All too often, cross-sector collaborations fail to include residents of the communities they purport to serve. Inclusion is usually advocated for on the basis that those experiencing difficult social circumstances have important contributions to make, both in terms of understanding the challenges being experienced and suggesting culturally-appropriate solutions. What’s less appreciated, however, is that inclusion per se is an important part of people’s health.
This tenet has been a part of the social determinants of health literature for decades. In the late 1970s Sir Michael Marmot illustrated that known risk factors explained only 50% or so of cardiovascular morbidity and mortality. His findings helped kick-start a search for other risk factors and yet, some 40 years later, despite more and more risk factors being discovered, it continues to be the case that they alone cannot fully explain ill-health.
‘Inclusion’ is but one term in an ecosystem of theories about why risk factors do not give us the full picture. Some others are ‘sense of control’, ‘social cohesion’, and ‘resilience’. Proponents of each of these theories push their world view in the pursuit of research dollars to help prove or disprove their hypotheses. This theory-specific work is important but what’s missing is an over-arching and agnostic ‘home’ for this kind of work.
That’s what we at Bridging Health & Community are seeking to build.
We grew out of the Creating Health Collaborative, an international group of innovators exploring what health means to people and communities. I started the Collaborative as the Physician Editor of TEDMED as I was convinced that in an aging world blessed with more and more biological discoveries our current approach to health (and innovation) was unsustainable.
Through the innovators in the Collaborative I’ve become convinced that fostering community agency is key to the future of health. Together with the assistance of my co-founder, Bridget B Kelly, formerly of the Institute of Medicine, I’ve gleaned 12 principles to this work, from eliciting, valuing and responding to what matters to residents to building teams capable of working in a collective and iterative way. The full list of principles is at the end of this post.
The 12 principles will frame our first national symposium, Community Agency & Health, which is being held on May 15-16 in Oakland, CA. It’s being supported by The California Endowment, Kaiser Permanente, and the Robert Wood Johnson Foundation (see this announcement for supporting quotes from their leadership).
The symposium features two in-depth case studies and six practice-oriented breakouts. One case study is from The California Endowment’s ‘Building Healthy Communities’ program and the other is from BUILD Health Challenge. Both have ‘inclusion’ at their core, the former framing it as democratic inclusion as a way to affect local policies, with the latter framing it as economic inclusion.
The breakouts will cover things like cultivating ‘facilitative leadership’ and the process for discovering new business models associated with health (see the full list, including the partners delivering them, on our webpage). There are also short keynotes from the perspectives of health, finance, evaluation, and community organizing.
A Field of Practice
Ultimately, we see our work, including the symposium, as building a field of practice.
Many innovators are seeking to be ‘inclusive’ but what drives them (such as social justice or health equity), the mental models they seek to test (such as salutogenesis or positive health), the structure of their work (such as collective impact or systems integration), and the things being measured (such as sense of control or resilience) all differ. We seek to help to organize and facilitate the field, one that we describe as ‘fostering community agency to improve health’.
We hope you’ll consider attending the symposium. Registration is open with early bird prices lasting until March 17th. We’re open to people from any sector interested in health and encourage place-based groups to attend as a delegation.
The 12 principles for fostering community agency are:
- Include in a community’s collective effort those who live there, those who work there, and those who deliver or support services provided there
- Spend time understanding differences in context, goals and power
- Appreciate the arc of local history as part of the story of a place
- Elicit, value and respond to what matters to community residents
- Facilitate and support the sharing of power, including acknowledging existing imbalances and building the capacity to use it
- Operate at four levels at the same time: individual, community, institutional and policy
- Accept that this is long-term, iterative work
- Embrace uncertainty, tension and missteps as sources of success
- Measure what matters, including the process and experience of the work
- Build a vehicle buffered from the constraints of existing systems and able to respond to what happens, as it happens
- Build a team capable of working in a collective, iterative way, to include navigating the tensions inherent in this work.
- Pursue sustainability creatively; it’s as much about narrative, process and relationships as it is about resources
These principles, and the experiential knowledge that underpins them, will be published in early March. To stay abreast of our work, sign up here.
Community Agency & Health is supported by The California Endowment, Kaiser Permanente and the Robert Wood Johnson Foundation and in partnership with Active Living by Design, the Business Innovation Factory, the California Endowment, Community Science, Hershey Cause Communications, the Insight Center for Community Economic Development, ISAIAH, MIT Community Innovators Lab, Rochester Healthy Community Partnership, and UnitedHealthcare.