FIELD A C TIO N REPORT

If W e Build It, W e W ill Com e: A M o del

fo r C om m unity-Led Change to T ran sfo rm
N eighborhood C onditions to S u p p o rt
H ealthy Eating and A ctive Living
| Vedette R. Gavin, MPH, Eileen L. Seeholzer, MD, MS, Janeen B. Leon, MS, RD, LD,
Sandra Byrd Chappelle, MA, and Ashwini R. Sehgal, MD

The Saint Lukes Foundation

Neighborhoods affect health. In 3 adjoining inner-city Cleveland, Ohio, neighborhoods, residents
of Cleveland, Ohio, funded and
have an average life expectancy 15 years less than that of a nearby suburb. To address this dispar
ity, a local health funder created the 201 0 to 2 013 Francis H. Beam Community Health Fellowship established the 2010-2013
to develop a strategic community engagement process to establish a Healthy Eating & Active Living Francis H. Bean Community
(HEAL) culture and lifestyle in the neighborhoods. The fellow developed and advanced a model, Health Fellowship (housed at the
engaging the community in establishing HEAL options and culture. Residents used the model to Case Western Reserve University
identify a shared vision for HEAL and collaborated with community partners to create and sustain Center for Reducing Health
innovative HEAL opportunities. This community-led, collaborative model produced high engagement Disparities) to engage the com
levels (15% of targeted 1 2 0 0 0 residents) and tangible improvements in the neighborhoods physi munity in improving conditions,
cal, resource, and social environments. (Am J Public Health. 2 0 1 5 ;1 0 5 :1 0 7 2 -1 0 7 7 . d o i:1 0 .2 1 0 5 / culture, and lifestyle around
AJPH.2 0 1 5 .3 0 2 5 9 9 ) Healthy Eating & Active Living
(HEAL) at the neighborhood level,
as part of their ongoing 10-year
NEIGHBORHOODS, THE neighborhood revitalization plan.
places where we live, work, The fellow functioned as facilita
play, and age, affect health and tor, connector, and catalyst to
K E Y F IN D IN G S
life expectancy.1 Residents of create a model envisioned by,
The Healthy Eating & Active Living (HEAL) Model was developed to test led by, and integrated into com
3 adjacent Cleveland, Ohio,
the feasibility of a community-led approach to change neighborhood munity, abandoning the usual
neighborhoods have average
conditions and improve community health. The work proves that commu life expectancies 15 years less community health approach that
nities can come together to articulate a shared vision for their collective than residents of a suburb 8 places manufactured health pro
future and take strategic action to implement it with the community-led miles away.2 Factors influenc grams into communities.
model for HEAL. ing behaviors around healthy
Establish a community leadership with majority community repre eating and physical activity are DEVELOPMENT AND
sentation. significantly linked to neighbor IMPLEMENTATION
Gather community voice to identify values and priorities for the hood conditions.3 The physical,
social, and resource conditions of The fellow used best practices
community's future, and conduct neighborhood assessments to
neighborhoods can promote or for community engagement and
identify current assets and resources.
deter healthy eating and physi health promotion to develop a
Identify and prioritize opportunities for collaborative action that is
cal activity behaviors.4 Although place-based community health
community envisioned, implemented, and sustained. model around HEAL. This model
some neighborhoods have fewer
Form collaborative community working groups to develop and is a dynamic, community-led pro
resources for making healthy
advance collaborative strategies. choices, research shows that cess that continuously engages
The role of the fellow as a facilitator and source of technical and theoretical when residents take an active community members in identi
assistance to the community, rather than as a prescriptive adviser, is role in improving neighborhood fying and prioritizing strategic
critical to ensure successful community-owned strategies. conditions, a positive effect on opportunities for HEAL, building
health results.5 HEAL culture, and implementing

American Journal o f Public Health | June 20 15, Vol 105, No. 6

1072 | Field Action Report | Peer Reviewed | Gavin e t at.

