How Community Action Shapes Health

by Deborah Puntenney, Peter Block, John McKnight on June 27, 2017

Tagged as: Gifts / Association / Cooperation / Acceptance of Fallibility / Raising Children / Health / Care of People on the Margin

How Community Action Shapes Health

with Deborah Puntenney

June 6, 2017

 

About every six weeks, for the last five years, John and Peter have hosted online / dial-up conversations with community-building pioneers as their guests. For their June 6, 2017 dialog they invited Deborah Puntenney to share her experiences in building new connections and relationships to strengthen our neighborhoods and communities.

 In addition to the transcribed discussion here, you can download or listen to the audio here.

 

Maggie Rogers:

We're pleased today to be joined by Deborah Puntenney. Deborah has been a colleague of John McKnight and Jody Kretzmann at the Asset-Based Community Development Institute for 25 years. Her work uses the ABCD approach to addressing neighborhood health issues. Much of Deborah's work focuses on how engaged citizens can become effective co-producers of their own health and well-being. We'll be talking today about what she has learned regarding community actions that improve health.

 

 

John McKnight is traveling and will be calling in as soon as he's able. So right now I'll turn things over to Peter to begin the conversation.

 

Peter Block:

 

Welcome, Deborah. How about if we begin by giving a little idea of what you're up to now, what you're doing, your Rochester work, and a little background. And then we'll take it from there.

 

Deborah Puntenney:

Thank you Peter, I'd be very pleased to talk about the work. My work for the last eight years has been with the Greater Rochester Health Foundation and a really stellar group of its grantees in what's called the Neighborhood Health Status Improvement Initiative. This initiative was launched in 2008 with a unique approach that is really different even for a foundation focused on health improvement.

 

 

The funding program is oriented to the social determinants of health. In other words, grantees are not meant to deliver programs or services, they're funded to organize their communities around the health improvements they want to see internally.

 

 

There are several social determinants of health, for those of you who aren't familiar with this framework. Certainly genetics is a determinant of health, but we don't focus on that because we can't do anything about it. Likewise, medical care and access to care is something that happens outside of ourselves. But within the community, people can look at the physical, social, and economic environments in that community and themselves do something about those things. So the goal is to create a context for health that supports people making good decisions.

 

 

The Health Improvement Initiative is based on a partnership model, meaning that the foundation is partnering with its grantees and working with them, as opposed to just giving them money. It's also based on a learning model, meaning that the foundation is really interested in what's working and why, in addition to the changes that are produced in the neighborhoods.

 

 

So the four groups are at different points along the way in the process. Meaning some started eight years ago and some have started more recently. But the foundation is supporting them in what we consider the long term. Ten years is the expected support for each group. Their progress is reviewed every three years, but the foundation has really acknowledged that you don't change structural conditions in a year or two.

 

 

Its funding also supports what we call evaluation coaches and technical support in asset-based community development, that would be me. And I wanted to say a little bit about two of these communities just to give you an idea of the array of things that they're doing and the kinds of progress they're making. Later on I'd love to tell you more about the evaluation and how that works.

 

 

But two examples. So one of these is an inner-city community. And this community did start eight years ago. The people who are involved are neighborhood residents, individuals, families. They've come together in block clubs, they have a neighborhood council. But these are informal groups, none of these are 501(c)3s except for the organization that actually received the grant, which is a CDC.

 

 

This community started out, I can tell you a short story about them, early on in their work, when they were conducting an asset map in the first year. They finished their asset map and then they met as a community and they had identified several issues that they wanted to work on. Healthy eating, healthy exercise, and doing something about the open air drug market that had plagued their community for about 30 years.

 

 

And it was really interesting at this meeting because the room was set up to provide for three discussion groups. And people were invited to sit down at any table and talk about one of those issues. Everybody in the room went to the table that had to do with getting rid of the drug market. So they knew what their health issue was. People had voted with their feet. They made it really clear, and they actually said that evening that none of the other improvements they might make would have any impact if that drug market was still there. Now that doesn't mean they didn't do all sorts of things in other areas. But really a big emphasis for this group was doing a variety of things against the drugs.

