Community gardens enhance nutrition and physical activity and promote the role of public health in improving quality of life. Opportunities to organize around other issues and build social capital also emerge through community gardens. California Healthy Cities and Communities (CHCC) promotes an inclusionary and systems approach to improving community health. CHCC has funded community-based nutrition and physical activity programs in several cities. Successful community gardens were developed by many cities incorporating local leadership and resources, volunteers and community partners, and skills-building opportunities for participants. Through community garden initiatives, cities have enacted policies for interim land and complimentary water use, improved access to produce, elevated public consciousness about public health, created culturally appropriate educational and training materials, and strengthened community building skills.

More than 40 cities have participated in the California Healthy Cities Project since its inception in 1988. Because Healthy Cities efforts are community driven, these cities address diverse health and social issues using a wide variety of strategies. This complexity, in addition to the usual difficulties associated with evaluating community interventions, creates many challenges for evaluation. Given the community building and process orientation of Healthy Cities, it may be most appropriate to measure intermediate community changes that have been linked to health outcomes in previous research or, at a minimum, theoretically. The California Healthy Cities evaluation framework conceptualizes change at five levels: individual, civic participation, organizational, interorganizational, and community. The framework, developed collaboratively with Healthy Cities participants, attempts to synthesize current thinking and practice on evaluation of community projects by applying concepts from community capacity/competence, social ecology, and urban planning.

As part of an evaluation of the California Healthy Cities and Communities (CHCC) program, we evaluated resident involvement, broad representation and civic engagement beyond the local CHCC initiative. The evaluation design was a case study of 20 participating communities with cross-case analysis. Data collection methods included: coalition member surveys at two points in time, semi-structured interviews with key informants, focus groups with coalition members and document review. Participating communities were diverse in terms of population density, geography and socio-demographic characteristics. Over a 3-year period, grantees developed a broad-based coalition of residents and community sectors, produced a shared vision, conducted an asset-based community assessment, identified a priority community improvement focus, developed an action plan, implemented the plan and evaluated their efforts. Local residents were engaged through coalition membership, assessment activities and implementation activities. Ten of the 20 coalitions had memberships comprised of mainly local residents in the planning phase, with 5 maintaining a high level of resident involvement in governance during the implementation phase. Ninety percent of the coalitions had six or more community sectors represented (e.g. education, faith). The majority of coalitions described at least one example of increased input into local government decision-making and at least one instance in which a resident became more actively involved in the life of their community. Findings suggest that the Healthy Cities and Communities model can be successful in facilitating community participation.

Political columnist Dan Walters has dubbed California the most complex society on the planet. One-third of the total U.S. immigrant population settles there, and the state's widening gap between the rich and poor is the highest in the country. Against this backdrop, California's local governments are struggling to meet ever-expanding needs brought about by continued population growth, economic restructuring, and the downward shift of responsibility for service provision.A recent study conducted by the California Center for Health Improvement (CCHI) found that Californians see better job opportunities, safer neighborhoods, higher-performing schools, and affordable health care as central to the health of their communities.l In addition, they recognize the interrelationship of these issues and do not see government as having all the solutions. In fact, the issues that people in California care most about cross jurisdictional boundaries and all three sectors: government, for-profit, and nonprofit. Healthy city and community models in California provide a process to start the dialogue and to cut across the "silo" or single-sector approach to problem solving.The CCHI study also found that over 50 percent of the respondents wanted local government to do more to bring everyday citizens into the planning process of building healthy communities. An almost equal number felt that individual cities should solicit the active participation of ordinary citizens in developing priorities and solutions. In Brea, California. City Manager Frank Benest and others have emphasized the need for a transformation from a "vending machine" civic culture, in which government dispenses services, to a "barn-raising" civic culture, in which members of the community are active participants.Sacramento's city government recently sought resident input on how the city should close its $11 million budget shortfall. Over five hundred residents took part in a hands-on budget-balancing exercise, and over fifteen hundred residents submitted their recommendations through a budget Note: 1 gratefully acknowledge the assistance of Vivian Look, senior project associate, and Gregory Shaffer, local program development specialist, in the development of this article.

Given the steadily rising costs of medical care — and increasing recognition of the role of individual responsibility in maintaining personal health — the concept of the “healthy city” may indeed be an idea whose time has come. The problem‐solving approach emphasizes prevention, an expansive definition of health and broad‐based participation.

A conversation with three healthy‐cities, healthy‐communities pioneers.

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