Small Town, Big Heart: How a Grassroots Effort Changed the Landscape and Health of a Community

State: OH Type: Promising Practice Year: 2019

The Union County Health Department, located in Marysville, Ohio, serves a rural community of over 54,000 residents. Union County's poverty rate is 7.7%, and 11% of residents do not have health insurance. Despite the percentage of residents with no health insurance and its poverty rate, Union County residents' average life expectancy is on par with national averages (~76 years for men and ~80 years for women).

Union County, like many other communities across the United States, is seeing a steady uptick in residents lacking physical activity, obesity, and the risk factors associated with heart disease and shortened lifespans. Specifically, in data from the 2018 Union County Health Assessment, 38% of adults are considered obese and 29% overweight, while 1 in 7 adults did not participate in any physical activity within the past week, and only 53% of youth participated in at least 60 minutes of physical activity per day on 5 or more days in the past week. Another area of concern was a lack of access to opportunities for physical activity, particularly in the more rural parts of the county. These trends and lack of access have played a role in increased rates of high blood cholesterol (38%), high blood pressure (28%), and other overall poorer health outcomes among residents.

To combat these trends and improve health outcomes, the Union County Health Department's Creating Healthy Communities program (UCHD-CHC) worked closely with community partners to develop projects that address the underlying policy, systems, and environmental changes needed to improve residents' health in the areas of healthy eating, and physical activity. Further review with residents and our rural community partners in the Village or Richwood revealed a desire to develop a trail in a local park in order to increase opportunities for physical activity. This led to the development of partnerships, a strong local trail coalition, and ultimately, a multimillion-dollar trail project.

The interest in improving the Richwood Lake Park through the development of a multiuse trail had been locally led by a few enthusiastic residents since 2013. The UCHD-CHC program, while investigating strategies to overcome higher than average rates of obesity and chronic disease risk factors, heard about the desire for a trail, and partnered with the resident group, and also applied and received a technical assistance grant from the National Park Service-Rivers, Trails and Conservation division. Working collaboratively, the new conglomeration of coalition members engaged the community through public meetings, surveying, and events to garner support, assistance in developing the plan, and ultimately, the groundwork for a multiuse trail was established. Beginning in early 2015, all the aforementioned partners formed a formal coalition, called the Richwood Trailblazers, and with the use of guides, such as the CDC and National Park Service's Parks, Trails, and Health Workbook”, an action plan for trail implementation was formed. As plans for the trail began to solidify, the Village contracted with an engineering firm to assist in bringing the team's ideas to life. Every step of the process, from idea to implementation, was reviewed by the coalition and shared with the community to garner feedback and approval of the project. Over the course of three years, the coalition and its partners, were able to secure a total of over two million dollars in order to construct a 1.2-mile trail. The Richwood Trailblazers continue to oversee new park developments, and also offer programming and events to encourage physical activity and foster a sense of community.

The creation of the trail required dedicated support from residents and technical guidance from partners before the trail could be established. The installation of the trail also required a set of objectives such as seeking public input, fund-seeking, and the establishment of timelines. Since its completion, the trail has seen over a 360% increase in use between a partial segment of the trail being completed in 2017, and the fully completed trail in 2018. The trail project also successfully completed all of its established objectives, and the Trailblazers and partners continue to develop strategies for sustainability, programming, and promotion of the trail. The success of the trail can be attributed to the leadership and collaboration of the Trailblazers, and technical assistance from partnering organizations. As the trail and park continue to be improved through new amenities and programs, the long-term impact will be measured by awareness and use of the trail, a decreased prevalence of chronic diseases and risk factors that lead to said diseases, and overall increased physical activity by residents.

The Union County Health Department's Creating Healthy Communities (UCHD-CHC) program, which began in 2015 with funding from the Ohio Department of Health, works to address public health issues in the areas of healthy eating, active living, and tobacco-free living through the development and implementation of policy, systems, and environmental changes. In order to address these issues, the UCHD-CHC program analyzes local health data, works closely with designated coalitions, and partners with local stakeholders and organizations to evaluate, prioritize, and direct projects that will combat health disparities in Union County. The UCHD-CHC program analyzed local Community Health Assessment data, and though Union County ranked fourth in overall health indicators, the county still exhibited a high number of risk factors that lead to cancer, stroke, heart disease, and other poor health outcomes for residents. Risk factors like overweight/obesity (67%), high blood pressure (28%), high cholesterol (38%), and lack of regular physical activity (14% of adult residents did not participate in regular physical activity in the past week, and only 26% of youth participated in at least 60 minutes per day in the past week), along with unhealthy lifestyle choices and, specifically in the Village of Richwood, a lack of a dedicated safe place for residents to engage in physical activity, were all contributors to the morbidity and mortality rates within the county.

