AJPH PRACTICE

Communities of Color Creating Healthy

Environments to Combat Childhood Obesity
Andrew M. Subica, PhD, Cheryl T. Grills, PhD, Jason A. Douglas, PhD, and Sandra Villanueva, PhD

Ethnic and racial health disparities present an enduring challenge to community-based that dysregulates physiological systems and
health promotion, which rarely targets their underlying population-level determinants contributes to disease pathology.11
(e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens pre- Collectively, population- and individual-
scription for using community organizing to treat these determinants in communities level health determinants increase disease
of color based on the Robert Wood Johnson Foundation’s Communities Creating burden in communities of color, requiring
community-based health promotion
Healthy Environments initiative, the first national project to combat childhood obesity
approaches that systematically involve
in communities of color using community organizing strategies. The lenses—Social
community stakeholders to develop envi-
Justice, Culture–Place, and Organizational Capacity–Organizing Approach—assist
ronmental and behavioral-based solutions
health professional–community partnerships in planning and evaluating community
to modify population and individual de-
organizing–based health promotion programs. These programs activate community terminants of health.3,12,13 These ap-
stakeholders to alter their community’s disease-causing, population-level determinants proaches are traditionally initiated by public
through grassroots policy advocacy, potentially reducing health disparities affecting health entities (e.g., local health de-
communities of color. (Am J Public Health. 2016;106:79–86. doi:10.2105/AJPH.2015. partments) that mobilize stakeholders to
302887) support multicomponent programs com-
posed of established treatments14 (e.g.,
behavioral, screening, educational) that

C ommunity organizing is an understudied

public health approach for reducing
ethnic and racial health disparities1,2 that is
designed to empower low-income commu-
nities of color to promote community health
by improving local policies and environ-
ments.3 However, minimal literature exists to
guide health professionals and their com-
munity partners in conducting effective,
community organizing–based health pro-
motion in communities of color. We address
this literature gap by presenting a 3-lens
prescription for framing and evaluating cul-
turally responsive, community organizing–
based health promotion derived from the
Robert Wood Johnson Foundation’s
(RWJF) Communities Creating Healthy
Environments (CCHE) initiative, the first
national program to apply community or-
ganizing to address the population-level
determinants of childhood obesity in com-
munities of color.
For individuals living in communities of
color, health disparities are strongly associ-
ated with inequalities in the social and built
environment (e.g., the overburden of
poverty, incarceration, poor-performing
schools, and neighborhood blight) that
contribute to the unequal distribution of
health protective resources (e.g., knowl-
edge, money, power, health care).4,5 These
inequalities, in turn, affect both population-
intervene across multiple levels of influence
(i.e., population, individual) to increase
overall treatment potency.15
and individual-level health determinants,6,7 Evidence suggests that community-based
limiting both community capacity8 and in- programs implementing environmental and
dividuals’ ability to make healthy personal policy interventions to stimulate healthier
choices.9 Specifically, population-level behavior can reduce health-related risk
health determinants consist of community factors and, possibly, disease prevalence.
and neighborhood contextual factors such These programs have led to improved
as ethnicity, education, unemployment, population-level health, including (1) reduced
problems in the built environment (e.g., alcohol-relatedharms by limitingalcoholaccess
poor access to healthy food, potable water, via legislative bans, increased excise taxes,
housing, and recreational spaces), and broad government monopolization of alcohol sales,
public policies that create inequitable social and control of alcohol-outlet density14,16–18;
conditions (i.e., structural inequities).7,10 (2) decreased tobacco use and secondhand
Individual-level health determinants— smoke exposure through litigation and
consisting of personal health behaviors adoption of smoke-free policies19–21; (3) en-
and risk factors—are also affected by struc- hanced skin protective behaviors through
tural inequities, which precipitate increased public provision of sunscreen and shade, and
allostatic load5,7—the cumulative biological awareness–educational interventions in pri-
stress response to environmental demands mary school, recreational, and tourism
ABOUT THE AUTHORS
Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside.
Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola
Marymount University, Los Angeles, CA.
Correspondence should be sent to Cheryl T. Grills, PhD, Loyola Marymount University, University Hall, 1 LMU Dr, Suite
4753, Los Angeles, CA (e-mail: cgrills@lmu.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
This article was accepted August 23, 2015.
doi: 10.2105/AJPH.2015.302887

