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7 communities are changing the way we think about, and bring about, better health. Why they're winning.

From tiny Native American communities to sprawling metropolises, across the nation a sea change in health is happening.

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.

Across the nation, a sea change in health is happening. In tiny Native American communities and sprawling metropolises, rural regions, and small- to mid-size cities, people are coming together and connecting the dots between health and all the other aspects of our lives: education, jobs, housing, food, parks, community safety. Each year, the Robert Wood Johnson Foundation honors the unique and innovative approaches of communities that have made great strides toward ensuring all residents have the opportunity to live longer, healthier, and more productive lives. Here are some of the most compelling and surprising ways this year's seven winners of the RWJF Culture of Health Prize are changing health:

Manchester, NH

1. Rethink What's in Your Wheelhouse: Enlist Fire Stations to Stem Opioid Epidemic

A bad month for opioids in Manchester meant 30 overdoses when Chris Hickey first started working as a paramedic in the city 15 years ago. These days, the emergency medical services officer says Manchester's emergency responders see 60 to 70 suspected overdoses each month. More than a half dozen of those are fatal, which represents a nearly 12-fold increase in the city's overdose deaths between 2003 and 2015.

The spike mirrors a national trend, with opioid prescription drugs, heroin, and illegally manufactured fentanyl fueling a 137 percent increase in deaths from drug overdoses between 2000 and 2014, the most recent year for which statistics are available.

"You have people of all backgrounds, of all ages who are all overdosing," Hickey says. And those are just the emergency cases, he says. "We know that we have a large group of the population who are functioning addicts."

Emergency medical services officer Christopher Hickey stands in front of Manchester’s Central Fire Station.

How Manchester weaves health into the community's fabric

How does one reach those who are addicted before they overdose? A small piece of the answer appeared to Hickey this spring when another firefighter's stepbrother — homeless and struggling with heroin addiction — posted suicidal messages on Facebook and his family sent him to the fire department for help. It was the first time Hickey had encountered an addict who really wanted to take the first steps to get better. The two drove in Hickey's pickup to Hope for New Hampshire Recovery, an organization that helps people overcome addiction. Three days later the man was in an inpatient treatment program, and Hickey was writing a proposal to Manchester's mayor to turn fire stations into intake centers, where people could come without fear of being arrested.

Safe Station, as the initiative is called, launched in May 2016 in Manchester's 10 fire stations. Within the first four months, more than 420 people had sought help and been referred to treatment. Twelve people came in on Father's Day, the program's peak day. "They wanted to get better to be with their kids," Mayor Ted Gatsas says.

Stephanie Bergeron, interim CEO of Serenity Place — a nonprofit treatment center in Manchester and a Safe Station partner — says all involved want to make the model as easy as possible for other communities to replicate. For her part, she would like to ramp up Serenity Place's staffing on the weekends to accommodate Safe Station patients any time of the week.

"You want to catch people right at that moment when they're ready to come in," she says.

Louisville, KY

2. Enlist Art as a Salve: "Artists Can Change the World"

"I don't think art in and of itself can do anything," says Theo Edmonds, artist and co-founder of IDEAS xLab, an artist innovation company in Louisville. "But I think artists can change the world."

More specifically, the former healthcare executive says artists can impact health in surprising ways. He's found believers across Louisville, from the mayor's office and local foundations to the area's healthcare institutions and the University of Louisville. Together, they're out to do transformative things across the city:

• A vacant lot in the Smoketown neighborhood will become the venue for a drum circle as part of Project H.E.A.L., a five-year effort that will employ the arts to help residents look for solutions to community health needs.
• This fall, a former liquor store will become home to the printmaking and bookbinding activities of Steam Exchange, a free, after-school arts program.
• A photovoice exhibit, featuring the photographs and written observations of West Louisville residents, will set the stage for a community meeting to pinpoint ways to start taking action to reduce violence in their neighborhoods, which have among the highest violent crime rates in the city.
• Roots & Wings, a performing arts group made up of nine young adults of African descent, is addressing community violence, black identity, and other topics in neighborhood workshops and main-stage performances. They hope to get people talking and thinking about what they can do to level the playing field in Louisville and give everyone a fair shot at success.
• In these projects and others, art has become a vehicle for change.

Cynthia Brown (center) dances during a Project H.E.A.L. (Health. Equity. Art. Learning.) drum circle session in the Smoketown neighborhood of Louisville.

Righting historical health wrongs in Louisville

"The power is in the people," says Hannah Drake, a poet and lead artist for Project H.E.A.L. "But sometimes you have to show people they have the power to change anything they want to."

Miami-Dade County

3. Make it Easy to Play: Parks, Playgrounds are Part of the Equation

It may be hard to imagine that residents of Miami-Dade County could have a difficult time finding places to exercise, given the region's abundance of beaches and natural beauty. But a drive through some of the county's underserved neighborhoods reveals a notable void: There aren't enough safe parks and playgrounds.

