After creating a community health needs assessment (CHNA) or when planning to engage the community as part of a health equity initiative, it's important to ensure that representatives and participants have community capacity.
Meaningful community engagement requires community capacity
Community capacity indicates that individuals from the community have the ability, power, opportunity, and tools to act and represent the needs and preferences of their community. It's the primary mechanism that ensures the democratization of decision making around health equity.
Five shifts to build greater community capacity
Engaging community members who face health inequities goes beyond analyzing health equity data or conducting primary research interviews, town halls, or listening sessions. It's about putting the community first and always. As the organizer or sponsor of the initiative, it's critical that you define your role as facilitator and ally, not the educator or leader.
Through cultural humility, organizational representatives – from healthcare, non-profits, governmental agencies – are walking beside people who will guide the goals and vision and, ultimately, benefit from long-term change.
Building capacity entails a fundamental shift in power
Shifting the locus of control to communities acknowledges that they are experts on their local needs, strengths, and history. Organizations, systems, and structures that have traditionally held all the power will be uncomfortable with sharing it, but fundamental to creating trusting relationships with a community and co-creating a new history.
- What are the stories that the community share around their history and the current state of health and well-being?
- What do community members see as the root causes of their concerns and what do they want to see improve?
- Who do they think hold the power and what kind of power do they want to build for positive change?
- What strengths, capabilities, and experiences can be identified and engaged to support community capacity?
Studies have uncovered several attributes that help communities succeed in health improvement efforts – a common vision, shared language, a strategy for diversifying funding, an integrator organization, and leaders that reflect the community's shared values. The studies also found that communities with capacity have “rich networks of organizations working together to effect health improvement." They experience significantly lower death rates from preventable conditions compared to those with less community capacity.
Link health and wellness to what the community values
Health may not be at the top of the list of community goals. Yet, improved physical and behavioral health could be important supports to achieving the goals that communities most value like more job opportunities, better education, and lower violence or suicide among young people. While better health may or may not be a central driving value, the manner in which it aligns to help communities achieve almost any other objective serves to highlight the power good health gives everyone.
- What data aligns with the issues that the community cares about?
- Is there data that demonstrates how health has impacted these issues or vice versa?
- What community values could be realized through improved health equity?
- How could better health equity empower this community to achieve their priorities?
Where and how the community is engaged is paramount
Community organizers must ask themselves, “Are we making ourselves comfortable and the people we want to support uncomfortable?" When healthcare organizations partner with non-profits or other community organizations, they tend to create programs, physical centers, and materials from their vantage point, not the community's. Equity centers, located within healthcare campuses, may seem too ingrained in historical systems and intimidate community members, triggering recall of negative experiences or encounters with healthcare.
Take a different approach:
- Identify and partner with "community hubs" where the community already gathers and feel comfortable – libraries, churches, parks, community centers, local restaurants or barber shops.
- Employ and train community members to act as facilitators who can bridge conversations among various organizations.
- Hire or enlist individuals from different education levels to review materials to ensure that the language is simple, clear, community-centered and without jargon or politicalized undertones.
- Connect engaged community representatives with people of power to collaborate on specific events or initiatives. Engaging networks is how power is distributed.
- Create community councils that are peer-led with representatives who can report back to the bigger group.
- Explicitly call-out ideas, decisions, and achievements that came directly from community groups or members, demonstrating how contributions become action.
- And, in keeping with Robert Wood Johnson's "Raising the Bar" health equity model, intentionally engage individuals in the community most impacted by inequities and with the greatest experience of historical marginalization and limited access to care.
Support and grow community leaders
The less your organization is seen at the forefront, the greater opportunity for community ownership to take root, leading to ongoing commitment. Community-based leadership is essential to long-term change. Providing access and resources for leadership development – whether through formal training or informal relationships – will encourage the next generation to assert authority and responsibility for achieving their community's vision. Here, again, this aligns with Raising the Bar and the Partner Role within their Principles into Practice.
Case in point: Community engagement at the Pine Ridge Reservation showed how multi-generational power can change long-held beliefs, creating new views of what's possible. During a community session, children were drawing what they thought was good for the community on a white board. Some elders questioned whether these things were even possible, affordable. The youth asserted their hopes and dreams when challenged. That kind of shared power can light a spark in community members who want to co-create better opportunities.