The Fundamentals

What’s an ACH?

An Accountable Community for Health (ACH) is a community-driven collaborative dedicated to making lasting and transformational change in the health of a community and forwarding the goal of health equity. ACHs provide residents and key partners from diverse sectors an infrastructure for working together to change systems, advance equity and build stronger, more cohesive communities prepared to address both existing and emerging health challenges over the long term. The ACH’s key roles—elevating community voices, facilitating multi-sector dialogues and aligning organizations and systems—fuels powerful and sustainable changes that reflect the needs of the community.

Critical to every ACH is the presence of a strong, skilled and experienced Backbone entity to manage the ACH and help steer its long-term strategies. Given the ACH’s diverse, multi-sector membership, its success relies on the Backbone to deftly work across organizations, sectors and community residents to shepherd a mindset of collective action and systems change. The Backbone facilitates activities, projects and schedules; coordinates and aligns programmatic, financial, communications and data strategies; navigates power dynamics and differences of opinion and helps ensure transparency and accountability.

While partners and residents assume a range of leadership roles within the ACH, it is the Backbone that provides the glue that keeps the ACH together—managing personalities, schedules, priorities and timelines. The Backbone ensures consistency of communications and follow-through in support of sustainable strategies to improve community health, ensure health equity and maintain momentum for the long term.

A Strong, Resourced ‘Backbone’ Supports ACH Infrastructure

Key functions of an ACH as facilitated by the Backbone include:

  • • Inform, engage and activate community leaders and residents

    • Recruit resident participation

    • Ensure residents have a role in decision-making

  • • Engage employers, sectors, systems and residents

    • Convene stakeholders for cross-sector collaboration

    • Provide technical assistance

    • Facilitate data sharing and analysis

    • Identify community assets

  • • Design and manage ongoing governance and infrastructure

    • Ensure leadership is distributed

    • Maintain communications between partners and the community

    • Facilitate fundraising and develop sustainable financing

    • Monitor progress and conduct evaluations

  • • Catalyze innovative thinking

    • Oversee alignment of existing stakeholder-defined strategies

    • Identify gaps and new solutions

    • Adopt new collaborative practices among partners and community

    • Manage power dynamics

  • • Identify and elevate community issues

    • Advocate for local and state policy change

Examples of how each key function can advance equity:

  • • Conduct targeted outreach and engage residents from communities that historically experienced discrimination

  • • Ensure that the ACH decision-making body is diverse, inclusive and equitable

  • • Investigate structural causes of inequities by facilitating difficult conversations and collaboratively collecting data from target communities

  • • Ensure funding is prioritized to serve historically under-resourced communities and groups

  • • Conduct a power analysis, develop power-sharing practices and intentionally increase—and monitor—community trust and participation

THE BOTTOM LINE

For decades, long-standing inequities have exacerbated health issues in low-income communities and communities of color, resulting in persistent health disparities. ACHs provide a powerful framework for tackling those inequities by breaking down barriers and promoting a new way of working together.

ACHs rely on three core principles to marshal the collective action and transformational systems change that lead to healthier, stronger, more equitable communities:

Center Community Voice

Community residents are too often excluded from critical decisions that impact their health. ACHs reengineer this reality by placing residents at the heart of all community health-related discussions. ACHs level the playing field by ensuring that residents have a prominent and active role in their ACH, helping to ensure that equity—and the realities that shape their health—is paramount.

Multi-Sector Engagement

ACHs include not only traditional healthcare and public health systems, but also partnerships that embrace the social drivers of health because improving health outcomes for all requires that health and other sectors, which reflect the various contributing factors needed for healthy communities, work in concert.

Align Systems and Priorities

ACHs help partners shift from transactional, program-specific approaches to a new norm where participants align local community interests, incubate fresh ideas and expand collective capacity. Built on a foundation of transparency and data sharing, this alignment results in greater impact than any one entity could achieve alone. By ensuring both transparency and accountability, trust is built among ACH members and the community.

“What worked really well…was when we had committed public health leadership coupled with strong, visionary, charismatic CBO leadership and a strong resident leader. When we had that trifecta, things were moving and shaking in all the right places.”

— East San Jose PEACE Partnership