image of MAP-IT

II. A Strategy for Creating a Healthy Community: MAP-IT

To begin to achieve the goal of improving health, a community must develop a strategy. That strategy, to be successful, must be supported by many individuals who are working together. 

In much the same way you might map out a trip to a new place, you can use the MAP-IT technique to 'map out' the path toward the change you want to see in your community.

The process of creating a healthy community will take time, much effort, and many steps. This guide recommends that you MAP-IT--that is, Mobilize, Assess, Plan, Implement, and Track. This MAP-IT approach will help you understand and remember the specific steps you will need to take and the order in which you should take them. Keep in mind, though, that there is no one way to do this, and many of these steps will need to be taken again and again.

Mobilize individuals and organizations that care about the health of your community into a coalition.

Assess the areas of greatest need in your community, as well as the resources and other strengths that you can tap into to address those areas.

Plan your approach: start with a vision of where you want to be as a community; then add strategies and action steps to help you achieve that vision.

Implement your plan using concrete action steps that can be monitored and will make a difference.

Track your progress over time.

Using this MAP-IT approach, your coalition can devise a step-by-step, structured plan that is tailored to your community's needs. 

MOBILIZE Key Individuals and Organizations

A public health nurse in a small New England suburban community is greatly concerned about the alarming increase in obesity in school-aged children. She needs action models and guidance she can use to help her mobilize the community and put together a healthy weight educational program to use in the community and in the local public schools. The nurse needs to mobilize others in her community to act.
Mobilize individuals and organizations into a community coalition that cares about the health of its community.

The first step in building a healthier community is to mobilize key individuals and organizations to form a communitywide coalition. Most communities already have health departments and other governmental agencies that are responsible for public health services. Many communities also have coalitions of key individuals and organizations that have organized to address specific issues, for example, block associations or neighborhood watch groups. These groups often represent diverse interests and resources for addressing issues that are vital to building and maintaining the health and stability of the entire community. A coalition will often, of course, work with the health department and other health organizations in the community. However, it can also help mobilize a wider range of other resources to address health issues.

How do you organize such a coalition in your community? Usually, it is easier to engage potential coalition members around issues that are already of special concern to them and the community. Successful community coalitions have been built, for example, around special issues such as substance abuse, HIV/AIDS, teen pregnancy, maternal and child health, environmental health, domestic violence, and neighborhood crime.

Coalitions have also been built around a broader range of issues, not all of which have yet become of the highest concern to community leaders. It is recommended that you have sufficient data to show community leaders that these issues are of real and immediate importance.

While it is sometimes possible to start building a coalition with a very general communitywide event (such as a town hall meeting or a media event), it is often necessary to target specific individuals and organizations and to work with them over a period of time until they become committed to working with you and others in the coalition.

Individuals. Many effective coalitions are built around a core of committed individuals. Coalition members must be willing to work, express themselves openly, and serve as catalysts to improve community conditions. The real key is to have members who have the energy, commitment, and willingness to collaborate with others to inspire and sustain action. Coalition members can be more easily motivated to work hard when they work in areas that they know are directly affecting their lives. 

Organizations. Many individuals in effective coalitions come from and represent community organizations. These community organizations can include religious institutions, businesses, schools, social service programs, hospitals, clinics, community groups, unions, and the like. Local organizations are valuable because of their influence, their resources, their involvement in the community, and the respect they command. They can support needed actions and they can mobilize resources to help implement such actions.

Helpful Hint: Talk to local businesses, charities, and religious organizations. They can be great members of your team.

One of the biggest challenges in creating a healthy community coalition is to sustain the members' involvement in the process. This challenge can be overcome in part by agreeing as early as possible on a vision for the community.

Creating a vision: Your vision should originate from your community's most important needs, values, and goals. It should be an idealized description of how your coalition would like your community to be. It should reflect the goals of the members of the coalition, and it should be consistent with their values. 

Indiana - Healthy Hoosiers
The challenge of Healthy Hoosiers 2000 is to use the combined strength of scientific knowledge, professional skill, individual commitment, community support, and political will in order to enable the citizens of Indiana to achieve their potential to live full, active lives. It means preventing premature death and preventing disability, preserving a physical environment that supports human life, cultivating family and community support, enhancing each individual's inherent abilities to respond and to act, and assuring that all Hoosiers achieve and maintain a maximum level of functioning.

