This two-day symposium will explore the link between the health sector and local communities, including the other sectors that serve those communities. It will extend the usual framings of ‘social determinants of health’ and ‘systems change’ to explicitly embrace the well-documented potential of community agency.

Rationale

Increasing sums of money are spent each year in the name of health, largely through health care and public health. It is widely acknowledged that this is unsustainable, which suggests that it is time to ask ourselves what we’re trying to achieve. If the answer is ‘health’ we need to ask, what is health?

The health sector tends to dominate the answer, and does so through a bio-medical lens in which: health is defined as the absence of disease; health and disease are primarily understood through biological measures; and prevention, treatment, and management of disease is provided by professionals. Yet in the context of the day-to-day what makes people feel healthy goes beyond the bio-medical to encompass things like safety, physical functioning, financial security, and emotional security. For them, bio-medical health is less an end goal than a means to achieve these other things.

The health sector recognizes the role of these other things, conceptualizing them as the ‘social determinants of health’. It has responded primarily by asking other sectors to contribute to its (bio-medical) agenda. Important though this is, the health sector often fails to appreciate that other sectors have their own priorities, seen through their own lenses. It also deprives us of another important lens–that of people and communities.

Engaging people and communities is not just about understanding their priorities. It’s well-documented, in research in health and other disciplines, that having a sense of control over one’s life is an important part of health, whether bio-medically defined or otherwise. For many, this will require a transformation in personal and community agency; they will need to rediscover or reclaim the connections, capacities, and opportunities that underpin their ability to influence the world they live in.

Aims

The symposium is part of Bridging Health & Community’s (BH&C) ongoing work to build a field of practice dedicated to understanding health from the perspective of people and communities, and to fostering community agency to improve health.

BH&C’s Creating Health Collaborative is a community of innovators already doing this kind of work. Across their work, the innovators: embrace the perspectives of different sectors, and of people and communities themselves, alongside what health care and public health professionals know; allow mutual understanding to lead to agreement on what priorities to pursue; pursue those priorities with communities, not for them; and focus not just on changing what they do, but also how they do it.

In our March 2017 report, Fostering Agency to Improve Health (see page 50), we identified 12 principles to the work of the innovators in the Collaborative. The principles both describe the field of practice and illustrate an inclusive, participatory and responsive process that fosters community agency.

1. Include in a community’s collective effort those who live there, those who work there, and those who deliver or support services provided there
2. Spend time understanding differences in context, goals and power
3. Appreciate the arc of local history as part of the story of a place
4. Elicit, value and respond to what matters to community residents
5. Facilitate and support the sharing of power, including building the capacity to use it and acknowledging existing imbalances
6. Operate at four levels at the same time: individual, community, institutional and policy
7. Accept that this is long-term, iterative work
8. Embrace uncertainty, tension and missteps as sources of success
9. Measure what matters, including the process and experience of the work
10. Build a vehicle buffered from the constraints of existing systems and able to respond to what happens, as it happens
11. Build a team capable of working in a collaborative, iterative way, including being able to navigate the tensions inherent in this work
12. Pursue sustainability creatively; it’s as much about narrative, process and relationships as it is about resources

The symposium aims to share the work of some of the innovators in the Collaborative, as well as others in the field, to build knowledge, capacity, networks, and readiness amongst participants:

• Knowledge: broaden how participants understand health so as to establish purposeful empathy and mutual respect for people across sectors and in communities
• Capacity: share methods, tools, and techniques used across sectors to support the design, implementation, evaluation, and financing of initiatives
• Networks: create new relationships among people who understand the plurality of health and the importance of nurturing community agency
• Readiness: through the knowledge, capacity, and networks attained, as well as through the examples and experiences shared in the agenda, embolden participants to try new approaches in their communities that embrace the potential of community agency

Approach

To structure the symposium to achieve its aims, the symposium is framed by three needs gleaned from the Collaborative’s work:

1. The need to create mutually accountable partnerships between institutions and communities
2. The need for new ways of thinking about how to understand, measure, and communicate value, including what communities value and the value of health beyond biological metrics
3. The need for capital – financial, political, and social – to be invested in ways designed to explore and nurture new ways of working

Our view is that addressing these needs requires leaders, whether in the health sector, in non-health sectors, or among residents, to develop greater understanding and empathy for one another. That is why the symposium is designed to include people from different sectors and roles, ranging from local to national perspectives, who may not typically attend the same conferences. It is also why significant time is given to participants getting to know each other and to sharing their perspectives in small groups and informal interactions. To aid this, there will be a commitment to plain language and everyone will be addressed without emphasis on titles and degrees. Facilitators will help the participants ensure there is space and mutual respect for the different perspectives present.

Participants

We have sought to convene a broad cross-section of those interested in innovative approaches to health sector partnerships that nurture community agency. This includes the health sector (health care, public health, health finance), those in other sectors exploring their relationship with health (such as community development, housing, education, social services), resident leaders in local communities, leaders of community-based organizations, researchers and evaluators working with local initiatives, funders considering new approaches to sustainable investments in community health, business leaders, and government representatives.

Table Assignments

We want people from different places, with different perspectives, and of different professions to spend time together and experience a little of what collaborative, cross-sector working feels like. That’s why we have used your registration information to decide which table you’ll be assigned to and have structured sessions throughout the symposium for dialog and activities among these ‘Table Top’ cohorts.

Afterwards

We are committed to supporting participants to build on new ways of thinking sparked by the symposium, to follow through on action commitments made, and to foster new networks developed. We intend to work with participants to better understand how we can develop that ongoing support.