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2 Key Concepts and Measures
Pages 5-20

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From page 5...
... , included presentations by Daniel Dawes from the Satcher Health Leadership Institute at Morehouse School of Medicine and Karthick Ramakrishnan of UCR and the Center for Social Innovation in the format of a "fireside chat." Link said that the concept of the social determinants of health has helped the field articulate how people's location in society "cascades down to influence people's health." The fireside chat, which was intended to be conversational, Link said, would examine "the sources of those positional locations and their meaning in our society" by looking "at what produces those hierarchical relationships." ON THE POLITICAL DETERMINANTS OF HEALTH Dawes discussed the "consequences of unrepresentative government and policies" as they are manifested in the striking inequalities seen in American society. He then listed some key effects of inequality: how it gets "under the skin," leading to premature aging or biological weathering (Geronimus, 1992; Geronimus et al., 2006)
From page 6...
... Those are the political determinants of health." Dawes listed examples of health inequities linked with specific environmental and social factors, from the prevalence of asthma in communities with pollution from highways, bus depots, and railroads, to the long-term and intergenerational health effects of the economic and policy system based on slavery. Over time, explicitly racist policies gave way to policies that appeared neutral on their face but that had the same
From page 7...
... The political determinants of health, according to Dawes, involve three systematic processes that work concurrently and reinforce each other to create or, in the examples below, hinder opportunities for improved health and health equity: • Structuring relationships: examples include redlining policies under the Home Owners Loan Corporation Act, anti-miscegenation laws, and immigration laws shaped by racist ideology; • Distributing resources: examples include a lack of access to special education and social services; and • Administering power: examples include gerrymandering and restricting voting access. Dawes concluded his remarks by noting that the work to further health equity requires consistency.
From page 8...
... The pillars of civic infrastructure (see Figure 2-1) include government agency coordination; community media; the education sector, which plays a key role in civic education)
From page 9...
... The question is how do we make sure that it improves governance and, in our more contemporary context, improves health equity." Dawes shared his belief that "the forces of division and polarization" must be confronted, and he asserted that health equity-focused policies in this country have generally enjoyed bipartisan support. It is important to use approaches and language that will resonate with people in order to persuade them to support the cause of furthering equity, for example showing how it may "align with a commercial interest and a government investment value." A second viewer asked if any communities have operationalized concepts about healthy civic engagement to deliver impact, and Ramakrishnan offered as an example of civic infrastructure the thousands of "complete count" committees and Census coalitions that were formed around the country to assist with the recent U.S.
From page 10...
... initiative, "a nonpartisan coalition of public health organizations working to advance health equity by ensuring that everyone has access to the ballot." For people wondering why public health organizations are interested in civic engagement, she explained that voting determines who gets elected and what laws get enacted and that these decisions in turn influence the conditions in which people live, work, play and learn -- the social and political determinants of health. She added that the evidence indicates that voting and civic participation, such as volunteering, yield many individual and community health benefits.
From page 11...
... The voting metrics reviewed include voter registration and voter turnout, along with indices that assess different aspects of elections. The Cost of Voting Index, first published in 2016 as an analysis of the relative cost of voting in presidential election cycles from 1996 to 2016, "measures the relative restrictiveness of each state's voting or electoral environment," and it consists of nine issue areas across two key categories, registering to vote and casting a ballot.
From page 12...
... For the deliberation criterion, Gastil described examples of governing institutions that engage in deliberation, from juries empowered to make a decision to "conventional government bodies or new deliberative bodies designed specifically to transform democratic practice." The latter are sometimes called mini-publics, and the Oregon Citizens Initiative Review provides an example (Gastil et al., 2018)
From page 13...
... The project uses semi-structured, longform conversations with the precise prompts that facilitate discovery, follow-up, and eliciting of authentic and honest conversation. P ­ roject data are transcribed, de-identified, and "made available to qualified ­researchers on secure servers." The American Voices Project, Grusky said, captured aspects of the unfolding pandemic-related crisis that conventional surveys and admin istrative data may overlook -- for example, uncovering coping strategies, gaps in the safety net, mental health needs, the heavy toll of the noxious contracts5 that "essential" workers were being asked to engage in, a new racial divide in discourse, and much more.
From page 14...
... The immersive interview process used in the American Voices Project differs from surveys because it is controlled by the person who is being interviewed, "and that's what makes it an engaging, cathartic and less dehumanizing experience," he said. To make sense of the evidence, it is important to bring community members, social scientists, and policy
From page 15...
... It is imperative to explain to community residents what happens with community feedback after they participate in city council meetings or other events. Earlier comments referred to the power imbalance between communities and researchers, Ramakrishnan noted, but there are other kinds of power that need to be examined as well.
From page 16...
... How did this come about, he asked? Gastil acknowledged that those who participate in elections exercise more power than those who do not, although the reasons senior citizens, who are known to be a reliable voting constituency, got access to the vaccine first may be more complex.
From page 17...
... Power-building enables people to engage effectively and to exercise influence and "shape the electoral environment over time." An audience member asked what members of the public can do, and Hunter said that people can get involved in their neighborhood associations, write op-eds to the local paper, attend school board meetings, and submit public comments on rules, laws, and ordinances that 6 The publication is available at https://nap.edu/26306.
From page 18...
... "When advocacy organizations become a little too interested in the exercise of strategic power without empowering their membership," Gastil said, "they do tend to drift away from those broader purposes of a democratic social movement." Ramakrishnan also passed along a question about gun policy reform and the possibility of finding common ground. Reflecting on the questions, Hunter used the example of Florida voters voting for increasing the minimum wage while also voting for Donald Trump and asserted that these seemingly discordant outcomes demonstrate that there was a heterogeneous group of voters all of whom found something resonant in the minimum wage ballot measure.
From page 19...
... " Hunter shared her hope from seeing grassroots work to register people to vote and push back against voting restrictions and from observing partnerships with business and philanthropy to support healthy elections by offering space for vote centers, supporting poll worker recruitment, and offering other assistance. Gastil reflected on the adoption in other countries of a range of democratic innovations that engage people in the political process or elevate democratic deliberation.


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