In late 2017, Bridging Health & Community (BH&C), in partnership with Collaborative Consulting (CC) and with support from The California Endowment (TCE) explored how public health might use power building as a strategy to improve health.

The work was made up of nine elements and the findings have been synthesized into 10 inter-relating sections:

1. The current state of public health with respect to power building
2. What is preventing public health embracing power building?
3. What community organizing’s role could be in supporting public health to embrace power building
4. Opportunities for change in the current health landscape
5. Best practices to bring about change
6. The role of narrative in change
7. Messages and vehicles in public health
8. Measuring changes achieved when power building is used in health
9. Conclusion
10. Appendices

The current state of public health. There was a general feeling that the fundamentals 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.

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.

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.

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, as does ’social justice’.

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 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.

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.

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 the above for community organizing. One of our findings was that ‘social determinants of health’ did not resonate in community organizing reinforcing the point that the field of community organizing does not have a strong grasp on what public health is.

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.

The ultimate aim of this work was to accelerate the adoption of power building in public health. Our findings provide the building blocks from which that acceleration will be possible, together with some key questions for organizations, including foundations, to consider for the road ahead.

This work was presented at a webinar delivered December 4th 2018. The slides of the webinar were shared through this post. The webinar presented the findings through an alternative structure and some readers may prefer it to the one used in this report.

We encourage the reader to dip into the appendices to experience the richness of the findings.