Through review of the aforementioned data, three priority communities were identified as targets for intervention: Union County, the City of Marysville, and the Village of Richwood. Each priority community has its own unique characteristics as well as varying rates of risk factors for chronic diseases and access to healthy foods, active living, and tobacco-free living. The primary areas of concern noted upon review of Community Health Assessment data was the low rates of physical activity by both adults and youth, and the number of Richwood residents without access to local recreation and places to be physically active. Further investigation led to the discovery of a desire from the community for greater access to physical activity, specifically through their local park. Though Union County has a number of parks and trails, there are very few, even fewer with trails, in the more rural areas of the county. The desire for a place to be physically active, such as a trail at the Richwood Lake Park, along with the concern over physical activity levels and overall access to physical activity in Richwood, prompted committed community members, the Richwood Village Council, and community organizations such as the UCHD-CHC program, to devise a strategy to best address the issues.

Upon meeting with the identified partnering organizations, it was decided that an intervention designed to provide sustainable, year-round access to physical activity was a priority. Community members involved in the review noted that for years, people have used a worn-in foot path around the lake as a way to get exercise without contending with traffic and other obstacles around town. The foot path was unsafe, narrow, and not accessible for people using bicycles, walkers, wheelchairs, and other mobility devices. The ultimate vision of the community was to construct a long-term solution that provided a paved, accessible trail for the entire community. In order to do this, the team, now growing in size with new partnering organizations, decided that additional technical assistance would be beneficial in implementing a new trail. The team applied for assistance from the National Park Service, and were awarded assistance from the Rivers, Trails, and Conservation group. Using the vision of the community and Village Council, as well as technical assistance from the National Park Service and other organizations, such as the UCHD-CHC program, a plan was rendered, and the layout of the trail was moving toward a reality. By this point, the various organizations and community members had come together to form a committee, known as the Richwood Trailblazers, and a name was born from the team's vision, the Richwood Lake Park Trail. The next step for the team was to consult current evidence-based programs and best practices to determine the ideal route for implementation. For this, the team consulted the Guide to Community Preventive Services and Center for Disease Control and Prevention's Recommended Community Strategies and Measurements to Prevent Obesity in the United States (Strategies 16: Improving access to outdoor recreational facilities, 17: Enhance infrastructure supporting bicycling, and 18: Enhance infrastructure supporting walking) as well as the County Health Rankings and Road Maps – What Works for Health, to facilitate the development and implementation of the trail. The team adhered to the guidelines and recommendations to ensure the use of best practices to help build a successful and sustainable multi-use trail that can accommodate all abilities. The team also utilized the creative concept of partnering with local organizations like the Richwood-North Union Public Library and the local Richwood Civic Center, to provide programmatic and educational opportunities to youth and adults throughout the community at the park and trail. These partnerships have helped establish a consistent interest in the park, and have continued to support the idea that the park and trail are the center of the community and a hub for activity. Walking programs for seniors, reading programs for youth, bicycle lending programs from the library for all ages, and other opportunities have all assisted in encouraging use of the trail and park, as well as connected people who may not regularly visit the park and trail to get more involved and interested in their health. The Trailblazers have also put together a volunteer group to assist in trail maintenance, which has helped the community adopt the trail as their own and enhanced accountability for the sustainment of the trail. The Trailblazers continue to build and expand activities and amenities, and now with the completion of the trail, the team is already looking at how it can be connected to other parts of the community.

