May 2025

Lessons from Invest Health: What Small and Midsize Cities Need to Know

by Emily Doglio, Mt. Auburn Associates

“From the beginning, the investment was really into our communities and in a unique way, which is across sectors… It really broke our silos and opened them up across our community… So I think what Invest Health has done has really opened up the opportunity to build and bring social determinants of health to light within our community.” – Invest Health city team member

Invest Health, an initiative managed by Reinvestment Fund and supported by the Robert Wood Johnson Foundation (RWJF), launched in 2016 with a vision to engage 50 small and midsize cities over 18 months to improve health equity through community development system change and investments in the built environment. After its initial phase, Invest Health continued through three additional iterations. The duration of the initiative and the consistent engagement of many of the original stakeholders in the 50 cities distinguish Invest Health in the field and provide a unique opportunity for learning. Mt. Auburn Associates, the long-term learning partner of Invest Health, completed the final evaluation at the end of 2024.

Hundreds of stakeholders in Invest Health’s 50 cities have not only informed the shared learning, but have shaped the initiative over time and realized impressive outcomes at home. At Mt. Auburn, we are grateful to learn alongside them and are eager to share back with the Invest Health city teams who shared their experiences and insights as part of this research.

This blog highlights key takeaways from the final evaluation that can help cities sustain and expand their progress and build new strategies around community development and health.

Five Key Findings for Small and Midsize Cities

1. Nurture broad, cross-sector relationships to create sustainable networks

Cities that engaged a broad set of aligned partners built enduring relationships that continue their collaborative work. The Invest Health cities show that broad, informal networks where there are deep relationships and aligned priorities can impact significant outcomes even without a formal “team” advancing collaborative work.

Example: In Spokane, WA, the Invest Health partnerships have expanded and although they only meet informally, they continue to coordinate their work and align priorities. Their collaborative network has contributed to built environment outcomes and system changes, including the establishment of the Spokane Regional Land Bank, which provides access to low-cost land for affordable housing development.

Example: In Lansing, MI, the Invest Health network has sustained itself through staff transitions, which often present major challenges for collaborative work. However, by maintaining these relationships, even as team members enter new roles or organizations, the team broadened their network of aligned partners. In an interview, a Lansing Invest Health stakeholder shared, “Members of our team have transitioned into leadership roles within their organizations and into new organizations, which also expands the Invest Health network.”

2. Align with existing collaborative efforts to maximize impact

Cities that aligned Invest Health efforts with other collaboratives or coalitions achieved more substantial, scalable results. When embarking on collaborative work, take the time to map the existing collaborative efforts in your city to find opportunities to align and build on existing efforts, maximize limited resources, and secure buy-in from key leaders.

Example: In Paterson, NJ, the relationships established through Invest Health have been the foundation for engagement in subsequent collaborative initiatives, including RWJF’s Building a Culture of Health Initiative and the Building Healthier, More Equitable Communities initiative. Over time, the participating organizations have grown together and started to think about and approach community development in a new way.

Example: In Roanoke, VA, the Invest Health stakeholders layered multiple initiatives with a shared vision to catalyze their efforts to advance equity and address disparities in health outcomes. The confluence of support from Invest Health, the National League of Cities’ Cities of Opportunity Initiative, and ChangeLab Solutions, was a pathway to build buy-in across sectors, embed change within organizations, and ultimately move the work forward

3. Engage anchor institutions to strengthen community development capacity

Invest Health teams that secured the commitment of their local healthcare institution or university benefited from the anchor organization’s capacity and influential role in their communities. In some cases, Invest Health teams influenced these organizations to adopt new practices or step into a stronger anchor role in their city. Anchor institutions vary in their commitment to health equity and the built environment. However, when possible, engaging key leaders of anchor organizations can amplify the impacts of collaborative efforts.

Example: In New Britain, CT, Central Connecticut State University (CCSU) strengthened its community engagement strategy based on lessons from Invest Health, including creating an advisory board, improving transparency, and establishing a community health education clinic.

Example: In Grand Rapids, MI, a core leader of the Invest Health work helped start a community land trust with significant financial support from its hospital partner, Corewell Health (previously Spectrum Health).

4. Build community development finance capacity to advance built environment projects

Particularly in small cities, building the capacity of existing organizations, such as community development corporations (CDCs), other mission-oriented developers, and community development financial institutions (CDFIs), and attracting the attention of national actors, is critical for accomplishing built environment outcomes. Some Invest Health cities were able to influence their local community investment systems in these ways, or through other efforts such as creating capital funds and amending zoning codes.