Healthy Hoosiers 2000: Health Promotion and Disease Prevention Objectives, 1992.

The vision can be created at the very start of the process--for example, when you are mobilizing others to work with you. Creating the vision early on allows all members of the coalition to feel committed to the long-term process. There may be disagreements because of the different values or different expectations of various community leaders. It is important, nevertheless, for the coalition to work toward a consensus on the vision and to enter the next stage in the process with a common mission.

Roseville, California - California Healthy City Coalition 

"We recognize that health improvement involves more than the diagnosis and treatment of disease. Rather, health results from the proper care of body, mind and spirit. To accomplish our vision, we will adopt a new view of health. We will shift from health care providers to the community for visionary direction; we will shift from State and Federal control, to local control; we will define health according to wellness instead of illness; we will focus on prevention and health promotion instead of acute, episodic treatment; leadership in our community will shift from autocratic to participative; and program implementation will shift from vertical to horizontal."

Profiles of Participating California Healthy Cities and Communities, April 2000.

ASSESS Community Needs, Strengths, and Resources

An urban core neighborhood in Kansas City, Missouri, had become concerned about crime and safety. The neighborhood decided to do something, but wanted to know when its efforts made a difference. They decided to use Healthy People 2010 objectives for assaults as their measure of success, and they began to collect crime reports for their neighborhood.
Assess the health issues of greatest importance in your community, as well as the resources and other strengths that you can tap into to address those health issues.

To get a better sense of what you can do, versus what you would like to do, you will need to take stock of the needs, strengths, and resources in your community. Because most healthy community coalitions will have limited resources to address all their needs, they must try to use their resources wisely. When coalition members work together to set priorities and to allocate resources to those priorities, they are far more likely to continue to participate in the process and to achieve measurable results. 

Using Healthy People 2010 to get started: Before you can set priorities, you must first determine what issues you want to improve. What kinds of things might you look at? Appendix A lists the 10 Leading Health Indicators. These 10 topics represent the major public health priorities facing this Nation as a whole. Appendix B offers selected Healthy People 2010 objectives to give you an idea of the kinds of health and community safety issues facing the Nation. After reviewing Appendices A and B and surveying coalition members, you can identify the health issues that your community would like to address. So, for example, your coalition may have 5 community-specific topics, plus 23 more from the Healthy People list that your coalition wants to work on. Can you work on all 28? Probably not. So, setting priorities becomes a must. 

How to set priorities? Because resources for addressing issues will most likely be limited, your coalition may need to set priorities for where to begin. Setting priorities should be a matter of consensus; all coalition members should make an effort to agree on which issues will be addressed immediately and which will be put off until a specified later date. 

Gathering and evaluating data: Whenever possible, either before or after you set priorities, gather and evaluate available information about the major health issues in your community. Data about some health issues may not be immediately available for your county, city, or neighborhood. When this happens, your coalition may have to collect the information for itself. See the inset and Strategies for Success sections for tips about where you can find the information you need. Whatever its source, it is important that your coalition have accurate information about what is really happening in your community so that you can clearly understand the community's needs and create a reasonable target for improvement. Be specific about who will gather what information from whom and when--and how it will be reported to the group. 

Ideally, your coalition should obtain baseline information on each issue before it initiates any actions to address those issues. Baseline information comprises information gathered before an action or program is started. By comparing this information with information collected after you have begun some actions, you can determine how successful your actions have been. Evaluators from a university or government agency may be able to help your group deal with data analysis and measurement issues. Documentation of progress can be a strong tool for enhancing your coalition action.

Helpful Hint: Work with your evaluator early and often. This will help you keep tabs on your community's program.

Resources: Once you have identified your community's major areas of concern and need, develop a list of strengths and resources. The list can include available technology, communication, "infrastructure" (such as supermarkets, roads, bus lines, housing, and office space), funding, professional expertise, and data. Don't think of money as your only resource. Every community has a wealth of non-monetary resources that can be used to address areas of concern. Information, too, is a resource. And a strong partnership with State and local governmental agencies may help to ensure that the data you will need are available and obtainable on a timely basis.