 

 

So the foundation, in addition to giving the primary grant, also allowed for the grantees to give mini grants to neighborhood residents in order to design and implement small-scale health improvement ideas on their own. So in this neighborhood, if you go back eight years you would have seen a stereotype of an inner-city neighborhood. A neighborhood that was ugly to look at, that was strewn with trash, that had very few amenities. Today when you go through the neighborhood, people comment all the time, this neighborhood group has managed to build community gardens, it has a developed a park and playground, it has completed a major trail going all the way through Rochester and right through the neighborhood. It has launched educational opportunities, it's got numerous activities for seniors, for youth. It has developed major partnerships, and by that I mean between neighborhood residents, the mayor, the police, the courts, the judges, the district attorney, anybody you can think of they are partnering with. There's been massive community change in this area.

 

 

And I want to say that this community is working at all three of what I consider levels of asset-based community development. You sort of have the entry-level things - what can we do right here, right now to change our space? You have the middle level, which is what can we do in partnership to help increase our momentum and expand what we can do? And then you have another level which I think of as the policy level, what kinds of policies do we need to change to make things possible in our area? They're doing all three.

 

 

We also have a rural community who is much, much newer to the program. But again, this is a loosely affiliated group of residents who participate across all kinds of categories of action. Several locally-based small groups, including one very interesting group that is focused on what they call closing the gaps in the trail system that runs across New York and through their area. They've done all the kinds of contextual improvements like starting gardens and offering residents opportunities to do these small health improvement grants. They also have major partnerships going right up to the state, and they have also already launched into all three of these levels of community engagement.

 

 

So that's kind of what I've been doing for the last eight years, and it's been a real learning exercise for me. And using this framework of health has actually really helped me in my ABCD work.

 

Peter Block:

Wow. We need about five hours Deborah Puntenney.

 

Deborah Puntenney:

We do, because I could talk about each of these groups for over an hour.

 

Peter Block:

Let's just pick the inner city. And each group you're learning things. And it's interesting to me, asset-based, what are people's gifts? And then dealing with the issue of drugs. Are you facilitating these meetings? Do you spend a lot of time with these grantees?

 

Deborah Puntenney:

I visit New York and spend about a week of every month in Rochester. Those visits are direct face-to-face work with the organizing team for each grantee, and then often times with the residents as well.

 

Peter Block:

When you began, how did you find the right residents? What's the launch process look like? This would be the first level that you're talking about.

 

Deborah Puntenney:

The grants were given, the first thing each grantee did was to hire a person to lead their team. Now you could call that person a community organizer, you could call them a community connector. But that was what their job was - to find people and bring them out. We actually encourage them to bring them out just to do something that would have a positive impact on the community. We did not start by talking about a reduction in the incidence of disease or any kind of usual framing of health.

 

Peter Block:

And that connector, is that a full-time job?

 

Deborah Puntenney:

I think some of them started out part-time. They very quickly moved to full-time, and now most of the grantees have at least two people that are working pretty much full-time on doing this connecting work.

 

Peter Block:

That's amazing. And you're giving them technical support, really to the connectors and their organizing efforts in the neighborhoods, or the community.

 

Deborah Puntenney:

Yes. One thing I didn't mention was that there's kind of a framework within the grants that we think of as assess, plan, and do. Which is, those three things are happening all the time. But the first year of the grants, they were urged to conduct an asset map of their neighborhood. So during that year I helped them design what that would look like, not get caught up in using their findings as data or getting tangled in that kind of thing. But really looking for the assets and starting to connect them one to another through relationship building.

 

 

As they started their planning year, that was an opportunity once they had some kind of critical mass of residents at the table and acting on their own. They sat down together and thought about what they would want to do together over time to move towards a healthier community. They were completely free to choose almost anything they wanted in the categories of the physical, social, or economic health. So each group came up with a plan and figured out how they were going to implement that plan. Which meant that the plans had to be, at least initially, kind of small scale.

 

 

And then the third year they really launched kind of full force into implementing their plans. But nothing really changed. It was still residents doing the majority of things on the plan.

