Health and well-being of individuals to a large degree depends upon and in turn contributes to healthy, vibrant, livable communities. This interrelatedness implies a need for a systemic approach to problems affecting the quality of life for individuals, families and their communities. Translated into public policy, such approach takes into consideration a plurality of factors working at different scales, from individual and family levels to neighborhood, larger community and regional levels in order to develop efficient policy instruments that will cause needed change. It also requires that a plurality of actors - from governmental agencies to community leaders, to grass-roots organizations, to ordinary citizens - become engaged in the development and realization of public policy initiatives. However, most participants in public health initiatives do not spend the bulk of their time studying theories of change or digesting manuals on strategic planning. They respond in a pragmatic solution-oriented way to specific pressing issues, concerns, and opportunities. They take specific actions based upon community orientations and cultural beliefs. We have a deep and abiding believe that language and cultural perspectives has a direct impact on final evaluation recommendations. When applying a theory of change approach to evaluation, the language used to establish the theory impacts the final service decisions. If decision-makers articulate theories about how to prevent negative results, they are likely to design programs to fix or prevent negative results. However, if they focus on obtaining positive results, they are likely to design opportunities to facilitate positive results. For example, striving to prevent unhealthy children may lead to the creation of lead and pesticide exposure programs, violence prevention programs, etc. However, striving to have healthy children may also lead to the creation of health care opportunities, and athletic opportunities, which are commonly, referred to as ‘up stream’ prevention strategies.
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