January 2016, Vol 106, No. 1 AJPH Subica et al. Peer Reviewed Perspectives From the Social Sciences 79
AJPH PRACTICE
settings22; and (4) increased physical activity
through community and street-scale changes
to urban environments such as increased bi-
cycle paths, safe passages to parks, and street-
lighting.23,24 Yet, despite these promising
health improvements, data are mixed re-
garding their sustainability.25
This may be partially because changes in
population-level health outcomes caused by
modifying social conditions26,27 take longer
to achieve than the lifespan of most health
professional–community partnerships28; as
a result, community stakeholders must sustain
progress by continuing health promotion
activities once program funding ends.7 Pre-
vious community-based programs frequently
placed stakeholders in advisory rather than
active roles, while health professionals de-
termined the problem and intervention
strategy before seeking community input
and support.7,14,28 This approach has occa-
sionally yielded positive short-term
population-level health change. To accom-
plish long-term health improvement in
communities of color, however, we propose
that health promotion should utilize the
principles and practices of community orga-
nizing by (1) having issues and strategies
emerge from community stakeholders to
ensure cultural responsiveness and accept-
ability, (2) acknowledging and building on
existing community strengths, and (3) in-
creasing residents’ and grassroots organiza-
tions’ capacity to address population-level
health determinants through popular educa-
tion, leadership development, and policy
advocacy.1,2,29,30
COMMUNITY ORGANIZING
AROUND ETHNIC AND RACIAL
DISPARITIES
The goal of community organizing–
based health promotion is to strengthen
community participation, empowerment,
and action in accordance with the
prevailing public health understanding that
the social and built environments in which
people live, work, and play have a profound
impact on their health.31 This approach
views community health as a community
responsibility in the form of healthier public
policies and social and built environments,32
while recognizing the importance of
80 Perspectives From the Social Sciences Peer Reviewed
individual responsibility in the form of
healthier personal choices.
In the public health context, we define
community organizing as grassroots move-
ments that empower and mobilize
individuals to act in their own collective
self-interest to address community health
problems by altering the balance of power,
resource distribution, and policy decision-
making in their environments. Thus,
community groups are united to identify,
nurture, and realize their shared health-
related values, interests, and goals.30
Community organizing is based on strengths,
in that the foundation for collective community
action and increased resident participation
in decision-making affecting their local
institutions and environments33 is grounded
in the community’s networks, strengths, and
values, and in individuals’ emotional and
historical ties to their communities.
Effective community organizing cam-
paigns are designed through careful analysis of
the local cultural, health, economic, and
political landscape—including relevant
power dynamics—and are geared toward
executing key sets of organizing strategies
(e.g., developing objectives, community
outreach, coalition building, direct actions)
and cultivating leaders to direct organizing
campaigns within traditionally disempowered
communities.30,34 As proposed by Paulo
Freire,29 enhanced community and leader
“critical consciousness” (i.e., awareness of the
structural causes of poor community health
gained through personal experience, popular
education, and collective dialogue) is essential
for determining a successful course of ac-
tion.30,35,36 These campaigns (1) lead to
empowered community members equipped
with greater self-efficacy, meaningful pur-
posiveness, and cognitive restructuring to-
ward civic responsibility,37,38 and (2) instruct
community members in the art (e.g., re-
lationship building, intuitiveness, passion) and
science (e.g., planning, analysis, research)
of community organizing39 to pressure
decision-makers to transform ineffective
policies restricting equitable access to health
protective resources.10,40–44
Although community organizing is an
empirically supported strategy for social
change,45,46 its systematic use in public health
has rarely been documented.47 Previous
programs such as the Communities
Subica et al.
Mobilizing for Change on Alcohol and the
Central Costa Health Services’ Healthy
Neighborhoods projects, which either hired
part-time organizers or trained residents to
become organizers, have generally reported
positive environmental outcomes, including
decreased youth alcohol consumption and
alcohol-related arrests, creation of a community
health center, and enhanced neighborhood
safety via speed bumps and street lighting.26,48–50
Although these early program findings are
encouraging, traditional power structures
(i.e., academics and health professionals) ini-
tiated and managed community participation.
In the CCHE initiative, by contrast, com-
munity stakeholders conceptualized and
governed all facets of grassroots health pro-
motion, including intervention targets, orga-
nizing strategies, and policy campaigns;
academics, health professionals, and the RWJF
adopted support roles as advisors, evaluators,
and technical assistance providers.
THE COMMUNITIES CREATING
HEALTHY ENVIRONMENTS
INITIATIVE
The CCHE initiative sought to combat the
obesity epidemic among children of color50–52
living in social conditions rife with multiple
obesity-causing risk factors.10 Such factors,
which preclude children’s healthy behavioral
choices,9 include low-income status, over-
consumption of calorie-dense, nutrient-poor
food and drinks, lack of recreational spaces
limiting physical activity, and poor health care
access.53–61 The initiative targeted 2 primary
obesity-causing population-level risk factors
through community organizing: food insecurity
and physical inactivity. Food insecurity is re-
duced access to affordable, nutritious, cultur-
ally appropriate food caused by structural
inequities.62,63 Combined with income dep-
rivation64–68 and the targeted marketing of
unhealthy foods toward people of color,69 it
has been repeatedly shown to be a principal
obesity driver in the nutritional habits of
children of color.70,71 Children’s physical
inactivity or sedentary activity (e.g., television
watching) is heavily influenced by environ-
mental barriers common in communities
of color; these include poorly built,
underresourced, or closed parks, playgrounds,
and recreational facilities; inadequate public
AJPH January 2016, Vol 106, No. 1