 

Peter Block:

How much money's involved here? Can you tell us about the scale of dollars ...?

 

Deborah Puntenney:

I think I can say that. These were very generous grants. I don't actually remember what the exact amount was. But in the first year, the asset mapping year, I think the grants were about $70-80,000. So there was generous money really to support the organizer and to provide for these mini grants. Once the groups had developed their plans and were in the implementation phases full force, the grants went up to about $160,000. So again, this is very unique in terms of the amount of funding and how long-term the funding is.

 

Peter Block:

That shows great consciousness on the foundation to be willing commit a couple million dollars over a 10 year period.

 

Deborah Puntenney:

Yes. And even with that investment it is remarkable and quite unique that they are not expecting health outcomes in a year or two.

 

Peter Block:

Well, they bought the logic, didn't they?

 

Deborah Puntenney:

Right. They absolutely understand how entrenched the issues are in terms of the social determinants of health, at least in terms of how they function in a negative way. And they sort of built backwards from, if we're hoping for long-term improvements in the incidence of say stroke or diabetes in these neighborhoods, we have to really think clearly about what we need to do to get there and how long that's going to take.

 

Peter Block:

That's wonderful. Because the big insight was that health is not fundamentally determined by the healthcare industry.

 

Deborah Puntenney:

Absolutely. That's absolutely correct.

 

Peter Block:

That's a big insight, because health is the easiest thing to get money for, but it usually goes to hospitals and clinics. It's really the expansion of health as the professionals. This money goes to residents, really amazing.

 

Deborah Puntenney:

Absolutely. And I don't believe anyone would question the contribution the field of medicine, access to healthcare has made in determining health outcomes, but I think the how behind that is very important. And as you say, the field of medicine isn't really oriented to the production of health, it's mostly focused on responding to health issues.

 

Peter Block:

I agree with you. So I'm interested in the framework you have of physical, social, and economic. Ultimately, before we get too along, I want to talk about evaluation and economics. Tell me what you mean when you talk about improvements in the physical and social.

 

Deborah Puntenney:

None of these are absolute categories with very finely tuned definitions. But when we talk about the physical, improving physical health, people can actually interpret that either as literally improving their own physical health. But we think of it more as the physical context for health. So literally the place. Where I live, the neighborhood I navigate, where I am much of my time. What does that physical environment offer me in terms of opportunities to be healthy?

 

 

Some neighborhoods clearly offer people lots of opportunities. They're safe, they're green, they have sidewalks, people can get out and exercise, they can get to a grocery store. Other neighborhoods do not have those amenities. And so the physical environment isn't supporting health very much.

 

Peter Block:

The opposite.

 

Deborah Puntenney:

Exactly. So we are inviting people to consider what they would want to see in their environment that could support health more and support healthy choices. And to do what they can do to make that happen.

 

 

In terms of the social determinants of health, or the more specific category of social health, we know from much research that people who are connected, who have good relationships, who know people, who work together with others, we know that that is a positive determinant of health. We also know that in some neighborhoods, people are disconnected for a variety of reasons. They don't have opportunities to work together. And so again, this is a very broad category, but we are inviting people to come together and figure out how to build that social cohesion and eventually some kind of individual and collective efficacy, which then has a clear positive impact on health.

 

Peter Block:

One of my colleagues and friend is with Mars Incorporated. They did a lot of research on social capital which shows exactly what you're talking about. If you have high social capital in a neighborhood, it impacts everything. And Putnam's work was like that originally. And their definition of social capital is two things. One is do people kind of trust each other? And do they do things cooperatively to make the community better?

 

Deborah Puntenney:

Exactly.

 

Peter Block:

Would you buy that as a definition of social capital? Or how do you think about that?

 

Deborah Puntenney:

I don't worry too much about being precise. But I would definitely include those things. There's so many academics who have come up with so many very precise definitions. But I do think that the notion of trust, I mean, if you cannot come out your front door and trust that the person walking past on the sidewalk is somehow a good, a well-intentioned person, and if you cannot find somebody to do something with, then you don't have any social capital. So those things definitely contribute.

