Identity: An unprecedented collaboration of change agents pursuing
an unprecedented result:
100 million people living healthier lives by 2020
Vision: to fundamentally transform the way we think and act to
improve health, wellbeing, and equity.
Equity is the “price of admission.”
Convened by the Institute for Healthcare Improvement as a partnership across
organizations.
100 Million Healthier Lives
www.100mlives.org
Approaching health equity
⚫ “Just and fair inclusion into a society in which all can
participate, prosper, and reach their full potential.
Unlocking the promise of the nation by unleashing the
promise in us all.” -Policy Link
⚫ 100 Million Healthier Lives approach: to ask and try to
answer open and honest questions:
“Who isn’t thriving? What would it take for that to change?
What is perpetuating poor health and life outcomes?”
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Theory of change – 100 Million Healthier Lives
Unprecedented collaboration
Innovative improvement
System transformation
100 Million People Living
Healthier Lives by 2020
A growing network: >1850 members in 30+ countries worldwide reaching >500 million people – come join us! www.100mlives.org/map
• 220+ communities on the journey
• 500+ health care organizations engaging
• 17 states advancing equity
• 30 countries –members advancing change, some at the country level
Shared priorities
“Whats” “Hows”
⚫ Shift culture and mindset
⚫ Develop the health workforce
⚫ Build the capability of key sectors and youth to transform
health
⚫ Elevate peer to peer approaches
⚫ Build improvement capability at the community level
⚫ Use chronic diseases and risk factors to build the health
continuum
⚫ Improve high quality primary health care access for all
⚫ Integrate data across siloes
⚫ Create new financing strategies
⚫ Transform from a health care system to a health system
⚫ Close equity gaps (price of admission)• Transform neighborhoods of concentrated poverty to
communities of solutions
• Interrupt the school to prison and incarceration pipelines
⚫ Help veterans to thrive
⚫ Address and improve social determinants across the continuum
⚫ Improve well-being of indigenous communities
⚫ Help all kids have a great start to life and thrive from cradle to career
⚫ Make mental health everybody’s job and take a prevention approach
⚫ Engage people in their own health (nutrition, exercise, sleep, stress, food security)
⚫ Improve employee health and well-being
⚫ Create well-being in the elder years and end of life
6 core strategies + equity as the price of admission
Health, wellbeing and equity
People
Systems (society)
Places
1. Create healthy, equitable communities
2. Build bridges across sectors
3. Create a health care system that is good at health AND good at care
4. Promote peer-to-peer approaches and people-driven change
5. Create enabling conditions
6. Develop new mindsets
Working in Unprecedented Collaboration To Make
5 Key Shifts
1. From a “sick care system” to a “health and wellbeing system”
2. Take our work on equity from “doing good” to a recognition that we are
interconnected and cannot afford the price of poverty and inequity in terms of
health and life outcomes or cost
3. From people and communities of poverty to people and communities of trapped
and untapped potential
4. From pathology to vision – change is possible
5. From scarcity to abundance
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What Skills are needed to
Achieve a Community’s
Health, Wellbeing and
Equity Goals?
Changing our ways of thinking and acting to create
health, wellbeing and equity: Community of
Solutions skills
Leading from within
Leading together
Leading for outcomes
Leading for equity
Leading for sustainability
www.100mlives.org/initiatives
The Community of Solutions
Framework
Overall Content Theory
• Leading from within (LW)
• Leading together (LT)
• Leading for outcomes (LO)
• Leading with equity (LE)
• Leading for sustainability (LS)
Community of solutions skills
• How people relate to themselves, one another, and to those affected by inequity
• How the community approaches the change process
• How the community creates abundance
Community of solutions behaviors, processes, systems
• Health as a shared value
• Thriving cross-sector partnerships
• Healthy, equitable communities
• Improved population health, wellbeing and equity outcomes
Culture of health outcomes
Leading from Within
● Leading from Within (LW) skills involve one’s inner journey as a
leader, including the ability to:
• Know oneself and what brings one to leadership (including biases and
"growing edges")
• Reflect, “fail forward,” and change as needed
• See and commit oneself to unlocking the leadership of others, especially
those with lived experience of inequity
• Approach change from a place of abundance, even in the midst of
scarcity
• Value difference – Habits of the Heart: (Palmer P., 2000)
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Leading Together
● Leading Together (LT) skills are grounded in a perception of
the community as a dynamic network of interacting people,
organizations, structures, and systems that are related to a place.
It is necessary to lead together with others in a community to
create effective, equitable change. Elements of Leading Together
skills include:
• Developing trust, relationships, and interconnectedness
• Effective teamwork
• Collaboration (including integrating people with lived experience in your
work)
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Leading for Outcomes
● Leading for Outcomes (LO) skills support communities in
applying design skills to co-create a theory of change, identify
measures, test the theory, and plan for implementation and
scaling up in a way that makes these tasks easier.
