Evaluation Findings & Conclusions

The broad scope of this evaluation resulted in extensive findings on key topics. Below are highlights from over the course of the 5 years of the initiative:

• Multi-sectoral coalitions were formed in each of the 11 counties, with relatively high levels of coalition functioning (e.g., leadership, communication, decision-making, satisfaction, leveraging member resources) and strong representation from education, community-based organizations, health care, social/human services, business & faith sectors.
• Coalition staff appreciated guidance received from the various support teams.
• Changes in community readiness to address health equity at the county-level were modest, with most of the coalitions in the Preparation stage at the end of the Initiative.
• Numerous indicators of community capacity to address health equity showed positive movement, including new opportunities for engagement by those with lived experience, new leadership development opportunities, strengthened planning and collaboration skills among coalition members, and expanded personal and professional networks.
• Coalition members representing organizations reported moderate institutional efforts to address health equity, with collaboration ranked most highly and internal talks on systemic racism ranked the lowest.
• The majority (70.5%) of planned intervention strategies were successfully implemented, even with major disruptions due to COVID-19.
• Efforts to address food access, physical activity, healthy lifestyle education, nutrition guidelines and policies, and health care access were the most common across coalitions.
• Coalitions contributed to a substantive amount of community change in these areas.
• An impressive amount of community change with respect to policies, systems and environments resulted from the Initiative. However, reach and intensity of efforts was often modest and likely impacted primarily those directly touched by a program or community change. Population-level change was harder to document, likely due to the relatively short time-frame of the Initiative relative to the magnitude of the needs rural communities face and the major impact of the COVID-19 pandemic on many of the longer-term outcomes assessed.
• Over 75% of the implemented strategies were likely to be sustained, and the coalitions were able to leverage over $12 million for community health improvement.

The Two Georgias Initiative was successful in creating and sustaining a broad array of community health improvements and laying the groundwork for continued efforts to address health equity in rural Georgia. The Initiative developed a model for creating, guiding and/or animating a collaborative spirit within participating communities in combination with strengthening capacity to address health equity. Leadership, mechanisms for interaction and alignment, inter-organizational and personal networks, skill-building, and an ability to leverage resources were seeded and nurtured for growth. Given that current inequities have been shaped and sustained over decades, and in some cases, centuries, it will take time to achieve the ultimate goal of health equity. Continued investment in rural communities will accelerate progress toward the shared goal of eliminating barriers to health for all.