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Manchester, NH, has a plan to transform residents’ health. The star: the city’s schools.

This feature was produced by Robert Wood Johnson Foundation, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

Founded along the Merrimack River in the early 19th century, Manchester, NH, sprang from a utopian vision: create an industrial center to rival its English namesake, complete with sprawling, red-brick textile mills, workers' quarters, schools, libraries, theaters, and parks for all who lived and worked there. But as manufacturing sagged in the latter half of the 20th century, the city lagged as well.

Today, in a transformation that has spanned the past several decades, the city's business core has repositioned itself for the 21st century. Manchester has evolved into a mid-sized city, and Elm Street — the city's main thoroughfare — has become a thriving urban hub with trendy restaurants and coffee shops. A few blocks away, long-vacant mill buildings are now home to tech startups, loft condos, and two universities.

Now this city of 110,000 people is applying the same resilience and determination that sparked the mill-yard comeback to what may be an even tougher challenge: revitalizing health and well-being throughout Manchester's neighborhoods, many of which struggle with common urban afflictions such as poverty, violence, homelessness, and the impacts of the opioid epidemic that has brought national attention to Manchester and other New England cities. Manchester's health promotion efforts focus on building and bolstering neighborhoods, an approach that harkens back to a time when the city's earlier immigrants created tight-knit communities and strong support networks. In this context, block parties, schools, community centers, homes, and fire stations have become tools for growing trust and delivering services while boosting health and well-being. Explore the links throughout this story to learn more about Manchester's work.

Lenny Bradford shops for greens at the farmers' market in Manchester’s Victory Park.

[Firefighters know people trust them. So they're inviting addicts to the firehouse.]

"We really focus on where people live and their daily lives," says deputy public health director Anna Thomas. "We try to respond proactively to residents' needs, rather than reactively."

The largest city in a rural and affluent state — and in all of northern New England — Manchester faces challenges similar to those of larger urban communities. The city is more racially and ethnically diverse than the rest of New Hampshire. And while the state has the nation's lowest child poverty rate — below 10 percent — one in four children in Manchester lives in poverty. Manchester also has the state's highest violent crime rate, with the most elevated levels concentrated in its highest poverty neighborhoods. And last year, nearly one in four drug overdose deaths in New Hampshire happened in Manchester.

[To change residents' health, funding for health projects had to change, too.]

The city's government, nonprofits, healthcare institutions, resident groups, and businesses have long invested in neighborhood-based programs to address emerging concerns and improve health. But they were energized to act more strategically when, despite the city's efforts, health and socioeconomic outcomes continued to trend in the wrong direction. The Manchester Health Department and its many partners wasted no time, going door-to-door with surveys and holding public forums to collect feedback that informed its 2014 Neighborhood Health Improvement Strategy, a new, more tightly integrated plan for reducing health and environmental inequities. The plan prominently positioned socioeconomic factors — such as poverty — as the focus of its recommendations, called for collective action through multidisciplinary partnerships, and identified strategies known to be effective at improving outcomes and changing systems.

Many community members who were surveyed cited education as their top concern. In the forum that gathered input on how to help Manchester's children succeed in the classroom, residents described their ideal city as one that addresses the needs of the "whole child."

[Want to improve the health of kids and families? Send them to school.]

Manchester is doing just that. Two main "community schools" provide a wide range of social services and education support to children and families in several of Manchester's most challenged neighborhoods, and two additional elementary schools are developing into community schools. Other projects have flowed out of the goals of the Neighborhood Health Improvement Strategy, including a successful effort, supported by Easter Seals New Hampshire, to boost by 25 percent the number of children who have received appropriate developmental screening by offering it at childcare settings and schools. The city's Police Department, in partnership with the Manchester Community Health Center and the YWCA, also has launched a new Adverse Childhood Experiences Response Team, which sends a crisis worker and a case manager along with police when they respond to domestic violence or drug overdose incidents at which children are present. A first of its kind in the country, the project aims to immediately connect children to services that help them avoid the anxiety, depression, and other problems that can come from witnessing traumatic events.

Curtis Bouchard, 6, reads in the library at Gossler Park Elementary School in Manchester.

[The most likely way to make housing healthier? House calls.]

"Childhood poverty has just kept growing," says Tim Soucy, Manchester's director of public health. "We realized if we were ever going to have an impact on the next generation and bring our collective efforts to scale, we needed to get way upstream with kids and families to address education, employment, and the other social determinants of health."

[Give people a chance to get fit — everywhere they go.]

It's taking a village to get there. Kris McCracken, president and CEO of the Manchester Community Health Center, says in her 20 years in the city, she's never seen such a spirit of collaboration on issues of health. She likens what her organization and others in Manchester are doing to a tree growing from a boulder. "We're the tree; the city's the boulder," she says. "Things grow as they need to survive, and we should be adapting and responding to the needs of the city."

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This feature was produced by Robert Wood Johnson Foundation, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

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