Legacy Community Alliance for Health (LCAH)

Legacy Community Alliance for Health is a project to build capacity within participating municipalities to improve health and health equity through the use of data and evidence-informed policies. The goal is to help communities achieve gains in at least one of four policy areas of interest: clean water, active transportation, safe and affordable housing, and/or healthy and affordable local food systems. Each participating community will choose its own policy approach.

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News from LCAH

Wisconsin Community Highlight – Bayfield

– Februrary 2021

Under the leadership of Carrie Linder, Aging and Disability Services Manager within the Department of Human Services, Bayfield County is committed to meeting the challenges of rural transportation. Linder applied resources available through the Legacy Community Alliance for Health (LCAH) to support the County’s longstanding efforts to address transportation challenges and to help collaborate with local stakeholders to take advantage of potential opportunities. The County is using a health equity lens to better understand the current state of their transportation network, improve discussions around transportation quality and needs, and inform prioritization and decision making for future transportation improvements.

Lead organizations for LCAH, COWS and the Population Health Institute (PHI), supported the county team in planning and hosting a 2019 Rural Transportation Summit designed to gather current and potential transportation stakeholders, better understand the transportation needs and issues that exist, discuss inequities in the transportation landscape, and consider potential solutions. The Summit attracted a wide range of attendees including state and local elected officials, community members, representatives of the Bad River and Red Cliff Tribal Nations, and city and county employees from Bayfield and Ashland County.

A core group of individuals continued to meet. Some of their first steps were to gather additional data and to assess who else should be at the table or engaged through a power mapping process. Based on this experience, outcomes from the Summit, and on data collected through a transportation survey, next steps were taken, which included the formation of a Transportation Coordination Committee (TCC) in 2020. The TCC is a formal body appointed by the county board for coordinating a county’s specialized transportation.

“In order to engage people who are impacted by transportation decisions, some of the early work included conversations with community members who were transportation users and advocates for people who have barriers using transportation options,” said Linder. “It also included reflective work and education concerning health equity, so this was engrained into our thought process as we moved along.”

Currently, the TCC is working to identify gaps and opportunities in current transportation services and make information regarding transportation services easier to access and navigate. As next steps, the TCC will determine ways to increase communication and collaboration between transportation providers and identify ways to expand transportation services. This committee is dedicated to improving access to reliable transportation networks and increasing social connectivity, economic prosperity, and community wellbeing.

The committee’s final recommendations will be presented to the Department of Human Services board for consideration and then to the County Board of supervisors for further consideration and final approval.

Linder’s advice for other communities facing transportation challenges is to start by seeking out local champions who understand that transportation is a key factor for keeping people and communities healthy and vibrant. It’s also critical to gather input from residents to understand what is important to them, what they are currently doing to meet their needs, what they are lacking, and what they will accept. Finally, transportation advocates need to base recommendations on sound evidence and feedback and take the time to do it right.

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Wisconsin Community Highlight – Ashland

– December 2020

The City of Ashland’s Planning and Development Department and Housing Committee, led by Megan McBride, Director of Planning and Development, is working to increase access to healthy, affordable housing. Using data from a 2017 Housing analysis and report completed by Northland College, the city is focusing on housing improvement in multiple ways, from changes to its housing rehabilitation program to updates to its zoning code, including a focus on Accessory Dwelling Units (ADUs).

First, they are targeting housing quality through expansion of their Housing Improvement Program, which offers up to $2,000.00 in housing rehabilitation assistance geared toward projects that improve home health and safety. The program was started in 2015 through a donation from an anonymous donor for repairs to single-family homes located along visible corridors, with a maximum project amount of $500 and a requirement that the property owner pay the majority of the project cost. In 2018, the City shifted program priorities to focus on addressing health and safety concerns, including demolition of severely dilapidated and fire damaged structures. The maximum project cost was also increased to $2,000 at that time, and the match requirement was removed.

