Local context includes “Local factors like geography, political will, socioeconomics, and community need impact aligning across sectors. Additionally, individual, organizational, and system-level factors can enable or hinder progress to align across sectors. These may include external pressures that spur a sense of urgency for sectors to align (e.g., state or federal pilot initiatives or policies, public health crises), internal factors within organizations (e.g., capacity, leadership, workforce, information infrastructure, incentives, financial management, and accountability), and softer elements impacting the ability to work together (e.g., interpersonal dynamics, past collaborative history or relationships, stakeholders’ mindset, and backbone support).”³⁵

“You go see Sally at the clinic, and she’ll help you figure out your Medicare coverage. That happens in rural areas, but I’m not sure it happens in the urban areas as well. There’s navigators and things like that, but it’s two different worlds.”

– Social Services Representative, WA

Key Takeaways

Local context considers factors relevant to understanding a community. This could be characteristics of the residents, the community’s history, economic conditions, or other defining factors that affect how sectors operate and relate to one another.
The most important components of local context identified through PHIL’s Aligning Systems for Health Deep Dive Study conducted in 2021 included (1) public health emergencies, (2) Native American roots, (3) geographic scale, (4) systemic racism.
Local context can have widespread effects on the perceptions of success within MSCs.

Local context matters. It influences everything that happens in an MSC.³⁶ For example, smaller MSC communities reported an easier time building trust among people and organizations than in larger communities but face capacity challenges because the same handful of people sit at multiple tables and wear multiple hats. On the other hand, larger and more diverse MSC communities reported abundant capacity (e.g., people and services) and systems (e.g., collaborative networks) allowing them access to greater quantities and types of resources but find they face complex coordination challenges. Income levels, racial and ethnic diversity, geographic characteristics, history of collaboration and conflict, political dynamics, public service and resource conditions, and many more elements weave the tapestry of each MSC’s unique local context.

Survey Findings

77% of respondents said their MSC strengthened their community’s ability to respond to COVID-19 and its consequences to a moderate or great extent (n=295).
69% of respondents agreed their MSC has active engagement from tribal nations (n=134).
93% of respondents agreed that systemic racism is a problem in their local community (n=383).
Across Washington and California states, MSCs serve geographic areas ranging from four to 15,000 square miles. Some MSCs serve a single neighborhood, while others work across large regions that include multiple counties and tribal nations. Total populations served range from 26,000 to over three million people.

“[We have] very small, rural, secluded, hard to reach areas, you have kind of a little bit more urban… and then you have all these different tribal governments. That was what really struck me like, at first, back in 2018 and 2017, it felt so vast to all work together. But it’s been really easy. There are so many similarities.“

– Health Care Representative, WA

The Influence of Local Context

Local context’s influence is widespread, with factors such as racial and ethnic identity, income, amount of startup funding, MSC backbone staff size, population size and density, and diversity in local representation all influencing perceptions of the MSC’s data use, finances, and capacity to develop shared purpose and create collective action.

“And so the geography, the other underserved component are those more remote communities, who often feel left out. And the county or the hospital’s justification is, ‘Oh, we’ll get the program going in the county seat, and then if it works, we’ll send it out to outlying communities,’ and it never really happens, because it’s hard to deliver services in places that are far away.”

– Community Representative, CA

Related Resources

Advancing Equity: Adapting to Local Context and Confronting Power Dynamics. Lessons Learned from Accountable Communities of/for Health, a Population Health Innovation Lab (PHIL) report (2022)
Advancing Equity: Adapting to Local Context and Confronting Power Dynamics, a Population Health Innovation Lab (PHIL) web discussion (2022)

View all references for the Data Walk.