Communities in Action Pathways to Health Equity (2017) / Chapter Skim
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4 The Role of Communities in Promoting Health Equity
4 The Role of Communities in Promoting Health Equity
Pages 185-210
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From page 185... ...
Conditions to foster actions toward health equity are reviewed as are the evidence and data necessary to inform community-driven solutions. Below, a first-person account of the Thunder Valley Community Development Corporation is provided as an example of the way in which one community organization is promoting health equity.
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From page 186... ...
For more information, email PARO@nas.edu. Taking Community Action to Promote Health Equity: The Thunder Valley Community Development Corporation Written by Nick Tilsen, Founder and Executive Director of the Thunder Valley Community Development Corporation1 Thunder Valley Community Development Corporation2 (CDC)
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From page 187... ...
Thunder Valley CDC has taken on a model community initiative through a 34-acre regenerative community development plan that provides the opportunity to begin to address the lack of physical, political, and economic infrastructure that exists and to create our own pathway out of poverty by building local skill and leadership capacity. Along with our work to develop the regenerative community in a way that honors our cultural heritage and is adapted for the needs and vision of our local community, we are intentionally disrupting the status quo by creating models
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From page 188... ...
Through our complex ecosystem of opportunity, the solutions we are creating will be able to address the root inequalities that negatively affect the social determinants of health. Today, Thunder Valley CDC operates at about $4 million with support from multiple federal agencies, foundations, and individuals, including Northwest Area Foundation, Doris Duke Charitable Foundation, Surdna Foundation, Novo Foundation, W.K.
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From page 189... ...
, affects local factors that can influence health, and has the potential to promote health equity. The potential of community-based solutions to advance health equity is a focus because the Robert Wood Johnson Foundation asked the Committee on Community-Based Solutions to Promote Health Equity in the United States to consider solutions that could be identified, developed, and implemented at the local or community level.
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From page 190... ...
As illustrated in the Thunder Valley CDC example, and detailed in Chapter 3, the community serves as the bedrock of health, a foundation for achieving other important goals, and key to building a productive society. Communities differ in the causes of health inequity they experience, from the availability of health care providers, the affordability and quality of housing, and employment opportunities, to schools, transportation systems, safety, the availability of parks and green space, and other aspects of the physical environment.
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From page 191... ...
In other words, this report is for communities that believe promoting health equity among their residents is important, but it is also for communities that believe better transit, more affordable housing, complete streets, and more small businesses are essential to a thriving community. THE EVIDENCE ON COMMUNITY-BASED EFFORTS Communities might not all be successful at building the type of organizational and collaborative capacity needed to achieve the changes they 4 Dubb et al.
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From page 192... ...
In 2002, Shortell and colleagues conducted a study of 25 public– private community health partnerships (out of 283 partnerships in the Community Care Network that responded to a request for application from the Health Research and Educational Trust of the American Hospital Association. Between 1995 and 2000, the partnerships had grown from an average of 10 to an average of 22 member organizations, including "hospitals, health systems, managed care organizations, clinics, public health departments, physician organizations, nursing homes, schools and school districts, local government agencies, state health departments, citizen groups, chambers of commerce, social service agencies, and local businesses" (Shortell et al., 2002, p.
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From page 193... ...
provide an overview of some of the factors that contribute to poor performance in achieving population health goals, including health equity, as established in Healthy People 2010, and some of the causes, including challenges in "engaging stakeholders at multiple ecologic levels in building collaborative partnerships for population health." The authors offer seven recommendations for strengthening collaborative partnerships for population health and health equity: measure progress, "develop and use action plans that assign responsibility," facilitate natural reinforcement for cross-sectoral collaboration, assure adequate base funding, provide training and technical support, establish participatory evaluation systems to document and review progress and make course corrections, and "arrange group contingencies to ensure accountability for progress and improvement" (Fawcett et al., 2010, p.
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From page 194... ...
The characteristics of community organizations, such as having passionate and competent leadership (see, for example, the Delta Health Center and WE ACT for Environmental Justice community examples in Chapter 5) , are important for successful interventions for health equity.
