KEY WASHINGTON HEALTH FOUNDATION STRATEGIC INITIATIVES:
HEALTHIEST STATE IN THE NATION CAMPAIGN
The Healthiest State in the Nation Campaign became one of the Foundation’s most visible and impactful efforts across its many years of service to the health of Washingtonians. It grew from the Transforming Health Care program, a WHF initiative focused on finding consensus among Washingtonians toward pursuing major health system change.
A series of community forum held across the state in 2003 produced a draft set of health values for the state, and these, and the imperative to pursue health reform, were presented to state and local leaders at a Leadership Forum held in Fall 2003. At the end of the day, attendees were asked to sign on to a Leadership Resolution, imbedded with a list of the values prioritized through electronic voting. First to sign the Resolution was Governor Gary Locke, then followed by almost all candidates running for Governor. Over 170 attendees also signed on.
The Resolution committed these leaders to seeking change on a consensus basis, and the Foundation was asked to activate this commitment in 2004. A series of discovery forums were held in early 2004 to explore how to do this, with many good ideas offered. Most that related to policy change, however, remained stuck in the conflicting ideologic battle between liberals and conservatives and Democrats and Republicans.
WHF needed a different consensus way forward and explored ways in could press for change outside of the typical issues and approaches. President & CEO Greg Vigdor suggested WHF approach change through vision, and WHF tested willingness to pursue change in the state through the vision of the “healthiest state in the nation”. The willingness was high, and WHF moved ahead with this as its change initiative, including developing a campaign of how to achieve the vision.
A Strategic Plan for the Healthiest State in the Nation Campaign was drafted and approved by the WHF Board. There were many elements to this Plan and the overall Campaign. Its action essence though, was an invitation to people and organizations to engage in the many ways that they could advance the vision of the Healthiest State through their own actions.
Early on, it became clear that many felt that they were already doing a lot to try to produce health consistent with the vision, but that these efforts were not appreciated in the greater context of the failures of the system. WHF developed approaches that would ground its Campaign in recognizing and thanking people and organizations for what they were already doing, and then encouraging them to do a little bit more.
WHF staff were encouraged by its early explorations of engagement around the Healthiest State vision, and brainstormed how to take this notion of engagement to greater, and great, scale. In the Fall of 2004, it kicked off the Campaign publicly, with the declaration of Washington Health Day on September 18 by Governor Gary Locke. Through the rest of 2004 and into early 2005, the Foundation began to build more substantive opportunities for people and organizations to engage. Around 100 organizations became Participating Organizations in the Campaign and several thousand Washingtonians signed on as individual “Champions”.
With the growing interest in the Healthiest State Campaign, WHF decided to take the idea to scale. The central idea for this was to host a six week health challenge across the state that could elevate the engagement effort and focus attention on the Campaign, and recruit more Participating Organizations, Champions, and other interest in the Campaign. The proposal was to create what was called the Governor’ Health Bowl, with the inaugural event to be held in the Fall of 2005. The specific challenge to Washingtonians was that the state collectively produce a million miles of health over the six weeks of the Bowl.
The Foundation developed a Scoreboard on its website to support the Bowl and track the miles of health. It also introduced a database on its website that enabled people and organizations to record their “miles of health”. New Governor Christine Gregoire not only embraced the million mile challenge, but also committed to a celebration to be held at the Governor’s Mansion should we achieve it.
The Foundation recruited organizations to participate in the Governor’s Health Bowl. Some became Major Partners, and even sponsors, with specific resource commitments. Hundreds of new organizations became Participating Organizations by agreeing to enter into the challenge and were then recognized on the Scoreboard, meaning that individuals could credit their miles to these organizations too.
A series of sub-challenges were created, and Participating Organizations could compete against each other using the technology developed by the Foundation on its website. The most prominent was a School Challenge in which K-12 schools across the state competed against other schools within the Governor’s Health Bowl. Another was a Healthy Business Challenge in which businesses challenged each other. The Greater Seattle Chamber of Commerce was a sponsor of this, and competed against other organizations.
Miles could be achieved through physical activity- walking, running, biking and the like. But participants could also get miles through other personal health behaviors related to nutrition, water intake, vaccinations and the like. This enabled WHF to educate about one flank of its message as to how we become the Healthiest State- individual actions to improve one’s own health.
