Highlighted Project: Building Healthy Communities Evaluation

A ten-year community power-building initiative

Building Healthy Communities (BHC) was a ten-year initiative of The California Endowment (TCE) designed to improve health equity in 14 communities. In the BHC theory of change, community power building is a key driver of policy and systems changes, which in turn lead to improved opportunity environments and, ultimately, more equitable health outcomes.

To evaluate this complex initiative, CORE collaboratively developed and applied a coding framework to connect the dots between TCE investments, BHC site-level activities and accomplishments, organizational infrastructure and networks, and key indicators of community power or other outcomes of interest to TCE. We coded and analyzed over 10,000 grants and 1,700 reports from BHC sites and conducted quantitative impact analyses in four domains:

Voice, power, and voting
Agency and belonging in schools
Housing and transportation
Healthcare access

We also created a social network survey to track how organizational and ecosystem capacity for power building changed over time.

Key Findings

BHC included numerous partners, local leaders, community residents, and evaluators, as well as related but independent investments and power-building activities driven by local organizations and leaders. Together we found that:

BHC led to over $800M invested in power-building that supported organizing and base-building efforts and more than 1,700 accomplishments across policy, systems, and the physical environment.
Investments focused on community voice, power, engagement, and participation were associated with increased voter turnout in BHC sites, with a greater effect in primaries than in general elections.
Policy, systems, and physical changes often catalyzed related changes, building momentum. These changes often connected to each other, creating a cascade of other changes. Furthermore, these changes often transcended BHC site boundaries.
TCE investments helped build partners’ capacity for power building. Organizations that received investments to build capacity for a particular power strategy tended to report more mature capabilities later.
The universal coding framework developed for this analysis proved particularly valuable, enabling evaluators to link data across multiple sources and leverage information that would not otherwise be available for synthesis and quantitative analysis.
Additional lessons from this work include the importance of identifying measures that span the initiative theory of change, aligning levels, units, and timing of measurement to enable connected analysis across data sources, and the value of integrating data collection into operational processes.

CORE’s evaluation demonstrates that power-building initiatives like BHC can have a significant, positive, and measurable impact at multiple levels. This work also provided valuable insights that will inform TCE's future work and partnerships in promoting health equity.

Approach

CORE’s work on BHC featured a number of different but interconnected components. Connecting the dots across this wide variety of data sources, methods, and perspectives revealed insights that might otherwise have been missed and helped TCE and its partners tell a fuller story of the initiative. CORE’s approach included:

Content analysis: Collecting and analyzing BHC documents to understand the emerging themes and patterns across documents and understand what was done, who was affected, and what impact the BHC initiative had on health equity. CORE’s team coded information on more than 10,000 TCE grants, and 1,500 reports of policy, systems, and physical changes in BHC communities.
Measure mapping and data aggregation: Assessing potential data sources and indicators relevant to the BHC theory of change, then accessing and combining data collected across the state of California with data collected by BHC to help understand what happened as a result of TCE’s investments.
Data tools: Creating tools that allow people to visualize, explore, and understand data, so that they can use it to answer their own questions about BHC.
Network surveys: Surveying organizations working in BHC sites to understand how they worked together on the BHC initiative.
Impact analytics: using existing and new data to answer research questions related to the impact of the work and to help The California Endowment plan for the future.