Background
The National Prevention Strategy [1] recognizes active living as a priority area for reducing the burden of chronic disease, and emphasizes safe and healthy community environments as a key strategic direction to guide actions that will demonstrably improve health. New financial incentives created by the Affordable Care Act to facilitate population health, complemented by recent private sector interest in health-related community investing [2-4] provide an unprecedented opportunity to implement active living policies and create healthy community environments, particularly for populations who need them most. For example, population subgroups that are at increased risk of obesity and related chronic diseases include lower socioeconomic (SES) persons [5], racial/ethnic minorities [6, 7], those living in rural areas of the U.S. [8], and persons with disabilities such as mobility limitations [9] [10, 11]. The purpose of this paper is to explore a key aspect of policy implementation pertaining to Active Living Research: Innovative financing mechanisms to support safe places for physical activity, such as high quality parks, trails, community recreation areas, access to healthy foods, and multi-modal transportation systems.   We will explore health-related community investing and new mechanisms created under the Affordable Care Act (ACA) that can be leveraged to support activity-friendly community environments.

Description
We will share lessons learned from the Financial Innovations Roundtable (FIR), which has created cross-sector partnerships among conventional and non-traditional lenders, community development organizations, and other types of financial institutions over the past 14 years to provide low-income communities with increased access to capital and financial services. Recently, the FIR entered into a partnership with the Federal Reserve Board of Governors in Washington, D.C., and selected health-related community investing as its focus for 2014. Although health is a new explicit focus for the FIR, many successful ideas developed at the FIR have been implemented, resulting in transformative investments in affordable housing, small and minority businesses, community facilities, and other community development efforts, in addition to new tools, policies and practices. Over the past year, the FIR engaged financial institutions, funders, and health partners to holistically examine the social determinants of health - including pertinent ALR domains such as community recreational environments and transportation systems.  Through document review, analysis of transcripts from the FIR’s 2014 dialogue, and interviews with FIR members, and case examples, we explore potential partnerships, synergies, and focus areas relevant to ALR goals.

Lessons Learned
We will have a complete summary of lessons learned as FIR continues its dialogues focused on healthy communities through 2014-15. Preliminary lessons learned include:  1)  FIR stakeholders established a matrix to delineate how various community stakeholders can define community, list accountability mechanisms, and identify opportunities for alignment; 2)   FIR stakeholders are deeply committed to addressing the social determinants of health and improving places where we live, learn, work, and play; 3)   FIR stakeholders expressed interest in learning more about shared metrics that allow us to measure positive change in communities. This is an important point of intersection with RWJF/ALR, as many existing metrics developed by RWJF/ALR may be useful to the FIR; 4)   Innovative examples from diverse communities were shared, such as Boston Community Capital’s focus on “transformation zones,” (which support grocery stores, health clinics, housing areas, commercial space, and housing).   Similarly, the Federal Reserve Bank of Boston’s Working Cities Challenge is helping to improve the health of low-income people while advancing collaborative leadership in Massachusetts’ smaller cities. As an awardee, the City of Fitchburg, MA works through its broad health promotion partnership, Fun ‘n FITchburg, to develop shared metrics for neighborhood health and well-being with the goal of making its North of Main neighborhood a place where residents choose to live, work, and invest. In Omaha, NE, traditional providers and funders of clinical care now invest in infrastructure projects to create better access to active transportation in the public space. The city’s new B-cycle membership bike rental system and rental stations have been supported by funders such as Blue Cross Blue Shield of Nebraska, Alegent Creighton Health, the Peter Kiewit Foundation and the Sherwood Foundation.  5)   FIR stakeholders identified Treasurers of hospitals as frequently overlooked partners,as they can facilitate collaborations between hospitals, Community Development Finance Institutions, and banks.

Conclusions
Raising awareness about innovative health-related community investing strategies and exploring ways to partner with community development and other types of financial institutions are key aspects of ALR policy implementation. By addressing these areas, the National Prevention Strategy’s key strategic directions pertaining to active living - safe and healthy community environments, empowered people, and elimination of health disparities - are more likely to be achieved.

Next Steps
The FIR stakeholders are currently exploring new opportunities for alignment, and discussing ways to diversify investment strategies to improve health outcomes. An important opportunity exists to explore synergies with ALR, particularly with respect to harnessing innovative financing mechanisms to  implement active living policies.

References

1. National Prevention Council. National Prevention Strategy. 2011  [cited 2014 July 27]; Available from: http://www.surgeongeneral.gov/initiatives/prevention/strategy/index.html#The%20Strategic%20Directions.
2. Mair, J., Milligan,K.,, Q&A Roundtable on Impact Investing. Stanford Social Innovation Review, 2012.
3. Fleming, D., Achieving Individual Health through Community Investment: A Perspective from King County, Washington, R.C.t.B.a.H. America, Editor. 2013.
4. Swack, M. Financial Innovations Roundtable. 2014  [cited 2014 August 14]; Available from: https://carsey.unh.edu/csif/financial-innovations-roundtable#.
5. Go, A.S., et al., Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation, 2014. 129(3): p. e28-e292.
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10. US Census Bureau, American Community Survey and Peurto Rico Community Survey 2012 Subject Definitions. 2012.
11. US Census Bureau, American FactFinder. Disability Characteristics 2010-2012 American Community Survey 3-Year Estimates. 2010.