A Collective Impact Gains Traction in Atlanta (Fulton County)

“The biggest lesson here is county government and non-profits and for profits can work together for a common goal and as a result, good things can get done,” says Smith.

Seeing the incidence of Type 2 diabetes double to nearly 12 percent in recent years, Fulton County, Georgia health officials are targeting elementary school-aged children to stem the tide. They are hoping to reach 20,000 students in the Atlanta area within the first year of a focused effort officials say is essential to containing a fast-expanding epidemic.

“Unless we turn the tap off, we can’t reduce the prevalence,” says Nazeera Dawood, Deputy Chief of Staff for Operations, Office of the Chairman, Board of Commissioners, Fulton County Department of Health & Wellness. The focus is unique. “We didn’t see anyone focused on the prevention of the future cases of diabetes among youth specifically,” she says, even though there are efforts addressing obesity and diabetes management underway. Often diabetes prevention efforts are intertwined—and risks overshadowed—in broader obesity or other similar efforts. Fulton County officials wanted to zero in on changing habits among students to best impact prevalence.

What makes Fulton County’s approach unique is that the effort is a non-budgeted model that pulls disparate community players together for a common purpose, with public health officials facilitating rather than leading the effort. To be sure, a non-funded effort that prides itself on lacking a hierarchical structure and that relies on bringing together committed-yet-busy stakeholders—and ultimately looking to them to pony up resources—for results has a high risk for failure. Fulton County is far from achieving tangible results yet as stakeholders are planning a pilot for late 2015.

But don’t bet against Fulton County or Dawood, who has started six other similar coalitions focused on asthma, managing diabetes, heart health, and others. The asthma coalition, for example, connected the health department’s preventive services with the clinical services at a major metropolitan community hospital to reduce asthma emergency room visits by 90 percent and school absenteeism by 92 percent, according to Dawood.

“The seeds were planted and now they need to be watered to produce fruit, or long-term outcomes,” says Dawood of the six very functional coalitions. The approach Fulton County health officials are taking—tapping and organizing local partners and resources, often doing so on no or very limited budgets, and being comfortable giving up the reins—is one other public health departments would like to emulate.

“A lot of us in the community touch diabetes in some way, and what’s tragic is we don’t talk to one another,” says Lucienne Ide, M.D., CEO of Rimidi, an Atlanta company developing chronic illness management solutions. That’s before Dawood pulled together Rimidi and a dozen other key team members, including Emory University’s business school, Georgia Public Broadcasting and an urban and community design firm. “We won’t move the needle dramatically if we don’t work together,” says Ide.

In starting the coalitions, Dawood uses the Collective Impact Model, which focuses on getting the commitment of a group of stakeholders from different sectors to a common agenda for solving a specific social problem, and doing so by using a structured form of collaboration. “I already knew the power for collective impact,” says Karl Smith, program manager at the Georgia Campaign for Adolescent Power & Potential, a nonprofit working to improve the overall health and well-being of young people by focusing on teen pregnancy prevention, physical activity and nutrition, and healthy relationships. “I was onboard on day one.”

In order for the team to meet its mission to reduce the prevalence of type 2 diabetes among Fulton County children through education, policies, systems and environmental changes, assessors from Rollins School of Public Health at Emory University recommended efforts be focused on improving connections with schools and after-school providers to, among other things:

  • Develop hands-on and interactive lessons and activities, and use technology when available;
  • Promote a curriculum infusion approach to health education;
  • Involve parents via PTAs, providing children with take home material to engage families, and have parents run school gardens and bring in fresh fruit to school regularly; and
  • Ban food as reward in schools and make school lunches more nutritious and appealing.

Under Dawood’s initial guidance, different stakeholders are on board that can advance the strategies and goals toward achieving the team’s mission. For example, Emory’s Goizueta Business School is developing the measures to track kids’ eating habits, soda consumption and others to guide the effort’s success, while Rimidi is developing technology, such as gamification and social media, to engage young students in the diabetes prevention effort. Smith’s organization can bring programming around healthy eating, cooking demonstrations, and physical activity programs that it already sponsors for a range of community-based organizations in the County.    

“This is not a government intervention, it’s a team intervention,” says Dawood, who also has told each partnering organization to put up seed money to support the coalition’s ongoing efforts. “Everything is there. Every ingredient is in a different room, and you want to create a tasty dish so you’ve got to bring it together.”  

“There are a lot of people in the community across sectors…who really care about the community in the same way public health officials do,” says Ide, adding Dawood knows how to bring the parties together, leverage commitments and resources and then set an environment where the public health officials step back and let stakeholders collaboratively run efforts to achieve improvements. “Nazeera is a force because she’s decided to do the right things despite all the bureaucracy in the way, and she saw a gap in how diabetes is being addressed in the community and wanted to fix that.”