 

John McKnight:

Peter. This is John McKnight, I'm finally joining you…. But go on.

 

Peter Block:

Glad you're here. This is just an amazing work that you're doing Deborah Puntenney, just so happy to hear about it.

 

Deborah Puntenney:

Now let's be clear Peter, I'm not doing it. The neighbors are doing it.

 

Peter Block:

No, but what you're doing is you're helping them think about what they're doing. So much of the asset-based work, a lot of it was let's count up the banks and institutions and agencies, and a lot of the United Ways ...  You're not talking about better agency services, better medical services, you're saying what can residents do to gain control of their own physical, social, and economic lives? And that's thrilling, the way you do that. So let me ask you before we get to evaluation, what's the level of economic impact? What have you seen happening growing out of the physical and social work? In terms of what economic difference do they make in terms of giving people more economic control of their lives?

 

Deborah Puntenney:

That's a really good question, and I talk to the grantees about this all the time. The economic issues are probably the most difficult ones to work on. Although they've certainly succeeded in some ways. For example, this inner city group had leveraged all kinds of money to facilitate what they're trying to do. So there have been major investments in the neighborhood. I could not say at this point that, I don't think they would say they had been successful in terms of, for example, any major employment initiatives or increases in individual earnings. But in terms of investments in the neighborhood they've been hugely successful.

 

Peter Block:

Could they focus at all on helping people expand their small businesses? Because in an inner city or rural, people don't realize how productive the residents are. You know, we've got such a negative story about people that don't have high income.

 

Deborah Puntenney:

Well that's true, and all these groups are aware of that. And there is a bit of a difference between the rural groups and this group in the inner city. They are actually focusing less on that right now. They're reached out and have attempted to develop some partnerships that will support residents as they try to move toward their own personal economic security. But I would have to say they've done more in terms of investments at the community level.

 

John McKnight:

Deborah ... stop me if you've gone through this already. But if you think that social capital produces a series of outcomes that normally are defined by programs. Outcomes that have to do with health, knowledge, housing, economic support, et cetera. Then how do you deal with funders who always want to come into the community in a silo, within a category, when so much of the research shows that if you increase the social capital you'll probably get more positive outcomes in the program areas than if you came in with a program?

 

Deborah Puntenney:

Great question. We haven't really talked about the funding question yet, other than my serious applause for the Greater Rochester Health Foundation and their innovative thinking. The fact is that the neighborhoods that I'm talking about right now do have the enormous benefit of having funding from a funder that gets it. And that is actually willing to fund resident action. I haven't found that many other foundations, certainly not government funders that I'm aware of, that are doing any kind of support for real grassroots, place-based, resident-driven work.

 

 

There are a lot of foundations who use the buzzwords - community, local. But they don't really, really indicate through their requirements that they trust people to actually make a difference in this regard. So I wouldn't say that there are long lists of funders doing these things. Now there's certainly funders doing good work, and there's certainly funders doing things in terms of the social determinants of health. For me, the missing piece in what they're doing is that they're still fairly prescriptive, and they usually start at the partnership level as opposed to the resident level.

 

Peter Block:

That's a beautiful way of putting that. Descriptive, that was the agencies and the institutions.

 

Deborah Puntenney:

And they encourage partnership, but generally it's a top down kind of thing where the people who are the experts, the professionals, are in the position of trying to get residents to partner with them. As opposed to what we're trying to do, which is to have the residents inviting agencies and institutions to partner with them.

 

Peter Block:

Exactly. So let me ask about the evaluation question and then we'll open it up. We're getting some questions on the chat. But tell me a little bit about what you call the evaluation. You had a second word next to it that I missed. And how are thinking about measuring what difference this is making?

 

Deborah Puntenney:

Well first of all, the foundation has as part of this initiative, has provided evaluation coaches. They're not evaluators, they are evaluation coaches. Meaning that they are working directly with the grantee groups to define what they are trying to achieve, to define what they consider success, and then to define the measures that they will use to evaluate whether they are achieving what they want to achieve. So it's not a top down evaluation, it's a community-based participatory evaluation.

