Healthy Monadnock Alliance
- Need: Improved health outcomes for Monadnock Region, a rural area of New Hampshire.
- Intervention: A wide-scale effort across multiple sectors is aiming to improve health outcomes throughout the region.
- Results: Community health trends have been tracked over time, and progress on goals such as increasing the number of residents with healthcare coverage, opportunities for physical activity, access to healthy foods, and smoking cessation has been made.
Region is made up of 32 primarily rural towns and one
city that surround Mt. Monadnock in the southwest part of
New Hampshire. It includes all of Cheshire County, a
county that currently
ranks at or below average on their health outcomes.
Monadnock Alliance began in 2007 as a community
health initiative when Cheshire Medical Center
Dartmouth-Hitchcock posed a challenge to Cheshire
County leaders to make the Monadnock Region the
"healthiest community in the nation" by the year 2020. In
2020 the Leadership Council for a Healthy Monadnock, who
oversees the initiative, reevaluated the mission, knowing
their health improvement efforts would continue far past
2020. This resulted in the formation of an Alliance and
an updated mission, "Better health and wellness for all,"
which represents the focus to address disparities,
equity, and trauma.
The vision became a framework that the
Leadership Council for a Healthy Monadnock, a
multi-sector group that oversees a network of
organizations, built upon to develop the
Monadnock Community Health Improvement Plan, revised
in July of 2020. The Council started by defining goals
and researching evidence-based strategies that would help
make the Monadnock Region a place that makes the healthy
choice the easy choice.
The Alliance spreads across all sectors in the Monadnock
many members in collaboration around the mission.
Members include employers, schools, coalitions,
nonprofits, and local government groups that bring
knowledge and expertise on different areas of health and
wellness. The effort has become a source of information
and encouragement for community stakeholders to take
preventive action through environmental, social, and
policy changes and to promote the efforts of the Healthy
Monadnock Alliance to their stakeholders.
Healthy Monadnock Alliance was developed and is funded
primarily by the Cheshire Medical Center
Dartmouth-Hitchcock. Supplemental funding comes from
private and public sources.
In order to advance their mission, the Leadership Council
for Healthy Monadnock updated their Community Health
Improvement Plan in 2020 and selected 5
priority issues to focus their efforts. The social
drivers of health, equity, and trauma are addressed
within each priority area:
- Behavioral Health
- Emergency Preparedness
- Food Access and Healthy Living
- Healthcare Access
- Protective Factors and Risk
Community programs that support these strategies include:
- The Run and Read project provides age-appropriate
books for children and families across the Monadnock
region. Through the partnership of the Keene Elm City
Rotary Club and the Advocates for Healthy Youth (AFHY)
coalition, Run and Read has donated more than 2,000 books
to local community sites since its start in 2014.
- Veterans Appreciation thanks veterans living in the
Monadnock Region for their service by providing them with
vouchers to purchase local food directly from the growers
at local Farmers Markets during the month of September,
which is Hunger Awareness Month.
- Building Resilience Against Climate Effects (BRACE)
which is dedicated to helping individuals in the region
prepare for natural disasters.
- Volunteer Driver program which aims to increase the
number of volunteer drivers to help with the
transportation shortage for vulnerable populations in
rural areas of the Monadnock region.
- NARCAN training via the Doorway at Cheshire Medical
Center and the Greater Monadnock Public Health Network
has trained more than 1,000 people in the Monadnock
region in the use of NARCAN since 2015.
- GETTING TO 'Y' program gives students the opportunity
to bring meaning to their own Youth Risk Behavior Survey
data through youth leadership, partnerships with adults,
action research, and peer and community engagement.
In order to better understand the impact of their work
and measure progress toward identified goals, the Healthy
Monadnock Alliance collects and analyzes a range of
regional health and wellness data related to their
programs and initiatives.
Community wellness metrics for each of the priority
areas set out in the 2020 Community Health Improvement
Plan are published online. Each metric tracks certain
health trends and indicators over time.
Some notable results include:
- Insurance coverage increased by 7% in Cheshire
County, with 93% of residents covered
- Approximately 2,300 residents have received
behavioral health education
- 89 secondhand smoke policies and protections have
- Over 11,000 workers gained access to worksite
- More than 1,000 individuals received emergency
preparedness training, including NARCAN training
- 88% of local adults reported experiencing good or
better health, an increase of 5.5%
Awards and Publications
- In 2013, Cheshire Medical Center/Dartmouth-Hitchcock
Keene received the
Carolyn Boone Lewis Living the Vision award from
the American Hospital Association for its community
outreach efforts that have exceeded traditional
- Healthy Monadnock was selected for the Institute for
Healthcare Improvement's SCALE Program for two rounds of
There were many barriers noted by the Council at the
start and continuation of the Healthy Monadnock Alliance.
Below are some challenges and how they have been
- There was an initial misperception among member
organizations that, in order to start an initiative for
the Alliance, Cheshire Medical Center Dartmouth-Hitchcock
needed to lead it. At the same time, the medical center
was hoping other members would start to take initiative.
Through redirecting and strategies, the Healthy Monadnock
Alliance has become an effort of the whole community, not
solely led by the medical center.
- Because environmental change often starts with public
policy, Council members have put more effort into
changing policy and environmental regulations in order to
carry out Health Monadnock Alliance initiatives.
- Traditionally, healthcare is often thought of as
confined within the walls of a clinic or hospital. Since
conversations around Healthy Monadnock Alliance started,
the perception that health and well-being extends to all
areas of life has become more widely accepted across
businesses and individuals.
- The availability of affordable healthy food has been
a challenge for the Monadnock Region. The Council has
been working with the Cheshire County Conservation
District to connect local producers to distributors in
order to improve food access on an institutional level.
Resources and efforts that may help communities implement
similar programs include:
Community engagement and volunteerism
Food security and nutrition
Networking and collaboration
Social determinants of health
Wellness, health promotion, and disease prevention
December 31, 2019
Date updated or reviewed
February 28, 2022
Suggested citation: Rural Health Information Hub,
Healthy Monadnock Alliance [online]. Rural Health Information Hub. Available at:
[Accessed 3 October 2022]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.