Everett Rogers’ (2003) model of innovation diffusion can be a valuable guide in the promotion of ideas and practices related to healthy habits and environments, as well as health-related public policies. The Tier Four coaching can help her client find ways to support those involved in the early implementation of healthy community policies and practices (Rogers’ early adopters). A Tier Four coach can also assist her client in the gathering and presentation of persuasive information regarding the effectiveness of healthy community policies and practices (Rogers’ early majority). Finally, the Tier Four coach can help her client or client system in devising ways (e.g. social media) of persuasively informing the general public about specific healthy community policies and practices that are now commonly in place and are the “norm” (Roger’s late majority).

You will notice that the Tier Four coach usually ceases to be a neutral party. She is committed to health and to the initiation of health-oriented public policies. Furthermore, her clients are often not individuals or even families or community groups. The coaching client is often an entire health care system, public agency or government office. Tier Four coaching is “big picture” – and not for the faint of heart—but it is essential.

I have recently helped to found an inter-community service agency—called “Communities Collaborating”—that is helping to set up programs that offer Tier Four (as well as Tier One, Two and Tree) health-based coaching in isolated communities (“islands” that might not be surrounded by water but are just as separated from major population centers). These communities are frequently populated by senior citizens who are “caught” in their homes (either be choice or because of economic exigencies). They are also often “caught” in a life style that is not conducive to sustained health (though they have managed to live many years without a major concern for nutrition and finish each day with a shot of whiskey or a smoke!!). Communities Collaborating is in the business of advocating for healthy practices (nutrition, exercise, sleep), while also helping to set up transportation for the elderly to health-care appointments, and providing the elderly with knowledge and assistance regarding health-related financial matters (e.g. government assistance programs, appropriate insurance plans).