 

Peter Block:

Where's the coach from? Is it someone with a history of this kind of citizen-based evaluation?

 

Deborah Puntenney:

These are two local individuals in Rochester. They know the community. They've done all sorts of different community work. One has worked for a long time with NeighborWorks. So yes, they have experience with grassroots kinds of efforts.

 

Peter Block:

What kinds of measures are they coming up? It's interesting that the evaluators are there to make a difference, not to be distant and watch someone else. Which is what 90% of the evaluation money goes for, an outside looking in. They're in. Where are they now toward the question of measures? Do you have any sense of what kind of measures they're heading towards?

 

Deborah Puntenney:

Absolutely. Let me just tell you a little bit about what we call our evaluation framework. And this is something that your listeners can download from the website. If they want more information they can go to the Greater Rochester Health Foundation's website at www.thegrhf.org. And they can click through What We Fund to the Neighborhood Health Status Improvement Initiative. And they'll find more information on the program, and they can take a look at this evaluation framework.

 

Peter Block:

Thank you.

 

Deborah Puntenney:

So what we decided was that if the ultimate objective is 15, 20 years out…we would love to see fewer health disparities between this neighborhood and other parts of the city and the state. And reductions in problematic conditions, diseases like diabetes, stroke, asthma. That's sort of the distant goal, to improve that. But since we're using the ABCD approach, and since we recognize that those things are not going to happen for a very long time, we have built backwards to the kinds of things we do think we can measure along the way.

 

 

Our model has four steps before we get to change in health status. We start out with what we call a change in the environment, exposures, and experiences. So that's really the context. People start out by just doing what they can do in their neighborhood, we're looking to see how that neighborhood environment changes at the beginning. So if we're talking about socially, we're looking at social cohesion, we're looking at engagement, collective efficacy, are people coming out and doing things? We're looking at the physical environment. Is it cleaner? Does it seem to be safer? Are living conditions improving? Economic, as I said, is very difficult. We originally defined that as opportunities for self-sufficiency, and we have not made a huge amount of progress on that. And we also add cultural factors to this environmental question, so we're looking at prevailing community norms.

 

 

So that's the area. Things we're looking at in terms of indicators, we started out with baseline indicators that look at the number of blocks, for example, in a neighborhood that have trash or show no trash. And we're looking over time, does the evidence of trash and litter decrease over time based on what the residents are trying to do? We look at whether or not, say, any particular block is more visually appealing. So the improvements could result from planting flowers, from painting, or any number of other things. So really, number one is this change in the environment.

 

 

Number two, we would say once you've done some changes in the space, you can progress to a change in people's attitudes, feelings, and understanding about their world and their future. So this is moving a couple of years beyond. And we're talking three, six, eight years out. We hope people in the neighborhood feel differently. So that might be in terms of their hope for the future, whether they feel a sense of cohesiveness and connectedness, whether they feel safe, empowered, capable, in control. And so we have measures that are attached to those things, and we're measuring changes over time.

 

 

From that the flow moves into, again, moving out in the years, we then go to changes in personal behaviors. So we think, contrary to many health interventions, that you don't start by telling somebody to stop smoking or to eat better. Changes in behavior quite possibly come after these other things happen. So the changes in behavior include all sorts of things. Getting more healthy physical activity, eating better, tobacco use, substance abuse, all kinds of things of that nature.

 

 

For example with the nutrition category, one measure is the number of fruits and vegetables somebody ate on the previous day. Or the number of cigarettes they used on the previous day. So we have baseline measures for these. We're not yet seeing too many changes. We're seeing changes in the nutrition category and the physical activity category. We're not yet seeing changes in too many of the others. But we're definitely seeing changes in the environment and changing in attitudes.

 

Peter Block:

Who does the looking? Is it residents trained to collect the data, or is it third parties?

 

Deborah Puntenney:

Yes. That is part of why we call them evaluation coaches. They work with residents. Every community does a community survey, usually every two to three years. But it is residents going out door to door and talking to their neighbors. So residents are trained. Residents actually participate in developing those instruments and then they are trained to go out to gather the data.

