The global age-friendly cities and communities (AFCC) movement has centered on the involvement of the public sector, calling on high-ranking authorities to commit to improving the built, social, and service environments of their localities. This interpretive review aimed to advance understanding of the ways in which the public sector is involved in AFCC efforts. Based on emergent themes from peer-reviewed articles from the United States and Canada published since 2010, we derived a two-dimensional framework for conceptualizing variability in public sector involvement, encompassing the internal/external (a) locus of responsibility for cross-sector change and (b) target for cross-sector change. We discuss implications for research, policy, practice, and further knowledge development in AFCC implementation.

Academic medical centers and university extension programs remain underdeveloped collaborators, despite the complementary objectives between translational science and extension. This case study details the creation of a nationally unique interprofessional organizational structure between the University of Missouri (MU) Office of Extension and Engagement (MU Extension) and the MU School of Medicine to accelerate statewide reach of research and education discoveries using high-touch community health approaches. This article describes specific strategies used to systematically plan for: 1) creation and operation of the new structure, 2) routinization and institutionalizing the work, and 3) sustainability. We further outline challenges and next steps. The development of the backbone organization office of Health Outreach Policy and Education (HOPE) brings together the interprofessional expertise of five units with a common agenda to advance mutually reinforcing activities. HOPE is poised to make significant contributions to amplify MU\'s land grant mission, garner additional grant funding, and advance the health of Missourians.

OBJECTIVE: To explore insights and perspectives of a collective impact (CI) partnership taking on a new project that aimed to reduce sugary drink consumption and promote water as the drink of choice across North East Melbourne.
METHODS: A qualitative case study was undertaken. Semi-structured interviews were conducted with key stakeholders in the partnership. Data were analysed using thematic analysis.
RESULTS: Fourteen organisations participated in the North East Healthy Drinks Alliance. The data demonstrated that investing in developing a common agenda supported the establishment of a CI approach. The backbone organisation was found to have played a crucial role in coordinating the activities of the Alliance. This coordination was found to be particularly important in terms of ensuring that organisations were able to work on mutually reinforcing activities at their own pace. Program planning and reporting was managed through open continuous communication by the backbone organisation. The data collected pertains to the activities of the Alliance in its first 2 years, prior to the development of a shared measurement strategy, thus no data was collected on this aspect of the collective impact framework. Although some participants were found to have limited knowledge of CI, this did not seem to hinder their participation in the Alliance.
CONCLUSIONS: Selecting a relevant and accessible focus area and investing in developing a common agenda supported the establishment of a CI approach. SO WHAT?: The CI framework offers a valuable tool for undertaking cross-sectoral, local partnerships for health.

The mounting evidence that loneliness is a determinant of poor health and well-being underpins the need for effective interventions and community action. \'More Together\' (MoTo) is a large-scale, complex, multi-component and multi-level intervention for community change that addresses loneliness among young people and older adults in Silkeborg Municipality, Denmark. The intervention is inspired by the Collective Impact framework, and it is practice driven and rooted in an extensive cross-sector partnership. This article outlines (i) the organization of the cross-sector partnership, (ii) the structure of the intervention programme, (iii) the key components and activities of the programme and, finally, (iv) the intervention setting and target population. MoTo aims to create new ways to develop, implement and evaluate loneliness interventions. Experiences gained from MoTo hold the potential to transform our understanding of loneliness interventions and may inform and guide future interventions.

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BACKGROUND: Communities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, the collective impact (CI) approach has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality.
METHODS: A web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement on a 4-point scale with six items assessing CI foundation adapted from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress achieved in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means and proportions. Qualitative data were analyzed using thematic analysis and an inductive approach followed by stratified analyses and co-interpretation of emergent findings with model developers.
RESULTS: Fifty-eight participants completed the survey, and 21 individuals participated in interviews (n = 12) and two focus groups (n = 9). Survey mean scores were highest related to initiative buy-in and commitment, and lower related to shared ownership, having multiple perspectives and voices involved, and adequate resources. Qualitative results showed that the framework\'s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging existing community assets that is characteristic of CI and the current framework. Counties implemented effective engagement and visibility strategies including mural projects and book clubs. Participants expressed communication challenges across county sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, in contrast with previous CI research.
CONCLUSIONS: Multiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Study results suggest that efforts to launch CI to address SDOH, which is by nature multi-sector, should include robust strategies to address communication needs of local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and a sense of collective efficacy that may portend sustainability; however, relying on volunteers in the absence of other resources extensively also threatens sustainability.

