Community Power
in Population
Health Improvement

PROCEEDINGS OF A WORKSHOP

Anna Nicholson and Tamara Haag, Rapporteurs

Roundtable on Population Health Improvement

Board on Population Health and Public Health Practice

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and AAMC, Aetna Foundation, BlueCross BlueShield of North Carolina, Nemours, The Rippel Foundation, Robert Wood Johnson Foundation, The University of Texas at Austin, and Wake Forest Baptist Health/Stakeholder Health. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-09349-1
International Standard Book Number-10: 0-309-09349-X
Digital Object Identifier: https://doi.org/10.17226/26306

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Copyright 2022 by the National Academy of Sciences. All rights reserved.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Community power in population health improvement: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26306.

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PLANNING COMMITTEE ON COMMUNITY POWER IN POPULATION HEALTH IMPROVEMENT¹

HANH CAO YU (Chair), Chief Learning Officer, The California Endowment, Oakland, CA

GARY R. GUNDERSON, Vice President, Faith Health, School of Divinity, Wake Forest University, Winston-Salem, NC

LOURDES J. RODRÍGUEZ, Senior Program Officer, St. David’s Foundation, Austin, TX

ARVIND SINGHAL, Professor of Communication and Director of the Social Justice Initiative, The University of Texas at El Paso, El Paso, TX

ADITI VAIDYA, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT¹

SANNE MAGNAN (Co-Chair through December 2020), Senior Fellow, HealthPartners Institute, Emerald Isle, NC

JOSHUA M. SHARFSTEIN (Co-Chair through December 2020), Vice Dean for Public Health Practice and Community Engagement, Professor of the Practice, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

RAYMOND BAXTER (Co-Chair from January 2021), Trustee, Blue Shield of California Foundation, San Francisco, CA

KIRSTEN BIBBINS-DOMINGO (Co-Chair from January 2021), Professor and Chair of the Department of Epidemiology and Biostatistics; Lee Goldman, MD, Endowed Professor of Medicine; Vice Dean for Population Health and Health Equity, University of California, San Francisco, School of Medicine; San Francisco, CA

PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC

DAWN ALLEY, Chief Strategy Officer, Center for Medicare & Medicaid Innovation, Washington, DC

JOHN AUERBACH, Executive Director, Trust for America’s Health, Washington, DC

CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance (MIHIA); Consultant for Health Strategy, The Dow Chemical Company, MIHIA, Saginaw, MI

DEBBIE I. CHANG, President and Chief Executive Officer, Blue Shield of California Foundation, San Francisco, CA

ALLISON GERTEL-ROSENBERG, Operational Vice President, National Policy and Practice Nemours, Washington, DC

MARC N. GOUREVITCH, Professor and Chair, Department of Population Health, New York University Grossman School of Medicine, New York, NY

GARTH GRAHAM, President, Aetna Foundation, Hartford, CT

MARGARET GUERIN-CALVERT, Senior Managing Director and President, Center for Healthcare, Economics and Policy, FTI Consulting, Washington, DC

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

GARY R. GUNDERSON, Vice President, Faith Health, School of Divinity, Wake Forest University, Winston-Salem, NC

DORA HUGHES, Associate Research Professor of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC

SHERI JOHNSON, Director, Population Health Institute; Acting Director, Robert Wood Johnson Foundation Culture of Health Prize; Associate Professor, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI

WAYNE JONAS, Executive Director, Integrative Health Programs, H&S Ventures, Samueli Foundation, Alexandria, VA

ROBERT M. KAPLAN, Professor, Center for Advanced Study in the Behavioral Sciences, Stanford University, Stanford, CA

MICHELLE LARKIN, Associate Vice President and Associate Chief of Staff, Robert Wood Johnson Foundation, Princeton, NJ

MILTON LITTLE, President, United Way of Greater Atlanta, Atlanta, GA

PHYLLIS D. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation, Troy, MI

BOBBY MILSTEIN, Director, ReThink Health, Morristown, NJ

JOSÉ T. MONTERO, Director, Center for State, Tribal, Local and Territorial Support; Deputy Director, Centers for Disease Control and Prevention, Atlanta, GA