transportation and street lighting; lack of wide
sidewalks and bicycle lanes; and crime
and safety concerns.31,68,72 Physical inactivity
has also been closely linked to childhood
obesity.73–76
Framing of the CCHE initiative toward
these risk factors began in 2006, when the
Praxis Project—a national, nonprofit in-
stitution of color supporting local, regional,
and national community organizing
movements—noted growing interest among
grassroots organizations to lead local food and
recreational movements linking community
health with human and civil rights.77 In light
of this community interest, the RWJF funded
the CCHE initiative to address the glaring
lack of affordable healthy foods and access to
safe places where children could be physically
active.78–80 In 2008, the Praxis Project con-
vened a National Advisory Committee of 15
renowned academics and community orga-
nizers with expertise in food, public health,
parks and recreation, and criminal justice
policy development to help steer the initia-
tive. This leadership team instituted a com-
munity organizing–based approach to
recruiting that resulted in approximately 300
and 600 applications received in 2009 and
2010, respectively. This approach consisted of
(1) outreach (e.g., multilingual informational
sessions) to networks of grassroots organiza-
tions, indicating that CCHE would fund
nontraditional applicants not typically com-
petitive for national grant initiatives; and (2)
technical assistance, including grant-writing
support.77 Twenty-two grassroots organiza-
tions or federally funded tribal nations
(i.e., “grantees”) serving African American,
Hispanic, Asian American, or American
Indian/Alaska Native communities received
3-year grants to grow their communities’
capacity to advocate for childhood
obesity-related policy, systems, and envi-
ronmental changes. Two cohorts of grantees
implemented their policy change strategies
between 2010 and 2012 (cohort 1; 11
grantees) and 2011 and 2013 (cohort 2; 11
grantees).
With support from the Praxis Project,
the RWJF, and Strategic Concepts in
Organizing and Policy Education (SCOPE;
technical assistance partner), grantees
applied their deep knowledge of their
communities’ social environments
(e.g., ethnocultural demographics, racial
January 2016, Vol 106, No. 1 AJPH
and political histories, power dynamics) and
organizing expertise to
1. identify priority food and recreational
issues in targeted communities,
2. formulate and launch grassroots health
promotion targeting policy change
around these issues,
3. develop community leaders and relation-
ships with like-minded organizations,
4. build and mobilize their resident base to
advocate to decision-makers, and
5. win administrative and legislative changes
regarding these issues.
By anchoring their health promotion ef-
forts for policy change in the culture, history,
and political dynamics of their target com-
munities, grantees ultimately obtained more
than 70 policy wins across 21 communities of
color, making it the first documented national
public health initiative to successfully use
community organizing to alter the underlying
social conditions driving childhood obesity in
communities of color.81
THE 3 LENSES FOR HEALTH
PROMOTION
We introduce and outline an innovative
3-lens CCHE prescription—Social Justice,
Culture–Place, and Organizational Capacity–
Organizing Approach—for planning and
evaluating culturally responsive, community
organizing–based health promotion (Figure 1),
an approach lacking established guidelines
and evidence-based practices.12,31 The lenses
are grounded in the Freirian model, which
emphasizes critical reflection and dialogue of
the structural causes of a social problem from
the community’s perspective before in-
tervention.29 Applying these lenses therefore
requires that program development and
implementation be led by grassroots organi-
zations belonging to the affected community’s
social fabric, rather than by health professionals.
This approach provides programs with the
necessary contextual grounding and commu-
nity access to effectively treat the local,
structural causes of the target health problem.
Development of the 3-lens prescription
involved a community-based participatory
research process82 in which the study authors,
who possessed community psychology and
grassroots program evaluation expertise,
Subica et al.
AJPH PRACTICE
consulted extensively via in-person, tele-
phone, and electronic mail presentations and
communications with the Praxis Project, the
National Advisory Committee, and SCOPE
to select and define the lenses as part of
a broader CCHE change model and eval-
uation frame.81 These lenses provided an
analytic tool to measure and interpret the
diverse processes, outcomes, and impact of
the CCHE programs by revealing how (1)
grantees’ social justice values affected their
programs throughout the change process,
(2) target communities’ culture- and
place-based dynamics influenced grantees’
intervention strategies (i.e., organizing
campaigns), and (3) selected intervention
strategies—influenced by grantees’
organizational capacity and organizing
approach—affected program benchmarks,
intermediate outcomes, and policy
achievements. Furthermore, in using the
lenses to analyze each program’s processes
and outcomes, it became evident that
the lenses could also guide future program
development by indicating key health-
oriented policy targets and intervention
strategies. The following sections describe
the 3 lenses for community organizing–
based health promotion and provide
examples of their implementation in
the CCHE initiative.
Social Justice Lens
The first CCHE lens, Social Justice, refers
to the understanding that all people should
be treated fairly, have equal access to goods
and resources, and have the right to self-
determination and cultural expression. This
lens prompts program developers to ground
their interventions in the particular social
justice perspective of the grassroots organi-
zation spearheading health promotion. For
example, an organization possessing a place
and infrastructure justice perspective
(i.e., improving community health requires
targeting structural inequities in the built
environment) may view the target health
problem as a consequence of the lack of safe
recreational spaces for physical activity. Such
a lack may result from limited media, po-
litical, or economic attention to the recre-
ational and health needs of community
residents. Consequently, health promotion
would not prioritize changing residents’
health behaviors but instead emphasize
Peer Reviewed Perspectives From the Social Sciences 81
AJPH PRACTICE