FIGURE 1 -C o m m u n ity -le d m odel fo r H ealth y Eating & Active Living (HEAL): C levelan d, OH, 2 0 1 0 - 2 0 1 3 .
and sustaining efforts that create
opportunities for HEAL within
the context of daily living in the
neighborhood (Figure 1).
Community Leadership and
Engagement
The HEAL Model elicits com
munity involvement and resi
dent leadership throughout the
process. Community leadership
begins with the HEAL Council,
composed of 15 neighborhood
resident leaders, supported by
community partners and stake
holders. Of the HEAL Council
members, 7 5 /o are in the
neighborhood daily. The HEAL
Council creates and guides
the implementation of the
HEAL strategic plan. Resident
leaders ensure that HEAL work
June 20 15, Vol 105, No. 6 | American Journal o f Public Health
FIELD ACTION REPORT
Community voice was elicited
with a comprehensive engage
ment strategy that included focus
groups, appreciative inquiry,
stakeholder interviews, the
arts, and large group visioning
forums. Equal resident participa
tion across neighborhoods was
sought. A complementary HEAL
asset assessment identified exist
ing neighborhood resources and
opportunities for healthy food
and active living (Table 1).
Collaborative, Community-Led
Strategies
Considering community-
identified priorities and existing
assets, the HEAL Council identi
fied actionable areas of opportu
nity to build infrastructure for
healthy living and develop a culture
of health in the neighborhood.
The council used the resulting
plan, the Community Vision for
Healthy Living, to engage the
larger community in creating, im
plementing, and participating in
strategies for each priority area.
HEAL strategies create
maintains fidelity to community create changes they envision in change in the neighborhoods
voice, provide on-the-ground their neighborhood. The HEAL physical, social, and resource
leadership to continuously in Model places the power to environments. HEAL strategies
crease community engagement, identify and determine how to align community voice and as
and advance the strategic plan. address priorities into the hands sets, providing opportunities for
Community engagement is of the community rather than residents and partners to work
the core of the HEAL Model. the institution or grant-making together to innovatively co-create
Guided by the principle Do organization. This power shift the changes outlined in the
Nothing About Me Without positions the fellow, community Community Vision for Healthy
Me,6 resident leaders and the partners, and stakeholders to Living. The strategies were built
community-at-large are empow support, rather than drive, with the HEAL core value of
ered throughout the process to the communitys agenda. community connectedness,
P ro je c t D escription
H ealthy Eating & Active Living (HEAL) engages residents of 3 ad jacent inner-city C leveland, Ohio, neighborhoods
in transform ing th eir com m unity to m ake healthy food and exercise a p art of the culture and daily living in these
neighborhoods. Since its inception in 2 0 1 0 , HEAL has grown into a com m unity m ovem ent, em powering residents,
producing high levels of resident engagem ent, and creating tang ible changes in neighborhood culture and
environm ent to support healthy living.
Gavin e t at. | Peer Reviewed | Field Action Report | 1073

