrupted
It is now November—three years later.
Since June three years ago, Anytown figured out a way to make the case that collective well-being matters for jobs and economic growth (and vice versa). In fact, economic well-being is now thought of as part of collective well-being, and leaders are mostly convinced that growth alone was not a good way to build an innovation economy. Anytown’s recently developed well-being economy attracted new businesses to the region and kept young people from leaving Anytown during the past few years.
It has been three years since the community planning process that produced the Anytown 2030 Plan. However, this past January, Anytown, like a lot of communities around it, was hit with a massive infectious disease outbreak. It was not as big or widespread as the COVID-19 pandemic, but it was devastating to the residents in the region. Some of the same challenges of COVID-19 (when and how to lock down) were present. The good news is that some of the investments into collective well-being that were made in prior years meant that people came together more quickly during the recovery process.
The bad news is that government services were stretched thin, and some businesses came fully back online only recently. Now that it is November, Anytown is in the community planning season again. What should the community consider during this planning season to keep its focus on well-being and be prepared for the next disaster?
Facilitator Instructions
After reading the scenario together, have the groups address the questions that appear in Figure 5.5.
Figure Details
A three-column graphic discussing planning considerations for the town of Anytown as it focuses on disaster preparedness and community well-being.
Text above the three columns reads: “It is not unusual for communities like Anytown to be hit by disaster. Anytown made some progress on collective well-being, even when there was a leadership shift. But it can be hard to keep that focus when emergencies and the risks of the next one loom. Now that it is planning season again, and Anytown is working on the Anytown 2040 Plan, what should the town consider in that work?” and a label “sample questions” appears on the far left of the visual.
- The first column is labeled “Centers addressing systems and
structures” and poses questions about the types of information that
would aid Anytown in realizing collective well-being outcomes and
incorporating disaster readiness into planning. These questions read:
- What information about systems and structures would help Anytown take stock of the disaster impacts and demonstrate that it is still able to realize collective wellbeing outcomes?
- Is there something about disaster readiness that can be incorporated in collective well-being information?
- The second column is labeled “Focusing on strengthening
interconnections” and focuses on strengthening interconnections and
asks how planning can help establish understanding between residents,
government, and business, especially under strained conditions. A
question in this column reads:
- Given the disaster impact (such as the straining of government resources), how could the planning process help establish understanding and connection among residents, government, and business?
- The third column is labeled “Emphasizes building well-being producing
assets” and discusses how the planning process can enhance community
well-being by evaluating future impacts of decisions on pandemics and
disasters. Questions in this column read:
- What about the planning process can elevate action that builds assets for collective well-being in the community now?
- What should be included in the plans to aid decisions that focus on impact on future generations, particularly given the likelihood of more pandemics and other disasters?
The graphic includes a box indicating a time commitment of 20 minutes for engagement with the content.
Facilitator Instructions
When you come back together to share, you can prompt questions such as the following:
- What did your group identify as ways to incorporate collective well-being in planning? How difficult was it to do so in the first scenario?
- In Scenario 2, what changes did you make to advocate for collective well-being and its connection to the economy? What was easy or difficult about that?
- In Scenario 3, what issues came up in terms of planning that could account for emergencies and routine collective well-being actions?
- Could you take an exercise such as this back to your community partners? Are there things you can be doing now in your community to ensure that the focus on well-being is sustained or grows in importance?
- What tools or resources would have been helpful for Anytown to have to facilitate planning?
Section C Planning Ahead by Considering Opportunities and Challenges
This section helps you bring toolkit concepts together, identify future real-world applications, and test how the concepts function in hypothetical but realistic situations that communities might face. The following two exercises, Three Horizons and Jump-Starting Action, were used in the Sentinel Communities workshops (see Appendixes B and C in the annex to this toolkit).
The following exercise emphasizes data and measurement but also requires that your community consider its health and well-being narrative and plans for action through a common initiative: the community health needs assessment.
Facilitator Instructions
We advise forming small groups of no more than six people. To ensure robust discussion, groups should reflect different perspectives and community sectors.
Ask groups to discuss each horizon for fifteen minutes. There are fields in the Participant Workbook for notes, but each group should also use an easel pad and markers to document their work.
Then, reconvene to share back as a larger group. Here are some additional questions you can pose to the group during discussion:
- Was it difficult to identify the future state of the third horizon? If so, why?
- What did you identify as a potential disruption in the second horizon?
