As our regular readers will know, we have described 12 principles for fostering the agency of communities as a way to improve health. We’ve now created a tool to help apply those principles to community health work.
If you are in the health sector working in community health, or if your community work involves partnerships with the health sector, we’ve designed it for you. It will – we hope – enable you to take stock of your work and start a dialog about how you might be able to more deeply foster agency.
There is more and more work attempting to address the social determinants of health through community-based interventions and collaborations. And yet, all too often, this work is solely informed by risk factors, despite the fact that it’s well-documented that risk factors alone cannot fully explain why people are healthy or sick.
The missing link is whether people have a sense of control over their lives, which requires ‘agency’ – the ability and opportunity to make purposeful choices. For communities, this agency comes from being able to come together to make decisions and take actions that create change.
Changing How, Not What
We don’t want to replace anyone’s work. We want you to ask yourself whether you might change how you’re working so that an intended outcome is greater community agency.
Each principle has been broken down into a continuum. On the very left is a statement that describes acknowledging the importance of the principle, while on the very right is a statement that describes what it looks like to deeply apply the principle in your work.
Under each continuum is a series of questions for you to consider, whether with your team or more broadly with the partners involved in the work. The idea is that you take stock of where you are, decide what actions you might take to change your way of working, make the changes, and then revisit the tool periodically to repeat the process.
For instance, Principle 11 is: “Build a team capable of working in a collaborative, iterative way, to include navigating the tensions inherent in this work”.
The statement on the very left acknowledges the principle thus:
- Participants in the community health effort acknowledge and embrace the value of an interdependent collaborative team
A page of the tool showing how to apply principle 11
While the statement on the very right describes deeply applying the principle as:
- The community health effort operates in an environment where motivations, assumptions, tensions and insecurities are routinely unearthed and understood through self and collective reflection, and the resulting cohesion of the team draws out insights and results not individually attainable
And along the way, one of the questions to consider is:
- How are self-reflection and assessment of motivations, judgments, and assumptions incorporated into your work?
Building the tool was important to us. We’ve appreciated the attention we’ve received off the back of the March 2017 report, Fostering Agency to Improve Health, in which the 12 principles were proposed, but our intention is to grow the field of practice – not just talk about it. With that in mind, we want to shift to enabling action.
We’re in the process of tweaking our website as we make sense of our place in the world off the back of the symposium. One of the pages we’ve changed is the one describing the field. We wanted to make clear that fostering community agency isn’t a new project for the health sector and communities to consider. It’s something that can – and should – be layered onto existing work.
An Alpha to Test
As with our recent symposium, we see the tool as an ‘alpha’, to borrow a term from product development (see our reflections on the symposium). It’s our first attempt to present the principles in a way that helps apply them to community health work. We’re keen to learn how it performs and in the coming weeks and months we’ll be looking to recruit a number of ‘pilot sites’. If you’re interested, please do get in touch (although note that we’re still working on the details).
My thanks to our new Chief Learning Officer, Maggie Hawthorne, for taking the lead in drafting the tool, as well as to Richard De Angelis and Bridget Kelly for reviewing and iterating it with Maggie.
Please do let us know your feedback on the tool and if you’d like to be a ‘pilot site’.