 

Peter Block:

That's a huge innovation, to say the neighbors can ask neighbors and collect the data, you don't need a third party independent professional. But the coaches give them the methodology, that's terrific.

 

Deborah Puntenney:

I want to say one more thing. I’d like to tell you the final category. The last area that we flow into once you've gone through those first three, we call it change in the medical conditions that precede disease. So if people's behavior changes and if all these other things have changed, we hope to see reduced blood pressure, reduced cholesterol, all of these pre-conditions. So eventually we hope we will be measuring those. So with that I will stop.

 

Peter Block:

So there are four categories. Environment, social, physical, economic.  John, do you want to ask anything before we open it up for questions?

 

John McKnight:

I wanted to ask one thing about local perceptions. I remember years ago when I was in a neighborhood, gathering a group of people and asking them what were the things that they thought made people in the neighborhood healthy. I remember at the end of the evening, there was quite a discussion, but nobody ever mentioned access to doctors or hospitals. And so it made me realize that there is sort of a local perception of health that often reaches beyond the medical definition. And I'm wondering, as you began or as you continue, when you talk with people about health, what kinds of determinants or factors do you hear them most often raising as critical to health?

 

Deborah Puntenney:

Generally… one of the examples I gave was the inner city community who uniformly mentioned getting rid of an open air drug market as the primary determinant of whether they were going to be healthy or not. So that one was very specific and unique. But they do mention things like, Peter was talking about trust, and the ability to know their neighbors. They mentioned cleanliness of the streets, whether the trash got picked up, whether their house is falling down, whether they've got a leak in their roof. Though they don't typically use the language of social determinants of health, when they talk about it they're absolutely mentioning things that fall into that.

 

John McKnight:

Good, good. All right Peter, go ahead.

 

Peter Block:

So why don't we stop for a second, and Maggie why don't you invite questions on the chat or people to call in, okay?

 

Maggie Rogers:

Sure. If you've dialed in, you can press star 8 on your telephone and you'll be in a queue to join the conversation and I'll see that. Also there are some questions in the chat.

 

Peter Block:

I've been working on those. The questions about measurement, evaluation. One question was IRB certification, which is kind of technical. But I assume your coaches know all about that. And so they go through that process. And maybe you could explain what that is, if you know what it is.

 

Deborah Puntenney:

Yes. The IRB is the internal review board, and in my world it is associated with universities, and anybody doing research at a university has to either go through an internal review in terms of having their research methodologies reviewed and approved, or actually get an exemption, which generally means that you're not doing anything that could potentially violate anybody's rights. And that's putting it very, very simply.

 

 

Our evaluators were absolutely aware of that and though I was funded through Northwestern University, they were looking at their local university to assist them in considering that, and did what was necessary.

 

Peter Block:

That's great. And it's really a way of making sure that the research is done ethically and respectfully and doesn't exploit anybody. So that's great. So are there other things about this? You started by saying they have a 10 year perspective, and then you went to 15 and 20.

 

Deborah Puntenney:

Yes. Interesting, isn't it? And I would distinguish that by saying that their board has made a dollar commitment for 10 years. Though they do simultaneously recognize that those ultimate health outcomes will probably not be achieved, I mean we don't know. We are actually sort of testing our logic model as we progress through it. One thing we've learned is that our initial estimates of how long each of these categories I gave you might take, that they were low. So for example, we initially assigned a year or two for the changes in the environment. Kind of three to six years out, changes in attitudes. And we already know that it's going to take longer than that. One thing that applies much more to urban communities than it does to rural communities, this particular community that we're working with in the city of Rochester has a transience rate of about 60% or more. Meaning that from year to year, 60% of the people are different. So we're not measuring the same people. This is in no way a true experiment….So we're battling, we move ahead, but it's new people coming on board all the time.

 

Peter Block:

Is that a goal in itself, to try to stabilize the population of the neighborhood?