“The intent of these changes was to ensure we can create the maximum positive impact with a limited amount of funds,” says Megan McBride, Director of Planning and Development. Notable projects which have taken place under these new program priorities include replacement of a leaking roof for an elderly, disabled community member, demolition of several fire damaged and/or failing structures, and replacement of severely deteriorated steps to create safe secondary egress. The City has budgeted $5,000 towards the Housing Improvement Program since 2019, and intends to continue diversifying funding sources to further expand the program in 2021.

Secondly, the city is seeking to expand availability of affordable housing through updates to its zoning code and, specifically, allowing for Accessory Dwelling Units (ADUs). Often referred to as “granny flats” or “mother in law suites,” ADUs are an important tool for local governments facing barriers to affordable housing. An ADU is defined in the amended ordinance as “a detached, smaller, secondary structure on the same lot as a principal dwelling. ADUs are independently habitable and must conform to Uniform Dwelling Code.” The primary changes made to expand standards for ADU development include 1) removing owner occupancy requirements, 2) allowing for ADU construction on any lots which meet the minimum lot size of their zoning district, 3) removing the requirement that ADUs must be located on the second story of an accessory structure, and 4) requiring a Development Permit rather than a Conditional Use Permit for construction of new ADUs. The City’s Housing Committee supported efforts to expand ADU construction in an effort to promote efficient use of the City’s existing housing stock and infrastructure, facilitate a broader range of accessible and affordable housing units, and increase diversity of housing options and choices that responds to varying income levels, changing household sizes and lifestyle needs.

“ADUs will help us increase housing choices and affordability in Ashland. They also bring income opportunity for homeowners, a chance to bring extended families together and age in place options for older residents — something I suspect many Ashland families would have appreciated during the COVID-19 pandemic. ADUs are a great infill option that will be consistent with neighborhood design and generally considered environmentally friendly options.” Ana Tochterman, Housing Committee member and Ward 5 City Councilor.

These initiatives align with the city’s Comprehensive Plan goals and this work is part of a larger effort in the city and region, working with other entities and local governments, to increase options for healthy and affordable housing in northern Wisconsin.

The City of Ashland, is participating in the Legacy Community Alliance for Health, a project of the University of Wisconsin that seeks to support local governments efforts in Wisconsin to improve health and reduce health disparities.

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Wisconsin Community Highlight – Fitchburg

– September 2020

Fitchburg’s Healthy Neighborhoods Initiative is Thriving!

Led by Wade Thompson, Fitchburg’s Community Development Planner, the Healthy Neighborhood Initiative (HNI) is a story of innovation and persistence. This concept was years in the making but needed support from the city and residents to make it a reality. When the opportunity arose five years ago, the Legacy Communities Alliance for Health (LCAH) seemed like a great option to help move the initiative forward. The city approved entering the Alliance for Healthy Communities – Health in All Policy Partnership with UW-Madison in 2017 and created a city work group to oversee the formation and implementation for the Healthy Neighborhood Initiative.

HNI identified three neighborhoods that have a disproportionate number of barriers for equitable access to opportunities. It was important right from the beginning to take a collaborative, holistic approach to strategic planning as the plan was developed. Wade Thompson described HNI as using the 3 P approach. People – neighborhood residents, non-profits, faith-based groups. Programs – developed as a result of the people partnerships. Places – gathering spaces to host the programs.

LCAH, led by COWS, the Health Population Institute, with support from 1000 Friends of Wisconsin, provided the data and a health frame that was needed to increase understanding and make HNI resonate with elected officials. No matter how innovative or visionary a concept, without the full understanding and investment from city officials and the community it just doesn’t happen. In early 2019 the city passed a resolution to approve the HNI strategic plan.

This process also led to the creation of the Healthy Neighborhoods Grant program. Grant proposals are selected based on their ability to serve the needs of the community and enhance the quality of life for those living, working, and recreating in Fitchburg.

Just recently the City Council included a teen center and a community center (The Hub) in their Capital Improvement Plan. This doesn’t guarantee funding but lays out priorities so there is still work to be done. This development lays the foundation for the third P – Place.

