Spring 2001

The Urban Health Initiative is about children, so half-way into its eight year implementation phase, maybe it's fair to ask as a child on a long trip would: "Are we there yet?" If "there" is true systems change, the answer, seems to be, "We're well on the way."

One of the hallmarks of the UHI is its emphasis on systems change. Systems change is a complex concept, and the five local UHI campaigns spent much time in previous years wrestling with it. They were trying to find common understanding of it among their leadership and scrutinizing their activities to determine if these were more appropriate for service providers rather than an organization seeking systemic change.

Now, many close to the UHI believe that the local campaigns have reached a new level. After a period of hard work, data gathering, coalition building, some leadership changes, but general awkwardness in articulating what the UHI is all about, the idea of systems change has taken hold, and each local campaign is now geared to achieve it.

Systems change, simply described, is getting best practices or innovative ideas accepted and then generating or redirecting the resources needed to support them for the long term. Systems change involves using money differently, changing how work is done, or a combination. It is usually achieved through legislation or other policy rulings; regulations or other administrative rules; litigation; retraining; changing performance evaluation measures; and/or indispensable and visionary leadership.

Local UHI campaigns are now, according to some observers, in full systems change mode. Local and state policy changes vital to implementing strategies are being identified. A study commissioned by the UHI's national program office last year pinpointed potential sources vital to bringing the strategies to scale, or implemented city or region-wide. Local UHI campaigns have or are developing strategic plans to secure those policy changes and dollars, which in many cases run into the tens of millions of dollars.

The campaigns are "no longer pie in the sky, they're driven by systemic approach," says Dr. Judy Palfrey, chief of the division of general pediatrics at Children's Hospital, Boston and a member of the UHI National Advisory Committee (NAC). "Everything being done is data-driven and accountable, and that is attracting serious attention from government, business, large youth-serving systems and others."

George Latimer, distinguished visiting professor of urban studies at Macalester College and NAC member, agrees. "This isn't just a pat on the back; there's been substantive, methodological scaling up in each campaign."

Jim Dunn, president of the Greater Richmond Chamber of Commerce, lead agency for Youth Matters, the Richmond area's local UHI campaign, can easily sense the "then and now" differences with the initiative.

"We started looking at everything, and had a great deal of frustration about the number of problems and possible solutions," Dunn says. "There was no common agreement on a solution or even a series of solutions."

Now, Dunn says that after a great deal of research and data gathering, "There's been a sigh of relief. We have agreement on what we want to address, the solution that we believe will have the most impact and, importantly, how to measure progress. Our partners are making the necessary commitments to make changes."

Naomi Post, executive director of Philadelphia Safe and Sound, one of the local UHI campaigns, notes that her campaign's activities and contacts has evolved significantly. "Previously, our work was primarily community-level engagement, as it was very important to gather information on needs," she says. "But now our discussions are with those who can meet those needs, the people who control tremendous public and private resources for kids."

Examples of systems change-thinking can be found in all UHI campaigns: Grenae Dudley, executive director of Detroit's The Youth Connection, recently asked policy makers to allow counties to use their local share of Child Care Fund dollars (and other private and public funds) to leverage federal Child Care Development Block Grant funds. Youth Matters' strategies were adopted by the Greater Richmond Chamber of Commerce as one of its top public policy priorities. Oakland's Safe Passages' board now includes the heads of virtually every major system (schools, health, juvenile justice, etc.). Baltimore's Safe and Sound Campaign has raised or redirected $77 million dollars for its strategies. Philadelphia Safe and Sound has leveraged $68.5 million.

The amount of leveraged money - a total of _____ so far from the five local campaigns - is one strong indication that systems change thinking is taking hold, according to NAC member Larry Brown, professor in the Division of Health Policy and Management at Columbia University. "This is a tangible, measurable indicator that things are moving in the right direction," he says.

Two issues appear to be key to reaching this new way of thinking and working: leadership and a dogged-determination to be guided by data.

"The five executive directors of the local campaigns are well-trained, articulate, focused and have an energy about them that sweeps you away," says Palfrey.

Latimer adds, "Each site has retained rare people, those who both work hard on their objectives and never lose the ability to criticize their work. And these are some of the most data-informed efforts I've ever seen. The sites are better today due in large measure to crunching numbers."

According to, "There's all sorts of conventional wisdom with regard to 'what works' that often turns out to be wrong. The UHI's emphasis on using good data has helped it distinguish more promising from less promising strategies."

Latimer also adds a note of caution. He believes the collaboration among disparate youth-serving systems is taking hundreds of hours on the part of the UHI campaigns to facilitate and maintain. "Nirvana would be to have collaboration that is active but less dependent on the large amount of time spend making sure various departments continue to talk to each other and to keep the data flowing," says the former St. Paul mayor. "For example, if we could get welfare and education dollars integrated and useable at the local levels, rather than in silos, that'd be great. We don't have that anywhere in the U.S., but the UHI is on the road."