Frequently Asked Questions

Letters of commitment should be addressed to the lead partner organization. These letters are an expression of commitment to join the cross-sector team and must address the three questions outlined on page 6 of the RFP.

Every community is unique and may require different approaches to promote health equity. The Healthiest Cities & Counties Challenge focuses on public health and prevention approaches that are likely to be most effective in small to mid-sized cities and counties. As such, we have put boundaries around the size of participating communities in order to ensure limited funds are directed to promising strategies, peer-to-peer learning and high-quality technical assistance.

For the purposes of this project, "cities and counties" means incorporated places within a defined geographic area with an active local government. They may include: cities, counties, municipalities, and federally recognized tribes. The Challenge is limited to cross-sector initiatives that operate within individual cities and counties that have a population of up to 600,000. Smaller segments and neighborhoods of cities and counties with total populations over 600,000 are not eligible to participate in this opportunity, nor are multi-city or multi-county collaboratives. There is no minimum population size requirement.

Each proposal will be checked for completeness, and the answer to each proposal question will be scored, with the exception of Potential Challenges and Technical Assistance Needs. Please refer to the RFP for selection criteria. Some applicants my receive a phone call if additional information is needed during the review process.

Only the requested information will be reviewed. Additional attachments beyond letters of commitment and links to outside pages or videos will not be considered. References are not required and need not be attached.

Both. The applicant must identify a priority population(s) from within the city or county that is significantly impacted by health inequity and stands to benefit from the proposed project. In addition, because the goal of this project is to improve the health of the overall community through systems-level approaches, we expect interventions to address policies and/or systems that have the potential to benefit the entire city or county. As such, we welcome pilot projects that focus more deeply on the priority population(s) identified in parallel with the broader work of systems change.

For example, a county's project may focus broadly on food security work and policy change within the entire county but prioritize pilot action/activities in an area that is characterized as a food dessert with a population that experiences health disparities.

Cross-sector teams can be comprised of local government, nonprofit partners, businesses, academic institutions, community-based organizations, and others that are ready to accelerate systems-level approaches to improving community health and to support community engagement through authentic resident participation.

The lead partner organization can be a city or county government agency, federally recognized tribal leader, non-governmental organization (501c3s), academic institution, or other organization that can effectively engage with all of the relevant partners and is able to receive and disburse grant funding on behalf of the community. The lead partner organization cannot be a for-profit corporation. State or national-level organizations cannot apply as the lead partner for a community.

Access to foods that support healthy eating patterns is impeded by barriers that limit the accessibility and availability of these foods in some communities, according to the U.S. Department of Health and Human Services. Disparities in food access that support healthy eating patterns arise due to limited availability of transportation options and a lack of access to supermarkets. The cost of food is also a barrier for low-income communities. Lack of access to foods that support healthy eating patterns contributes to disparities in chronic disease outcomes, such as diabetes.

Examples of projects addressing access to foods that support healthy eating patterns at the systems level include those that address food policies and the food environment within a community. These strategies help increase access for all members of the community, rather than only those individuals being served by one particular organization. While systems-level food access projects should not focus on promoting individual behavior change, they should align with and complement existing behavior change efforts.

Access to health services has been defined by the U.S. Department of Health and Hyman Services as a social determinant of health connected to residential location. External forces such as cost of care and availability of culturally competent services within a community contribute to an individual's use of health services. Communities can help their residents gain access to care by supporting them in:

• Gaining entry into the health care system (usually through insurance coverage).
• Accessing a location where needed health care services are provided (geographic availability).
• Finding a health care provider the patient trusts and can communicate with (personal relationship).

Lack of access to care contributes to health disparities between communities, with some individuals having unmet health needs based solely on where they live. These unmet needs can lead to further health complications and emotional distress, as well as increased cost.

Examples of projects addressing access to health services at the systems level include those that address health systems policies and the availability of and timely access to a trusted provider and culturally competent workforce. Systems-level projects in access to health services go beyond individual insurance coverage or help-seeking behaviors to create supports that improve timely access to a trusted provider for all members of the community, while complementing existing programs that focus on individual-level interventions.

According to the American Public Health Association, health equity means everyone has the opportunity to attain their highest level of health.

