Our Approach

Our work starts with listening to our community.

The Healthy Monadnock Alliance’s strategic goals are based on the Greater Monadnock Community Health Improvement Plan (CHIP). This plan, rooted in findings of our region’s Community Health Needs Assessment, is drafted by the Healthy Monadnock Alliance Executive Committee and CHIP Workgroup members with support from Cheshire Medical Center. The CHIP includes input from numerous public health partners and community members, who work together to create a roadmap for regional health priority areas. This roadmap inspires all our health and well-being partnerships, programs, policies, systems, and environmental changes.

In all of our priority areas, we are focused on a number of key factors that affect health outcomes. However, we know that these factors do not impact each area equally. We approach each of our goals with this in mind.

Social Drivers of Health

Studies are clear: the conditions where you live, learn, work, and play seriously affect your health. In fact, 50% of health outcomes are connected to a person’s physical environment and socio-economic status.


Equity means ensuring that every individual has what they need to thrive. One size does not fit all. Solutions to health and well-being challenges must account for these individual differences.


We know many adverse behaviors or beliefs people exhibit towards their health and well-being are often rooted in a traumatic event or set of circumstances they experienced. Our work is informed by the role trauma plays in health, to prevent further harm and promote better outcomes.

Our Theory of Change: PPPSE

Partnerships, Programs, Policy, System, and Environmental changes (PPPSE) is an approach used to create large-scale, sustainable change. It stresses an awareness that these factors often work hand-in-hand, influence one another, and should all be considered. For example, an environmental change may be implemented due to a newly formed partnership, or a program may be developed to encourage people to follow a new system change. The PPPSE process is not linear, and it functions best when all five elements are working together in unison.

Partnerships: A partnership in its most basic form is when two or more people or organizations come together around a common cause—such as the Healthy Monadnock Alliance. Partnerships are key to creating community-wide improvements, not just to share the workload, but also to minimize the duplication of efforts, and to make sure all populations are being represented.

Programs: Programs often focus on individual behavior change, and are short term—meaning they have a specified start and end date. Programs are often used as an engagement tool to coincide with a policy and/or environmental change. An example of this is the community-wide Safe Routes to School program that was developed to promote walkability in conjuncture with a new policy.

Policy Change: Policy change can happen on an organizational, local, or governmental level and represents the rules and protocols that need to be followed for specific situations. These policies are wide ranging and can include anything from changing the statewide smoking age from 18 to 21, to setting rules for what is or isn’t allowed to be served in school cafeterias. Policy change can be incredibly effective in creating lasting change throughout the populations it serves.

System Change: System change involves the changes made to the rules within an organizational structure, i.e. “how things are done”, and often work hand-in-hand with a policy change. As an example, this could include a business creating a new system for how employee orientation is run, based on state-wide recovery policies that were recently enacted.

Environmental Change: Environmental change is a change made to the physical environment. Environmental changes can be as simple as installing bike signage on already established bike routes, or as complex as sidewalk installation and pedestrian friendly intersections to promote walking and biking.