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A children’s community event hosted by The City of Manchester Health Department. Courtesy photo.




A massive youth-health plan
Manchester releases multi-organizational health improvement strategy

07/03/14



 You’ve heard the saying, “It takes a village to raise a child.”

In Manchester, it takes a city to keep a child healthy. 
After more than 10 years of planning, local health authorities have published a comprehensive Neighborhood Health Improvement Strategy. It creates a framework to address six areas of neighborhood wellness, sets priorities and begins a course of action toward youth health that involves multiple facets of city government, as well as public entities. 
“This is the first time the city had a plan that is this holistic,” said Anna Thomas, Manchester Department of Public Health director. “The police department may have its plan. The health department had its plan, but this is the first time we are looking at all those worlds and saying, what are the cross-cutting changes that are going to be beneficial for everyone?”
 
A long-term communal effort 
Work on the strategy began around 2005 when the health department started looking at the needs of  children more closely. It monitored community benchmarks including teen birth rates, immunization levels, childhood poverty and other indicators of childhood welfare.  
The results weren’t good.  
“The indicators started to shift in the wrong direction,” Thomas said. 
A number of factors could be responsible for that, she said. Manchester is growing, and the demographic has changed. Because the city has more access to social support and nonprofits than the state’s more rural communities, it has been very attractive to families that are struggling financially and seeking a safety net. Changes in the financial circumstances of longtime Manchester residents could also contribute. 
“The most troubling factor is our childhood poverty is just as high as some of the largest cities in the country. If I was going to convey a sense of urgency, we absolutely have to focus on what’s happening with children and break those trends,” Thomas said. 
Officials at the Public Health Department started addressing the problem by trying to get access to health care for kids. But they quickly recognized that in order to get kids as healthy as possible, all basic needs were interconnected and equally important — everything from good education and financial resources in the family to healthy behaviors and healthy neighborhoods. 
With a goal of creating a framework to improve the city’s most impoverished neighborhoods, the Public Health Department went door-to-door, conducted focus groups and held multiple community forums to discover the barriers and enablers and what people thought was most important to improving the health of children and families. Results are expressed in the final product - throughout the 71-page NHIS document, maps show which communities have high poverty, lower education, high teen pregnancy rates,   inadequate access to prenatal care and high crime and accident rates. 
“This was not written in a room,” said Dorothy Bazos, a Dartmouth professor who worked as a consultant to the City of Manchester for years. “It’s been a call to action. We can no longer ignore the fact that in our center city neighborhoods there are real issues that cannot be solved with just one-on-one intervention. These are social issues.” 
The information gathered in the community was paired with qualitative research on how similar cities implemented plans, executed them and got results. 
“There are lots of communities who are also going through this culture shift and we’ve been able to take pages out of their playbook,” Thomas said. “We have been able to learn from those communities. They are tackling their issues in similar ways where they bring in multiple partners from all facets of the communities to create a multi-pronged strategy. You can’t do it with one program or agency. It needs to be integrated.”
The Neighborhood Health Improvement Strategy outlines seven priorities stakeholders felt most strongly about. They include creating resident leadership training opportunities, establishing a coalition of key stakeholders to “conduct an asset mapping and gap analysis of” essential local resources, creating lasting “healthy homes” system and ensuring children and families have early development support, among others. 
Needless to say, there’s a lot of work to do. City leaders including Mayor Ted Gatsas, Police Chief David Mara and local nonprofit leaders are working together to develop and operationalize a business plan. 
“How will we get this off the ground?” Bazos said. “There is a leadership team that is committed to this, and they will take each piece and divide it into small steps that are manageable. Then they will start. The key to this is starting.”
Funding for the work has been provided in part by the New Hampshire Charitable Foundation and The Robert Wood Johnson Foundation. The NH Charitable Foundation donation was possible because of the demonstrated success of similar programs across the nation, according to Anne Phillips, senior program officer for the Manchester and Nashua regions.
“I was having conversations with some of my donors who know Manchester very well and were saying … ‘How can we try to bring resources to address the root of the problem rather than making grants later that address symptoms?’”
 
Measuring success
Thomas has some idea of what the program’s success could look like. Early on, she expects to see families more engaged in their neighborhoods, an increased access to services, and higher attendance at schools, especially in center-city areas where the fewest students come to school. 
School attendance is a big one, Thomas said, because just getting to the classroom equates to a stronger academic performance. Long-term indicators of success would include kids coming to school healthier, academically performing at higher levels, and families more equipped and able to solve problems together. 
“That doesn’t happen overnight,” Thomas said. “But I feel people see that we need to work differently because what we’ve been doing to this point is not making the difference we need to see. At the end of the day, it’s really about having a systems change in communities that will last for multiple years.” 
 
As seen in the July 3, 2014 issue of the Hippo.





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