The use of the trail has grown significantly since its completion in June of 2018. During the first phase of the trail's completion (around 1400 linear feet) in 2017, there were an average of 18 users per day on the path. Once the loop trail was completed, the number of average users per day swelled to 84, a 366% increase in use. In reviewing availability of the trail to Richwood residents within a half mile of the park, as a suggested measurement by the Centers for Disease Control and Prevention's Improving Public Health through Parks and Trails – Eight Common Measures Summary Guide, there are approximately 150 residents who live within a half mile of the park, which is roughly 6% of the population of Richwood. However, the park's proximity to the rest of the Village, which is only 1.25 square miles, as well as the local school campus, with a student population of around 1600, and a senior housing complex means that both within, and just beyond a half mile, there is a much higher percentage of residents who do have close access to the trail. General feedback from residents and patrons of the park has all been positive, and the overall perception of the park has been enhanced due to the implementation of the trail. The UCHD-CHC program, Trailblazers, and other partnering organizations meet monthly to review plans for sustaining and encouraging trail use, providing programs, enhancing the park's amenities and aesthetics, and ensuring sustainability. Evaluations of park and trail use will continue, and new evaluation measures will be added and assessed as needed.

The UCHD-CHC program is the focal point of all the Union County Creating Healthy Communities activities.  Historically, the Union County Health Department has pioneered projects that have addressed prevention programming and risk factor reduction for chronic diseases, and has been a leader in the community in working towards reducing and preventing the burden of disease for residents. Since receiving the Creating Healthy Communities grant in 2015, the Union County Health Department has been able to expand on its existing successes and further its efforts to improve the health of Union County residents. This success, however, would not be possible without existing coalitions and partnerships, as well as new partnerships that work alongside the UCHD-CHC program.

Since 2006, the Union County Health Department has worked with a multitude of local partners, to include businesses, schools, healthcare, and other agencies, under the Union County Wellness Consortium (UCWC). The UCWC was formed to bring agencies and organizations together to address health issues in the community, and has been an anchor for many projects and programs in Union County. Currently, the UCWC is the home base for reviewing projects, disseminating information on the progress of the projects, and identifying new focus areas as well as partners for projects and programs. The Union County Health Department also works with smaller coalitions and teams in priority communities. Some of these teams consist of committed residents, members of local councils, businesses, and community organizations, and are brought about to address one project focus area.

When planning for the development of the trail, the UCHD-CHC and its partners established objectives to reach the goal of building out the trail as part of the overall Creating Healthy Communities annual work plans for 2015-2018. The first objective was to establish a formal committee to assist in the development and implementation of the trail. This committee would be made up of what would later become the Richwood Trailblazers, along with the Village Council, National Park Service, and the UCHD-CHC program. More partners have come to the table since, but the core organizations remain as pillars for the project. Once the committee was established, it was tasked with following through on the following objectives and activities to complete the goal of developing the trail:

  1. Establish local partnerships and to review the need and efficacy of a trail at Richwood Lake Park.
  2. Create project proposal and receive local government endorsement
  3. Consult guidance documents and best practices to facilitate the project outline, objectives, and evaluation measures.
  4. Gather information from residents through surveys and public meetings to create a vision and design for the trail.
  5. Identify appropriate engineering firm to facilitate construction.
  6. Finalize trail design and overall project timeline.
  7. Procure funding through various sources to construct each phase of the trail.
  8. Procure land and easements near park for appropriate space needed for trail and park enhancements.
  9. Create communications and events to promote to the community to build awareness and interest.
  10. Complete all phases of the trail within construction timeline.
  11. Host a kickoff event and grand opening to celebrate with community.
  12. Complete/Finalize all evaluation measures to assess initial project success.
  13. Develop a sustainability, maintenance, and programming plan with trail committee and local partners.
  14. Provide continuous technical assistance to ensure trail success through use, sustainability, maintenance, and access.

Throughout the years, the UCHD-CHC program, Trailblazers, and other partners worked on each of the objectives, and successfully completed them by the summer of 2018. The committee used community feedback and reviewed the existing foot path to establish the ideal location for the trail, worked closely with the engineering firm to finalize the overall design and timeline, and secured enough funding through various grants, fundraisers, and in-kind donations to cover the entire cost of the trail, along with some additional park amenities, such as a new shelter house and restrooms. Throughout the process, the Trailblazers created their own social media page and regularly posted updates about the trail to build interest and offer the opportunity for residents to get involved in planning meetings, events, and park clean up activities. The UCHD-CHC program provided technical assistance and funding throughout the project to help pursue funding, initiate and maintain communications with the public, review and utilize best practices for project implementation, develop appropriate data collection tools and evaluation measures, and support overall project management.

