Weaving Health Into the Community’s Fabric: RWJF Culture of Health Prize winner Manchester, NH

Founded along the Merrimack River in the early 19th century, Manchester, N.H., 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—its 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.

“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 1 in 4 drug overdose deaths in New Hampshire happened in Manchester.

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.”

Read more at rwjf.org.