Health & Mental Health

Access to comprehensive and affordable health and mental health services promote well being and reduce disability among individuals, which can create barriers to employment, programs, and services.

  • Expand access to affordable, healthy foods through healthy corner stores, farmers markets, community gardens, and mobile markets.
  • Bring health and mental health services to residents in need through community outreach, mobile services, and online tools.
  • Promote healthy communities, active lifestyles, and access to preventive health care services to improve health outcomes.
  • Why This Strategy Matters

    Nearly 95,000 residents in the region, including 21,600 children, live in neighborhoods designated by the USDA as "food deserts" where healthy food access is limited and food insecurity is high. Nearly half of these individuals live in or near poverty, so being able to afford food is a constant concern for many. Not having a car adds another obstacle, and nearly a quarter (22%) of households in food deserts do not own a vehicle. Overcoming these barriers to make healthy food more affordable and accessible is critical. A healthy diet can help prevent obesity and curb related health conditions like diabetes, heart disease, and hypertension. Moreover, many strategies to improve healthy food access, like community gardening, also benefit physical and mental health.

  • Potential Action Steps

    Expand mobile markets and healthy corner stores in areas that are designated as food deserts. Locate markets along walking and biking paths to encourage physical activity in addition to healthy eating.

    Promote individual and community gardens. Integrate gardens in revitalization of neighborhoods and the development of new rental housing.

    Repurpose vacant land to expand opportunities for residents to grow fruit trees and vegetable gardens.

    Install community gardens at schools where young students can experience educational, nutritional and emotional benefits of growing food.

  • Potential actors in the Community

    School districts
    Agricultural extension programs
    Development corporations
    Local government leaders
    Block group leaders
    Health services providers
    Land trusts
    Existing community gardens and health stores
    Religious organizations

Models to Consider

  • FeedMore WNY

    Western New York

    FeedMore WNY serves four counties in WNY with food access services. It was created in 2019 through the merger of the Food Bank of WNY and Meals on Wheels for WNY to better serve those in the region without reliable access to healthy, affordable foods. Both organizations collaborated for decades and shared a common mission. By working together as FeedMore WNY, the organizations will expand services, including summer meal programs for kids along with after-school food programs, and food pantries for seniors. The organization also predicts that its food distribution will increase by 10 percent in the first three to five years. In the process of merging, all employees were retained, and the new organization feels the merger is financially advantageous and allows greater flexibility in providing food services to the region.
  • Grassroots Gardens of WNY

    Buffalo and Niagara Falls, NY

    Grassroots Gardens of WNY (GGWNY) fosters food access, community revitalization, and innovative mental health care for refugees, seniors, and others. The organization's network includes 110 community gardens across Buffalo and Niagara Falls. Aside from offering community members a way to grow fresh, healthy food and vegetables, community gardens can also have therapeutic value. GGWNY is exploring new programs to use existing gardens, both ornamental and food-producing, for behavioral health interventions. These programs, including GGWNY's new therapeutic gardening initiative, have the potential to support the mental wellness of seniors, children, and other residents. The organization is primarily funded through grants and donations. Through its community gardens and other programs, GGWNY engages over 2,000 volunteers from the community. GGWNY is working to become one of the first accredited community garden land trust in the country, and already owns two of the gardens in the network.
  • Healthy Corner Store Initiative

    Healthy Corner Store Initiative

    Buffalo, NY

    Started in 2016 as a project developed through the Mobile Safety-Net Team's North East Buffalo Coalition, the Healthy Corner Store Initiative aims to alleviate the issue of food deserts in Buffalo's east side neighborhoods. The initiative works with corner stores in area neighborhoods to bring fresh, healthy foods into stores that typically only sell processed foods, while also providing technical support to store owners, and education to community members. Since it began, the Healthy Corner Store Initiative has brought healthy foods to six stores on Buffalo's east side. Outside of the support of the Mobile Safety-Net Team, the project was funded by a grant for $118,000 from General Mills, and the initiative is also seeking additional funding from the US Department of Agriculture.
  • Why This Strategy Matters

    For many residents, access to healthcare services can be limited, especially those without a vehicle, in rural areas far from doctors and hospitals, and others facing economic, social, or language barriers. Thousands of Buffalo Niagara residents face such obstacles—over 60,500 households do not own a car, nearly 36,000 people with a disability live in poverty, and over 18,000 individuals have limited English fluency. Mobile health clinics can overcome these barriers by bringing essential health care services directly to residents in need where they live and work. Similarly, proactive community outreach by medical professionals, and online tools and resources can increase awareness and access to health care services, especially for those who face physical, cultural, or financial barriers.