The Manawatū Food Action Network (MFAN) is a collective of social service and environmental organizations and community stakeholders that work together to promote collaboration, education and awareness of issues surrounding food security, food resilience, and localization in the local community. In 2021, the 4412 neighborhood was identified as requiring urgent assistance, with approximately one third of residents experiencing food insecurity. The 4412 Kai Resilience Strategy was developed with the community to move from food insecurity to food resilience and sovereignty. Recognizing that food security is complex and based on multiple causes, six interwoven workstreams were identified to create a multifaceted, coordinated strategy. This includes education, food economy, community, food support, māra kai, and social enterprise. The strategy cultivates local ownership and commitment to change. It creates a broader constituency of support, balancing the urgent need to feed people today with the long-term need to change systems through step-change initiatives. Through this approach, communities can better make sustainable and meaningful changes to their lives and circumstances rather than relying on external resources.

People who are homeless disproportionately experience the burdens of chronic disease, have limited access to preventive care, and may be less trusting of healthcare agencies. The Collective Impact Project created and evaluated an innovative model designed to increase chronic disease screening and referral to healthcare and public health services. Trained Peer Navigators (PNs), who were paid staff with lived experiences similar to the clients served, were embedded in five agencies serving people experiencing homelessness or at risk for homelessness. Over two years, PNs engaged 1071 individuals. Of those, 823 were screened for chronic diseases and 429 were referred to healthcare services. Alongside screening and referrals, the project demonstrated the value of convening a coalition of community stakeholders, experts, and resources to identify service gaps and how PN functions might complement existing staffing roles. Project findings add to a growing literature documenting unique PN roles that potentially reduce health inequities.

BACKGROUND: Preterm birth, defined as birth at gestational age before 37 weeks, is a major public health concern with marked racial disparities driven by underlying structural and social determinants of health. To achieve population-level reductions in preterm birth and to reduce racial inequities, the University of California, San Francisco\'s California Preterm Birth Initiative catalyzed two cross-sector coalitions in San Francisco and Fresno using the Collective Impact (CI) approach.
OBJECTIVE: The purpose of this study is to compare two preterm birth-focused CI efforts and identify common themes and lessons learned.
METHODS: Researchers conducted in-depth interviews (n = 19) and three focus groups (n = 20) with stakeholders to assess factors related to collaboration. Transcripts were coded and analyzed using modified grounded theory. Findings were compared by year of data collection (first and second cycle in each location) and geographic location (Fresno and San Francisco) and discussed with CI participants for input.
RESULTS: Although both communities adopted the core tenets of CI to address preterm birth and racial inequities, each employed distinct organizational structures, strategic frameworks, and interventions. Common themes emerged around the importance of authentic community engagement, transparency in the process of prioritization and decision-making, addressing racism as a root cause of disparities in birth outcomes, and candid communication among partners.
CONCLUSIONS: Future CI efforts, particularly those catalyzed by academic institutions, should ensure community members are active partners in program development and decision-making. CI efforts focused on combatting racial health inequities should center racism as a root cause and build capacity among coalition partners.

Complex social issues such as population health mean that no one person, organization or sector can resolve these problems alone and instead require a collaborative approach. This study applied the Collective Impact framework to evaluate the alliance responsible for delivering a large-scale health promotion initiative. Committee meeting minutes for a 4-year period and qualitative interviews with key stakeholders (N = 14) involved in the design and implementation of the initiative explored the factors that contributed to collaborative efforts and initiative outcomes. Major strengths of the Healthier Queensland Alliance (the Alliance) stemmed from identifying a common agenda and using frequent communication to develop trust among Alliance partners. These processes were important, particularly in improving key relationships to ensure inclusivity and equity. Reinforcing activities helped to support individual organizational efforts, while shared measurement systems promoted data-driven decision-making and learning, which contributed to continuous improvement and innovation. Current findings support the use of the Collective Impact framework as a scaffold to assist collaborative alliances in working effectively and efficiently when implementing large-scale initiatives aiming to create positive social impact. This study has identified the foundations of practice to establish a successful Collective Impact alliance.
Collective action to achieve social impact requires collaboration allowing organizations to expand their resources and abilities to enhance their collective capabilities. This paper reports on the use of the Collective Impact framework to show how a collaboration of partner organizations was developed to achieve social impact in a large health promotion initiative. The study identified six foundations for practice to enable successful collective partnerships that will be useful for practitioners and policy-makers when developing health promotion initiatives targeting a range of priority groups. The Collective Impact framework offers a strategic approach for building capacity in a range of communities to navigate power dynamics and find new ways of collaboration to achieve positive social impacts for their communities.