Community Action in Context

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JA PreventnCD's Community Action for Health guide provides a shared methodology for all the 51 pilots on Healthy Living Environment being developed across 15 countries. However, the local conditions in which each pilot operates are far from shared: institutional histories, political moments, data infrastructure, and team experiences vary widely, shaping how interventions are developed and implemented. As a result, things do not always unfold as planned, and pilots need to adapt the guide to their context. Governance structures sometimes take longer to form than expected, while communities reveal needs that no predefined indicator had anticipated. This makes learning from experience essential.

To support this, the working team on Healthy Living Environments has built a monitoring and learning system into the methodology from the start. At each step, pilots document their progress, providing a structured way to share experiences and lessons across countries. As pilots progressed through Step 0 (setting selection) and Step 1 (Core Group and Health Network), important early lessons emerged that are worth sharing in this article.

Step 0 highlighted a practical starting point: pilots that built on existing structures and relationships (such as the French pilot within the Healthy Cities Network) were generally able to move faster and with greater stability. However, these conditions were not always present, and even where they existed, they did not guarantee smooth implementation. In Valencia, flooding caused by the DANA disaster abruptly interrupted timelines and required a reconfiguration of priorities and engagement processes, despite the pilot being embedded in an active local network. In Portugal, pre-election transitions halted stakeholder engagement mid-process.

These experiences show that initial assets are constantly shaped by changing constraints. Across all three steps, implementation requires ongoing adjustment. When strong foundations are in place, they can support early progress but still need to be maintained over time; when they are weaker or disrupted, the ability to adapt becomes essential.

Step 1 showed that forming a Core Group or Health Network is not just a preliminary step, but a core element for implementation. In practice, these structures evolve over time, shaped by political cycles, workloads, staff turnover, and external events.

In several pilots, delays in forming Core Groups were not due to a lack of commitment, but to institutional constraints. Stakeholders were often willing to engage, but faced competing priorities and limited time. In settings such as schools, health services, and municipal departments, staff were already managing heavy workloads, limiting their capacity to engage in new cross-sectoral initiatives.

Forming a Core Group therefore required more than identifying the “right” actors. It involved negotiating roles, responsibilities, and decision-making processes across departments with limited experience of working together. In many cases, this took time, as it required aligning mandates, administrative procedures, and internal hierarchies. Governance, in this sense, is not just about setting up coordination structures once, but also about sustaining collaboration over time under changing conditions.

Addressing non-communicable diseases prevention requires attention to inequality, as patterns of exposure, vulnerability, and access to resources are unevenly distributed, Interventions that do not account for this risk reproducing existing gaps. Across all steps, equity was widely acknowledged but not always consistently applied in practice. In the initial phases, many pilots approached equity mainly in terms of inclusion or universal access, without clearly defining how different social positions, such as gender, migration background, or socioeconomic status, influence participation or outcomes. At the same time, Step 2 showed that these challenges are not only conceptual but also practical. Even when pilots aimed to address inequalities, they often lacked disaggregated data or the methodological tools needed to capture lived experiences.

Over time, however, these limitations became a source of collective learning, and through iterative exchanges and dedicated workshops, pilots progressively refined their understanding of equity. When pilots engaged more deeply with communities through participatory and qualitative work, equity began to shift from an abstract principle to a practical lens shaping both knowledge and action, revealing spatial barriers, gendered constraints, how needs are defined, whose voices are heard, and how power relations influence both processes and outcomes.

In this sense, equity is not something that can be added at the end of the process, but must be embedded in the methodological choices through which evidence is produced and interpreted.

These lessons will continue to be documented and shared as pilots move through the remaining steps, and will be made available through a capacity building platform together with tools, pilot experiences, and guidance for each step of the methodology. Stay tuned to learn together how to make our environments healthier.

Camila De Ambroggi and Lucia Dansero,
University of Turin, Italy