When asked what was the most important support provided by LCAH, Wade Thompson thought the brainstorming, data, and shared case studies were very helpful. “Most importantly, the fact that equity is the core of LCAH and Health in all Policy is especially important in our diverse community.”

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Local messaging that supports thriving for all Wisconsinites

– June 2020

Health Equity Messaging During COVID-19 offers a set of statements developed by the Wisconsin Healthiest State Initiative Narrative Workgroup that can be utilized as a guiding framework for developing messaging. They provide a common foundation to create consistency across health equity messaging in Wisconsin. Narrative statements are used to develop short talking points relevant to health equity during COVID-19. These bulleted talking points are examples of wording to include in your messages; they require more context for the specific issue you are addressing.

Wisconsin Healthiest State Initiative partners are currently working on messaging resources for essential workers, immigrant groups, rural equity, racial disparities, housing, a healthy economy, and mental health and social isolation.

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Equity analyses for rapid response practices and policies

– June 2020

The Community Resilience, Equity, and Mental Health Considerations in Rapid Response tool is intended to be used as a decision-assistance tool during rapid response in emergencies or similar urgent high-risk scenarios to analyze action, policies, and guidance. The questions of this tool are designed to lead to strategies to prevent or mitigate adverse impacts and unintended consequences on marginalized populations in rapid response efforts. It should be used when diverse representation and appropriate collaboration with impacted parties are not feasible because of an emergency and there is a lack of representation in emergency response structures. Include and document multiple voices in this process.

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Local reopening plans that apply Health In All Policies approaches

– June 2020

Health in all policies and a healthy economy are not at odds with one another. Health in all policies can support long-term economic health and thriving communities. To help advance a more just and equitable recovery from COVID-19 that promotes the thriving of all, here are some key considerations for local reopening plans:

  • Include discussion of social determinants of health: Risk reduction strategies, such as social distancing, testing, and PPE, are important, but so are drivers of risk, such as housing, employment, and paid sick leave policies. Addressing the social determinants of health is a necessary strategy to prevent further spread of COVID-19 in all of our communities.
  • Analyze the unintended distribution of effects of reopening policies on different population groups: plans should acknowledge the ways that reopening requirements unintentionally burden particular groups in our populations more than others and consider potential strategies for mitigation.
  • Develop community-driven recommendations: reopening plans should incorporate the perspectives and needs of community members, especially those who are most vulnerable to COVID-19 and those who are structurally marginalized.
  • Focus on the local context: the need for city and county-level reopening plans is highlighted by the unique context of each city and county, beyond the general state-level plan. Rural counties will face different issues and have different needs than urban or suburban counties.
  • Prioritize the needs of structurally marginalized populations that experience greater risk: while many federal, state, and local reopening plans include guidance for testing, contact tracing, ICU bed availability, etc., plans with equity lenses can explicitly mention the prioritization of these resources for those who are structurally marginalized that experience collateral risk factors.
  • Include provision of basic needs: communities do not only need testing, preventive strategies, and ICU beds to reopen. Provision for food, housing, water, and social support services for unhoused people, people leaving prisons and jails, and people experiencing poverty are essential to a swift recovery.

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Understanding and Responding to COVID-19

– April 2020

As the COVID-19 crisis shines a light on growing inequities and gaps in our current systems at the local, national, and global level, it also serves as a urgent reminder of why a Health in All Policies approach is so critical to individual, family, and community health.

As communities around the country and here in Wisconsin grapple with how to understand and respond to COVID-19, we must recognize that the virus threatens to exacerbate inequities. This includes gaps in health care access, but also in things like lack of access to broadband, safe and healthy food, reliable transportation, stable and sustainable employment, affordable childcare, safe housing, financial resources, and education. Wisconsin’s non-white, senior, rural, and low income communities are likely to be those hit hardest by these access issues, and by the threats to mental health that accompany them.

