Community Power in Population Health Improvement Proceedings of a Workshop (2022) / Chapter Skim
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3 Community Power in the Context of Population Health
3 Community Power in the Context of Population Health
Pages 21-36
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• Power building requires infrastructure built around the mission of changing society. Institutions must invest resources into a broader mission beyond internal efforts.
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Milstein noted that collectively, Healey and Heller have 70 years of experience working at the interface of population health and civic life -- an intersection where people's power to shape a common world, as well as their own lives and livelihoods, comes into focus. SHIFTING DEFINITIONS OF POWER "The key word for this entire workshop is power, a word that is notorious for wobbly definitions and even outright discomfort in the classical, detached discourse of health science," said Milstein.
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He added that the notion of what constitutes power relates to the tools available to effect societal change. ADDRESSING POWER DYNAMICS IN HEALTH Milstein asked how health professionals can create space to consider power dynamics and building power.
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Heller recalled, "[I was] naively thinking that if I just did reports, like health impact assessments, and brought data to decision makers, they would change their minds.
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ADDRESSING INTERNALIZED DEVALUATION Milstein highlighted the key role of power in issues of equity and justice, as demonstrated when the initial efforts of the community organizers were ignored by the developers during Heller's experience in West Oakland. He contended that the tendency to ignore the needs of devalued people must be met with efforts to gain dignity and respect for devalued groups, just as NDWA and the Black Voters Matter (BVM)
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Heller emphasized that the entire process is focused on validating community concerns, bringing the voices of the community together, and helping community members build their power to tackle issues affecting their lives. COMMUNITY-BUILDING INFLUENCES Milstein commented that lifting up human dignity and helping people change the circumstances of their lives requires a shift or evolution in how knowledge is pursued.
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Community organizers such as Deepak Bhargava from Community Change,5 Doran Schrantz from ISAIAH,6 and others were instrumental in helping Heller shift from a perspective of hard sciences to a focus on relationships and organizations. In applying public health ideas to community organization, he built on the foundation laid by such leaders as Tony Iton, senior vice president of programs and partnerships at The California Endowment (TCE)
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This enterprise is challenging, considering the varied missions and internal cultures community organizers and state health departments have. These organizations are constrained by the political bodies they report to, and their immediate mission is different than that of community organizations.
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When community organizations, trade unions, health departments, and legislatures work together, it shields people from attack, enabling them to work beyond their usual comfort level without fear of being fired. Creating this type of space and security requires resources, which gives philanthropy an important role to play in community organizing, Healey concluded.
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Given the extent to which values and beliefs shape the research process, the idea that science is purely objective is a false narrative, he asserted. However, public health departments can take advantage of that narrative by validating community concerns, giving them scientific language, and including them in scientific publications.
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Once people experience organizing around an issue, they may expand to other issues. He said the founders of the United States were afraid of democracy and thereby created a relatively weak government, as a true democracy could result in property being shared, white supremacy being overturned, and people speaking for themselves and working together as they realize their larger self-interests.
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In giving community-organizing groups access to these governmental relationships, public health agencies can support power building through establishing power-sharing infrastructure, added Heller. 10 Stacey Abrams and LaTosha Brown led efforts to address voter suppression and engage Black voters.
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Bearing these social dynamics in mind, Milstein asked whether there is a way to spring forward from the current crisis into a renewal of civic life. Heller remarked that many of the dominant narratives have led to dynamics present in the current crisis.
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Referencing Brown's earlier talk about centering human value in decision making, Healey emphasized the need to move away from the narrative of profitability of health and determine other types of criteria for health decisions. VALUES OF PEOPLE AND MONEY Milstein referenced the recent release of the Surgeon General's Community Health and Economic Prosperity report, which established that healthy communities are needed to prosper economically, and an inclusive economy is needed for everyone to be healthy.11 Without both community health and economic prosperity in place, society can spiral into adversity; when they work in tandem, opportunities arise for both to grow simultaneously.
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12 See, for example, https://www.openmarketsinstitute.org/publications/eyes everywhere-amazons-surveillance-infrastructure-and-revitalizing-worker-power (accessed February 21, 2021)
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