Healthy Families NZ (HFNZ) is a place-based systems-change initiative to improve health in ten communities.

For eight years a developmental evaluation has contributed to the evolution of HFNZ, offering insights over time.

Local priorities include the food system, built and natural environments, local voice and practices, and joined-up policy.

Attention is needed on how communities organise to act on health, which acknowledges sophistication in local relationships.

HFNZ illustrates how scaling of action to address the determinants of health requires a paradigm shift towards complexity.

This article describes findings from the evaluation of Healthy Families NZ (HFNZ), an equity-driven, place-based community health initiative. Implemented in nine diverse communities across New Zealand, HFNZ aims to strengthen the systems that can improve health and well-being. Findings highlight local needs and priorities including the social mechanisms important for reorienting health and policy systems towards place-based communities. Lessons encompass the importance of local lived experience in putting evidence into practice; the strength of acting with systems in mind; the need for relational, learning, intentional, and well-resourced community organisation; examples of how to foster place-based ‘community-up’ leadership; and how to enable responsiveness between communities and local and national policy systems. A reconceptualisation of scaling in the context of complexity and systems change is offered, which recognises that relationships and agency are key to making progress on the determinants of health.

© 2024 The Authors. Published by Elsevier Ltd.