Downers Grove, Illinois 
"We've been able to do some pretty remarkable things without very much money simply by knowing who had what and who could share their resources. Good Samaritan Hospital did the writing, the municipal government did the printing, and the newspaper did the distribution, and it didn't cost anybody any additional money."

A Message to America from America's Communities: A Call to Action, January 2000.

The value of working with strong community-based organizations should not be underestimated. Local businesses, service organizations, medical associations, civic groups, faith communities, and community leaders are themselves resources that should be identified. Groups such as these are vital to the success of community efforts--because of what they know about the community as well as whom they know.

PLAN for Action

A social worker in a rural town is concerned by the increase in reported child endangerment cases attributed to the use of methamphetamine by parents. The town has also seen an increase in the number of household fires in trailer park homes. The social worker contacts local police officials to help the local community health coalition develop an action plan.
Once you have set your priorities and gathered your data, you will need to plan your approach. This involves creating an action plan with concrete steps and deadlines.

With your vision as your guide, create an action plan with concrete steps that will help you achieve that vision.

The plan of action should include action steps, assignment of responsibility, information collection, and a timeline. Objectives should have specific targets. What, specifically, do you want to achieve? For example,

Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day. 

Target: 30 percent.

Baseline: 15 percent of adults aged 18 years and older engaged in moderate physical activity for at least 30 minutes 5 or more days per week in 1997 (age adjusted to the year 2000 standard population).

The target is a measurable outcome that you want to achieve within a given amount of time. Healthy People 2010's timeframe is the decade but you may want to work in smaller increments. Wherever possible, each objective should be measurable. While it is possible to have a target that cannot be directly measured, such as self-assessed quality of life, perceived safety, and the like, you will have difficulty assessing your progress without some degree of measurability. It is important early on to determine how you will measure such a target so that you can properly track your progress.

An important note about target setting: Be realistic! If drug abuse is running at 25 percent among high school kids in your community, don't set the target at 0 percent by next year. Setting unrealistic targets sets you up for a demoralizing failure that can jeopardize your coalition, as well as your achievement of the vision.

Action steps: What concrete actions will you take to achieve the target? For example, do you intend to invite the mayor and city or county council plus local media people to a 5K run/walk to promote your coalition's efforts? Could the schools offer "adult nights" at their athletic facilities? How will you collect data on this? Will you need monthly reports? How will those be collected and by whom?

Don't hesitate to spend time--a good deal of time--identifying the specific action steps needed to reach your desired targets. The more specific you can be, the better. And recognize that some objectives may be too big at first glance to achieve in a single action step. For example, reducing infant mortality is an objective that may require numerous action steps over several years to achieve a very small targeted improvement. 

Action steps may be developed independently or as part of an overall strategy. Strategies can be helpful for topics that may be controversial in your community because they allow disparate groups to work toward the same goal while following unique paths. This approach allows coalition members to find their own comfort level and still work as part of the coalition. 

Strategies can serve as umbrellas under which all coalition members can contribute in some way to a given target. And don't forget to include ongoing data collection in your action plan--often called monitoring because it refers to the collection of data.

Assignment of responsibility: Which member or members will complete which action steps or part of the action steps? For example, who will take responsibility for planning the 5K run? Who will create the program to teach abstinence? 

The action plan also needs to indicate who will be responsible for overseeing and following up on specific action steps. Assigning specific individuals to well-defined and agreed-upon roles will facilitate the action plan. It also will help the coalition members feel that they are important parts of the team, with responsibility to fulfill their roles and help realize the vision.

A timeline: How much time will it take for each part of the plan to be completed?

An important note about setting deadlines and/or schedules: If it is February 1, don't expect to plan a communitywide 5K run by March 1 and have all the dignitaries there. There simply isn't enough time. So be realistic! Maybe by March 1 you could have in place the list of dignitaries to be invited and your plan for the run. Remember, failing to prepare is preparing to fail.