TABLE 1-S u m m ary of Healthy Eating & Active Living (HEAL) Actualized in Community Across 3 Neighborhood Environment Domains:
Cleveland, OH, 2 0 1 0 -2 0 1 3
HEAL Priority
Affordable
accessible food
Opportunities for active living
that build relationships
Hubs and safe spaces
Opportunities to learn and
practice healthy living skills
Intraconnected and
interconnected communities
Branding and awareness
1074 | Field Action Report | Peer Reviewed | Gavin et al.
FIELD ACTION REPORT
Neighborhood Environment
Physical Resource Social Evaluation
Gardening Education Support networks Food retail scans
Neighborhood garden Hands on gardening training Garden mentor network Food access surveys
network(192 backyard and support led by
gardens, 13 community residents and organizations Garden leader network
gardens, 1 urban farm and Garden evaluation to
orchard, 3 school-based gardens) assess change in skill,
Retail capacity, and diet
Produce in corner store
Space Group exercise activities Leadership Tracked repeat
5 community centers, Year-round free exercise Exercise classes and participation, retention,
1 church, 3 parks classes (> 40 volunteer-led walking groups led by and growth of class size
host free exercise activities activities/week for all ages) resident volunteer instructor and number offered
(80% of instructors are from
Silver Sneakers gym the neighborhood)
3 marked walking routes
Space Connectedness Resident surveys:
Established 6 community hubs 1 hub in each neighborhood change in community
Strong relationships connectedness
between neighbors
Safety in numbers
Space Cooking classes Resident-initiated efforts Assessed satisfaction,
Hands-on learning community Year-round healthy cooking Walking groups and events change in knowledge,
kitchen courses for adults and youths Health forums in skill, and intent among
Neighborhood walking routes Adult and youth healthy weight, salons and barbershops participants
with route markers and maps healthy lifestyle clinical coaching Resident-led healthy
cooking and snack
demonstrations
Space Communication Leadership Counts of reach and
Kiosk at library Multimedia neighborhood Established HEAL Council response rate for flyers,
communications: flyers, mailers, with resident leaders from Web, etc.
Web, mobile application, video, each neighborhood
and social media Cross-neighborhood community
planning and workgroups
Semiannual HEAL focused community
planning and resource events
HEAL cobranding Communication HEAL events Brand awareness survey
Signage connecting partner programs Interactive HEAL Web site and HEAL and the arts
and establishments social media HEAL wristbands
HEAL partner even
American Journal of Public Health | June 2015, Vol 105, No. 6
 FIELD ACTION REPORT

1
whereby relationship building is
the primary driver for garnering
COMMUNITY VISION FOR
resources, aligning strategy, and
HEALTHY LIVING building necessary infrastructure
Buckeyes Residents living to create change at a scalable
h ealthy lifestyles as a result level. The fellow modeled this
o f having access to
concept in the visual of a Buck
resources and living in a
eye Tree (Figure 2).
healthy neighborhood.
The HEAL Council formed
Branches Ways th a t healthy

neig h bo rh oo d resources are

community working groups that
spread th ro u g h o u t th e connected and engaged resident
com m unity, (ie. Personal leaders, lay residents, and com
relationships, newsletters,
munity partners in developing
events, co m m u n ity m eetings)
and advancing strategies for pri
Residents o r
ority areas (Table 1).
o rg a n iza tio n s th a t cre a te o r

b rin g h e a lth y neig h b o rh o o d

E x a m p le : C re a tin g
fe a tu re s in to th e co m m u n ity .