Through a series of actions, Miami-Dade is changing that.

A park used for after-school programs near Charles R. Drew Middle School in Miami’s Liberty City neighborhood.

Miami's master plan for health

The county is carving out more space for cycling by building nature trails and bike lanes throughout the city. New playgrounds have been added as well, and the Consortium for a Healthier Miami-Dade County is creating "pop-up parks" in urban neighborhoods that have little green space. These parks come to life when a team temporarily cordons off an area for a day, lays down mats, and brings in play equipment — notifying the community with flyers.

But the most ambitious undertaking is the Underline, a 10-mile, 100-acre ribbon of a park to be built on the unused land below Miami's Metrorail, running alongside the Miami River. Construction is scheduled to start in 2017.

Designed by the same firm responsible for Manhattan's wildly popular High Line park — which was built on an abandoned elevated rail line — the Underline will use private and public funds to cover its $100 million cost. Walking and cycling paths will run the length of it, winding through permanent and temporary outdoor art installations.

"Miami-Dade County is known for its tough traffic, and so we're looking for alternate methods for people to commute to and from work and play," says Miami-Dade Deputy Mayor Russell Benford. The Underline will offer residents the opportunity to ride their bikes or walk to work, and it will serve as a connector between adjacent communities. An added bonus: It's expected to generate $50 million in economic activity annually once completed.


4. Prepare for the Unexpected: Meet Climate-Related Threats on High Ground

If you live in the tsunami hazard zone of the Pacific Northwest, you brace for disaster.

About 100 miles off the coast of Washington is the "Cascadia subduction zone," where pressure between two of the earth's plates could cause an earthquake, sending a wall of seawater slamming into the coastline.

Twenty years ago, Washington state stepped up its tsunami preparedness and began reaching out to coastal communities. At the Shoalwater Bay Indian Reservation, tribal elder Lee Shipman took on the task of emergency planning. She participates in Federal Emergency Management Agency-sponsored drills on how to manage a tsunami emergency and prepares tribe members for how to react.

The mythology of the Shoalwater tribe is filled with stories about great floods and earthquakes, says Earl Davis, who runs cultural programs. "I never got the sense in any of those stories of fear or terror," he says. "It's always, the water rose and this is what we did."

Siblings Sam (left), Maybelle (center) and Ferril Johnson (right), take part in a "tsunami and health walk."

A small tribe's big ambition for better health

Today, that narrative would include regular instruction on how to react in the event of an earthquake and tsunami. A large number of tribe members have CPR training. The youngest ones are taught to "drop, cover, and hold on" if they feel an earthquake and to hurry to high ground if they hear the tsunami siren.

With federal funds, the tribe has built a multi-purpose center on higher ground, equipped with a full-service kitchen, a generator system, and a back-up computer server for the tribal government. Outside the center sits a new mobile command unit with a built-in satellite system to handle communications during an emergency.

The goal is to make everyone feel safer and more resilient — from residents on the reservation to neighbors in towns like Tokeland, WA, or visitors to the tribe's casino and restaurant. The Shoalwater tribe's commitment to fostering a sense of shared well-being and community is infused in all their efforts. "If they're down here and something bad happens," says Joel Blake, the tribal treasurer, "we'll take care of them and they'll have a place to go."


5. Address Hunger with the Good Stuff: Make Fresh Produce a Must-Have

To drive through the Hood River Valley is to witness the bounty of the land. Pear and apple orchards, plus vineyards, stretch for miles. But against this cornucopia, there is hunger: A 2015 survey found that 34 percent of people in the region worry about running out of food, and 15 percent actually ran out of food in the previous month.

A coalition of groups in the Columbia Gorge Region of Oregon and Washington — from health care providers to a network of farmers — came up with a way to address the problem. They mapped out "Veggie Rx," a fruit and vegetable prescription program designed to increase intake of fresh produce.

Clinics and social service agencies screen for candidates who are worried about running out of food, or who actually have gone hungry in the past year. Some people find the screening uncomfortable because hunger remains a taboo subject, but others understand that fresh food is one key to better health.

June Husted qualifies for and uses "Veggie Rx" vouchers to receive free vegetables from places like farmers' markets.

Better health on both sides of the river

Participants receive a monthly packet of vouchers worth $30 and can use them at 10 farmers' markets or 29 grocery stores, but only to buy whole fruits and vegetables. The funds for the vouchers have the added benefit of helping local farmers and grocers by bringing more customers their way.

Usage has been high: The redemption rate for the Veggie Rx is 98 percent at senior centers, one of the distribution points for the vouchers. "The seniors say that there's something different about being handed this by a health care professional who is telling them this is essential to your health and you deserve this," says Sarah Sullivan, executive director of Gorge Grown Food Network, which administers the program.

June Husted, 69, who lives on the Washington side of the Columbia River in a former logging town, picks up packets from her doctor at a clinic 45 minutes away, and calls the vouchers "a godsend." Husted, who relies on Social Security income and lives with her 73-year-old husband, who has a disability, normally eats canned vegetables because fresh produce is too expensive in her small town of Klickitat, WA. The cost of housing and utilities are the first bills she pays every month, leaving little room for food. "Fresh fruit and vegetables," she adds, "are way down at the bottom."

The program has fed more than 6,500 people in just one year with an emphasis on pregnant mothers, children younger than 10, diabetics, and the elderly. Funding support has come from local hospitals and clinics, as well as private sources, with efforts underway to raise additional public and private funds to expand and sustain a larger base of users.

The Veggie Rx program has been a tool for linking farmers with local consumers. Gorge Grown is getting "fruits and vegetables into people's hands who wouldn't normally be able to afford it," says Randy Kiyokawa, a third-generation fruit farmer. "We're fortunate to be a part of that."


6. Innovate During Times of Crisis: Build Wealth in Struggling Neighborhoods

Chris Krehmeyer, president and CEO of the neighborhood development group Beyond Housing, estimates that the 24 small, North St. Louis County municipalities he works with lost 6 or 7 percent of their 15,000 households during the 2008 foreclosure crisis. And eight years later, he says, "We're still struggling."

Property values haven't rebounded, and the area, known as "24:1," now has more renters than ever, he says. "That doesn't have to be bad, but there's strength in homeownership." Homeowners create stability in a neighborhood because they generally move less than renters, and often they are more invested in the property and the community. Their children are more likely to stay in the same school, and that continuity can benefit students academically and socially.

One can see the decline in homeownership on the street where Pagedale Alderwoman Marla Smith lives. Seven houses on her block are Beyond Housing subsidized rental homes. Three belong to the Housing Authority of St. Louis County. Six houses are vacant. Two have been torn down by the city.

"That leaves maybe six homeowners," Smith says.

The City of Pagedale has seen a flurry of economic development, starting with the opening of a discount supermarket in 2010.

A community's all-for-one approach to healing

Beyond Housing is working to boost homeownership in 24:1 in a number of ways. Its nonprofit 24:1 Community, MO Land Trust uses a variety of subsidies to make homeownership affordable for people who would otherwise be locked out of the market. Residents own their homes, but lease the land, which is owned by the trust. The houses stay affordable because the trust controls the price owners receive when they sell. Buyers receive financial and homeownership counseling before they buy, and supportive services after they sign the contract.

With its partners Prosperity Connection, a nonprofit financial education provider, and Red Dough, a lender that offers lower-interest alternatives to predatory payday loans, Beyond Housing has established a "Wealth Accumulation Center" in downtown Pagedale. The center offers free financial coaching and classes on home-buying, credit repair, college and retirement savings, and other topics.

"We help people be aware of what they're doing with their money," says financial education specialist Evette Baker, "and pave the way to saving so they can have a family legacy."

Santa Monica, CA

7. Always Put People First: A Human Approach to Homelessness

It's a little after 4 a.m. when two officers and a passenger step out of a police cruiser to talk to a middle-aged woman sitting on the sidewalk. She wears very little.

"Good morning," greets the passenger, kneeling down to speak to her. "It's Brian from human services. It's been awhile since we talked."

Every day from 3 a.m. to 1 p.m., pairs of specially trained officers reach out to homeless individuals on the streets of Santa Monica, CA. On this morning, the team is joined by Brian Hardgrave from the city's Human Services Division. The trio know many of the people they encounter and ask everyone the same question again and again: "Would you like help?"

Santa Monica's police street team includes six officers and one sergeant who are focused exclusively on homeless issues. "We use the police strategically to engage these individuals who might not normally seek traditional homeless services on their own," Hardgrave says.

The unit is one of many initiatives in Santa Monica that addresses the problem of chronic homelessness. In the most recent one-day count taken last January, Santa Monica had 728 homeless people, 60 percent of whom were unsheltered. In comparison, in Los Angeles County — which includes Santa Monica — an estimated 47,000 people experience homelessness on any given night.

Felix Garcia is a former homeless man who lives in Santa Monica.

Beyond the pier: Health for all in Santa Monica

A network of Santa Monica partners — police and fire departments; city human services, health and housing offices; and nonprofit service providers — collaborates to find innovative ways to help the homeless. A guiding principle is the "housing first" philosophy, which maintains that it is not only more humane, but also more cost-effective, to house people as quickly as possible, and then make sure they receive services to resume stable lives.

Santa Monica was one of the first cities in the nation to develop a registry of the most vulnerable individuals experiencing chronic homelessness. And in 2007, it introduced another innovation — the Homeless Community Court. People who are cited for quality-of-life infractions such as trespassing or public intoxication are offered housing and treatment, and, in the process, can clear their records.

Sgt. Jeff Glaser said an officer on his team recently received a thank-you email from a woman he helped. "He changed her life basically by waking her up one morning when she was living on the street," Glaser says. "It's those things that make us happy about what we do."

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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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