Community-based cultural Community partner’s

needs, barriers, and available resources to
facilitators to implementing effectively implement
policy interventions interventions

O r Ca
ga pa

CULTURALLY RESPONSIVE
Po oot

POLICY INTERVENTIONS
n i cit
lic Ca
(R

HEALTH PROMOTION
yT u

Cu

za y
ar ses

tio
ltu
ge )
CHILDHOOD

ts
List of

na
re
OBESITY

Social

l
Culturally
Justice Informed
Interventions

ns l
tio tia

oa g
en en

pr izin
e
rv ot

ch
c
te P

Ap gan
Pla
In t of
Lis

Identifies structural causes
(policy targets) of target
public health
problem/disparity using
community partner’s social
justice perspective
Or
Physical, historical, Community partner’s
economic, and political preferred community
context of the target organizing strategies suited
community that impacts for characteristics/needs of
intervention effectiveness target community and the
health promotion program’s
parameters

FIGURE 1—Lens Protocol for Designing Community Organizing–Based Health Promotion Programs: Communities Creating Healthy
Environments

building residents’ sustained power to ad-
vocate for equitable allocation of recrea-
tional resources (e.g., recreational
programming, enforcement, and security in
parks) using media, community engage-
ment, and leadership-training interventions.
These interventions could complement
more traditional health interventions (e.g.,
exercise prescriptions, health education) and
built-environment interventions (e.g.,
walking trails, playgrounds) to address the
community’s immediate and long-term
recreational needs.
Different social justice perspectives (Table 1)
often emphasize different structural causes
of health disparities. Therefore, it is impera-
tive that grassroots organizations, which
possess the greatest understanding of their
communities’ needs, guide decision-making
about appropriate intervention targets. By
crafting their interventions around grassroots
organizations’ social justice perspectives,
programs will appropriately target the prin-
cipal social and environmental conditions
underlying the target health problem,
thereby strengthening community buy-in,
engagement, and program success. After
identifying the structural causes of the health
problem using the Social Justice lens, in-
terventions must be fitted to the specific
community context via the Culture–Place
lens.
Culture–Place Lens
In community organizing, the character-
istics and scope of the target community must
be delineated.20,24 The Culture–Place lens
cues programs to define the target com-
munity’s culture (i.e., the total way of life of
a people, including values, rituals, patterns
of thinking, and group identity) and place
characteristics (i.e., local geographic envi-
ronment situated within its cultural, histori-
cal, economic, and political context).
Specifically, intervention strategies are made
realistic and culturally responsive by con-
textualizing them in the (1) varied health
needs of, and interactions between, the
community’s affected ethnocultural groups
(culture); and (2) geographic, political,
and social contexts of the community’s
built environment (place; e.g., geographic
distribution, political climate, recreational
accessibility). For example, shaping culturally
and geographically responsive cancer pre-
vention interventions for Alaska Natives in
a tribal community requires analyzing the
following culture–place elements: (1) eth-
nocultural composition (e.g., exclusively
Alaska Native or combined Alaska Native and
nonnative populations), (2) cultural impact on
health behaviors (e.g., Alaska Native tradi-
tional beliefs about cancer-suppressing
screening rates), (3) geographic distribution
(e.g., 1 tribal group vs a nation of 5 dispersed
tribal groups), and (4) historical place-based
influences contributing to elevated commu-
nity cancer rates (e.g., excision from tribal
homelands to areas with underdeveloped
health facilities).
By addressing the previously diagnosed
structural cause of a community’s target
health problem, the Culture–Place lens
grounds organizing interventions in
a community’s culture- and place-based
characteristics to ensure they are culturally,
historically, politically, and geographically
responsive. The succeeding lens finalizes the
program intervention strategy by analyzing
the community-based organization’s

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 AJPH PRACTICE

TABLE 1—Primary Social Justice Perspectives of Grassroots Organizations in the United States

