Inevitably, people view the world through their own personal experience and perspective. In reading the Eleven Principles of Creating Health, our thoughts are about how these principles relate to our work with Evidence for Action (E4A) – a national program of the Robert Wood Johnson Foundation, which funds rigorous research to assess the population health, well-being and equity impacts of various policies, programs, and partnerships. Below we discuss how two of the principles manifest in our work.
Principle five, “Measure What Matters”, is immediately relevant. This is an issue with which we struggle in evaluating proposals. In an environment of scarce resources and competing priorities, usable information about the most effective and efficient strategies for improving health and increasing equity is critical. For each proposal we ask the question: will the proposed research matter? In other words, will it address an important issue and will it yield information that will inform the way decisions are made, resources are allocated, or priorities are set? In determining which proposals to fund, we are thus affected by the importance of the issue of concern, how well the research is designed, and how useful the results of the proposed research will be in addressing the issue.
Although our focus is on what works, equally important is knowing what doesn’t work. Individually and collectively we sometime hold ‘cherished beliefs’ about useful approaches to creating healthier communities. Unfortunately, many of these have not been evaluated to assess whether or not they are achieving the desired outcomes. Thus, in evaluating proposals, we look for those that are designed carefully enough that either positive or null findings will be informative.
Principle three, “Share Power”, is also relevant to our work, and is demonstrated by establishing meaningful partnerships between researchers and those whose lives are most impacted by the research. We all bring valuable perspective, knowledge, and skills to bear in creating healthy equitable communities. Both community knowledge and research expertise is needed in identifying questions that matter and designing studies that can provide clear answers to these questions.
In E4A, we’ve tried to recognize the complementary roles of researchers and community stakeholders. Community-based organizations (CBOs) or other non-academic entities can serve as the lead applicants for our grants; and we do not require principal investigators to hold advanced degrees, although it is important to have a member of the project team with demonstrated research capacity. We are sensitive to the fact that while authentic relationships exist between community members and academics, there is also a history of failed partnerships and, in the worst cases, exploitation. We have tried to design E4A in a way that does not perpetuate this experience. To avoid token partnerships, we do not require collaboration; yet we value evidence of authentic partnerships.
Grass roots and CBOs, activists, organizers, and residents know more about community needs and resources than they are often given credit for. We believe that genuine collaboration between researchers and community members increases the likelihood that a study will address salient problems and yield findings that can be used by the community to inform policy and intervention. We see true partnership and sharing power as synergistic. Shared power is an essential attribute of genuine partnerships, and the act of building authentic partnerships will foster a more balanced distribution of power and control.
The Eleven Principles of Creating Health resonates with similar principles, blueprints, and frameworks – such as the Convergence Partnership’s Blueprint for Change, the California Pan-Ethnic Health Network’s Multicultural Principles for a Healthy California, or the Robert Wood Johnson Foundation’s Culture of Health: Underlying Principles, among others – focused on promoting healthy equitable communities. It is our hope that the burgeoning support for equity-based approaches in the field is indicative of growing momentum to do this work of creating health in a new way.
- Nancy Adler and Erin Hagan
Nancy Adler, PhD, is the Lisa and John Pritzker Professor of Medical Psychology, the Director of the Center for Health and Community, the Vice-Chair of the Department of Psychiatry at the University of California, San Francisco, and the Co-Director of Evidence for Action. Erin Hagan, PhD, MBA, is the Deputy Director of Evidence for Action.