By Dan Linehan

Their goals are ambitious: Help Sussex Countians develop as children, graduate on time and find a good job, all while avoiding long-term physical and mental disorders like addiction, diabetes and obesity.

If that sentence seemed overstuffed, then so does the mission of the Sussex County Health Coalition. Formed about 15 years ago to reduce child obesity, the coalition's mandate has ballooned.

Compounding their challenge is a budget of only about $250,000 a year, funded mainly by state agencies and private charities. That's a little more than $1 per Sussex County resident per year. Going it alone, in other words, is just not an option.

Executive Director Peggy Geisler says their role is to build what they call capacity and infrastructure to help other groups be efficient and effective. What does that mean?

It can be expensive for outside groups to reach into the largest county east of the Mississippi River. A charity that wants to help Sussex Countians can partner with the coalition instead of establishing its own location or hiring local outreach staff.

At other times, it means helping like-minded groups work together. At its monthly educational "Lunch & Learn" events for example, local libraries donate the space, the University of Delaware Extension brings educators and the coalition receives a small grant to pay for food and printed materials.

"That's the benefit of having [the coalition]," said Nancy Mears, a UD extension agent based in Georgetown. "We all work together for common goals, share resources and reduce costs."

Geisler describes the coalition with an analogy. If Sussex County were a sick person, you'd want a line through which you could administer medicine directly to the illness as efficiently as you could. Health promotion isn't solely, or even mostly, about trips to the doctor's office. Geisler says about 80 percent of our health is determined by our circumstances and choices, like eating right or the quality of our schooling.

That's why the coalition's mandate is so large and its mission so difficult. Education may be the easy part.

Beyond education

Take the example of a person with diabetes, as about one in eight Sussex Countians do (a rate about a quarter higher than in New Castle County). Simply telling them about proper nutrition doesn't help if they can't
drive to the store to get fresh food, for example. And getting medication may be difficult without a job that
gives them health insurance.

"It's easy to change the numbers on education," Mears says. You test a person's knowledge before and after, and if you've done a good job they'll remember some of it. Changing their health is something else entirely.
That often requires a whole bunch of experts, from economic development to nutrition to social work. The coalition, Geisler says, can coordinate all of those resources and help them work together.

Unfortunately, the very services that make the coalition unique - its ability to line up different groups to work toward a shared purpose - are often a low priority for funders.

Collaboration with other groups is typically not a hard sell, Geisler says, as the logic of working together is pretty obvious. Finding money to pay for that collaboration is a different story.

Funders often want to directly support services; to, say, feed children or treat addiction, not support an umbrella group like the health coalition. But partnership development is the coalition's main value proposition.

"People don't just collaborate because it's a good thing to do," Geisler said. "It takes extra effort."

Without someone like the coalition to take the lead, different groups may disagree about what's to be done and continue to work on their own.

Finding results amid limits

The goal, from a funder's perspective, is often to "move the needle." That means making a difference significant enough to appear on countywide measurements of health and social problems like obesity and addiction.

Still, these expectations often "need to be managed," Geisler said. Because grants tend to be in a limited place and time, their results need to be measured in a different way.

For example, the coalition helped several county school districts work together to form a mental health collaborative.

The Indian River School District has increasingly tried to address the mental health conditions of its students and has gone from treating about 30 kids a decade ago to about 1,300 today, said Kim Taylor, its special outreach services director. Meanwhile, waiting times have dropped from about 10 weeks to fewer than two weeks.

The coalition didn't directly fund the new services - about half comes from the school board and the other half from outside groups - but it provided a consultant and helped the districts work together.