The goal of 100 Million Healthier Lives initiative was ambitious: transform the way people think about health, well-being and equity. Launched in 2014 with APHA as a core partner, the initiative set out to help 100 million people worldwide live healthier lives by the end of 2020.

The initiative is made up of 1,500 partners in 30 countries who are committed to improving health in communities. Members agree to adopt core principles, called the Community of Solutions Framework, and be leaders for outcomes, equity and sustainability, as well as leading together and from within. Other core partners of 100 Million Healthier Lives — which was convened by the Institute for Healthcare Improvement — include Communities Joined in Action, the Network for Regional Healthcare Improvement and Institute for People, Place and Possibility. Now that the initiative has concluded, Niñon Lewis, MS, vice president of the Institute for Healthcare Improvement, and Marianne McPherson, PhD, MS, the institute’s senior director, examine the project’s lessons.

Why was 100 Million Healthier Lives created?
Lewis: We needed some kind of collaboration that was different if we were going to get where we needed to go. What we focus on, how we partner, what we do to advance health outcomes and how we do it together in communities needed to be different. We needed to fundamentally change the system in which we all work. Six years later, the movement’s unprecedented collaboration that we designed into the system expanded from 35 partners that connected to reach about 35 million people around the U.S. to 1,500 partners reaching 500 million globally in 30 countries.

The initiative is based on the Community of Solutions Framework. What is that and how is it applied in communities?
McPherson: It’s about working in relationship in a broader and deeper way. 100 Million Lives brought together a broad-based network of partners in different sectors at all levels with a set of specific initiatives that address topics like homelessness, chronic disease, high school graduation, food insecurity, job training and so much more. Together, we applied a set of tools, resources and skills, so that no matter what challenge a community was facing, they had ways to improve their way out of it and create sustained change.

How do you transform the way people think about health, well-being and equity?
McPherson: One of the ways to center equity is to elevate the importance of what health and well-being are and measure them in a way that centers the individual or community experience…as a measurement tool and a way to guide the work. We’ve seen people’s well-being go from struggling to thriving in less than 18 months. We’ve seen this approach work.

How do you effect that kind of behavioral change?
McPherson: We did much more co-design with folks, so it didn’t become a “doing to,” which is how many communities have experienced well-intended interventions over time. Part of our aim was to not be yet another program coming into a community to work on a topic and then go away — we recognize the harm that can cause. Rather, it was about bringing tools from improvement science and the other areas, but knowing that was never going to succeed if we weren’t willing to be shaped by the process of sharing what we know and having communities share what they know so that, together, we can combine our efforts and lead to transformation over time.

Can you share a success story from 100 Million Healthier Lives?
McPherson: A lot of communities shared with us that being a part of 100 Million Lives and utilizing the movement’s skills and tools allowed them to figure out what mattered to them and to work in partnership during that shift to the COVID era. We had been learning from the All Children Thrive network in Cincinnati. When the pandemic hit, they were able to quickly learn from families in their community who were not thriving and deploy their partners to deliver masks, basic goods like diapers and food. They were able to detect the social isolation that was developing through that connection. 

Lewis: Every person connected to 100 Million Lives has a story about how they won’t work the same way, show up as a human being the same way again after doing this work. It’s a testament to the need to move from demonstration to transformation. So much of philanthropy in the U.S. is based on demonstration and then hoping someone else will scale it up later. The system won’t change that way.

What comes next?
Lewis: The initiative has ended but the movement continues. It has legs, and I think it’s going to be evergreen. Responding to this unique moment, many of the 100 Million Lives partners, including IHI, are committed to the reinvigoration of public health. Powerful stakeholders are not the ones who create health; it always starts with the individual, the family, the community. Our job as stakeholders in health and equity is to support that individual, family and community. Just like with all our partners in the initiative, our job is to lift up, amplify, magnify. We do not take credit for leading the work. We just provide the tools and resources.

This interview was edited and condensed.

Launched in 2014 with APHA as a key partner, the 100 Million Healthier Lives initiative began with 35 partners motivated to create new ways and strategies to help individuals, families and communities improve health. About 1,500 groups were involved when it concluded in December. (Photo by Mladen Zivkovic, courtesy iStockphoto)

(This story will also appear in the May issue of The Nation’s Health.)