Planning for Health Equity in Appalachia
An Unusual Partnership
Communities come in many shapes and sizes. Each has its own set of strengths and assets, and each faces unique problems and challenges. When it comes to health, partnerships between community institutions are often best situated to create long-lasting solutions. Take Roanoke, Virginia, for instance.
Located in green rolling mountains in the southwestern part of the state, the city of Roanoke is taking bold action to ensure that all residents can live healthy lives. Roanoke community leaders and institutions are stitching health equity into Roanoke’s plan for the next 20 years of development and growth.
Partnerships between community institutions are often best situated to create long-lasting solutions.
“As a smaller city, we have to engage and utilize partners,” says Wayne Leftwich, senior city planner. “Despite our size, we serve the whole region. The advantage is access to a lot of resources and partners who want to engage with the city.”
Why would a private liberal arts college and a community development financial institution (CDFI) be interested in supporting local health policy initiatives?
“This partnership works well for us,” says Tim Cerebe, vice president of community development at Freedom First. “We all have a responsibility to improve the communities we’re a part of, the places where our members actually live. Health is a major part of that responsibility.”
As a CDFI, Freedom First embraces a mission to proactively reach underserved communities and neighborhoods in the Roanoke area and help support their financial health and stability. Additionally, Freedom First has been exploring how health affects financial wellness, in order to better serve its members and help vulnerable populations avoid predatory lending.
In a similar vein, Roanoke College is gathering quantitative and qualitative health data to help make sure that residents’ experiences, perceptions, and voices are included in the city planning process. This isn’t the first time that Roanoke College and Freedom First have worked together. Since 2015, the two organizations have been leading efforts to combat food insecurity in some of Roanoke’s less affluent neighborhoods. The partnership with the city’s planning department is just the latest chapter of a long-standing collaboration.
Assessing the Problem
In Roanoke, as in many places in the United States, not everyone has an equal opportunity to live a healthy life. Health disparities — in which one group of people experiences a different level of health than another group — arise from complicated circumstances like structural discrimination, exclusion from public policy decisions, and other unfair and harmful causes. Solutions that work in one place may not work in another; therefore, it is essential to solicit residents’ input when seeking to reduce local health inequities.
When first confronting the existing health disparities in Roanoke, the partners went to a veritable community crossroads: local schools. Because children’s health is particularly influenced by their surroundings and schools are a point of intersection for families, it made sense for the partners to begin their assessment in schools, where kids spend much of their waking lives.
"Residents can accurately describe the barriers to healthy living they face — and offer recommendations for overcoming those barriers."
Roanoke College’s inquiries about health in the local community quickly grew into something much bigger. Through her roles as associate professor at the college and director at the Center for Community Health Innovation, Dr. Liz Ackley created an annual health assessment of how residents perceive their level of access to health-promoting resources like parks, food retail, safe gathering spaces, and support services. Using mapping tools, Dr. Ackley and her students visually match health outcomes of Roanoke city youth with resident-identified barriers to healthy resources.
“Residents can accurately describe the barriers to healthy living they face — and offer recommendations for overcoming those barriers,” says Dr. Ackley. “Once city officials and local leaders have that information, they can create enduring, inclusive solutions.”
This project is now formally known as The Roanoke Valley Community Healthy Living Index. City planners are using the data from that assessment to help create a long-range plan that will promote health and equity in Roanoke for the next 20 years.
“When paired with youth health outcomes, our data tell an incredibly interesting story,” says Dr. Ackley. “Having this information positions city leaders to make changes that suit the needs of each neighborhood in ways that residents support.”
As the City of Roanoke’s 2040 comprehensive plan begins to take shape, Roanoke College and Freedom First have been working alongside the city’s planning team and other community stakeholders to place health equity front and center in the strategic vision and guide the public engagement process. While the city has considered the role of infrastructure and land use changes in community health in the past, this project allows local leaders to look at their work from a new perspective: how they can directly affect community health.
"Our partners’ assistance enables us to take public information and translate it into meaningful, implementable, and measurable strategies for the comprehensive plan."
“We expect our new partnerships [with Roanoke College, Freedom First, and other community partners] to provide a clear direction and focus on improving community health outcomes over the next 20 years,” says Ian Shaw, planning administrator for the City of Roanoke.
“Our partners’ assistance enables us to take public information and translate it into meaningful, implementable, and measurable strategies for the comprehensive plan,” says Wayne Leftwich.
One of City Plan 2040’s six primary themes is “interwoven equity.” With the guidance of Freedom First and Roanoke College, the city planning team has been hosting events at Roanoke’s libraries and other public centers to discuss how the city “can make equity a priority for the future.” The city plan lays out a vision of an inclusive community where access to opportunities — including education, housing, health care, employment, and quality of life — is available to all.
Both Roanoke College and Freedom First brought in ChangeLab Solutions — a nonprofit that works across the nation to advance equitable laws and policies that ensure healthy lives for all — to provide equity-focused legal and policy technical assistance to the city and its partners.
“Now we have an actual policy process for improving health that reflects the perceptions and needs of community members,” says Dr. Ackley. “It’s amazing what happens when the community, local institutions, and city government are pulling together in the same direction. In Roanoke, we are well positioned to become a healthier, more equitable community as a result of partnerships like this.”
By Shauneequa Owusu
Learn more about The Roanoke Valley Community Healthy Living Index at Roanoke College and community development at Freedom First Credit Union. Learn more about how the City of Roanoke's planning department used public deliberation to incorporate community views into local government decision making.
ChangeLab Solutions provides technical assistance to local and state leaders and other community stakeholders nationwide on a wide variety of public health topics. Visit us online, subscribe to our news updates, and support our work.
1/29/2020; updated 5/17/22
Photo credit: Photographer Payton Chung, "City Market and permanent farmers market stalls with curbless / shared space streetscape, Roanoke VA," circa 2018, via https://creativecommons.org/licenses/by/2.0/