  • Potential Action Steps

    Operate mobile health clinics that travel to communities lacking convenient access to key health services. These can provide low-cost alternatives to primary care, screening and testing, mental health counseling, and other important services, including care outside of normal business hours..

    Leverage data to determine where and how mobile health clinics can best reach underserved populations.

    Travel to workplaces, and contact businesses, to directly reach people in need of health care services.

    Consult with individuals experiencing financial, legal, cultural, or psychological barriers to accessing health care.

    Provide consultation services to increase enrollment in health insurance, set up appointments with primary care or other physicians.

    Advocate for policies that can facilitate the adoption of information technology for health solutions.

    Hire social workers to work in the public library system.

    Integrate and coordinate bi-directional primary care services and behavioral health services in one location.

  • Potential Actors in the Community

    Health clinics
    Health care providers
    Health insurance companies
    Local governments
    Colleges and universities

Models to Consider

  • Health Wagon

    The Health Wagon

    Various locations in Virginia

    The Health Wagon is a non-profit organization created in 1980 that focuses on improving access to a range of health care services among uninsured or underserved populations in a rural region of Virginia. The Health Wagon provides preventive care, primary care, dental, behavioral health, pharmaceutical, and specialty care services. The organization runs 11 mobile units, two fixed location clinics, local health fairs, and the largest Remote Area Medical Corps (RAM) event in the US. The Health Wagon is led by a team of clinical nurses and volunteers from local colleges and universities. Support staff also include an outreach coordinator, a data systems specialist, and directors of development and operations. In 2017, the organization provided nearly $4.3 million in health care services through over 4,000 patient visits, 86% of whom were uninsured. The program is funded through the support of local foundations, government agencies, and community member donations.
  • Mental Health Outreach for MotherS (MOMS)

    New Haven, CT

    The MOMS Partnership is a program that has successfully reduced depressive symptoms among over-burdened, under-resourced pregnant women, moms, and other adult female caregivers in a family. Launched in New Haven in 2011 by the Yale School of Medicine, the MOMS Partnership brings mental health within reach of women, literally meeting them where they are. The Partnership is supported by collaboration between service providers in the community, the City of New Haven, and the Yale School of Medicine. Specific actions that the MOMS Partnership takes include conducting mental health treatments specific to mothers; developing a maternal mental health-literate, community-based workforce; conducting research on family mental health and its connection to social and economic mobility; and providing centralized family economic success and job readiness supports.
  • Friendship Benches


    Based in Zimbabwe, this program aims to close the gap between the number of people suffering from mental illness and the number of people who can actually receive treatment for mental illness. Access to mental health treatment through primary care providers in Zimbabwe is extremely limited and does not currently meet the mental health needs of people in the community. The program's novel solution was to place a bench near primary care clinics and train lay health workers (who are all women and 58 years old on average) to recognize and treat mental illness through evidence-based problem solving therapy. When clients come to the clinic, primary care providers can make an initial assessment of need and refer patients to the Friendship Bench based on their assessment. The bench provides a comfortable, outdoor space for clients to talk through their challenges with "community grandmothers." Clients are also given the additional option to join an income-generating peer support group in which they create bags from recylced plastic and are able to share their experiences with other people suffering from mental illness. Since its inception, the program has scaled up to cover 72 clinics in 3 cities, and has provided treatment for over 40,000 people.
  • Erie County Anti-Stigma Coalition

    Erie County, NY

    Sixteen organizations from across Erie County and the greater Western New York area came together to form the Erie County Anti-Stigma Coalition. On its website,, there are educational resources aimed at dispelling negative stereotypes about mental illness, such as that people with mental health problems are violent or that they are bad employees. The coalition also aims to "remove the shame and secrecy surrounding" mental illness through its Join the Conversation campaign, which launched in 2017 and shares the stories of those who have suffered or are suffering from mental illness. On the website, one can also pledge to end stigma by, for example, avoiding using stigmatizing words like "crazy" and "pyscho" in everyday conversation. As of December 2019, over 3,000 people have taken the pledge.
  • Mobile York South Simcoe

