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Improving Health by Changing the Environment

March 8, 2016

By Adam Beyer

Sarah Strunk PPS’87 never envisioned she would be working in public health, much less that she would have to consider the needs of a local pig hunters’ association to do it.

“There are probably not too many public policy students who have had to think of the interests of pig hunters,” she said.

Sarah Strunk

But hunters were central to a plan to improve the conditions for residents in Oahu’s Kokua Kalihi Valley, by creating a park, community gardens and a system of trails on an undeveloped 100-acre parcel. The park has allowed residents to grow traditional crops and help preserve their culture, she explained. Hunters had been using the land for decades.

It is just one example of the projects supported by Active Living By Design, a nonprofit consulting group that works with national, state and local partners to promote healthier communities. Strunk helped found the organization and serves as its strategic advisor. She was formerly its executive director.

“Where we live has a huge impact on people’s health,” she said. “If communities don’t have supportive policies or systems in place, it doesn’t matter how hard people try. It’s going to be a lot more difficult to be healthy.”

​Strunk discovered public policy as a freshman through a class with former Sanford professor Bruce Payne, now director of the graduate program in arts administration at Baruch College, and witnessing the enthusiasm of two of her RAs. Other significant professors include Joe Lipscomb, now at Emory University and Charles Clotfelter, whose microeconomics class she found tough, but useful. Strunk credits the school for emphasizing writing and critical thinking, and exposing her to many perspectives.

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  • Sarah Strunk

    A Team Effort

    Sarah Strunk (third from the left on the bottom row) works with Active Living By Design to help improve the health of communities across the United States.

Her involvement in the Durham community was equally important during her time at Duke. She worked on Ninth Street and volunteered with the Rape Crisis Center and Helpline. During her junior year, she became interested in health policy, leading her to earn a master’s degree in health care administration from the University of North Carolina at Chapel Hill.

While many of her classmates aimed to be hospital CEOs, she was still determining her focus. A one-year post-graduate fellowship at Wake Forest University Baptist Health in Winston-Salem, NC was transformative, providing her with an in-depth view of the strategy and operations of a large academic medical center. From there, she served in strategic planning and business planning roles at Duke University Health System and Blue Cross and Blue Shield of North Carolina. In 1998, she returned to the School of Public Health with a desire to focus more on the upstream causes of poor health. . In 2002, she was part of the team from the Gillings School of Public Health that founded Active Living By Design.

It is a cross-disciplinary group with staff representing public health, public policy, community planning, nutrition, social work, architecture and design, and communications. This makes sense, she said, because solving complex problems requires a comprehensive approach. 

“I think there has been a renewed focus on communities,” she said. “Those in public health have long recognized that where you live can impact your health. And now there’s even more evidence that healthy communities are also safer, more prosperous and have more civic engagement.”

She initially served as Active Living By Design’s deputy director before becoming executive director. After 10 years in that role, she is now the group’s strategic advisor. The job requires traveling across the country to meet with community partners and other advocacy organizations, which Strunk says she enjoys.

Many times, the most important community leaders do not hold formal positions of authority. Influencers might be a grandmother who has lived in a neighborhood her whole life, a block captain or a PTA mom. Individuals such as these are more than just valued stakeholders; they are critical agents in the policy change process.

Closer to home, the organization is working with a variety of organizations in North Carolina, including the John Rex Endowment to improve community health in Wake County. The five-year project supports municipalities with projects such as creating new farmer’s markets, expanding bike trails or offering healthy options in vending machines.

Although many college students worry about where their lives are headed, Strunk urged patience and hard work, noting that she was often surprised by the unexpected opportunities that arose over the course of her career.

 “Students are under a lot of pressure these days. It’s great to have a plan, but you don’t have to know where you’re going to be twenty years from now.”