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In addition to federal government programs such as Promise Neighborhoods and the Sustainable Communities Partnership and foundations that support community work (e.g., the California Endowment's Building Healthy Communities, the multi-partner Build Health Challenge), the funding landscape now includes the community development sector, led by the Federal Reserve Bank of San Francisco and others, for-profit financial institutions, social investors, and others. In recent years, the array of funding sources and financing structures for community-based efforts to address social, economic, and environmental factors that shape health has greatly expanded. The remainder of this chapter is dedicated to describing these different stakeholders and the roles they may assume in supporting community interventions, ending with a discussion of cross-sector collaboration. Research on community engagement initiatives suggests that these partnerships generate benefits at both the individual and community levels ( Attree et al., 2011). Innovative approaches to fostering multi-sector collaboration to achieve health equity will require participation from many different partners. In the following sections, different health equity actors are highlighted, with their unique roles in promoting health equity outcomes described and various examples offered of how they have been able to create partnerships to advance progress toward health equity.
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These could include combining professional education, joint conferences, new educational tracks within professional schools, and new positions within institutions that span multiple skill sets-for example, a planner embedded in a health department and a health worker embedded in a planning department.
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In addition to new ways to bring cross-sector partners together across levels, new forums will likely emerge. More of these partnerships with various cross-sector groups are likely to arise in the coming years ( Active Living By Design, 2016). Different models have used design thinking for place-based initiatives as well as solutions aimed at improving other social determinants of health. Particularly for health equity, community engagement plays a central role in finding solutions. Human-centered design is an approach that places communities and individuals at the center of the solution. However, the outcomes that result from those systems need to improve, and to get to the improved outcomes will require novel ways of both defining the challenges and thinking about how cross-sector partners can come together, leverage work from other fields, and work effectively as a team. Systems have functioned in silos for decades for good reason: efficiency, expertise, and logistics have all kept programs moving down the same course. The concepts of disruption, innovation, paradigm shift, and design thinking have become guiding principles for engaging in this emerging collaborative cross-sector work. As philanthropy and other partners engage in actions and interventions that address the underlying or “upstream” causes of health inequity ( Mitchell, 2016), innovative ideas from the private sector are being brought to bear in addressing health inequities. A partner, such as a public health agency or a congregation, may serve as the convener of coalitions as a source of data and analysis (e.g., the local hospital, university, or school district), as a funder (a foundation or community development financial institution), or all of the above. Partners are able to deploy unique skills and access resources to serve a variety of roles in community-based solutions for health equity. In some communities these traditional partners are joined by public- and private-sector partners, including community-based organizations, faith-based organizations, businesses (from Fortune 1,000 to small employers), the education sector and academia, philanthropy, housing, justice, planning and land use, public safety, and transportation agencies. These include organizations with a health mission, such as public health agencies, hospitals, or federally qualified health centers. Many different stakeholders can lead or participate in championing and implementing such solutions. Effective partnerships are essential for community-based solutions for advancing health equity by making it a shared vision and value, increasing the community's capacity to shape outcomes, and fostering multi-sector collaboration.