As just one small but relatable example, our rural and low income students are those most likely to lack access to broadband, tablets, and computers at home. This was true before COVID 19; while it’s encouraging that many schools will be shifting to virtual classroom instruction or work, what will we do to ensure all students have access to the resources they’ll need in the months ahead?

It’s clear now more than ever before how health impacts every other aspect of our lives, and how everything that we do impacts our health. This crisis demands a Health in all Policies approach.

COVID-19 and Health Equity in the News

COVID-19 Related Community Resources

COVID-19 Wisconsin Funding Resources
The Wisconsin Partnership Program just announced the COVID-19 Response Grant Program, designed to help community organizations and UW-Madison researchers address the urgent challenges of the COVID-19 pandemic. This grant program will provide a strategic, flexible, rapid-response mechanism to support innovative, responsive, high-impact projects that aim to improve the health of the people of Wisconsin by lessening the impact of the COVID-19 pandemic through scientific, medical, or public health approaches and/or by supporting those most at risk or experiencing the greatest disparities in care. Applications  due April 15.

Read the newsletter.

LCAH and Mobilizing Action Toward Community Health (MATCH) are pleased to share this first jointly published newsletter

– January 2020

Legacy Community Alliance for Health (LCAH) and Mobilizing Action Toward Community Health (MATCH) group at UW Population Health Institute are pleased to share the first jointly published newsletter featuring content on health equity and health in all policies relevant to Wisconsin communities. Please don’t hesitate to contact Katya Spear with comments or if you have ideas for content you’d like to see.

Read the newsletter.

Middleton, Monona, and Fitchburg teams meet in Madison to discuss health equity

-By  Katya Spear, Senior Associate, COWS, UW Madison, December , 2019

In November, LCAH teams from Middleton, Monona, and Fitchburg met to orient new city staff to the discussions they’ve been having around health equity and Health in All Policies. The event featured an overview of HiAP and provided time for teams to workshop their projects and participate in peer learning activities. Fitchburg continues to focus on robust community engagement through its Neighborhood Navigators program as part of its Healthy Neighborhood Initiative. Both Middleton and Monona are interested in applying health equity tools and analysis to facilities and planning projects. Similar to these three communities in Dane County, there are clusters of cities, villages, and counties participating in LCAH around the state (see map at the top of the page). Let us know if you’d like support in connecting with communities in your region on HiAP, or if you have new staff that you’d like to orient to HiAP.

How Counties Play a Critical Role in Advancing Health Equity

-By Marybeth McGinnis, Associate Outreach Specialist, COWS, UW-Madison, September 2019

Health in All Policies (HiAP) is a framework for recognizing and addressing health inequities by centering the social determinants of health impacts in discussions of wide-ranging policy topics. HiAP incorporates five elements, each of which are crucial for the success of policies across diverse departments and sectors that aim to reduce health inequities:

  • Promote health, equity, and sustainability.
  • Support intersectoral collaboration.
  • Benefit multiple partners.
  • Engage stakeholders.
  • Create structural or process change.

Appleton using LCAH mini grant to help reach underrepresented communities

-By  Katya Spear, Senior Associate, COWS, UW Madison, August 23, 2019

Following the LCAH Community Engagement training this past April, LCAH offered $1000 mini grants to participating communities to help fund engagement activities that support their health equity work. To receive the grant, communities must complete a short community engagement plan. Once the plan is approved by LCAH, the funds are released. That’s it!

So far, two communities have been approved for the mini grant. Below, Appleton, one of the communities approved, describes how they are using their mini grant funds to enhance their health equity work. If your community hasn’t yet completed the steps to recieve its mini grant, contact us today to finish the process and get your funds!

The City of Appleton wants to better understand the health needs of their residents and work to reduce health inequities in their community. Our goal is to add to existing data sets such as: key leadership surveys, random adult phone surveys and the Youth Risk Behavioral Surveillance Study (YRBSS) .

We are talking directly with people who are often underrepresented or where community resources may be helpful for targeted members of the community though a series of listening sessions. To date Appleton has reached out to marginalized groups such as people of color, residents with physical disability, community members with limited resources, youth, and the LGBTQ community. Each of these listening sessions is scheduled for a minimum of one hour. Community leaders and elected officials have been involved in the discussions surrounding these community conversations and several have taken active involvement in the planning and facilitation of these sessions to create a more supportive environment for participants. We are using LCAH’s mini grant funding to incentivize community participation in the listening sessions with snacks and gift cards.

The summary of these findings will be included in Appleton’s next community health assessment and community health improvement plans. This work will meet the requirements for accreditation of our health department in the process. The community engagement training with LCAH helped us better understand the value of stakeholder engagement in our community work. The workshop examples and the dialogue with other communities were very well done.”

Congratulations to Appleton for being approved for the community engagement mini grant! If your community has been approved for a community engagement mini-grant and would like to be featured in the next LCAH newsletter, please let us know!

Convening Stakeholders for Rural Transportation in Bayfield

-By  Katya Spear, Senior Associate, COWS, UW Madison, May 30, 2019

Bayfield County hosted a rich discussion on challenges and opportunities in rural transportation during a day-long Rural Transportation Summit on April 16th. The event was organized in collaboration with and support from partners from Northwest Regional Planning Commission, Bay Area Rural Transit, UW Madison, UW Extension, the Wisconsin Counties Association, and the League of Wisconsin Municipalities.

Sessions focused on best practices and emerging innovations in rural transportation, the important connections between transportation and health equity, and the need for broad community and stakeholder engagement in transportation planning decisions. Notable attendees included State Senator Janet Bewley and State Representative Beth Meyers, and Wisconsin’s Lieutenant Governor joined the group at lunch to talk about the importance of rural transportation access for health equity and proposed increases to transit and transportation options in the state budget. This event will continue to propel the ongoing work that Bayfield County and its partners are doing to increase access to transportation.

Wisconsin Rapids completes a rapid Health Impact Assessment on Senior Housing

-By Madeline Petz, Community Development Specialist, City of Wisconsin Rapids, March 4, 2019

With support from the Legacy Community Alliance for Health project (2017-2022), the City of Wisconsin Rapids has teamed up with the Wood County Health Department to conduct a series of Rapid Health Impact Assessments(HIA) on timely development projects taking place in the City.

The first HIA in the series focuses on a new senior housing development in the central core of the City. With direction from a project advisory team made up of various community leaders, the City selected this as our first HIA to satisfy a local desire to devote attention to housing needs and associated health impacts in the community. We were also eager to zoom in on this downtown neighborhood, where multiple other exciting developments are either underway or slated for the near future. This geographic focus provides a way to explore some of the broader health impacts that the project has the potential to influence by way of proximity; or how appropriate planning can ensure that all of the connected developments together generate positive ripple effects for the whole population.

The learning and execution of the HIA process was a great success, and the recommendations generated for the senior housing development are currently coming to life. The senior housing development will open for business in the fall of 2019, including impactful building and site design elements that are direct results of recommendations from the HIA.

The advisory team is concurrently developing an HIA Matrix that summarizes our collective and co-created health areas of focus and the subtopics we are interested in exploring within each. Our intent is to use the Matrix to screen other potential HIA projects in the future, while also providing a less intensive, but still effective, tool to routinely incorporate health into City decision-making  and considerations. We also plan to carry out another HIA by the end of summer 2019.

Informed by a Health in All Policies approach, the City is using the HIA project experience to build the appropriate local capacity to incorporate a tangible health lens tool into planning processes, which will evolve into the new “business as usual”. The City is also motivated by the community engagement component inherent to HIA projects, which allows staff and elected officials to further increase transparency and trust in local government decision-making processes, as this has been identified as a need in the community. We are grateful for the stakeholders we have at the table and excited about the potential this approach has to support long term positive changes in health outcomes in the community.

You can read the full text of our newly released HIA Report here.