• Innovation/Design Thinking – Using stories to understand the experience
of people affected by a change
• Improvement science – Developing aims, drivers, and measures, and
running tests of changes
• Implementation skills – Making implementation easier, more effective,
and more joyful
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Leading for Equity
● Leading for Equity (LE) skills apply Leading from Within,
Leading Together, and Leading for Outcomes skills through an
equity lens:
• Leading from Within – Understanding implicit bias, understanding power
and privilege
• Leading Together – Recognizing interconnectedness; everyone owning
the process of creating equity; fostering ownership and solutions by
people with lived experience; mapping assets to potential levers
• Leading for Outcomes – Using data to identify those who may not be
thriving; identifying potentially replicable bright spots; testing policy and
programmatic changes that have the potential to disrupt systems
perpetuating inequity – Equity Action Lab
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Leading for Sustainability
● Leading for Sustainability (LS) skills facilitate an ongoing
process of transformation in a community (generative
sustainability) as opposed to maintaining programs as they are.
Four key elements of sustainability are:
• Environmental sustainability – Stability of the physical, political, and
cultural environment
• Resource sustainability – Availability of intrinsic (will for change,
relationships) and extrinsic (financial, in-kind) resources needed to
maintain, spread, and scale changes
• People sustainability – Cultivation of change leaders in a community
• Change sustainability – Growth and sustainability of the change process.
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● SCALE Regions of Solutions - 18 communities spreading the “Community of Solutions” approach regionally to accelerate improvement in health, wellbeing and equity at the community and regional levels
● SCALE States of Solutions – 17 states working to build unprecedented collaboration, engage in innovative improvement, and system transformation to advance equity in a state
● SCALE Health & Care (Pathways to Population Health) – builds capacity of 500+ health care organizations to advance on the journey to population health
● Community Health Accelerators Initiative (CHAI) - an online training, coaching and support system that can help people, organizations and communities anywhere to develop core skills to advance improvement
● Generously funded by Robert Wood Johnson Foundation
17100MLives Capability Development Initiatives
100 Million Healthier Lives Measurement: Top Level
Whose Lives Are Getting Better Because We Are Here?
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Would they
agree?
If not, what will
we do
differently?
Valuing lived experience in measurement: People-reported
outcome measures (PROM) as measures for wellbeing
⚫ People-reported outcome measures are validated, objective outcome
measures of people’s perception of their health and wellbeing.
⚫ People’s self-perception of their health and wellbeing is as or more accurate
than anything else we have to predict long-term morbidity and mortality.
⚫ When combined with predicted life expectancy, the two serve as powerful
and objective drivers to improve health, wellbeing, and equity.
⚫ Recommended for global adoption by the Organisation for Economic Co-
operation and Development.
⚫ Recently adopted by the National Center for Vital and Health Statistics as
part of the Wellbeing in the Nation measurement framework
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A simple, powerful approach to outcome measures for
health and wellbeing20
Age
Sex
Race/Ethnicity
Education
Zip code
Veteran status
% people thriving
% people suffering
% people with hope
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Ph
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Common
Measures for
Adult Well-
being
4 subdomains:
mental,
physical,
social, spiritual
Measuring Equity Equitably
People
• Difference in health
and wellbeing
• Years of life gained
___________________
_
Places
• Safety
• Reincarceration
• Education
• Employment
• Racial segregation of
neighborhoods
Wellbeing Measurement
Community indicators related to what you are
working on
Wellbeing measured with an equity lens
Equity gaps in wellbeing closed
Hope
Years of life gained
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Downtown Women’s Center Results 24
Figure 1. % of people suffering
Figure 2. % of people thriving
Leading indicators:
84% improvement
in healthier lives
92% improved
blood pressure
44% improved diabetes control
Measure What Matters
⚫ A free, powerful platform
to help you measure and
create equitable
improvement
⚫ Co-designed with
communities.
⚫ Helps you find measures
that matter to you.
⚫ Helps you administer
questionnaires (like the
wellbeing questionnaire)
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Change Library http://changelibrary.100mlives.org/
5 tools for the road to make your path easier
1. Map of the Movement – Helps people to find collaborators
2. 100MLives approach to equitable measurement – Helps people to measure
what matters to them
3. Measure What Matters - Helps people measure, track, and share data
across sectors
4. Change Library - Makes it easy to see for people to find the bright spots,
stories and tools they need across organizations
5. Pathways to Population Health framework and website
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Thank you!
Contact Information:
Shannon Welch, MPH
Project Director, 100 Million Healthier Lives
www.100mlives.org
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