Group Exercise 5C.2: First Horizon
First, try to think about the first horizon in the context of your community and a health-related community planning effort (e.g., your community’s next health needs assessment). Then, consider the following questions:
- How would you describe the current state of that planning effort?
- What types of data are being collected and used to inform decisionmaking?
- What are the working assumptions about the data and measures used and how those data inform health equity and collective well-being?
- Are there assumptions that conflate health care with health?
- Are there assumptions that health sectors have more to contribute than nonhealth sectors?
- Are measures of disparities and equity treated as interchangeable?
- Which sectors are involved in this community planning effort? Which sectors are not?
Group Exercise 5C.2: Third Horizon
Next, consider what the third horizon would look like in your community. Think about an ideal future state in which your community planning efforts are realized. Then consider the following questions:
- Using the community health needs assessment example, what could data and measurement look like in your community in five to ten years?
- What new paradigms and novel ways of measuring, understanding, and advancing health equity and collective well-being are emerging in your community?
- What data or measurement advancement excites you?
- Would a different mix of sectors be involved in your community planning effort if you were to approach data and measurement in novel ways?
Group Exercise 5C.2: Second Horizon
Finally, explore the second horizon for your community. Looking at what you came up with for the first and third horizons, identify one area that seems ripe for disruption or change in the community health needs assessment process, an area that would get your community closer to health equity and collective well-being. Then, come up with an interesting transition idea that could help successfully bridge the first and third horizons. Once you have come up with an idea, pick a promising area in which you see pockets of innovation that can spread or scale or a potential for catalytic change.
- What would these changes look like?
- How could you realistically implement them?
Figure Details
A line graph illustrating the "Three-Horizon Foresight" framework for visualizing change over time. The y-axis is labeled "Fitness for current environment," and the x-axis is labeled "Time." The graph contains three distinct curves representing three horizons.
- The "First Horizon" shows the current state, which has high fitness now but declines over time
- The "Second Horizon" signifies conflict resolution and the graph depicts low fitness now, it peaks at the mid-point and then declines.
- The "Third Horizon" indicates desired future states, with multiple dashed lines representing alternative future scenarios. The graph depicts an initial increase in fitness, over time.
Facilitator Instructions
We advise forming small groups of no more than six people. To ensure robust discussion, groups should reflect different perspectives and community sectors.
Ask groups to discuss potential action items for fifteen minutes and see if they can agree on priorities. There are fields in the Participant Workbook for notes, but each group should also use an easel pad and markers to document their work.
Then, reconvene to share back as a larger group. Here are some additional questions you can pose to the group during discussion:
- In listening to each group’s ideas, what is the most actionable? Why?
- What do you think you can seed in the next six months to pursue that action and make sure it continues?
Figure Details
A flowchart titled “Jump-Starting Action” divided into five sections, each assigned an icon and containing a prompt.
- The first section features three figures representing people in a small group with the instruction: “In your small group, use everything from this toolkit.”
- The second section includes a film clapperboard icon and the question: “Identify two to three action items in the areas of narrative, data, and/or investments that would be the most aspirational for your community to pursue in advancing health equity and collective well-being?”
- The third section displays a group of people with a shared speech bubble above them with a question asking: “Why did your group pick those actions?”
- The fourth section shows a person on a starting block at the start of a race with question asking: “What can be done in the next six months to start on each action or move each action forward?” A label under the question reads “Finding the moment”.
- The fifth section features a chart icon with the inquiry: “What would need to happen after that to keep that action going?” A label under the text reads “Leaving residue and building change.”
- The sixth section features an icon of interconnected shapes and asks: “What would each of you be doing differently in your work to help get the action going?” A label under the text reads “Advancing and pivoting”.
Section D The Final Module
By the end of this fifth module, you should have
- reviewed toolkit concepts related to (1) promoting a cohesive health and well-being narrative, (2) shaping the measures and data your community uses to track progress in these areas, and (3) ensuring that community investments align with your health and well-being narrative to effectively mobilize your community to action (Section A)
- prepared to adapt when community conditions change while maintaining a focus on health and well-being—especially health equity and collective well-being (Section B)
- identified short- and medium-term steps to advance the concepts in this toolkit by planning ahead and considering potential opportunities and challenges (Section C).
If you have a good understanding of these issues in your community, congratulations! If not, you can revisit the sections of this module and the corresponding exercises to deepen your insight.
We encourage you to revisit this toolkit as you continue your community’s work on health and well-being, try out the exercises again with new participants or when you have made some progress, and use some of this toolkit’s key concepts in your work.
For feedback on this toolkit and to share how you are using it in your community, please send an email to: