Community in Action
Examples of programs, policies, and tools in action.

Developing a Common Language and Understanding in New Hampshire

September 22, 2015

When data showed repeating patterns of childhood poverty and other poor health indicators in several New Hampshire neighborhoods, the City of Manchester Health Department, community leaders, and residents united to spark change. Working together, they built a common knowledge base and language to support a neighborhood-based approach to change through community schools.

“We needed to step back and come to terms with the reality that, as a community, what we were doing wasn’t working; we’re not serving the needs together as a united front,” said Anna Thomas, Deputy Public Health Director at the City of Manchester Health Department. With unprecedented investment by state funders and the leadership of a diverse team of city and resident leaders, these community members set out to develop a comprehensive neighborhood improvement plan. They began by intentionally seeking community-wide input about the neighborhoods’ needs and about local solutions that would work.

Looking for ideas outside of the city and inside local neighborhoods were important components of Manchester’s early process. The leadership team looked at best practices from County Health Rankings & Roadmaps, Promise Neighborhoods, and others. “We had an improvement strategy summit,” Thomas said. “We were looking at cities that had turned themselves around and asking what were the defining features and evidence-based models from those cities that we could all learn from?”

At the neighborhood level, the team gathered input through multiple door to door surveys, community forums, individual interviews, and focus groups. This outreach was conducted in multiple languages to reach as many residents as possible. “We used the health improvement framework. We defined health by six major issue areas—such as access to care, economic wellbeing, and neighborhood connectedness and safety—which helped to develop a common language,” explained Jaime Hoebeke, Division Head of Neighborhood Health at the City of Manchester Health Department.

The city also brought literature and experiences from outside experts to its work with residents, helping community members to identify not only issues, but also potential solutions. Thomas noted the community’s high crime and poverty rates, as well as increasing transiency among residents, as some of the biggest challenges to address. She added, “We recognized that we had priority neighborhoods in the city, but no infrastructure.” This barrier led to the idea of using schools as neighborhood hubs or community schools.

The community also began shifting to a systems approach to foster a Culture of Health through its schools. “We were building connectivity between school home, medical home, and neighborhood home,” Hoebeke said. “We were building and strengthening the bonds across systems, not just adding one more program or event to the schools.”

It was an inclusive process, with time spent on relationship building across many groups that touch schools in different ways. Hoebeke and the Community Schools Team worked with each school to create individual school action plans. They also helped form school health and wellness teams, which included principals, educators, social workers, counselors, parent liaisons, parent-teacher groups, and after-school programs. “We were changing the way people were looking at the community,” Hoebeke said. “It needed to be positive, empowering, and most importantly, shared.”

Thomas and Hoebeke reiterated that the common agenda has been crucial to their success. “Everyone has an understanding and a clearly defined roadmap,” Thomas said. A backbone organization plays a key role, too—one organization that’s willing to champion the cause. In Manchester, it was the health department. Using the right language was also essential. “It’s not one agency, one nonprofit, or one neighborhood,” Thomas explained. “We all have to see ourselves in it and have to own it in some way. That’s the way it truly becomes sustainable.”

To reach Anna Thomas, email [email protected], to contact Jaime Hoebeke, email [email protected]. To learn more, visit or read this Issue Brief from the University of New Hampshire Carsey School of Public Policy.

Communities in Action provide examples of strategies or tools in action. Their purpose is to connect like-minded communities in their implementation efforts, giving insight into how others are tackling key challenges and what they've accomplished.

Date added: September 15, 2015