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The Case for the Place-Based Approach

By Marijo Wunderlich, Researcher — Health and Nutrition

What happens when the people closest to a problem are part of the solution?

This is the question that we at the University of Minnesota Extension Center for Family Development in Health and Nutrition are exploring. Our strategy is increased public engagement and community activism across sectors that we’re calling the “place-based approach” or PBA. Health and Nutrition staff and faculty tackle problems like limited access to healthy foods and challenges to more active living and physical activity. The goal of the place-based approach that we’re taking is that residents become more involved in activities that build community, such as advocating for policy changes to make streets safer and communities more livable or starting and sustaining community gardens.

group of four people standing in a community garden
Urban Farm and Garden Alliance members and Zoe Hollomon
former metro SNAP-Ed project coordinator.

How PBA Works

A place-based approach focuses on work in a specific locale, such as a neighborhood, which fosters social cohesion and builds social capital. By bolstering social networks, residents increase mutual trust, civic engagement, and ownership of community challenges.

PBA brings multiple local lenses to look at a community’s context (what's going on). This sets up a scenario in which we can go beyond siloed interventions and programs to involve individuals, community groups, businesses, government offices, and education sites to work together.

So where did PBA come from and where are we going with it? Keep reading.

Two Examples from Public Health History

My experience with this approach comes from a background in public health. The public health field boasts an extensive history of community-oriented and community-based initiatives that emerge from a population approach to understand and assess threats to health on an aggregate or population level.

1960s: Neighborhood Health Centers

The government-funded neighborhood health centers (NHC) established in the 1960s were attempts to ground primary care and population health strategies in the contexts (neighborhoods) where people lived. The idea was to authentically understand the lived experiences of a community beyond the clinical encounter, and mutually identify what neighborhood factors and living conditions impacted health, broadly interpreted. There were three keys to implementing this idea:
  • Many NHC workers lived or spent significant time in the neighborhoods to be part of the community and its dynamics.
  • Community members were board members, advisory committee members and played other proactive roles to bring in community voices to NHC decision-making. 
  • Community organizers collaborated with NHCs to involve the community in setting community health priorities.
One example from this era is the high rates of dog bites in one community. To address this health issue, the community and NHC devised and implemented a comprehensive, multi-sector strategy to reduce the number of feral and unlicensed dogs running the streets.

1980s: The Kellogg Foundation

Another era of innovation began in the 1980s. The Kellogg Foundation funded early promotion of community-based public health initiatives that turned the traditional model on its head. Instead of prescribing interventions and programs and giving money to individual institutions, the foundation allowed community grantees to take a ground-up and grassroots approach to public health challenges that affected neighborhoods and communities. The problems were indigenous to the community, and these approaches regarded the people indigenous to the community as the problem-solvers.

CDC and the Social Determinants of Health

So we are following in the footsteps of public health trailblazers from the past. We are also following in the modern-day footsteps of the Centers for Disease Control and Prevention (CDC).

In response to the increasing needs of practitioners seeking tools to advance health equity, the CDC) developed A Practitioner’s Guide for Advancing Health Equity, published in 2013. A key concept in the advancement of health equity is social determinants of health. This phrase is used to express what research shows causally impacts individual and collective health.

screenshot of page 4 of the CDC health equity guide
A snippet from the health equity guide: Terminology.

Social determinants of health include community safety and violence, employment, community or historical trauma, public transportation options, quality education, high rates of poverty (especially intergenerational poverty), healthy and affordable food access, parks and recreation areas, “walkability” of sidewalks and safe streets, and institutional and governmental structures and policies that are discriminatory and continue racial and economic inequities.

One strategy that public health practitioners can use to move the needle on health equity is to make policy, systems, and environmental changes that address social determinants of health. And starting soon after the CDC published their guide, our SNAP-Ed educators got the opportunity to use that strategy.

SNAP-Ed’s Paradigm Shift and SHIP

In 2014, the national SNAP-Ed program implemented through Health and Nutrition made a significant transition when the Healthy, Hunger-Free Kids Act expanded SNAP-Ed’s mandate to include obesity prevention. Federal dollars can now be used to fund not solely a direct education approach, but also policy, systems, and environmental (PSE) changes to improve healthy food access and increase physical activity in communities.

The Minnesota Department of Health’s Statewide Health Improvement Partnership (SHIP) initiative is taking a similar approach. SHIP and SNAP-Ed staff work together in many ways and many areas in Minnesota. SHIP’s approach prioritizes collaboration and networking, with and across community partners (both individuals and organizations). This building of relationships is paramount to authentic problem identification, priority setting, and solution strategies. As in SNAP-Ed, SHIP believes that improved community health comes through community-informed and developed nutrition and physical activity infrastructure, systems, and policy changes.

Where We Go from Here

As you can see, PBA has a long history, fits well within our federal context of SNAP-Ed guidance, and matches the approach of one of our statewide partners, the Minnesota Department of Health. And because we strive to take evidence-based approaches, we are collecting data and evaluating the results of this approach. We hope that by working with those closest to the problem, we will arrive at better questions, better strategies, and better solutions, for the better health of all Minnesotans.

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