Ensuring Community Investments Boost Health Equity and Wellbeing

These principles can help communities align resources to advance health and collective wellbeing, even when resources are scarce. 

Editor’s note: This post is part of a three-part series that distills key insights from the RAND ALIGN Toolkit intended to support community leaders in advancing health equity. Other posts in the series explore measurement and narrative strategy.

Investing in health equity and wellbeing often benefits the entire community. Parents, kids, elders, and people at all income levels want to live in neighborhoods where they feel valued, safe, and connected. The challenge is how to achieve these conditions at a time when longstanding federal investments in health research, coverage, and care are at unprecedented risk. In many ways, communities are on the front lines of protecting the health and wellbeing of their residents while facing intense pressure.

Given these circumstances, aligning a community’s investments with its health and wellbeing goals is more important than ever. Misaligned investments hinder success of local health initiatives. This can happen when investments fail to establish a strong foundation for positive impact from the start, or when design does not support long-term sustainability.

We created the RAND ALIGN for Health and Well-Being Toolkit by working directly with communities to address challenges like these. The toolkit aims to help local government agencies, community-based organizations and community partners apply local insights that inform practical solutions for promoting health and wellbeing. ALIGN’s Connecting Intention to Action module focuses on aligning investments and resources—like community budgets, policies, and leaders’ time—so their intentions lead to concrete change. It builds on other modules in this Toolkit to make this work seamless. The community’s health and collective wellbeing narrative informs this process.

These three principles can support the work to ensure investments support a community’s goals:

1. Align your community’s health narrative with collective wellbeing and health equity investments.

Budgets reflect values, so alignment matters. Begin by reviewing strategic plans for both your community as well as the department, agency, or organization you work with. Assess how their priorities and budgets align with your community’s health narrative. Too often, broad community strategies, such as a 2030 vision, aspire to prosperity and vitality, yet their budgets do not. Aligning how your organization’s efforts fit with larger community plans can go a long way to advance coordinated and collective action for health.

From your organization’s plan, select a few programs, initiatives, and/or line items in the budget. Then consider whether they contribute directly to making the community more equitable and healthier by answering:

• Do they directly or indirectly advance equity in the community? For example, does a housing program help first-time homebuyers?
• Do they have no effect on equity?
• Or do they unintentionally contribute to or reinforce inequity in the community?

Consider the same questions for the priorities and budget line items, this time through the lens of collective wellbeing.

2. Identify investments that produce multiple benefits.

Often community resources are stretched thin. That’s why a single investment that produces multiple benefits is useful. For instance, investments that benefit public safety or infrastructure also advance health equity. And investments that enhance quality of life, support people’s connection to nature, and/or enhance social connections can yield broader benefits for a community’s overall wellbeing.

Examine your community’s portfolio to determine whether its investments deliver benefits that span multiple agencies, departments, or community-based organizations. If investment plans don’t provide multiple benefits, consider whether redesigning the investment approach could unlock that potential. This discovery process can help inform adjustments.

3. Consider the sustainability of investments in health equity and wellbeing.

Many drivers of health equity and collective wellbeing, such as safe housing and access to fresh, healthy food, lie outside traditional health services and systems. To ensure these investments are sustainable, look for ways to connect them with long-term funding streams when possible (e.g., funding for essential services written into a city’s core budget, not grant funding, in a city budget) and complementary initiatives, such as youth programs, parks, or community infrastructure.

To assess sustainability:

•  Look at the stability of your department, agency, or organization’s funding and consider opportunities to diversify funding sources or link with other community investments that share similar goals.
• Then, for each program, initiative, and budget line item, assess the nature of its funding. Does it have multiyear investments and commitments? If not, is it included in the annual budget and reviewed each year for continuation? Is it included in the budget but supplemented when grants or external funding come through? Or is it funded solely through grants or external agencies?

Identifying gaps in longer term budget planning is essential to ensuring that priorities remain funded over time.

Put these principles into practice to improve community health!

To begin applying these principles:

• Review budgets for a few local government departments like housing and transportation. Then consider ways to braid funding to advance the community’s health and wellbeing. Are there opportunities to shift funding within or across departments to better support health and wellbeing, or phase out funding for items that counter it?
• Next, identify upcoming policy or budget decisions that could shape how investments are made to improve health equity or collective wellbeing. Are there ways to join forces across departments, agencies, or organizations on a shared budget request, or to participate in those discussions? Are there ways to revise policy language to emphasize the importance of health equity or collective wellbeing in future investments?

Exploring these questions and using additional tools and strategies in the Connecting Intention to Action module (including worksheets, exercises, and more) can help successfully align investments that endure over time. Doing so helps communities make lasting progress toward their health and wellbeing goals. The module offers tangible tips that can help communities prioritize the investments that matter most for health and wellbeing.

About the Authors

Laurie Martin is a social epidemiologist and senior policy researcher at RAND, and a professor of policy analysis at the RAND School of Public Policy.

Leia Carey is program officer, Research-Evaluation-Learning, at the Robert Wood Johnson Foundation.