How do we achieve health equity? We address the conditions in which people are born, grow, live, work, learn, play and age. These social determinants of health are shaped by the distribution of money and resources that include employment, housing, education, health care, public safety and food access.

The Challenge will fund systems-level, community-based projects focused on access to foods that support healthy eating patterns and access to health services.

APHA promotes a health-in-all-policies approach to addressing community health. In order to achieve this, communities must be prepared to engage cross-sector teams including local government, nonprofit partners, businesses and others to address pressing local health challenges by bringing in a diverse range of experiences and technical knowledge.

Most importantly, these teams must include community residents as equal partners. While public health science and expertise are essential, knowledge of community context and lived experience are crucial assets in creating change. The APHA Community-Based Public Health Caucus states "that in order for these partnerships to be equal and for interventions to be community-based, community members must participate fully in the identification of health issues and the selection, design, implementation and evaluation of programs that address them."

For examples of evidence-informed policies and programs, we suggest the following resources:

• Healthiest Cities & Counties Challenge Toolkit
• HealthyCommunity50
• What Works for Health
• Better Health Through Equity: Case Studies in Reframing Public Health Work (PDF)

Teams that are selected for award will be expected to use the grant funds to address one or both of the program’s two priority topics: access to foods that support healthy eating patterns and access to health services. Selected communities must utilize HCCC grant funds in accordance with their approved HCCC project plan. After award, selected teams must develop an initial project budget as part of their Challenge plan that will be updated over the course of the 2-year Challenge, with the support of their HCCC liaison. Applicants should consult pages 3-4 of the RFP for more information about expectations of grantees. The second disbursement will be contingent upon meeting the Challenge’s Year 1 expectations.

Funds may be used for staffing and materials costs associated with project activities. They may not be used to fund large capital expenses. Up to 15% of the overall project budget can be used to pay for indirect costs. Rent, utilities, and telecommunications are considered indirect costs. Communities should consider how funds might be leveraged in their youth and resident engagement, if applicable. All grant funds must be expended by the close of the grant period in April 2022.

There will be opportunities during the grant term for all selected communities to participate in in-person convenings. Each community will be eligible to receive stipends to support attendance and stipends must be used to cover associated travel and lodging costs.

All communities interested in participating should look to develop new partnerships and strategies, even if building on existing activities and goals for the community. The proposal should be based on actions that are new and specifically in response to this RFP, and any existing partnerships or projects need to demonstrate innovation/evolution in their approach and partnerships.

Each community will develop a plan to guide their participation in the Challenge. Each grant team, including community members, will be expected to draft a Challenge Plan in the first three months of the Challenge with support from their assigned liaison and technical assistance partners. Where applicable, communities may connect this document to their community's existing plans and programs.

A living document, the plan will evolve as teams learn from residents, implement their projects and explore the social factors and systems that are influencing health outcomes for community residents. At the conclusion of the Challenge, each grant team will have a deeper understanding of their community priorities and a plan for building on their collaborative work, including strategies for sustaining their partnerships and proposals for longer-term investments to reduce disparities in chronic disease outcomes and improve health equity.

Grant teams will receive 1:1 technical support from a designated liaison from the American Public Health Association or the National Association of Counties. These liaisons will engage regularly with communities as they work through barriers and solutions to implementing their proposed projects and developing their Challenge Plan. Liaisons will also coordinate with the Challenge's multiple technical assistance partners and an advisory council consisting of specialists in relevant subjects to ensure teams receive customized support over the life of their grants.

Additionally, Healthy Places by Design will facilitate a well-supported peer network and learning opportunities led by subject-matter specialists in health equity, community engagement, access to care and healthy food, and other important topics. The peer network will complement and deepen content-based learning and enable grantees to build capacity, develop relationships and address common barriers.

You must have a Google account so you can sign the submission form. Sign-in is required to receive a copy of your responses and to upload letters of commitment.

Visit https://support.google.com/accounts/answer/27441?hl=en for step-by-step tips on creating a Google account.

You can watch the recording of the Feb. 10 informational webinar we hosted for potential applicants. This presentation provides an overview of the program, tips for submitting an application and answers to live questions from participants.

You can also reach us by email at hccc@apha.org.