Lens Social Justice Targets for Organizing Resultant Ethnic and Racial Health–Social Disparity
Civil and human rights justice Discrimination,a immigrant and refugee rights, lesbian, gay, Restricts social mobility, suppressing income and ability to meet
bisexual, and transgender rights basic health needs
a
Climate, energy, and environment justice Toxic waste exposure, access to clean air, water, and soil Results in elevated rates of chronic medical conditions
(e.g., asthma, cancer)
a
Economic justice—business Unfair business practices in service, manufacturing, agriculture, Closes small businesses selling healthy cultural foods to make way
and banking and financial sectors for large corporations, creating food deserts and unhealthy
nutritional habits
Economic justice—labor Living wages,a jobs, working conditions, job security and benefits, Low income suppresses ability to meet basic health needs
advancement
Education and learning justice Education and teacher quality,a equitable funding and facilities, Poor education quality and opportunities suppress income and
restorative justice ability to meet basic health needs
Food justice Healthy, affordable food access,a genetically modified organisms, Poor diet and resulting obesity lead to chronic medical conditions
community gardens (e.g., diabetes, cardiovascular and cerebrovascular disease)
a
Government justice Prison industrial complex, juvenile justice, voting High incarceration rates of people of color create single-parent
households with limited ability to meet children’s basic health
needs
Health justice Health care system—policies and equitable services and Results in untreated chronic medical conditions (e.g., cancer,
resources,a health coverage cardiovascular disease)
Place and infrastructure justice Recreation access,a community development, land use, Physical inactivity causes obesity, which leads to chronic medical
transportation, affordable housing, gentrification conditions (e.g., metabolic disorders, diabetes, cardiovascular
disease)
a
The resultant ethnic and racial health disparity refers to these social justice targets.

organizational capacity and organizing
approach.
Organizational Capacity–
Organizing Approach Lens
The Organizational Capacity–Organizing
Approach lens matches the culture- and
place-grounded organizing interventions
with the practical strengths, limitations, and
interests of the grassroots organization
implementing them. “Organizational capac-
ity” refers to the human, physical, financial,
political, and information resources of an
organization to accomplish program in-
terventions. “Organizing approach” refers to
the organization’s preferred community or-
ganizing strategies (e.g., leadership develop-
ment, direct actions and protests, strategic
mapping, action research) and their alignment
with the intended health promotion param-
eters and goals (e.g., project scope, budget).
Performing an Organizational Capacity
lens analysis reveals the organization’s avail-
able resources to perform interventions
grounded in the Culture–Place lens (e.g.,
growing leader base, mobilizing community
base, reframing policy messaging); those ex-
ceeding the organization’s capacity must be
modified or eliminated. For instance, policy
interventions targeting large geographic ter-
ritories (e.g., state vs district) must be scaled
down if community partners possess small or
less-experienced staff, or a limited number of
strategic allies. Finally, the Organizing Ap-
proach lens analysis determines which
remaining interventions align with both
the organization’s values, interests, and
expertise—to ensure interventions are
enacted with the organization’s will and
enthusiasm—and the initiative’s scope,
budget, and desired health outcomes,
leading to the final intervention strategy.
Lenses Overview
To review, the Social Justice lens isolates
the structural causes of the target health dis-
parity. The Culture–Place lens identifies
culturally and geographically meaningful and
responsive interventions to address these
structural causes. The Organizational
Capacity–Organizing Approach lens
pinpoints the most efficacious overall
intervention strategy on the basis of a
participatory analysis of the grassroots
organization’s capacity and interest in
executing the culture- and place-grounded
interventions within initiative parameters.
COMMUNITIES CREATING
HEALTHY ENVIRONMENTS
GRANTEE IMPLEMENTATION
To demonstrate the 3-lens prescription
applied to real-world community organizing–
based health promotion programs, we discuss
case examples of 2 CCHE grantees.
Southwest Organizing Project
The Southwest Organizing Project
(SWOP), a CCHE program in Albuquerque,
New Mexico, is the city’s oldest, largest, and
most successful grassroots association orga-
nizing low-income families to advocate for
healthy, sustainable social environments. The
program is a case example of food justice–
oriented health promotion. SWOP applied
a food justice perspective to determine that the

