Setting a policy agenda for community-level action: Mobilizing communities from their grassroots to grasstops

Identifying the social, economic, historical, and political characteristics of the community and understanding the varied manifestations of health and chronic disease based on these characteristics becomes critical when setting an agenda for community-level action. Therefore, in order to achieve health equity and eliminate health disparities in communities with varying geographical elements, racial and ethnic diversity, and political will, community context helps to define not only who, but how to engage decision-makers and community leaders to help facilitate local-level change. Building upon the evidence-base for community-level interventions used to improve social infrastructures and built environments, communities funded through CDC's Healthy Communities Program employed strategies to address neighborhood living conditions (e.g., improving neighborhood safety and sidewalks), community development (e.g., developing walking paths, retrofitting streets with bike lanes, and creating farmer's markets and community gardens), social cohesion and civic engagement (e.g., engaging and sustaining community coalitions and partnerships), and improved health care opportunities (e.g., creating health care navigators). By building community capacity (e.g., commitment, resources, and advocacy skills) within almost 500 communities, the traditional chronic disease paradigm is shifting from focusing on the individual to a more upstream approach that creates a concentrated effort in employing policy, systems, and environmental changes that can directly impact social determinants of health and related chronic disease risk factors. By taking a population–based approach, community-level change is being executed and sustained by mobilizing communities from their grassroots (community members) to grasstops (decision-makers) in this policy implementation process.