The other flank though, was that the Healthiest State would also be pursued by exploring collective commitments to improve health, whether through government policy, business practices or other social group efforts to improve health. WHF developed a way to provide miles for these commitments too. For example, a weekly Health Quiz allowed for participants to get health miles by answering questions successfully about these commitments. As just one example, Washingtonians learned that efforts to improve high school graduation rates was an essential element of the Healthiest State in the Nation Campaign.
Through engagement, WHF spread its Healthiest State message to hundreds of thousands of Washingtonians. The Healthy LIving- Healthy Systems paradigm was a core message, but so were expressions relating to the other prioritized values from the 2003 Health Leadership Summit.
Over 40,000 Washingtonians participated in the 2004 Governor’s Health Bowl, making it the largest civic engagement project for health in state, and as near as we can tell, national history. The Million Mile Challenge was met, with the miles putting us over the top being recorded with several hundred school children moving up the steps of the State Capitol to be welcomed by Governor Gregoire and WHF President and CEO Greg Vigdor.
Not only did the first Governor’s Health Bowl succeed in accelerating the rollout of the Healthiest State in the Nation Campaign, it led to requests to WHF for additional challenges and opportunities. Schools in particular wanted WHF to keep their students active, and a “playoff” for schools was created in late fall 2004. More challenges were added into the next year, including a New Year’s Resolution challenge and a Spring Training Challenge. The Governor’s Health Bowl became an annual event and WHF held these for another seven years.
While engagement was our essential strategy, the point of the Campaign was to advance the vision with tangible progress around the state health rank for Washington. Essential to this was knowing where we stood as a state in terms of this health rank, and understanding the key issues that made up this relative ranking. After extensive study, WHF chose to rely on the United Health Foundations annual ranking of the states as a tool to begin its Campaign. In 2003, Washington ranked as the 17th healthiest state in the Nation.
While the Foundation then developed its own unique data approach for measuring state rank through staff and consultant research experts, the initial rank and its sub-elements gave WHF a set of issues and opportunities to focus engagement efforts. In subsequent years, WHF not only continued and grew its general engagement opportunities, it created and supported targeted efforts on key issues where we felt advancement could greatly improve our state health rank.
For example, WHF pressed the link between high school graduation rates and health, and worked with schools and communities on evidence based approaches to improve both. It brought together the state and many organizations around further reductions in tobacco use, which remained a major health priority. It looked to accelerate quality improvement and access enhancements, and especially a major focus on the use of preventive health services, where Washington State ranked surprisingly low. These efforts were usually multivariate approaches, using engagement, messaging, public policy, and other leadership tools to bring about actual improvement and change and not just superficial attention.
The Foundation redeployed all of its resources toward the Healthiest State over the next few years. It maintained many of its previous activities, but linked them to the Campaign. For example, grantees were asked to engage in the Campaign as part of their awards. Access clients were asked, after addressing their urgent or emergent clinical needs, to advance their health, and their families, in other ways.
With the success of the engagement dimension of the Campaign came the opportunity to use our network to advocate for public policy change consistent with the Campaign. WHF adopted a policy agenda for the Healthiest State and advanced this in both Olympia and Washington D.C.. An important opportunity became major health reform, both before and during debate on the Affordable Care Act. WHF developed a specific policy agenda on this issue and worked for inclusion of these policies by Congress.
The Healthiest State in the Nation Campaign was widely viewed as a success story across Washington state, and was able to celebrate Washington’s advance up the state scoreboard,. By ____, WHF moved into the Top Ten in state health ranking. While WHF could not take full credit for this advance, it was clear that its role was a major factor in such improvement.
While the Campaign was a great success, and managed efficiently, its cost was primarily financed by the use of WHF’s reserves. The plan was to eventually use the Campaign as a way to generate new investments into the Foundation, and a fundraising plan centered on the Healthiest State in the Nation Campaign was developed and implemented. A key resource was to be angel investors excited by the change WHF was bringing to Washington State and many key issues.
WHF was in negotiation with several such angel investors when the 2008 Great Recession hit the Nation and the State. This chilled interest in these investments, as potential funders were soon pressed to help individuals and organizations facing immediate crises.
WHF tried to weather the storm during these difficult economic times and even conceived other funding strategies- see the Healthiest State XChange, for example. Meanwhile, it continued to run the Healthiest State Campaign through 2012. Resource constraints forced WHF to stop the program then, and soon the organization was forced to suspend operations.
The Healthiest State in the Nation Campaign had run its course, but not before achieving major health improvement across the state, and serving as a national model for leadership change.