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AJPH PRACTICE
structural cause of Albuquerque’s childhood
obesity problem was children’s limited access to
affordable, locally grown, healthy foods (due to
lost cultural farming and gardening practices)
and the exclusion of fresh produce from school
meals. Accordingly, SWOP directed its CCHE
program toward restoring children’s and par-
ents’ cultural gardening practices (i.e., having
them grow food and reconnect with the land)
by transitioning vacant city properties to urban
community gardens, and integrating healthy
foods into school meals.
The Culture lens analysis indicated that
potential organizing interventions to increase
children’s healthy food access should be tai-
lored to the cultural demographics of SWOP’s
2 target communities: (1) Albuquerque’s
Hispanic population and (2) the Albuquerque
International District’s blended Hispanic and
American Indian populations. The Place lens
analysis further revealed that (1) traditional
Hispanic and American Indian farming and
gardening interventions would generate In-
ternational District support given its historical
farming culture, (2) the transient, pre-
dominantly immigrant International District
population would necessitate short-term
multilingual interventions, and (3) policy in-
terventions to increase healthy school lunches
throughout Albuquerque should target the
state legislature (rather than the Albuquerque
city council or school district) because of strong
support from several state legislators.
The Organizational Capacity lens analysis
revealed SWOP’s capacity as (1) 10 adult and
3 youth leaders, (2) key alliances with 3
community organizations, (3) established city
and state council relationships, and (4) limited
school decision-maker relationships. Finally,
the Organizing Approach lens analysis, which
matched SWOP’s identified organizational
capacity and expertise in utilizing food justice
organizing approaches with the 3-year
CCHE funding, illuminated how and why
SWOP elected to use the following in-
terventions to address childhood obesity: (1)
build its parent and youth leader bases by
launching an urban community garden on
city-owned property and instituting on-site
parent leader trainings and a youth leader
apprenticeship program, (2) build its resident
base by conducting community outreach
(e.g., workshops, door knocking, social
media) to educate residents in cultural
farming, gardening, and healthy eating
84 Perspectives From the Social Sciences Peer Reviewed
practices and policies, (3) build its ally base by
forging new alliances with key stakeholders
(school decision-makers, community-based
organizations), and (4) mobilize the
resident, leader, and ally bases to advocate to
the state legislature for healthier school
lunches. These interventions culminated in
a $1.44 million appropriations bill for public
schools to purchase locally grown produce
being included in the New Mexico
governor’s 2014 state fiscal budget.
Safe Streets/Strong Communities
The CCHE program Safe Streets/Strong
Communities (SSSC) is an example of recre-
ational justice-oriented health promotion. It is
a grassroots organization in New Orleans,
Louisiana, historically successful at campaigning
to redistribute public resources away from
policing and incarceration toward community
resources and recreational opportunities. To
develop this program, SSSC used a place and
infrastructure justice perspective, which in-
dicated that increasing recreational opportu-
nities for children and youths of color could
reduce childhood obesity.