Highlighting Fitchburg’s Healthy Neighborhood Initiative

-By  Katya Spear, Senior Associate, COWS, UW Madison, November 9, 2019

The city of Fitchburg has launched a 5-year inter-departmental pilot program to identify neighborhoods struggling with access to services and opportunities and to engage residents in those areas to co-create and implement solutions that have a beneficial impact on health, well-being, and equity. The initiative, called the Fitchburg Healthy Neighborhood Initiative (HNI), is already seeing progress in the following areas:

  • Working in partnership with United Wayto develop a “Fitchburg Fund” (a community-based fund-raising campaign spearheaded by United Way, focusing on N. Fish Hatchery Road
    Neighborhood and HNI priority issues)
  • Exploring local food drink/concession contracts in select City parks and ways to potentially direct revenues to the HNI
  • Implementing the HNI grant program, with $46,000 in awards in 2018 to five different community/neighborhood organizations focusing on: Youth education; Neighborhood engagement; Food access/security; Sexual/domestic violence; and Environment/local food systems. Similar grant program funding has been included in the 2019 draft budget as well.
  • Working in partnership with Dane County Department of Human Services, and their funding, to develop a N. Fish Hatchery Road Neighborhood Navigator Program (hiring two neighborhood residents to connect other neighborhood residents with needed resources/programs/services, and facilitate better communication and resource/program/service development and delivery between City and neighborhood)
  • Secured funding to initiate Nine Springs Neighborhood “Hub” (i.e. neighborhood center) site planning at the City-owned Nine Springs Golf Course and future adjacent park space, with various non-profit partners
  • Working with a non-profit partner to develop a Verona Road West Neighborhood “Hub” at a privately-owned facility
  • Allocating funding to initiate North Fish Hatchery Road corridor planning.

HNI is an exciting effort by the city of Fitchburg to improve health and well-being. For more information, please contact Wade Thompson, City of Fitchburg Project Planner, at wade.thompson@fitchburgwi.gov.

Appleton is the first community in Wisconsin to pass a Health in All Policies Ordinance!

-By  Katya Spear, Senior Associate, COWS, UW Madison, July 20, 2018

Appleton staff attended a Health in All Policies (HiAP) training with LCAH colleagues in spring 2017. Staff that attended thought that one way to institutionalize considerations of health equity in day to day decision making in the city was to pass an HiAP ordinance. Appleton Health Department Officer Kurt Eggebrecht and his colleagues formed a interdepartmental “Health in All Policies team,” which spent the next few months drafting an ordinance and presenting it – and the social determinants of health model – to key committees and stakeholders in the community to increase common language, understanding, and buy in. The city passed the ordinance in December 2018 and is working to implement it, beginning with a focus on accessible built environment structures that promote health and safety. Learn more by accessing these resources:

Health Alliance Brings Together Statewide Partners

-January 2017

Across Wisconsin, opportunities to live a long, healthy life are not shared equally by all. Many of Wisconsin’s health outcomes lag behind national averages, and the state is home to some of the most extreme health disparities in the nation. In response to this problem, Wisconsin local governments, state agencies, academic partners, and nonprofit groups have joined forces to create the Legacy Community Alliance for Health (LCAH). The collaborative was awarded a $1 million Community Impact Grant from the Wisconsin Partnership Program at the UW School of Medicine and Public Health. Through the project, the LCAH aims to improve health and health equity through local government policymaking and programming.

LCAH, which launched in January 2017, is a five-year project to build capacity within participating municipalities to improve health and health equity through the use of data and evidence-informed policies. The goal is to help communities achieve gains in at least one of four policy areas of interest: clean water, active transportation, safe and affordable housing, and healthy and affordable local food systems. Each participating community will choose its own policy approach.

Participating communities will be drawn from the Green Tier Legacy Community Network, a coalition of local governments focused on advancing goals around sustainability, equity, and economic growth with the support of participating organizations and state agencies. Academic partners under the umbrella of the UW-Madison UniverCity Alliance will support this work with data, research, evaluation and training expertise. These diverse partners are excited to work with local governments in Wisconsin to improve the long-term health of their constituents and communities.



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