    Mobile York South Simcoe (MOBYSS)

    Ontario, Canada

    The Canadian Mental Health Association's Mobile York South Simcoe (MOBYSS) launched in 2015 as Ontario's first mobile mental health clinic. MOBYSS focuses on providing a range of confidential mental health services to youth ages 12-25 free of charge, without appointments. The clinic also offers preventive care, acute care, and reproductive health services to youth in the region. The clinic is funded by a number of organizations, including the United Way and provincial government departments, along with community donations. MOBYSS has nurse practitioners, peer support volunteers, and mental health counselors on its staff that assist young people at the travelling MOBYSS vehicle. In its first 18 months, the clinic met with nearly 4,200 young people, 40% of which used mental health support services.
  • Why This Strategy Matters

    Healthy lifestyles and preventive care can help people avoid many common health issues. But compared to the US overall, Buffalo Niagara residents are less likely to be physically active or to use preventive services, and more likely to have common chronic diseases. Exercise and healthy diets can decrease the risk of heart disease, diabetes, and other common chronic conditions. Immunizations and screenings can also prevent future health complications. Many residents face barriers to physical activity based on their environment and may not take advantage of preventive services due to lack of awareness or high costs. Encouraging healthy lifestyles while promoting access to preventive health services can help residents avoid serious health conditions.

  • Potential Action Steps

    Calculate the “return-on-investment” of preventive services, and use other metrics to advocate for the adoption of preventive services, like cancer screening, to health care providers and residents.

    Promote the use of preventive service among residents through targeted outreach, marketing, and offering low-cost, or free preventive services.

    Promote the formation of community walking or biking groups, or host community events to get people active and exercise on a regular basis.

    Proactive outreach to workplaces, schools, and community groups to promote exercise and physical activity and healthy lifestyles.

    Raise awareness of opportunities to lead active lifestyles, like bike share programs, parks and multi-use trails, or recreational athletic leagues.

    Foster partnerships between schools and service providers, like that between HOPE Buffalo and Buffalo Public Schools, to address the physical, mental, and emotional well-being of teens.

  • Potential Actors in the Community

    Health clinics
    Health care providers
    Health insurance companies
    Local governments
    Public school districts
    Colleges and universities

Models to Consider

  • Albert Lea Blue Zones Program

    Albert Lea Blue Zones Program

    Albert Lea, MN

    This program aims to increase physical activity of local residents in the rural community of Albert Lea, Minnesota. The program began in 2009 with funding from Blue Zones, LLC, and other partners, including local health systems, state agencies, and corporate sponsors. The Albert Lea Blue Zones Program focuses on three service areas: promoting walking at local schools and businesses through public education; encouraging residents to form their own neighborhood walking/biking groups, and; creating quality public spaces that facilitate active recreation. The program also aims to limit tobacco use, promote healthy diets, improve the physical and mental health of employees through workplace interventions, and revitalize Albert Lea’s downtown. The program has shown progress by tracking local health outcomes, including a 70% increase in walking trips, and a combined weight loss of nearly 8,000 pounds in the community from 2010 to 2015.
  • The Community Health Worker Program

    The Community Health Worker Program

    Dan River Region, VA

    The Community Health Worker (CHW) program takes a personal approach to promote access to critical health services in Virginia’s rural Dan River Region. The program is an initiative of The Health Collaborative, a group of local organizations working to limit rates of chronic disease, that was launched in 2017 with a three-year funding commitment of $3.9 million from local foundations. Community Health Workers (CHWs) are health professionals and trusted community members who volunteer to meet with interested patients soon after hospital stays to ensure they can access the services they need to prevent future hospital visits. Along with linking patients to healthcare and social services, CHWs also offer personal counseling and health education. The program has shown early success in reducing emergency room visits among clients, and has also benefited the career development of CHW volunteers. Many CHW volunteers have used the experience to earn related full-time positions, and the CHW position is now a certified profession in the State of Virginia.

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