Promoting Health Equity - A Resource to Help Communities Address ...

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36 PERSPECTIVES — Community Yvonne Lewis: Faith Access to Community Economic Development; Flint, Michigan (Participant in Learning From Doing forum) Involving the community into the decision-making process is critical for ensuring that decisions concerning community health are just and right for all, not only those in charge. People in communities know what their problems are, and researchers can learn from the experiences of community members by talking with them rather than talking about them. Communities have been defned or characterized in a number of ways, including as groups of people who live in a particular geographic area, have some level of social interaction, share a sense of belonging, or share common political and social responsibilities. 60–65 Each community has its own set of structures and norms that govern interactions among its members. A person may be part of many overlapping communities, some of which infuence access to social resources more than others. Thus, someone living in a geographically defned community that is economically depressed might have less access to affordable healthy food options (e.g., grocery stores or supermarkets) and medical care (e.g., hospitals or clinics) than someone living in a more prosperous area, even though this individual may have a relatively high personal income. The following questions can help you think about how to defne your community: Who does the community include? Who does it not include? Does the community have defnite geographic boundaries? Are there social or cultural ties that link community members? What are some shared characteristics of the community? (See “Example from the Field: Building Community Partnerships.”) Once your partners have been gathered, consider ways to meaningfully involve this diverse group of community leaders (e.g., businesspersons, clergy, Correcting inequities requires knowledge of how systems work. For example, communities need to understand how the legislature decides to allocate money. Then they can ask questions of the folks saying, “please vote for me,” and work to achieve things that will make a difference in their communities. health care providers) and community members. This may include informal as well as formal strategies. For example, it is often useful to have an informal meeting at a restaurant. Informal activities such as “ice breakers” can encourage members to get to know each other and enable them to learn how to work across inherent power differences within the group. 66, 67 It can also be useful to choose a neutral facilitator or facilitators to help keep the group focused and moving forward. A facilitator recognizes that a group can accomplish more than one person alone because of the varying skills and talents of group members as well as different norms, cultures, and processes of your partners. A facilitator can encourage all partners to take part in the group and help the group address confict when it arises. An important formal strategy is to establish guiding principles for partnership interaction. These principles can include how partners agree to interact within the partnership and how information is shared within the partnership and with those outside the group. Some principles to consider are listed in “Moving Forward: Partnership Principles.” You and your partners can use these to guide the development of your own principles. Once agreed on by all partners, your principles can be posted at meetings and referred to when necessary. To sustain the partnership, it is useful to revisit and modify your principles as new partners join your group.
ExAMPLE FROM THE FIELD Building Community Partnerships A local public health agency has just received funding for a communitybased initiative to address diabetes, a growing community health concern. Evidence suggests that at least 10%–15% of adults in this community have diabetes (note: this does not include people with undiagnosed diabetes) and this number continues to rise. Local hospitals report an increase over the past year in the number of people coming to their emergency departments seeking care for uncontrolled diabetes, including high blood glucose levels, foot infections, high blood pressure, and vision problems. Doctors advise the patients to eat healthy, be physically active, and take their medications. However, many of these individuals lack access to medications or health insurance. In addition, living conditions, such as inadequate housing or homelessness, lack of resources or places to purchase healthy foods, and an absence of employment opportunities, make it diffcult to eat healthy or be physically active. For these reasons, the agency decided it was important to focus on the social determinants contributing to diabetes and overall health. To get started, agency representatives began within their own organization and listed partners as follows: > Someone with community health assessment experience. > An epidemiologist. > Someone who knows about health surveillance. > Someone with community outreach experience. > Someone with health education experience. Next, they identifed potential partners in their community, including: > Nurses, doctors, or other health care providers, particularly those who treat people with diabetes. > Hospital and health clinic administrators. > Individuals from volunteer agencies. > Representatives from local businesses (e.g., pharmacies, recreational facilities, and grocery stores). > Representatives from local homeless shelters and food pantries. > Faith-based organization leaders and members. > Local media representatives. > Policy makers and local government offcials. > Community members who know the history of the community, including those with diabetes and those who care for people with diabetes. > Local school administrators. > Funding agency representatives. 37
Page 1 and 2: Promoting Health Equity A Resource
Page 3 and 4: Promoting Health Equity A Resource
Page 5 and 6: Table of Contents Introduction p.4
Page 7 and 8: Participants October 28-29, 2003 So
Page 9 and 10: Infant mortality Table 1.1: Example
Page 11 and 12: Access to resources Income Housing
Page 13 and 14: Learning from doing Chapter 2 of th
Page 16 and 17: 14 1CASE STUDY Who we are: A black
Page 18 and 19: 16 CASE Poder es Salud 2STUDY (Powe
Page 20 and 21: 18 CASE 3STUDY Project BRAVE: Build
Page 22 and 23: 20 C ASE 4S TUD Y Healthy Eating an
Page 24 and 25: 22 5CASE STUDY Taking Action: The B
Page 26 and 27: 24 6CASE STUDY The Community Action
Page 28 and 29: 7CASE STUDY 26 New Deal for Communi
Page 30 and 31: 28 8CASE STUDY From Neurons to King
Page 32 and 33: 30 9CASE STUDY The Delta Health Cen
Page 34 and 35: 32 Developing a Social Determinants
Page 36 and 37: SECTION 1 34 Creating Your Partners
Page 40 and 41: 38 MOVING FORWARD Sample Partnershi
Page 42 and 43: 40 Building partnership capacity Re
Page 44 and 45: SECTION 2 42 Focusing Your Partners
Page 46 and 47: 44 2. Talk to other community partn
Page 48 and 49: 46 > Qualitative interviews or focu
Page 50 and 51: 48 Photovoice Community audits Heal
Page 52 and 53: 50 7. With information gathered and
Page 54 and 55: 52 ExAMPLE FROM THE FIELD Creating
Page 56 and 57: SECTION 3 54 Assessing community ca
Page 58 and 59: 56 ExAMPLE FROM THE FIELD Mapping C
Page 60 and 61: SECTION 4 58 Once your partnership
Page 62 and 63: 60 ExAMPLE FROM THE FIELD Selecting
Page 64 and 65: 62 MOVING FORWARD Community Develop
Page 66 and 67: 64 Social action What is social act
Page 68 and 69: 66 When working to incorporate chan
Page 70 and 71: 68 Be sure to frame your message in
Page 72 and 73: 70 Policy and environmental change
Page 74 and 75: 72 MOVING FORWARD Ways to Support P
Page 76: 74 ExAMPLE FROM THE FIELD Selecting
Page 79 and 80: Before writing your action plan, yo
Page 81 and 82: Continually monitor your group’s
Page 84 and 85: SECTION 6 82 It is important to inc
Page 86 and 87: 84 MOVING FORWARD Evaluating Your P
Page 88 and 89:
86 It is important to note that mos
Page 90 and 91:
SECTION 7 88 Eliminating inequities
Page 92 and 93:
90 Closing Thoughts Since the Socia
Page 94 and 95:
92 Suggested Readings and Resources
Page 96 and 97:
94 Miringhoff M, Miringhoff, ML. Th
Page 98 and 99:
96 James SA. Confronting the moral
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98 Partnerships Alter C, Hage J. Or
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100 Wolff T, Kaye G. From the Groun
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102 Kingsley GT. Building and Opera
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104 Stokols D. Translating social e
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106 References 1. Institute of Medi
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108 34. Hertzman C, Power C, Matthe
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110 71. Granner ML, Sharpe PA. Eval
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