A Culture lens analysis revealed that, given
SSSC’s prior success at organizing low-
income African American residents, the ideal
program target would be the historically
disinvested, predominantly African American
9th, 10th, and 15th wards. A Place lens
analysis revealed that (1) after Hurricane
Katrina, these wards received the lowest levels
of environmental pollution cleanup in the
city, rendering local parks critically under-
resourced, unsafe, or unusable; (2) the re-
building process failed to equip these wards
with adequate health resources, including
restored parks and recreational facilities; and
(3) the recently formed policies of the New
Orleans Recreation Development Commis-
sion (NORDC)—responsible for allocating
public recreation and private endowment
funds throughout the city—had created
a closed decision-making process, resourced
only 15 of 146 city parks, and resulted in ward
residents being charged more to participate in
recreational programming than higher-income
community residents. This data supported
SSSC’s decision to direct its CCHE health
promotion toward advocating for more equi-
table NORDC policies for the target wards.
An Organizational Capacity lens analysis
identified SSSC’s capacity as (1) 15 adult and 3
Subica et al.
youth leaders, (2) established partnerships
with 15 community organizations, and (3)
low support for recreational justice issues from
elected officials, including the mayor, deputy
mayor, and city councilman at large. An
Organizing Approach lens analysis indicated
that SSSC’s expertise lay in organizing residents
of color and that, because of CCHE’s 3-year
funding, interventions should focus on building
residents’ capacity to advocate for change be-
yond this term. The combined findings of these
2 analyses illuminate why SSSC employed the
following CCHE interventions: (1) build its
adult and youth leader bases by conducting
adult leadership development–political educa-
tion trainings hosted by SSSC and allied or-
ganizations, and school-based leadership
trainings and summer intern programs for
youths; (2) build its resident base through
community outreach that reframed recreational
justice as affecting other community priorities
such as improving community health, lowering
crime, and reducing incarceration of African
American males; (3) solidify its ally base by
leading the formation of a recreational justice
coalition that hosted community rallies and
generated significant public presence at
NORDC meetings; and (4) assemble residents,
leaders, and coalition members to advocate at
NORDC meetings for increased recreation
equity. These efforts eventually led the
NORDC to agree to form a community ad-
visory board as well as to rely on SSSC for
guidance on recreational issues.
CONCLUSIONS
Using the 3-lens prescription allows health
professionals to support grassroots organiza-
tions and community partners in developing
community organizing–based health pro-
motion in communities of color. On the basis
of CCHE grantee experiences, 3 conclusions
can be drawn. First, applying the lenses re-
quires health professionals to be open to (1)
addressing health disparities in communities
of color by targeting its structural causes in lieu
of, or in addition to, individual health be-
haviors; (2) empowering community-based
organizations to lead program planning and
operations; and (3) targeting seemingly
non-health–related issues (e.g., gentrification
displacing low-income residents and small
businesses selling cultural foods) to effect
health change. Second, funding streams from
AJPH January 2016, Vol 106, No. 1

