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Earning Trust to Build Equitable and Healthy Societies

Addressing health disparities, increasing government legitimacy, and fostering community trust for equitable and healthier societies.

About the program

The Earning Trust to Build Equitable and Healthy Societies (ET4HS) program is a dedicated initiative that addresses health disparities while increasing government legitimacy in local communities. Through an international network, participating cities and counties learn and source innovative solutions for health equity challenges, gaining access to proven approaches tailored to their context. The program fosters relationships between the government and the community, laying the foundation for more effective governance. Teams receive valuable resources, including workshops, community engagement exercises, and expert insights, to positively impact health outcomes.

At the core of ET4HS is the concept of "earned legitimacy," recognizing that a government's credibility depends on trust and support from its people. By addressing complex social factors and systemic barriers that lead to disparities, local governments rebuild trust with affected communities, creating equitable and healthier societies for all.

The 2023 cohort and our international partners

In the 2023 cohort, six local governments will joined with community partners to address issues ranging from inequities faced by the disability community to lead contamination to building trust for greater collaboration. Selected cities and counties include: Detroit, MI; Guilford County, NC; Montgomery County, MD; Shelby County, TN; St. Louis, MO; and Tampa, FL.

ET4HS connects these U.S. governments to a global network advancing solutions for health equity. Our 2023 international partners include: Butuan, Philippines; Latrobe Valley Health Assembly, Australia; Latrobe Valley Health Advocate, Australia; Lusaka, Zambia; La Fábrica de Renca, Chile; and Umuaka, Nigeria.

How our program helps governments

During the ET4HS program, government participants develop skills to better work with communities and then create a plan to tackle a specific local health equity issue.

Participants receive the following support while working on their city-specific health equity issues:

  • A series of cross-city exercises and workshops where all participants come together to learn about and discuss concepts that are core to building legitimacy. Topics can include examining where power sits, sharing power, and reimagining more legitimate systems.

  • Individualized support from a Learning Liaison, serving as a CPI coach and trained in the core components and skills of the curriculum, to guide and facilitate the work of the city team throughout the program.

  • Skill-based exercises that equip teams with core community engagement and legitimacy skills, preparing them to apply what they learn in their local communities to increase trust between government and residents.

  • Mini-cohort sessions where city teams working on similar problem scopes are connected to discuss learnings and best practices, accelerating their progress towards health equity solutions and building legitimacy.



6 government teams participated


21 government staff involved on core teams


93 residents engaged during the program


100% of survey respondents would recommend the program to their peers


100% of survey respondents report learning new skills


92.3% of survey respondents plan to use processes and skills they learned after the program


“By participating in the Earning Trust to Build Equitable and Healthy Societies Program, we created space to hear real-feedback from real-people about the state of ‘trust’ between our community and the Guilford County Division of Public Health. These conversations - held between public health employees, trusted community partners, and residents - helped provide insight into what 'access to care' means to the people being impacted by our services every day. This opportunity provided us with tested tools and techniques to prioritise the community’s voice in shaping how we do our work. Long-term, we envision continuing to work with our diverse community, and provide a permanent space for listening and co-creation sessions – which will involve capturing the community's voice in the decision-making process. We recognize that it will take hard work, time, and organisational commitment to make this work, but we're optimistic about the future.”

Eli Saavedra, Healthy Communities Program Supervisor, Guilford County Division of Public Health

“We’re proud to support CPI and the Earning Trust to Build Equitable and Healthy Societies program, and we’re excited that, as part of this program, these cities and counties connected with global experts working to advance solutions for health equity. We have a lot to learn from the experiences of communities around the world facing similar challenges, and we hope participants can continue to engage in mutual cross-border knowledge sharing in the future.”

Shilpa Shankar, Program Associate, Robert Wood Johnson Foundation

“The City of St. Louis Department of Health benefited greatly from participation in the Earning Trust to Build Equitable and Healthy Societies program. We took deliberate and critical steps forward in health equity planning and action. Experiencing this program with other cities across the world inspired us as we face similar and daunting challenges in our daily work that are the result of decades of structural racism. Through the skills and inspiration gained in this program, we are poised to partner with our community to roll out an impactful citywide health equity plan in the next few months.”

Dr. Julie Gary, Behavioral Health Bureau Chief, City of St. Louis

“I was thrilled to work on this ET4HS Project with colleagues across Shelby County, TN. I have worked for both local government and in the non-profit field for over 30 years and have answered the same questions now as I did 30 years ago about the hazards of lead in our community. During this project, I was especially moved by the interviews we conducted with people in our community who are looking for help and don’t know where to go. I am excited that Green & Healthy Homes Initiative (GHHI) and the Shelby County Team will be asking our local Healthy Homes Partnership to endorse an environmental scan to identify the roles of the 30+ agencies responsible for lead poisoning prevention and lead services. We learned in listening sessions that the community believes government has a responsibility to assure children are lead safe. Through the scan we aim to clarify agencies’ moral and legal accountability, as well as the referral pathways for various lead services.”

Sharon Hyde, Program Manager at Memphis/Shelby County Green & Healthy Homes Initiative

Support for this program was provided in part by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.