Normally, I don’t post more than once a fortnight but I wanted to let you know that earlier this week Health Affairs published our article on community power and health.
- Building Community Power To Dismantle Policy-Based Structural Inequity In Population Health
- Anthony Iton, Robert K Ross & Pritpal S Tamber
- Health Affairs 41, No 12 (2022): 1763-1771
When we set out to write the article, we wanted to build the argument for community power brick-by-brick. There’s a lot of passion for community power but we wanted to be dispassionate, rigorous, and clear eyed – in essence, we wanted to be scientific.
I think we’ve done that (but you should judge for yourself). And in the process, we’ve put forward the idea that population health strategies need to be democratic, not technocratic.
As we describe in the article, technocratic strategies focus on individuals’ behaviours, genes, or access to health care. They fail to truly appreciate that socioecological conditions are fundamental to health. By contrast, democratic approaches start from the importance of our conditions, see that they’re created by policies, and conclude that policy reform is key.
This requires communities to have power. Building on the work of others, we define community power as:
“The ability of people facing similar circumstances to develop, sustain, and grow an organized base of people who act together through democratic structures to set agendas, shift public discourse, influence who makes decisions, and cultivate ongoing relationships of mutual accountability with decision makers that change systems.”
There’s a lot in that definition, much of which we’re covering in depth in my ongoing podcast series on community power in collaboration with Ratio. There’s the clear distinction between base building and acting (Martha Mackenzie of the Civic Power Fund talks about this in next week’s episode), there are the three faces of power that Jonathan Heller talked about in early November, and there’s the idea of ongoing monitoring or governance that Paul W. Speer talked about last week.
New and Challenging
As well as wanting to be scientific, we wanted to be practical. If communities have power, how does that change the role of organisations in health? We think they will need to learn how to partner with and facilitate power-building organizations, develop processes to be accountable to communities, and be open to change in the pursuit of health equity. In essence, leaders in health must learn to work alongside community organizations.
We know this will be new and challenging work. We’ve made the on-ramp a little gentler, however, by proposing a model that links community engagement, health improvement and community power (see the appendix). The idea is to help leaders in health get clear on the levels of engagement possible and work towards collaborating with communities on an equal basis.
There’s a lot more in the article and I hope you’ll make the time to dig in. To aid that, the California Endowment, the organisation that Tony and Bob lead, paid for the article to be open access. That doesn’t just mean you can access it for free, it means that you can distribute it yourself – such as posting it on your website or emailing it to colleagues. I hope you’ll consider doing so.
I also hope that you’ll find things to disagree with in the article. As one reader has said to me, we’ve created a “one-stop-shop” on community power and health, a place where the theoretical, empirical and experiential knowledge is brought together. But as with all areas of science and practice, there’s more to learn and lots to debate.
The article marks the end of my Agency, Belonging & Health project. Its other main output was my review of the medical evidence linking community power and health (see the report here). I’ve enjoyed doing the project and thank the California Endowment for funding it and the Insight Center for Community Economic Development for overseeing it.
In my next project, once again with the California Endowment, I’m getting further into the practicalities. We’ll be exploring and describing what community-driven public health looks like while seeking to push the discourse on what it means to pursue structural change and health equity.
You’ll be hearing from me one more time this year. As I mentioned, next week we’re releasing the next episode in my podcast series on community power, a conversation with Martha Mackenzie, the Executive Director of the UK-based Civic Power Fund.