N eighb o rho o d
O p p o rtu n itie s fo r E x e rc is e
features th a t create a In the Community Vision for
h ea lthy en v iro n m e n t th a t Healthy Living, residents identi
p rovides o p tio n s fo r
fied opportunities for active
h ea lthy life style choices.
U sin g re la tio n s h ip s , th e HEAL C o u n c il d ra w s re s o u rc e s in to th e n e ig h b o rh o o d (ro o ts ) t h a t a re nece ssary to c re a te th e
living that build relationships
fe a tu r e s id e n tifie d b y th e c o m m u n ity as nece ssary f o r h e a lth y liv in g (w a te r). O nce p re s e n t in th e n e ig h b o rh o o d ,
re s o u rc e s s p re a d th r o u g h v a rio u s o u tle ts a n d n e tw o rk s (b ra n c h e s ) t o re a c h each re s id e n t (b u ckeye s)._______________ as essential for a healthy, thriv
ing neighborhood. The HEAL
FIG UR E 2 H e a lth y E a tin g & A ctive Living (H EA L) Tree: m odel to develop and im p le m e n t com m unity-led resources assessment showed
HEAL s tra te g ie s : C le v e la n d , OH, 2 0 1 0 - 2 0 1 3 . few organized opportunities for
active living. One recreation cen
ter, shared by 4 neighborhoods,
operated at maximum capacity
with limited hours and activities.
Fifteen neighborhood parks and
D em o graph ics: 3 N eighborhoods, 1 Place green spaces were identified
as community assets. Consider
Although Buckeye, Larchm ere, and W oodland Hills are neighboring com m unities in Cleveland, Ohio, sharing
ing community voice, available
th e sam e schools, library, recreation center, and o ther am enities, they differ dem ographically and have distinct
resources, and opportunities for
identities. In 2 0 1 0 , th e com bined neighborhood population was 2 1 0 5 9 (down 22 % since 2 0 0 0 ). Hit hard by
action, the HEAL Council led
the foreclosure crisis, vacan t hom es, blighted structures, and unem ploym ent presented serious challenges for
a community working group to
Buckeye and W oodland Hills, with the population shrinking by 2 4% (2 0 0 0 -2 0 1 0 ).
create a free summer outdoor
Buckeye: largest neighborhood; housing prim arily renter-occupied duplexes; struggling com m ercial corridor
exercise series. The community
Larchm ere: sm allest and m ost econom ically vibrant; anchored by a strong com m ercial corridor of an tiq ue
working group used personal
shops, salons, barbershops, and eateries
relationships to recruit volunteer
W oodland Hills: predom inantly public housing; few com m ercial businesses
activity leaders and exercise in
Change in
structors from the neighborhood
Race % R enter % Below
D em ographics P o pulation, % % B lack % W hite O ccupied Poverty
to lead 8 activities at 3 neighbor
Buckeye -2 4 80 16 67 32
hood parks for 12 weeks. The
Larchm ere -2 0 71 21 70 10
first quarter had 400 regular
W oodland Hills -2 6 97 2 70 43
participants. Within 2 years, 40
weekly volunteer-led activities
Source. W e lc o m e to N E 0 C A N D 0. C ase W estern Reserve University. A vailable a t: h ttp ://n e o c a n d o .c a s e .e d u . Accessed February 1 ,2 0 1 4
were offered each quarter, aver
aging 300 monthly participants.
The HEAL Council and resi
dents also worked together to

June 2 0 1 5 , Vol 105, No. 6 | American Journal o f Public Health

Gavin e t at. | Peer Reviewed | Field Action Report | 10 75
 FIELD ACTION REPORT

All HEAL Community

Engagement Efforts
(1,800+) (ages 18+) d ir e c tly
M o r e th a n 1 8 0 0 re s id e n ts
in 24 months (15% of
e n g a g e d in HEA L
Resident neighborhood focus population 12 000)
HEAL Council Mem bers
(15)
j

f . ..........'S < A
Focus Group & Community Community Leaders HEAL Council Outreach
Visioning Sessions Planning Groups & Partners & W orking Groups
(124) j l (175) J (900+)
l <240>

FIGURE 3 Healthy Eating & Active Living (HEAL) community engagement flowchart: Cleveland, OH, 2 0 1 0 -2 0 1 3 .

