Cultivating a Healthier Policy Landscape: The Building Healthy Communities Initiative.

OBJECTIVE: To identify effective methods for local public health departments to secure policy and systems changes that will achieve health equity and improve health outcomes across diverse populations. METHODS: We reviewed 220 documents from a philanthropic initiative that funded collaborative efforts to improve conditions for health and equity in 14 California communities from 2010 to 2020. We examined the role of factors associated with movement-building approaches-such as organizing, base-building, investing in organizational capacity, and forming alliances-in securing policy and systems changes that foster more equitable community conditions. RESULTS: All 14 sites made progress in implementing policies and systems to improve the social determinants of health, including neighborhood conditions and the built environment, health care access, social and community context, economic stability, and education access. All 14 also shifted processes to be more inclusive of and responsive to community members, who in turn gained capacity to advocate for change and build collective power. CONCLUSION: Local public health leaders can make progress toward health equity by drawing on movement-building approaches to change policies and systems that affect social determinants of health.