IMPLEMENT the Action Plan

After the Columbine tragedy, concerned citizens in Lafayette, Louisiana, formed a community task force on the prevention of violence in schools. In concert with local school officials and psychologists, the task force proposed closer monitoring of cases of anger and early intervention with professional help to defuse potentially dangerous situations. Healthy People 2010's Focus Area on Injury and Violence Prevention has been helpful as a guide for assessing workable solutions.
Initiate action: Once the action plan is established, coalition members can begin to implement the strategies and action steps set forth in the plan. Coalition members who have accepted responsibility for specific tasks will need to complete those tasks in a timely manner, consistent with the schedule agreed upon in the action plan. 

This part of the process is helped by having a diversified and cooperative group of community leaders who share the same vision. For example, having the school superintendent as a coalition member and supporter of the healthy community initiative could make it easier to implement proposed actions in the schools. 

Implement your plan by taking concrete actions that will make a difference.

Another key to implementation is monitoring or routine tracking of events. For example, if your action plan calls for weekly reports to be created by a given group on a set topic, monitoring will let you know that this is, indeed, occurring. A good monitoring system will help you understand if the action plan is being implemented as anticipated. Also, remember that it is best to plan how to monitor an initiative before the initiative has begun. 

Helpful Hint: Remember, bringing about change may take weeks, months, or years. Don't lose sight of what you set out to do--improve your community.

Implementation of most action plans to improve the health of a community will require patience. Organizing community groups and getting people involved in your community's action plan may take longer than you expect. Maintaining a positive outlook and a healthy reserve of patience will help the members of your coalition overcome initial disappointments. 

Staying the course that you and the other coalition members have agreed upon can be very rewarding. It often leads to positive changes that can strengthen your pride in your community.

image of city buildings

TRACK Progress and Outcomes

In Polk County, Iowa, Healthy Iowans 2010 informs business, government, nonprofit and citizen leaders about local performance on Leading Health Indicators. Based on available data, leaders have mobilized disparate groups to work together on priorities. Healthy Iowans 2010 will allow them to track performance and hold leaders accountable for results.
Tracking is a two-part step. First, you will need to analyze or evaluate all the data you have collected to determine your progress. Then you will need to report your progress.

Progress reviews: As the implementation of your action plan moves forward, it is important to inform the rest of the community of the progress being achieved. You can hold meetings, often called progress reviews, to communicate the progress being made in your community. Examples of some ways to structure and conduct these reviews can be obtained from the Office of Disease Prevention and Health Promotion in the U.S. Department of Health and Human Services, Washington, DC. (See Resources for more information.) 

Evaluation and tracking are vital to the long-term success of your coalition's efforts. If the coalition doesn't document its actions, it may be ineffective; your coalition may not be able to determine if what it is doing is improving your community's health concerns.

Continuing support: Monitoring and continuing support can allow you to keep things on track. One convenient way to handle this step is to hold regularly scheduled meetings in which everyone reports on actions taken, no matter how small. This kind of ongoing support can help keep members interested and involved in the mission, so that the vision can be achieved. Also, remember to celebrate small successes along the way to your larger goal. Your members will be more likely to stay involved if they can see that their efforts not only are making a difference, but are appreciated. And using the local media--school or city papers, television, radio, coalition member newsletters--can be an effective way of letting the whole community know about your efforts.

I've learned about MAP- IT: Now what?
Don't be afraid to reread the MAP-IT steps again and again. Getting started can appear complex, but it's not really; there are many ways to get started. For example, you can talk to your neighbors and friends, contact your city or town officials, visit with local civic organizations, or speak with community-related departments at your local colleges and universities. 

As you begin your journey, remember these three things:
  • The change you seek may take weeks, months, or years to achieve. So don't be discouraged if things seem to move more slowly than you would like. Try to set short-term and intermediate goals, in addition to longer term goals. In this way, every member of the coalition can feel a sense of accomplishment as you move step by step toward your overall objective.
  • Sometimes people have bad days. They won't always share your enthusiasm. They may back out of commitments. And they may make honest mistakes. Try not to be disheartened and remember why, in the first place, you decided to work to make your community a healthier and a better place.
  • You are limited only by your own imagination and the strength of your resolve, as an individual and as part of a group. There are more resources, in ourselves and in our communities, than we often realize. And when those resources are more fully mobilized, the possibilities are enormous--even though it may take time before those possibilities become realities.

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