Fresno Building Healthy Communities (Fresno BHC) began with a realization that the challenges residents brought to local advocates could not be addressed in isolation.

What started as an informal coalition focused primarily on health care access grew as its members recognized how closely health is connected to housing, food, transportation, land use and other conditions that shape people’s lives.

Today, Fresno BHC brings together approximately 30 community-based organizations and grassroots groups that represent more than 97,000 Fresno County, California residents. The coalition is working to connect residents to public decision-making and generate the investments communities need to thrive.

Through participation in Kresge’s Climate Change, Health & Equity (CCHE) initiative, Fresno Building Healthy Communities is strengthening its work in Fresno, one of four focus cities where Kresge supports long-term, place-based efforts to advance equity and opportunity.

In this Q&A, Fresno BHC President and CEO Sandra Celedon reflects on what they hope to learn from its peers in the health equity space, their role in translating complex policy for residents and partners, and the patience required to build lasting community power.

Q: Tell us about Fresno Building Healthy Communities and the work you do

A: We started as a loosely organized coalition of advocates in Fresno County working primarily on health care access. At the time, we called ourselves the Patient Care Coalition.

Different organizations would come together to talk about the challenges their clients were experiencing, how they were responding and how they could support one another. Eventually, those conversations expanded beyond health care, because people who have difficulty accessing health care often face challenges related to food, housing, transportation and other basic resources.

We realized that many of us were attending multiple meetings with the same people to discuss interconnected issues. We decided it made more sense to bring everyone together and address those issues collectively.

When I talk about Fresno BHC, I am really referring to the broader coalition, not simply the nonprofit organization that provides the structure through which we employ staff and operate. The coalition includes approximately 30 community-based organizations and grassroots groups that align around issues important to the community.

Our work focuses on what we now call the social determinants of health. We engage in policy advocacy, organize residents and community members, and work primarily across Fresno County and the city of Fresno, with a particularly deep base in South Fresno and West Fresno County. Our priorities include health care access, transportation, housing, outdoor access, community safety, economic development and land use.

Across those areas, our goal is to ensure that residents are connected to decision-making and to help generate the investments and resources people need to thrive.

Q: How do you expect participating in Kresge’s climate change and health equity cohort to strengthen your work?

A: What I am most looking forward to is learning from organizations in other parts of the country.

Fresno has made meaningful progress in areas such as land use, the environment and transportation. At the same time, we face significant political barriers. California is often viewed as a uniformly progressive state, but the realities of the Central Valley are much more complicated, particularly when you consider who has historically held power and influenced public decisions.

Our work is explicitly about power. It is about disrupting traditional power structures, changing who holds power and influencing how decisions are made. That can make every effort feel like an uphill, David-and-Goliath battle.

I am interested in learning how other communities have secured significant policy victories, how they organize their work, and what lessons we can bring back to Fresno County. Those insights could help us navigate some of the political barriers that are especially prevalent here.

The cohort also gives us an opportunity to step back and assess our progress. When you are deeply involved in the day-to-day work, it can be difficult to recognize how far you have come. Looking outward and learning alongside our peers can provide valuable perspective.

Q: Why are spaces like this cohort valuable to people working at the intersection of environmental policy and health?

A: These spaces allow us to learn from people who understand the nuances of the work. Environmental, transportation and health policy can become very technical, particularly when you examine those systems at a broader level.

Fresno BHC serves as a backbone organization for the coalition. We organize directly with community members, but we also provide technical assistance to our organizational partners. We help strengthen their civic engagement work, build leadership capacity and support staff development.

To do that effectively, we need to develop our own expertise. We are often learning alongside our partners and community members. It is helpful to have a space where we can do those deep dives and learn from technical experts who can help us understand these issues.

Then we must translate that knowledge. We need to distill complex policy so that it is relevant and understandable to everyday people. Successful organizing depends on helping people see how an issue connects to their lives and why their participation matters.

A cohort like this gives us room to start with the highly technical conversation and work toward a clear explanation that supports community action.

Q: What do you want others to understand about this work and about Fresno?

A: This is long-term work.

I have been doing this work for more than 20 years. We are advancing a $7.4 billion transportation measure that our community has worked on for approximately 18 years. Its potential impact reaches well beyond transportation. It could improve air quality, expand the tree canopy, support housing and help shape Fresno County’s development for the next 30 years.

Those are the kinds of efforts I want people to understand. You cannot always point to a visible win after one, two or even three years. Policy and systems change take time. Community organizing takes time. A parks measure that we advanced in 2018 required eight years of work to get to the drafting of the measure and then another eight years of work after to fight for its implementation.

That is why it is so important to work with people who are rooted in their neighborhoods and committed to the community over the long term.

I also want people to understand Fresno differently. Some still think of us primarily as a rural community. Fresno County does include rural areas, but Fresno is the fifth-largest city in California. A great deal of important and creative work is happening here, and many movements have roots in Fresno and throughout the Central Valley.

We are confronting deeply entrenched power structures, but Fresno also has a long history of innovation, resilience and community power. Fresno BHC is building on generations of people who refused to give up.

We recognize the elders who sustained this work, and we are organizing with the next generation. Our youth internship program engages high school students and helps them understand their own ability to influence change.

This work is generational. It is not simply a project or a short-term campaign. It is a lifetime commitment.

Want more stories about our partners in Fresno? For season 2 of Kresge’s PathBreakers podcast, we took the show to Fresno, California to explore how local leaders are shaping the story of their city. Listen or watch on YouTube, Apple Podcasts, Spotify or wherever you get your podcasts.