 

Deborah Puntenney:

Now you are moving into a different sort of an economic question. I would have to say that, if you're looking broadly at economic development, one of the most important issues is gentrification. So we have no desire whatsoever, I mean if you look at the pathway to developing a neighborhood or a community, depending on how you're measuring success, what can end up happening is that neighborhood becomes desirable, and new people move in, and the values increase. And there's a big question about where does the value of that begin and end? We don't want everybody to have to leave the neighborhood, but yet we would like it to improve enough so it's a reasonable place to live and there are reasonable amenities for people living there. But it's very hard to control all that.

 

Peter Block:

Well, yeah. Because it has to do with affordable housing, and there's a book out now that's very popular about eviction and [inaudible 00:44:03].

 

Deborah Puntenney:

Well once you make a neighborhood desirable enough for somebody to invest in it, that can get out of control.

 

Peter Block:

Exactly. And there's this huge displacement. So that's the challenge is to make it attractive for the residents who choose to stay and have the economic means to stay. That's just, it's great.

 

Maggie Rogers:

We have a caller…. from Texas. Hello?

 

Tony:

My name is Tony, and I'm wondering if we could hear a little bit from Deborah about what she may be learning that's different about the rural community than the inner city community? Thank you.

 

Deborah Puntenney:

Tony, that is a great question, and actually that is one of the big lessons, is that these communities are very different. So I would say that my first big lesson about the difference between working with urban and rural communities is that I see that in an urban community there are more issues of trust and problems with people feeling safe, coming out and doing things. So in other words the challenge in an inner city community may be to actually get people to come out and try to do something. Once you get them going, they're fine, but just literally that first step of feeling comfortable enough to come out and do something can be an issue.

 

 

In rural communities, you have almost the opposite. You have a real tradition, and John, you'll laugh, but I think this is kind of a la Alexis de Tocqueville, you have people who are absolutely accustomed to doing things together to make their community a better place. Whether it has to do with farming or whatever, people are used to doing things for themselves and working together to get that done. However, I find in rural communities, a bigger challenge is to sort of blur the boundaries between the people who can do and the people who can't. So oddly enough, I think there's much more cliquish behavior in rural communities. Sometimes that is based around longstanding associations, whether it's a church or a grange, or groups that have been together for a long time and they see themselves as actors and other people perhaps not so much. So two different kinds of sets of challenges. Does that help at all, Tony?

 

Tony:

Yes. Thank you, Deborah.

 

Deborah Puntenney:

Also, one more thing about the rural communities that becomes apparent very quickly when you start trying to organize is the distances. So our inner city neighborhood can be measured in blocks, whereas our rural communities that we're working with are measured in miles. So you have, certainly people that live in villages function a bit more like the urban communities. They're close by, they know people more. And then you have people who are living out on a rural road and they may be half a mile from their nearest neighbor. So that becomes a little bit harder. Knocking on doors is a little bit harder. Talking people into joining a group is a little bit harder.

 

Peter Block:

So let me give you some questions from the chat; I’ll give you a series of questions, you can pick the one you want to speak to. How were residents involved in deciding how investments were made? Did your coaches serve as liaison to developers? I'm not quite sure where developers are in the conversation. As you're measuring, how do outcomes and deliverables get communicated to members and residents?

 

Deborah Puntenney:

I will start with the last one if I may. Because the evaluation is a community-based model, the evaluation coaches do whatever number crunching is going to be done. And they immediately take that back to the grantees, each one individually. They present the, whatever they have found, in a variety of ways. And that is not just to the team, but also to residents if they're interested. And then they converse with them about what those things mean, how they might want to use those findings in things that they're doing. So for example, grantees have said, "We're really interested in that finding, and we'd like to present that in a video we're making or in a report we're doing." And the evaluation coaches help them with that. So the grantees and the residents have every access to the data. They can call on the evaluation coaches to help them use it in any way they want to.

 

Peter Block:

So the coaches organize and present the data, not the residents who collected that data?

 

Deborah Puntenney:

Ultimately the coaches will help residents also think of ways to present the data and take it out and do it on their own. The evaluation coaches are acting as resources at every step of the way.