governmental entities and nonprofit foun-
dations cannot be used to lobby elected of-
ficials for policy changes. As a precaution,
CCHE grantees’ lobbying activities were
evaluated quarterly to ensure that they either
(1) advocated exclusively to government de-
partments and agencies (e.g., school districts,
zoning commissions, parks and recreation de-
partments) and not to elected officials or (2)
used non-CCHE funds to reach elected offi-
cials. Third, programs benefit from being
flexible in focus, scope, and organizing
approach, as unforeseen community changes
(e.g., election or appointment of new decision-
makers, natural disasters, concurrent local
social or racial movements) are common
and can hinder rigid programs or bolster
agile ones.
Transitioning from conventional
community-based health promotion strate-
gies that engage communities but remain
orchestrated by health professionals to com-
munity organizing–based health promotion
empowers communities of color to take di-
rect, long-term action against the unequal
social and environmental conditions un-
derlying ethnic and racial health dispar-
ities.1,2,5,6,10,27 Health professionals also
benefit from being a co-journeyer in the
grassroots health promotion process, thus
gaining a deepened understanding of the
trajectory and contextual realities of health
disparities from the community’s perspective.
In conclusion, the 3-lens prescription for
shaping and evaluating health promotion in
communities of color provides health pro-
fessionals with a viable tool for partnering
with community stakeholders to utilize
community organizing practices that chal-
lenge the structural causes of public health
problems,10,27 potentially advancing com-
munity health and well-being through en-
vironmental and policy change.60,83,84
CONTRIBUTORS
A. M. Subica wrote the first draft of the article. A. M.
Subica, C. T. Grills, and J. A. Douglas conceptualized
the study. C. T. Grills and S. Villanueva designed the
original 3-lens evaluation tool. All authors contributed to
and approved the final article.
ACKNOWLEDGMENTS
We sincerely thank the Robert Wood Johnson Founda-
tion for providing funding for the Communities
Creating Healthy Environments initiative and for the
Communities Creating Healthy Environments grantees,
which made this study possible.
January 2016, Vol 106, No. 1 AJPH
We also thank Glenn Reyes, Brittani Hudson, and
Michael Lebsack-Coleman for their efforts in processing
study data. Finally, we extend deep appreciation to Makani
Themba-Nixon and Ditra Edwards of the Praxis Project
for helping us to interpret study data.
HUMAN PARTICIPANT PROTECTION
Protocol approval for the overall program evaluation of the
Communities Creating Healthy Environments project
was obtained from Loyola Marymount University’s Com-
mittee for the Protection of Human Subjects. The present
study was classified as exempt from protocol approval because
no individual-level personal data were collected or used.
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