VON NGUYEN, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of North Carolina, Durham, NC

WILLIE OGLESBY, Interim Dean, College of Population Health, Jefferson University, Philadelphia, PA

JASON PURNELL, Vice President, Community Health Improvement, BJC HealthCare; Associate Professor, Brown School, Washington University in St. Louis, St. Louis, MO

LOURDES J. RODRÍGUEZ, Senior Program Officer, St. David’s Foundation, Austin, TX

PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ

KOSALI SIMON, Herman B. Wells Endowed Professor, Associate Vice Provost for Health Sciences, Paul H. O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN

HANH CAO YU, Chief Learning Officer, The California Endowment, Oakland, CA

Health and Medicine Division Staff

ALINA BACIU, Roundtable Director

CARLA ALVARADO, Program Officer (through January 2021)

AYSHIA COLETRANE, Senior Program Assistant

HARIKA DYER, Research Assistant

ROSE M. MARTINEZ, Senior Director, Board on Population Health and Public Health Practice

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Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRUCE N. CALONGE, The Colorado Trust. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

We also thank staff member ANA FERRERAS for reading and providing helpful comments on this manuscript.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION

Workshop Objectives

Organization of the Proceedings

2 DARING TO LEAD

National Domestic Workers Alliance

A Theory of Power to Achieve Change

Radical Reimagining

Discussion

3 COMMUNITY POWER IN THE CONTEXT OF POPULATION HEALTH

Shifting Definitions of Power

Addressing Power Dynamics in Health

Personal Experiences in Power Building

Addressing Internalized Devaluation

Community-Building Influences

Institutionalizing Power Building

Objectivity and Relational Work

Equality Improvement Conditions

Progress in Power Building

The Effect of Narrative on the COVID-19 Pandemic

Values of People and Money

4 COMMUNITY POWER: APPROACHES AND MODELS

The Measure Care Model

Healthy Richmond Collective-Building Policy Initiative

The Positive Deviance Approach

Discussion

5 FROM VISION TO ACTION: EFFECTIVE WAYS TO SUPPORT GRASSROOTS COMMUNITY POWER BUILDING

Community Power-Building Ecosystem

Partnerships Between Researchers and Community Groups

Current Power-Building Strategies and Approaches

Discussion

6 COMMUNITY-LED TRANSFORMATIONAL NARRATIVES

Agency and Community Power

The Power in Honoring Culture

Go Austin/Vamos Austin Community Initiatives

Church-Based Community Services

Policy Advocacy for Health Equity

Community-Centered Revitalization

Discussion

7 AMPLIFYING THE EMPIRICAL BASE LINKING COMMUNITY POWER AND HEALTH EQUITY

Personal Drive for Power Building

Challenges and Tensions in the Exercise of Community Power: Practice Implications for Research

The California Endowment: Building Healthy Communities

Building Evidence for Power and Health: The BHC Initiative as a Learning Engine

Community Power and Health Equity: The Memphis Model’s Cardiac Disparity Case Study

Community Empowerment and Health Equity: Practicing Community-Based Participatory Research in the Time of COVID-19

Discussion

APPENDIXES

A References

B Biosketches of Speakers, Moderators, and Planning Committee Members

C Workshop Agenda

D Readings and Resources

Boxes, Figures, and Table

BOXES

1-1 Statement of Task

1-2 Workshop Highlights

1-3 Definitions of Power Provided by Speakers

2-1 Recognizing Oppression Within Oneself

4-1 Healthy Richmond’s Vision, Purpose, and Horizon Statements

5-1 Robert Wood Johnson Foundation’s Definition of Community Power

FIGURES

2-1 The theory of power used by NDWA

4-1 The MEASURE CARE model

5-1 Domains of power in health, equity, and justice

5-2 Approaches to cultural, political, economic, and transformative power building

7-1 Power-building ecosystem

7-2 Example of comparative interrupted time series design

TABLE

7-1 Diverse Practices for Developing Community Power

Acronyms and Abbreviations