Cultures of Health: A Transformative Alternative Approach to Public Health

In 2014 Cooperative Extension in the United States, the land-grant system which provides educational opportunities to adults outside of the college environment introduced a new focus on Health & Wellness. Extension is unique in that it places masters-level faculty members in every county of every state in the nation to offer evidence-based knowledge to local communities. The courses offered have historically been primarily agriculturally based, and/or focused on home economics. In 2017, the Robert Wood Johnson Foundation partnered with Cooperative Extension and 4-H to create a "Culture of Health," using a community based model. Five states were each asked to select three different communities to begin developing such a culture. Communities had to range from being innovators in health & wellness community initiatives to beginners. We offer reflections and insights into the development of the participatory, community-focused decision making processes of three communities in Utah. This transformative alternative to addressing public health issues resituates local communities as the origin and arbiter for health decision making and influence. In particular, we use this as a case study to highlight incongruencies with funding mechanisms. Agencies are accustomed to more positivist research methods than a community based approach. In addition to these process-oriented considerations, we offer lessons learned one year into this two-year initiative.