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Healthy Monadnock

  • Need: Improved health outcomes for Monadnock Region, a rural area of New Hampshire.
  • Intervention: A wide-scale effort across multiple sectors is aiming to make the region the "healthiest community in the nation."
  • Results: Indicators were established to track health tends in the community. Progress on their goals such as diabetes reduction, increasing the number of residents with healthcare coverage, and smoking cessation have been made.


The Monadnock Region is made up of 40 primarily rural towns that surround Mt. Monadnock in the southwest part of New Hampshire. It includes Cheshire County, a county that currently ranks lower than average on their health outcomes.

Healthy Monadnock is an initiative that began in 2007 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.

Healthy Monadnock Logo 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. The Council started by defining goals and researching evidence-based strategies that would help make the Monadnock Region a place that encourages health and wellness, particularly access to nutritious food and physical activity. Originally named Healthy Monadnock 2020, the Leadership Council dropped the "2020" from the title in 2017 because they intend to continue their health improvement efforts far into the future.

The initiative has spread across sectors in the Monadnock Region, engaging many members in collaboration around the mission. Members include employers, clubs, 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 Healthy Monadnock to their stakeholders.

Healthy Monadnock was developed and is funded primarily by the Cheshire Medical Center Dartmouth-Hitchcock. Supplemental funding comes from private and public sources.

Healthy Monadnock Banner Image

Services offered

In order to achieve their goal of becoming the "healthiest community in the nation," the Council identified 7 strategies, each with different action steps:

  1. Increase healthy eating
  2. Increase active living
  3. Increase educational attainment
  4. Increase income and jobs
  5. Improve the conditions and skills that support mental well-being
  6. Reduce tobacco use
  7. Prevent substance misuse

Additional efforts that support these strategies include:

  • The Wellpowered Worksites Program offers tools and assessments to be used by employers to create an environment of health in the workplace.
  • The Youth and School Wellness Program provides a toolbox and tips for building wellness in the school setting. Over half of the schools in Cheshire County are engaged in the program.
  • The Leadership Council oversees a series of community meetings to equip members and residents to build partnerships and take initiative to start their own health endeavors.
  • Clinical-based programs at Cheshire Medical Center Dartmouth-Hitchcock provide care coordination to help address social determinants of health factors for patients.
  • The Regional Planning Commission assists with improving transportation resources and other matters for a safe and healthy environment.
  • The Cheshire County Conservation District connected area farmers to merchants and schools in the Monadnock Region to increase local and healthy food access.


Health indicators were established by the Council to track health trends in the community. Examples of key indicators included adults with diabetes, residents with healthcare coverage, and youth smoking. Although indicators have changed from the original 27, progress is assessed through a community survey conducted on a biannual basis.

The Healthy Monadnock Indicator Focused Report is based on those surveys and outlines improvements needed for the health and well-being of people in the region. The Indicator Report has been used by the Cheshire Medical Center Dartmouth-Hitchcock as a community health needs assessment tool and has also informed the 2015-2018 Greater Monadnock Public Health Region Community Health Improvement Plan (CHIP).

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 hospital services.
  • Healthy Monadnock was selected for the Institute for Healthcare Improvement's SCALE Program for two rounds of innovation funding.


There were many barriers noted by the Council at the start and continuation of Healthy Monadnock. Below are some challenges and how they have been addressed:

  • There was an initial misperception among member organizations that, in order to start an initiative for Healthy Monadnock, 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, Healthy Monadnock 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's initiatives.
  • Traditionally, healthcare is often thought of as confined within the walls of a clinic or hospital. Since conversations around Health Monadnock 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:

Contact Information

Shawn V. LaFrance, MSUP, MPH, Vice President, Population Health & Health System Integration
Cheshire Medical Center Dartmouth-Hitchcock

Community engagement and volunteerism
Food security and nutrition
Networking and collaboration
Physical activity
Population health
Wellness, health promotion, and disease prevention

States served
New Hampshire

Date added
December 31, 2019

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.