Following the Healthy People 2030 model, this article series focuses on 6 aspects of social determinants of health (SDoH), including food insecurity, economic stability, neighborhood and the physical environment, education, community, social support, and healthcare access. Here, we'll discuss the impact of community engagement on health and well-being. From the benefits of civic involvement to the extensive role of community health centers, engaging with one's community matters.
Involvement can boost individuals and communities
Whether it's volunteering for a neighborhood association, joining a scout troop, or campaigning for a political candidate, civic engagement can impact people's physical and mental health.
Broadly speaking, this term refers to any individual or group action that identifies or addresses the concerns or well-being of a community, social group, or overall society. Some of these activities—take, for example, community gardening or volunteering as a youth sports coach—not only impact the participating individual's health and well-being, but can also build and strengthen the broader community.
How does civic engagement relate to health?
Community participation improves health in myriad ways, explains Healthy People 2030, a government initiative aiming to improve health and well-being. Research has shown that members of civic groups are more likely to be physically active. That could be because people are connected to broader networks, which may make them aware of more opportunities to be social and involved. Mental health benefits stem from the sense of purpose developed by engaging in meaningful activities.
Participating in the electoral process itself by registering to vote, or helping to register others, can also impact health, the Center for Disease Control and Prevention explains, noting studies that have linked voter participation with better self-reported health. Volunteering, too, can result in improved emotional health, leading to reductions in stress, anxiety, and depression. The sense of belonging that comes from membership in groups, such as Rotary or Kiwanis, or even informal gatherings like a book club can decrease social isolation among participants, the agency adds.
The civic engagement/health equity connection
Organizations that prioritize health equity are increasingly looking at the role of civic engagement in advancing their missions, according to a Grant Makers in Health publication. In interviews with more than a dozen health funders, Grant Makers in Health found that civic engagement work often focused on increasing participation in the democratic process and prioritized historically marginalized populations.
Health foundations focusing on civic engagement
Among the examples of health foundations prioritizing civic engagement:
- Vitalyst Health Foundation, which supports efforts to improve the health of people and communities in Arizona, included “civic health" as a priority in its strategic roadmap. By 2024, the organization described the following goals: “to build resident, community, and civic leadership; connect empowered voices to influence policies; to promote fair processes in civic institutions."
- In an article in Philanthropy News Digest, the California Endowment leadership described the importance of “a robust, participatory democracy for low-income Americans of all backgrounds," offering the example of how Fresno, California residents helped shape a park-centered platform in the mayoral race.
- Health Forward Foundation, which supports projects to achieve health equity in Kansas and Missouri, notes the role of powerful communities. The organization describes working to “adjust the balance of power" by encouraging communities to participate in democracy, get involved in community movements, and support community advocates.
Community involvement benefits youth, too
Getting involved in one's community can also have important developmental and health benefits for adolescents and young adults. That's the finding of a recently-published article from the American Academy of Pediatrics, which described the empowering role of this involvement and its importance in developing one's identity. Whether this engagement happens digitally or in-person, it can help youth figure out their role in broader society.
“As illustrated by youth political participation, social activism, and rallies for racial justice during the COVID-19 pandemic, youth civic engagement is often inspired by and responsive to problems that are salient to a young person's lived experiences," the authors write. “Providers can empower youth and encourage civic engagement by eliciting issues that are important to them and directing them to community resources and opportunities for civic participation that can help them address these issues."
Engagement isn't limited to the public realm
As attention on the civic engagement/health link grows, it's important to note that community participation isn't limited to the public realm. This collaboration can also come from cultural groups, life-stage groups such as older adult organizations, and faith-based organizations.
A recent example stems from the role of historically Black churches during the COVID-19 pandemic. According to findings from the Pew Research Center, members of the historically Black Protestant tradition who regularly attended church were more likely to be vaccinated than those who did not regularly attend. Indeed, the role of the Black church in community engagement has a long history in the US, including offering job training programs, libraries, and athletic clubs.
Healthcare organizations can play an important role
Do healthcare organizations have any opportunities to foster this kind of engagement? With roughly 67 million Americans participating in a Medicaid Managed Care Plan (as of 2020), the answer is a resounding yes, writes the Association of State and Territorial Health Officials.
In fact, some plans include provisions for community health workers, which can share prevention and health education that is tailored to meet the community's cultural and linguistic needs and experiences. Others collaborate with local public health agencies as well as economic, social, educational, justice, and recreational organizations to promote community health and engagement.
Waiver program supports SDoH
Some of Medicaid's 1115 waiver programs are also focused on building these critical community relationships. Section 1115 demonstration waivers give states a chance to test out coverage approaches not otherwise allowed.
A North Carolina program called the Healthy Opportunities Pilots provide for non-medical interventions that address the social determinants of health, or the nonmedical factors that influence people's health, explains a Kaiser Family Foundation brief. Eligible beneficiaries who meet certain health and social risk criteria may receive enhanced case management and additional support in areas such as housing, food, and transportation.
Community health centers are vital connectors
Along with offering healthcare delivery, Community Health Centers (CHCs) also play a key engagement role in fostering community interactions, write the authors of an article in the NEJM Catalyst. These centers are located in medically underserved areas; they offer comprehensive health services; they are open to anyone regardless of ability to pay; and they have patient-majority governing boards.
As a result, “…they are well situated to be responsive and accountable to the needs and values of their communities," the authors write. “Beyond health services, they can be one of multiple institutions within a community where social forces gather to build social cohesion that can, in turn, promote community empowerment."
Understanding a community's interconnected needs
CHCs understand how multiple needs can be addressed at the same time, the authors continue. That translates into health centers that offer voter registration and education and encourage Census participation, steps which help provide a sense of empowerment in historically marginalized communities.
Some health centers may also directly get involved in advocacy efforts such as support for immigrant rights. The organizations may serve as a physical place where elected officials or candidates can gather. Centers also address SDoH by connecting people with key community resources, from housing advocates to domestic violence advocates, and programs for people impacted by substance use disorders.
Community conversations highlight key concerns
Along with benefiting the individuals involved, community involvement can help advance health equity on a broader scale by identifying needs and gaps. In numerous conversations, a health partnership identified the most salient health-related issues distinct regions in South Carolina face.
The summary report from 1 county pointed to concerns with gun violence, the need for more youth programs, and frustration with the lack of transportation and grocery options. In another, a community member described how alcohol and loan stores are readily present (even while food stores are scarce), and the importance of including disenfranchised youth in these conversations.
Engaging diverse audiences in SDoH work
Those examples demonstrate how engaging the community can be an instrumental part of SDoH work. This may be especially helpful in health systems that serve historically marginalized communities.
That's because SDoH data collection may be stigmatizing to patients, write the authors of a report published in the Permanente Journal. They describe a project that explored how to integrate SDoH data into electronic health records in an Alaska Native/American Indian health system. Through that process, focus groups were able to refine SDoH subdomains through their understanding of local community values.
Let RTI Health Advance help you
Healthcare settings are an optimal place to support and connect people to community services, a collaboration that also builds trust.
As increasing numbers of health equity efforts focus on civic engagement, RTI Health Advance can help you develop research-based approaches, interventions, and recommendations designed to bolster community involvement. We can help you create meaningful community engagement and outreach efforts that promote health equity and improve individual patient as well as population health outcomes.