Community Power & Public Health
Last week we held a webinar on what it might take for public health to adopt ‘community power building’ as a strategy to improve health. The webinar was based on conversations with proponents of power building in California, Connecticut, Michigan, Minnesota and Wisconsin, as well as reviews of the websites of 83 organizations in public health and community organizing, 32 reports of work that bridged power building and public health, and 17 reports examining how organizations change.
It was a bit of a disaster.
Not because people did not sign up (they did) or because they weren’t interested (you could tell by their questions that they were) but because the technology failed spectacularly. We presenters could not log in and so had to dial in as audience members and then ask the rest of the audience to mute their phones. We then talked through the slides despite not being able to see them while the host clicked through them as we spoke. Madness.
To add insult to injury, what we recorded was incomplete. That’s a shame because multiple people had told me they could not make the webinar and wanted to hear it afterwards. I was hoping to share the video in this post but it seems that won’t be possible.
Instead I’m sharing the slide deck of the webinar (see PDF) and below is the executive summary of the report from which it was created. The deck and the report were structured differently so, depending on how you like to read, that is either helpful or a hindrance (you’re welcome/I’m sorry, in advance). Also, I realise that the summary reads a bit like a list so if you want to explore some of the themes in more detail (and the deck doesn’t help), do drop me a line.
Executive Summary of the Report
Our report was broken down into 9 inter-relating sections.
1. The current state of public health. There was a general feeling that the fundamentals of public health do not adequately cover the importance of civic life. Even where the importance is understood, public health fails to make the leap to democracy or organizing as areas of focus. The science of public health needs to become more realistic about how social factors that influence health are measured. Public health practitioners fear advocating for organizing, either because they do not think politics is part of their domain or because they’re worried about losing their jobs if they are political. In the places where the importance of civic life is understood, the fear is overcome, and the leap to democracy and organizing is made, many public health practitioners don’t know where to start.
2. What is preventing public health embracing power building? Some practitioners simply do not support the importance of organizing as a way to improve health. There is a perception of a lack of evidence of the effectiveness of organizing as a way to improve health. The public health workforce lacks the skills needed to work in ways that embrace power building. People are busy, although the lack of depth in their work means their efforts not only have little impact but also obfuscate the true nature of the problems. And there was some suggestion that the obfuscation is, in fact, intentional by those with power.
3. Community organizing’s role. Community organizing could support public health to embrace power building but it does not have a strong grasp on what public health is. Although this needs to be overcome, there was caution about asking community organizing to see its work solely through a health frame as it could diminish its value, perhaps even in an insulting manner. Sharing health data with organizers could help them see the health consequences of inequity and hence understand the role of public health.
4. Opportunities for change. There was a general advocating for opportunism – using existing policy priorities as places in which ideas of equity and power might be inserted. The ones that surfaced explicitly were community engagement, health in all policies, and increasing access to care. Implicit to the advocating for such opportunism is the critique that current activities in those areas are not going far enough. In order for the work in these areas to go further, there was an advocating for the use of the frame of health equity. However, there was also caution that the term scares some people in public health, as does ’social justice’.
5. Best practices to bring about change. We resisted presenting a single, over-arching framework for change based on the many we read about. Instead we highlighted some key considerations peculiar to public health. These were: to not worry too much about convincing everyone; to not ‘soft pedal’ the message; to share the practicalities and outcomes of power building work (including non-health outcomes); to have a clear theory for organizational change, including readily available tools; to engage actors both in public health institutions and communities of residents; to have a common purpose and/or a shared vision; to create a funding and policy environment that’s supportive of power building work; to accept that change takes time; and to accept that there are lots of contradictions to be managed.
6. The role of narrative in change. Four things to be considered when building the narrative for power building in public health are: it must make sense to those on the left and those on the right; public health professionals need to be reminded of the profession’s radical roots; the narrative needs to be based on solid research; and the research needs to be shared and debated.
7. Messages and vehicles in public health and community organizing. We established audiences within public health, prioritized by how important we perceived them to be in terms of taking up power building. We also established 11 terms that might resonate with these audiences, from the safest to the most challenging. While the idea of using ‘safe’ terms goes against the advice to not ‘soft pedal’ the message, we suspect that the entire spectrum of terms will be needed to engage the different audiences within public health. We also presented the vehicles that might be used to deliver messages to prioritized audiences. Although not the focus of this work, we repeated this process for community organizing. One of our findings was that the term ‘social determinants of health’ did not resonate in community organizing reinforcing perhaps the point that the field of community organizing does not have a strong grasp on what public health is.
8. Measuring changes when power building is used in health. We struggled to find commonly used measurements for success, which resonated with the finding that the science of public health needs to evolve (see above). However, the measures that we did hear of could potentially inform a change process.
9. Possible next steps. The next steps that we suggested were for The California Endowment. As you likely know, they have an initiative called Building Healthy Communities at the heart of which is the idea that communities need greater power over their environments and circumstances as a key driver to improve health. Thinking beyond the Endowment, however, one of our recommended next steps was to work out which entity might hold this agenda - that community power matters to health - at the national level. Our observation was that no existing entity was fulfilling that role.
We hope this summary, coupled with the slide deck, make up for the lack of a video of the webinar. As we draw towards a new year, I can assure you that one of my resolutions will be to never use WebEx again.
I’ll end by thanking: our host for persevering, including clicking through the slides; Rachel Poulain of The California Endowment for the excellent opening, despite the high-pitch feedback we were getting as people slowly muted their phones; Lori Peterson of Collaborative Consulting for co-presenting; and, of course, our audience, not only for persevering (amazingly, hardly anyone dialled off) but also for their excellent questions at the end.
And That’s It For 2018
And that’s a wrap for 2018 from us at Bridging Health & Community. I recently reviewed our journey over the last six years as part of my five-part series and in 2019 we’ll be back to start work on the ‘learning environment’ that I described in the final part of the series. If you’re in a health care organization and are interested in exploring your role in fostering community agency as a way to improve health, drop me a line.
See you in 2019.
Dr Pritpal S Tamber MBChB
CEO, Bridging Health & Community