Example: In Akron, OH, Western Reserve Community Fund, a member of the Invest Health team, received certification to become a CDFI. The team also contributed to creating the Summit County Affordable Housing Trust Fund, which offers loans of up to $500,000 with flexible terms to non-profit developers. The Akron team also helped establish a Minority Contractor Capital Access Program, providing financial assistance and educational resources for construction contracts.

Example: In Des Moines, IA, The Invest Health team advocated for increased funding to address abandoned and boarded-up homes, resulting in a $7 million annual commitment from the Iowa Finance Authority to support 27 local housing trust funds.

5. Maintain Cross-City Relationships to Foster Learning and Innovation

Invest Health created a platform for cross-city relationships where stakeholders collaborated to solve complex problems in implementing new projects, programs, or policies. The great value of the Invest Health network highlights the importance of sustaining these relationships as the 50 cities continue to advance health equity in an evolving context. Small and midsize cities without access to a cross-city network may benefit from supporting public sector staff and other leaders in attending conferences or webinars or identifying other ways to tap into existing networks focused on small and midsize cities.

Example: The Henderson, NV, and Iowa City, IA, Invest Health teams advanced zoning changes to encourage greater housing options in their cities based on learning from a collaborative trip to Fort Collins, CO. The teams focused their learning agenda on zoning changes that could facilitate the transition of downtowns from single-family neighborhoods by including duplexes, townhomes, and smaller-scale residential developments, often referred to as “missing middle” housing.

This experience encouraged Henderson to add minimum housing type requirements to its zoning code to strengthen the city’s ability to increase housing choice. Similarly, Iowa City already had proposals in place but faced political opposition. Members of this team brought home pictures of the diverse housing options in Fort Collins to share with the planning and zoning department and with other key stakeholders in the public review process, which helped change stakeholders’ perspectives and gather support for the proposal.

Example: The Tallahassee, FL, team visited Dayton, OH, through a collaboration grant trip to learn about its Fruit and Vegetable RX program, including how it integrates healthcare systems with farmers’ market stalls at bus stations. Inspired by this model, the team returned to Tallahassee to collaborate with local health partners, neighborhood associations, healthcare providers, and area universities. The Tallahassee team revitalized its Southside Farmers Market and launched its Fresh Fruit and Vegetable RX program based on cross-city learning.

Conclusion

Documenting the growth, learning, and meaningful progress with the 50 Invest Health cities has been an enriching experience. Mt. Auburn Associates would like to thank each contributor to the learning and evaluation process and encourage others interested in advancing community development work through a health equity mindset to dive into the four reports that document the deep impact Invest Health has achieved across the country.

About the Author

Emily Doglio joined Mt. Auburn Associates in June 2017, bringing enthusiasm and a collaborative spirit. She has a wealth of experience contributing to evaluative, strategic planning, creative economy, and various other projects. Emily excels in helping her colleagues, clients, and the collaborative work they undertake thrive through effective project management, skillful facilitation, and creative problem-solving

Emily’s expertise extends to managing research and evaluation projects of economic development efforts. Emily served as the project manager for a research project on the role of public libraries in workforce and small business development as part of Chief Officers of State Library Agencies (COSLA) and the Institute of Museum and Library Services’ (IMLS) Measures that Matter initiative. This project encompassed ten case studies of library systems across the country and a cross-site report, both informed by the development of a theory of change for how libraries contribute to their local workforce and small business development systems and make an impact on the economic conditions of their communities, as well as a thorough literature review.

Emily’s involvement extends to the evaluation of the Robert Wood Johnson Foundation’s Invest Health initiative. She has been engaged in this initiative since the final evaluation of its initial phase in 2017, continued contributing during Phase 2, and currently provides crucial leadership in the cumulative evaluation of the initiative’s progress over time. She has also played a significant role in the evaluations of the Federal Reserve Bank of Boston’s Working Cities Challenge (WCC) in Connecticut, Massachusetts, and Rhode Island. Her work included in-depth research on collaborative leadership and racial equity within WCC initiatives. She has experience evaluating workforce and small business development initiatives, including The Foundation for Business Equity’s Business Equity Initiative (BEI) and the Massachusetts Growth Capital Corporation’s (MGCC’s) Small Business Technical Assistance program. As part of her role, Emily conducts interviews and focus groups, administers and analyzes stakeholder surveys, and synthesizes research to support Mt. Auburn’s projects.

Emily graduated from Brown University in 2017 with an A.B. in International and Comparative Political Science. Her educational background sparked her interest in system change, qualitative analysis, and policy. Emily has experience in research and advocacy in higher education as a student as well as work experience in the public and financial sectors. She is interested in issues relating to social and economic justice, such as access to quality education, housing, food, and healthcare.