Understanding Power Through Stories of Change

Pritpal S Tamber

December 1, 2022

A conversation with Paul W. Speer on the role of relationships, conversations and mediating institutions in building community power

The latest episode in my podcast series on community power in collaboration with Ratio is a conversation with Paul W. Speer, a former community organiser who is now a leading researcher on community organising, social power and community change. 

You can find the episode on Ratio’s website and Apple Podcasts

I’ve been lucky enough to talk to Paul a few times over recent years and every time I deepen my understanding of community power. For me, there are three important insights in the episode. 

Relationships, Conversations and Institutions

The first is the fundamental nature of relationships in community power. As Paul puts, members of a community need to build their relationships with each other in order to form a collectivity. Once that’s formed, it needs to develop a sense of its agency. Relationships are core to collective agency. 

The second is the importance of conversations in the process of turning agency into power. Although many different types of conversations are needed (including between community members as they build their relationships and collectivity), the one that stands out is when community members talk to people working in government and service providers. It’s through those conversations that the collectivity understands how government works, and hence how to use their agency as power. 

The third is the importance of mediating institutions. As Paul puts it, the above process is only possible if there are organisations small enough for people within it to get to know each other but also large enough to build relationships with other organisations. Paul describes this as “the meso level” of community power building and it’s clear to see how getting the size of each organisation right is crucial for the overall endeavour. 

On Structural Change

While you enjoy Paul’s insights (Ratio/Apple), I also want to share what he’s taught me about structural change and health equity. 

More and more people and organisations are talking about the need for structural change to achieve health equity. Paul tells me that structures are defined differently in different disciplines. The definition I use is the one that predominates in health, namely that structures are the laws, policies, institutional practices, and entrenched norms that scaffold our systems.

Health inequities exist due to an injustice. In one way or another, a group of people is being unfairly disadvantaged, which adversely affects their health. Injustice is especially powerful when it’s structural – in other words when it’s down to unfair laws, policies, institutional practices, and entrenched norms. Ergo, one important way to achieve health equity is to change these unfair structures. 

There’s a neatness to that conclusion but, as Paul explains, it’s inadequate. While health inequity might stem from unfair structures, changing those structures won’t necessarily lead to health equity. 


Resources and Opportunities

To answer that, we have to look at what sits between unfair structures and health outcomes – namely, disadvantage. When we talk about advantage and disadvantage, we tend to think about resources, especially money. But opportunities are also advantages. And whether you have opportunities is highly dependent on where you stand in the social pecking order. Things like race, class, ethnicity, religion, gender, sexual orientation, and disability can affect that. 

So, whether a structural change contributes to health equity comes down to whether it leads to an increase in the resources and opportunities available to the disadvantaged group. 

However, it’s not just about whether these resources and opportunities increase but whether they increased in comparison to what other groups have. Paul’s example of this (which he borrows from Edward Seidman, a Professor of Applied Psychology at NYU) is Sesame Street. 

Sesame Street: A much-loved intervention that didn’t quite work as hoped (See-Ming Lee, CC BY-SA)

The show was created to increase the academic readiness of lower-class children. It worked. But it also increased the readiness of children from higher social strata. In fact, it helped the children from the higher social strata more than it helped the lower-class children. In the end, in comparison to other children, it reduced the academic readiness of lower-class children. 

What does all this mean for community power? It means that using power cannot stop at structural change. All too often people think that success is a change in a law or a policy but what matters just as much is how that change is implemented and what impact it has. Implementation and impact have to be, to use Paul’s word, monitored. And when things are going astray, the community has to be able to intervene. Other leaders in community power, such as ISAIAH and the Equity Research Institute, call this process governance. 

For me, Paul has a strong grip on the realities of community organising and community-driven change. I suspect it’s borne of frontline experience. I never tire of the patient way in which he tells a story and then examines it for how power manifests and how it ebbs and flows. I hope you enjoy listening to him too (Ratio/Apple).

Pritpal S Tamber 

PS: To learn more about Ratio’s work, sign up for their newsletter or drop them a line: hello@ratio.org.uk

Previous Episodes in the Series 

Further Reading 

  • Paul is worried about our ability to form relationships. He explains why in this 2018 article describing three interrelated trends threatening developing social relationships
  • The definition of structures that I’ve used was taken from this recent article by Paula A. Braveman and colleagues in Health Affairs
  • As far as I know, the argument that inequities arise from injustices was first made by Margaret Whitehead in this 1992 article and expanded upon in 2014 in this article by Paula A. Braveman 
  • I have used injustice and unfairness somewhat interchangeably but, as I learnt from Margaret Whitehead, they are subtly different. Injustices are more formal in that they offend a society’s agreed moral codes and standards as set out in law or in the systems of state. Unfair is less formal and is an appeal to commonly held perceptions of what is decent and proper. 
  • Seidman’s Sesame Street example was taken from this 1988 article (although he seems to completely misunderstand the flux capacitor)
  • ISAIAH is a multi-racial, nonpartisan coalition of faith communities fighting for racial and economic justice in Minnesota. It’s considered to be at the leading edge of how community power can pursue equity and Paul and his colleagues looked at it in this case study
  • In 2016, the Equity Research Institute wrote Changing States: A Framework for Progressive Governance, a report in which they expanded upon what Paul calls monitoring and what they call governance 
  • To get a sense of how people-centred governance works, see the top of page 61 of this report by Pastor and colleagues, which briefly describes how groups in Minneapolis used it to ensure that a new policy in which employers had to provide sick time was properly implemented 

The photograph behind the title is by Stuart Kinlough / Ikon Images

Pritpal S Tamber

I’m a doctor who trained as a medical editor and publisher and now researches and consults on the link between community power and health equity. My interest in community power started when I was the Physician Editor of TEDMED and is explained in My Perspective. I also work as a freelance medical editor and publisher for organisations that want to write high-quality articles and a strategy for their publishing and promotion. Find out more on my About page.

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