As of the fall of 2018, the committee met to review the most recent data collected, and worked to finalize a sustainability plan. This plan includes the expansion of the park and trail, fund seeking for maintenance and improvements, continuous monitoring and evaluation of the park and trail for use, accessibility, and safety, event planning and programming, communication to the public, and sustainment of a dedicated volunteer group. The UCHD-CHC program, and other community partners have committed to provide support for the aforementioned efforts of the Trailblazers. Costs and overall funds associated with the development and implementation of the Richwood Lake Park Trail between the 2015 and 2018 are listed below.

2015-2018 Richwood Lake Park Trail Costs and overall funds:

In-Kind Volunteer hours: $11,535.00 (500 hours valued at $23.07 an hour over 3 years)

In-Kind Technical Assistance from National Park Service: $20,030.00

In-Kind Technical Assistance from UCHD-CHC program: $16,500.00

Local funds raised (to-date): $5,100.00

Local Grants: $35,000.00

State and Federal Grants: $2,030,470.00

Other Grants: $25,000.00

Total funds raised and in-kind contributions (2015-2018): $2,143,635.00

Project Costs:

Erosion Control: $1,157,927.00

Engineering and Implementation Fees: $343,600.00

Land Acquisition: $179,000.00

Trail Construction (includes cutting, gravel, paving, seeding, etc.): $360,100.00

Total Project Costs (2015-2018): $2,040,627.00

One of the primary objectives of the UCHD-CHC program and its partners in the establishment and sustainment of the trail is not only the regular evaluation of it, but also the community's health. Prior to the trail's implementation, both census data and Union County Community Health Assessment data were analyzed. As a result, it was found that physical activity among youth and adults was low, overweight and obesity levels were high, and risk factors like blood pressure and cholesterol levels among Union County residents, which are influenced in part by physical activity, were high. The combination of these data points, along with the willing partnership of a local grassroots group of residents, and other community organizations, helped identify the need for, and establish the Richwood Lake Park Trail. From this, the UCHD-CHC program and its partners were able to identify and reach out to other organizations that could provide assistance to the project. The result of the outreach, along with the data reviewed, served to further develop the parameters and objectives of the project, and provided a baseline to measure future programmatic needs and community health outcomes.

As process objectives for the development of the trail were established, so were process evaluation measures. These measures would be used to evaluate the success of the various objectives, and provide insight into the completion of the trail. Some key process evaluation measures reviewed were the number of key community partners, completion of a project outline, number of regular volunteers and sustained committee members, amount of funding raised to help implement the trail, number and quality of communication materials disseminated to the public, adherence to project timeline, number of community events for feedback, and number of residents who have immediate access to the trail.

By the summer of 2018, it was clear that the process objectives had been met using the process evaluation measures and a heavily used and accessible trail had been established as an immediate outcome measure. In order to effectively measure the success of the trail, outcome evaluation measures were developed. Using trail counter data, survey data from residents, and GIS analysis to determine resident density within close proximity to the trail, among other measures, the UCHD-CHC program and its partners were able to capture quantitative and qualitative data on the trail that could be compared between the start of the project, and its completion in 2018. These outcome evaluation measures included changes in daily use of the trail, knowledge and perception of the trail by residents, and change in volume of programming and events around the park and trail.

A primary goal of the UCHD-CHC program and its partners is to develop every project with sustainability in mind. With the Richwood Lake Park trail, several mechanisms have been put in place to assist with sustainability as the community and park grow. Every month, the Trailblazers, UCHD-CHC, and other community partners meet to review the current status of the trail and park, and work on scheduling events, such as park cleanups, trail fundraisers, family events, and physical activity opportunities, among other activities. The team also works on developing plans for new connections to the trail, exploring new funding opportunities for trails and park amenities, as well as reviewing pertinent data to assess trail use. Each meeting also includes representation from the Village Council, who provides updates on plans for the Village and also ensures that the voices of the Trailblazers and greater community are heard in regards to the trail and park. The team also annually reviews short and long-term goals in order to ensure a clear vision and plan moving forward year after year.

Sustainability needs will also be met through continued partnership from organizations like the National Park Service, the local school district, Civic Center, and local library. Through continued park and trail expansion and maintenance, dedicated local volunteer groups, community partners, and consistent evaluation, the Richwood Lake Park Trail will continue to grow to better serve the community. In approaching 2019, the Village of Richwood, Trailblazers, and UCHD-CHC program will continue to work toward increasing accessibility to physical activity in the Village, and encourage use of existing amenities, such as the trail, to reduce the burden of chronic disease and lack of physical activity in Richwood and Union County.   

Colleague in my LHD