 

 

And then I think the first question was how are residents involved in deciding about the investments. Now I'm not quite sure what that means. Part of the grants do go to support salaries for the community organizers or connectors. But the monies that are available for the mini grants, we call them resident health promotion projects, those are smaller amounts. And different groups have set up different ways of doing that. Sometimes residents are involved in reviewing and choosing what gets funded. They are always able to contribute thoughts to that. Some of the grants have made those small grants larger amounts, some really are working with very small amounts.

 

Peter Block:

What's a large and small amount?

 

Deborah Puntenney:

I think the largest one would probably have been a couple of thousand dollars. But often they're several hundred dollars.

 

Peter Block:

Can you just give an example of one of these grants.

 

Deborah Puntenney:

Sure, absolutely. Just recently in one of the rural communities there was a community celebration. People wanted to resurrect sort of events that happened in their community from many years ago. And so, I can't remember the exact amount, but say roughly $500 was put towards putting together a festival day for the community that everybody could participate in. And sort of try to get the feeling of history in their neighborhood.

 

Peter Block:

That's helpful.

 

Deborah Puntenney:

And there's been many of them that have gone to developing community gardens. Whether it's vegetable gardens or flower gardens or things like that.

 

Peter Block:

What do you call the grants? You had a long name that had the word health in it, didn't you?

 

Deborah Puntenney:

That was designed explicitly to keep reminding people that what they're doing is related to health.

 

Peter Block:

I love it.

 

Deborah Puntenney:

That having a party, having a festival, growing a garden, whatever it is, that is related to health. When they apply for the funds they have to say how they think that doing what they want to do will contribute to the health of their community.

 

Peter Block:

That's part of the education and kind of the narrative transformation. That's beautiful. So we're getting near the end. You know, one of the things that strikes me, and then John, you may have a comment or a question, is how complicated this is. It's so much easier to put up money and run a program and have people to come and graduate from a program. Where this is so much more complicated and nuanced and subtle and patient. Why this is so radical,…it's just amazing, the way you described it.

 

 

My final question, which you don't have to answer, is when are you finishing the book on this? Or do we have to wait 10 years?

 

Deborah Puntenney:

That's in conversation right now. But I will tell you that the program officer, Barb Zappia and I have written a number of papers that have been presented at academic conferences. And those can be downloaded both from my personal website, I think I have them on there, and from the ABCD Institute website.

 

Peter Block:

Do you mind listing your website in case people want to contact you or ask questions?

 

Deborah Puntenney:

Oh sure. My website is www.dpuntenney.com.

 

Peter Block:

Thank you. Well that's great. So John, any thoughts or questions?

 

John McKnight:

No, I think it's a wonderful exposition of health determinants thought of outside the medical domain and how the community is the primary site for increasing well-being including health. And Deborah Puntenney's done a spectacular job. Really appreciate your doing this webinar with us Deborah Puntenney, and I know I speak for everybody in saying thank you.

 

Deborah Puntenney:

You're very welcome.

 

Peter Block:

Anything, any thoughts Deborah Puntenney about this conversation, or things, last thoughts you'd like to leave us with?

 

Deborah Puntenney:

Again, I want to compliment the Greater Rochester Health Foundation for its innovative thinking in both designing and supporting this work. And if there are any other foundations on board, I want to encourage you to try something similar.

 

Peter Block:

Exactly. All right, thank you so much, Deborah. Maggie, why don't we bring it to a close?

 

Maggie Rogers:

Sure. This was really wonderful. Thank you so much Deborah Puntenney. Thank you for taking the time out today to be with us. And to our listeners and those who were active in the chat and to Tony for giving us a call. And the website has been put on the chat, I'll repeat it, Deborah Puntenney's website is www.dpuntenney.com. And a recording of this call will be on our website later on today or tomorrow.

 

 

Our next conversation will be on Tuesday, July 25. We'll be joined by Cormac Russell. Cormac has also worked with John for a number of years, and has worked in over 30 countries around the world training in ABCD and other strength-based approaches. So that'll be an interesting conversation. Until then, please visit our website www.abundantcommunity.com and stay in touch with us on the web and on Facebook.