construct 2 community gym
spaces and created a community
exercise certification program,
providing scholarships for in
structor certification to residents
who, in return, provide free in
struction hours to the community
to sustain this infrastructure for
active living.
EVALUATION
The fellowship focused
primarily on the feasibility of
successfully developing and
implementing a model for
community-envisioned and com
munity-implemented change in
neighborhood conditions around
healthy food and exercise. The
program evaluator (J.B.L.) and
evaluation intern (Erica Cham
bers, MPH) evaluated the 6
HEAL priority areas to assess
change created in 3 neighbor
hood domains: physical, re
source, and social environments
(Table 1). Change indicators for
each environment were mea
sured with varied data collection
methods.
Engagement was evaluated for
reach and authenticity according
to the definition, core values, and
10/o participation goal set by
the HEAL Council at the onset
of the work. The HEAL Model
exceeded the goal, engaging
15% of the residents (1800) in
the focus population (Figure 3)
in 2 years.
NEXT STEPS
The next key steps are to (1)
support continued use of the
model to evaluate long-term sus
tainability and engagement for
HEAL activities, and (2) replicate
the model in other neighbor
hood settings to establish proof
of concept.
Future evaluation should in
clude measures to understand
and validate the community en
gagement process, describe
changes in relationships and be
haviors associated with imple
mentation of the work resulting
from the model, and assess
changes in neighborhood health
associated with the work.
About the Authors
Vedette R. Gavin is with Case Center fo r
Reducing Health Disparities at Metro-
Health and the Saint Lukes Foundation,
Cleveland, OH. Eileen L. Seeholzer is with
the Center fo r Healthcare Research and
Policy and Department o f Medicine, the
MetroHealth System, and Case Western
Reserve University School o f Medicine,
Cleveland, OH.Janeen B. Leon is with the
Center fo r Healthcare Research and Policy,

1 0 7 6 | Field Action Report | Peer Reviewed | G avin e t al. American Journal of Public Health | June 2015, Vol 105, No. 6
 FIELD ACTION REPORT

the MetroHealth System, and Case West
ern Reserve University School o f Medicine.
Sandra Byrd Chappelle is with the Saint
Luke's Foundation. Ashwini R. Sehgal is
with the Case Centerfor Reducing Health
Disparities at MetroHealth and Depart
ment of Medicine, Case Western Reserve
University School o f Medicine.
Correspondence should be sent to
Vedette Gavin, MPH, Centerfor Reducing
Health Disparities, 2 5 0 0 MetroHealth Dr,
Cleveland, OH 4410 9 (e-mail: vgavin@
metrohealth.org or vrgavin@yahoo.com).
Reprints can be ordered at http://www.
ajph.org by clicking the Reprints link.
This article was acceptedJanuary 20,
2015.
Contributors
All authors collaborated in designing
the project and writing and revising the
article.
Acknowledgments
The project was generously supported
by the Saint Lukes Foundation, Cleve
land, OH. Residents and community
partners also contributed significant
social capital and raised more than
$5 0 0 0 0 in grants and sponsorships
to create environments, neighborhood
amenities, and programs that support
healthy living.
Our thanks to the HEAL Council
for their dedication, commitment, and
hard work. Members include Lynn
Alfred, Anthony Benson, Ali Boyd,
Vera Brewer, Marilyn Bums, Bianca
Butts, Erica Chambers, Freddy Col
lier Jr, Monica Dumas, Stephanie
Fallcreek, Jackalyn Fehrenbach, Julia
Ferguson, Kim Fields, Marka Fields,
Kimberly Foreman, Keisha Herbert,
Tamika Herndon, John Hopkins,
Sheen Jeffries, Kevin Kay, Jessica
Kayse, DeAngelo Knuckles, Mary
Ellen Lawless, Kimalon Meriwether,
Jackie Mills, Jealene Pardon, Kathryn
Plummer, Joyce Rhyan, Jose Sanchez,
Candace Smith, Nakia Smith, Robert
Smith, Tearra Smith, Ron Soeder,
Chris Stocking, Tanesha Tate, Damien
Ware, and Robert White and in lov
ing memory of Rayshawn Armstrong
and Gloria Moose. Thanks are also
extended to our many community
partner organizations: Buckeye Shaker
Square Area Development Corpora
tion, Shaker Area Development Cor
poration, Fairhill Partners, Cuyahoga
County Metropolitan Housing Author
ity, Neighborhood Progress Inc,
Harvey Rice K-8 School, Cleveland
Public Library, Boys & Girls Club,
Cleveland Botanical Gardens, Cleve
land City Planning, and the Cuyahoga
Place Matters Team.
Human Participant Protection
This project did not include human par
ticipant research; therefore, institutional
review board approval was not sought.
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