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From page 195... ...
Funding is another element of the larger policy context supporting community action. In the Thunder Valley CDC example described earlier, funding from the U.S.
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From page 196... ...
. ELEMENTS OF SUCCESSFUL COMMUNITY EFFORTS Communities working to promote health equity or to address social or environmental conditions in their neighborhoods may use different types of partnerships that include community-based organizations, local government agencies, and residents themselves.
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From page 197... ...
Many organizations have identified the fostering of cross-sector or multi-sector collaboration as a key ingredient for promoting health and health equity (Mattessich and Rausch, 2014; Prybil et al., 2014)
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From page 198... ...
In their assessment of the association between multi-sector population health activities and health outcomes over time, Mays and colleagues found that communities with comprehensive system capital -- rich networks of organizations working together to effect health improvement -- experienced significantly lower death rates from preventable conditions (e.g., cardiovascular disease, diabetes, and influenza) compared to communities without this capital (Mays et al., 2016)
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From page 199... ...
, and it is reasonable to expect that success in addressing health inequities also requires a shared vision and shared values. Holding health equity as a shared vision and value is an aspirational notion; in many communitybased partnerships to address any number of community challenges, health equity may simply be an implicit vision and value.
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From page 200... ...
Community members who come to know and trust their neighbors and have a sense of ownership and belonging in the place where they live are more likely to work collectively to solve common problems related to promoting health equity. True community-led action is only possible insofar as communities have the capacity to organize for health equity.
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From page 201... ...
See, for example, the Magnolia Community Initiative in Chapter 5 for a collaborative community initiative with partners across government, nonprofits, private entities, and faith organizations. Just as a shared vision is important to unite a multi-sector collaboration, authentic partnership with representatives from all affected community segments is essential to help community interventions succeed.
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From page 202... ...
Specifically, it is important for leaders of such efforts to document and describe on an ongoing basis the engagement of different parts of the community, particularly residents not usually at the table and those most affected by inequitable health conditions. BUILDING EVIDENCE TO SUPPORT COMMUNITY ACTION There are numerous examples of successful community-based solutions that promote health equity.
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From page 203... ...
Currently more is known about the problems of health inequities than about the solutions. Additionally, more is known about the programs that have worked in the past to marginally improve health equity than about the strategies and broad, interactive, crosscutting interventions that could bring greater and more widespread progress in the future.
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From page 204... ...
The National Scientific Council on the Developing Child reviewed the evidence on commonalities among child care environments that promote healthy development and found that the critical elements are ensuring "that relationships in child care are nurturing, stimulating, and reliable, [leading to] an emphasis on the skills and personal attributes of the caregivers, and on improving the wages and benefits that affect staff turnover" (National Scientific Council on the Developing Child, 2004)
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From page 205... ...
is an example of ongoing, disciplined inquiry in action. The Carnegie Foundation for the Advancement of Teaching created CCP in response to the extraordinarily high failure rates among the half million community college students annually assigned to remedial math instruction as a prerequisite to taking collegelevel courses.
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From page 206... ...
The CHI Navigator8 is intended for individuals and groups who lead or participate in community health improvement work within hospitals and health systems, public health agencies, and other community organizations. It is a one-stop shop that offers community stakeholders expert-vetted tools and resources for depicting visually the who, what, where, and how of improving community health; making the case for collaborative approaches to community health improve ment; establishing and maintaining effective collaborations; and finding interventions that work for the greatest impact on health and well-being for all.
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From page 207... ...
Providing relevant assistance, guidance, and support to local community leaders (e.g., identifying data sources, accessing funding available from federal agencies, and using civil rights law) could improve the chances of success for community organizations.
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From page 208... ...
2016. Sustainable communi ties regional planning grants.
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2014. Improving community health through hospital-public health collaboration: Insights and lessons learned from successful partnerships.
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From page 210... ...
. Thunder Valley CDC (Community Development Corporation)
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