Supporting a Movement for Health and Health Equity Lessons from Social Movements: Workshop Summary (2014) / Chapter Skim
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3 Lessons from Health-Related Movements
3 Lessons from Health-Related Movements
Pages 21-38
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has made significant strides toward health and health equity by identifying social conditions linked to the existence of avoidable social inequalities in health, documenting health disparities, and using this information to drive health strategy. Thus, the EU could serve as an example and a source of lessons learned as we attempt to encourage similar thinking in the United States, she observed.
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To present this model to the Obama administration in hopes of scaling it up, PolicyLink worked in partnership with the Food Trust and The Reinvestment Fund; together they assisted in creating a federally funded National Healthy Food Financing Initiative that supports new grocery stores, converting neighborhood stores to offer healthier products, and promoting farmers markets that offer access to healthy food. This process exemplifies how PolicyLink supports valuable ideas through networking, outreach, and engagement at many levels, she said.
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This is not a vision that the foundation can achieve on its own, she emphasized; rather, the role of foundations such as RWJF is to help shape public dialogue and thereby build demand for change, to invest directly in the people and projects that propel social movements, and to advocate for policy changes that support movement objectives. Building Demand for Change Shaping public dialogue begins with getting people engaged with an issue, Larkin said.
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The foundation has gathered evidence on effective strategies for reducing childhood obesity through both individual choice and policy initiatives, and it is beginning to see signs that the issue is gaining attention in diverse communities and populations throughout the United States, she said. RWJF is also involved in research to support efforts toward health improvement and equity by raising awareness of the social determinants of health.
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The notion of a "culture of health" is both inspiring and daunting, Larkin said, much as were the ideas that launched the civil rights and marriage equity movements as well as specific health initiatives such as seatbelt use and efforts to counteract childhood obesity. To establish a culture of health, she said, it will be necessary to connect the vision of a culture of health with the dreams and aspirations of individuals, to build engagement and partnership across broad sectors of society, and to set concrete, meaningful targets to gauge progress.
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She acknowledged, however, that policy making is critical to the work, and her organization has formed productive alliances with respected associations and organizations who have the ear of those in power and who can link them to governmental agencies involved with issues such as sustainable communities, transportation, climate change, and environmental justice. Geopolitical Context and History Matter "If we are trying to influence policy makers, we need to be most concerned with their concerns, which is their sphere of control," Twiss said.
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Phenomenal work in healthy communities has been achieved through the health departments of Los Angeles County and San Diego, which have been recipients of federal grants, such as Communities Putting Prevention to Work and Community Transformation. In Los Angeles, the county worked with cities that would not have been competitive in a standard competition for funds, she said.
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BUILDING PUBLIC WILL TO ACHIEVE HEALTH EQUITY Ned Calonge, president and chief executive officer of The Colorado Trust, described four frameworks of social movements and focused on the process of building public will in support of a cause. For The Colorado Trust, that cause is health equity, an issue that the organization has embraced relatively recently and around which it is maturing.
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Calonge illustrated this point with the example of the RWJF health equity slogan, "Your zip code is more important than your genetic code." Although it may have resonated in some parts of the country, he reported that it fell flat in rural Colorado, where people simply countered, "I can't change my zip code." Conveying the meaning of health equity to that particular population required that they understand that some people are unfairly denied access to a healthy life. "Opportunity and fairness play a little bit better than equal in rural Colorado," he said; in order to build public will there, one must recognize that attitude and connect the issue of health equity to opportunity and fairness.
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. It comprises eight stages through which social movements transition on their way to establishment (see Box 3-1)
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LESSONS FROM THE WALKING MOVEMENT In introducing his presentation, Raymond J Baxter, senior vice president for community benefit, research, and health policy at Kaiser Foundation International and president of Kaiser Foundation Health Plan, invited the audience to join a social movement in development.
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Successful social movements have always been messy. Rather than rely on a linear plan, the leaders of these movements relied on and built relationships and capacity and capabilities, embracing opportunities as they emerged.
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Baxter concluded his presentation with a video clip that showed the summit.5 In the discussion session following panel presentations, Terry Allan asked what lies ahead for the walking movement. Baxter responded that in the quest for distributed leadership, Kaiser Permanente downplayed its brand, focusing instead on funding and supporting various initiatives and on building relationships and social networks.
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These moments have provided useful opportunities for community leaders and members to openly discuss issues that might otherwise have been avoided, she said, and they have also raised awareness of the often invisible, but significant, divisions that exist within communities. Terry Allan argued in favor of a collective, community understanding of "the narrative around issues of the ‘isms.'" In Cleveland, he reported, eliminating racism as a social determinant of health emerged as a central theme of the city's health improvement plan as a result of discussion with community groups.
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Raising the example of gay marriage, he noted that the tide of public opinion in the United States turned "when we stopped talking about being anti gay marriage as being homophobic and we started to present it as freedom to marry and marriage equality." By reframing that issue in terms of personal freedom, the marriage equity movement connected with values shared by a majority of Americans rather than challenging personal beliefs regarding marriage. Changing Values Versus Changing Attitudes Sanne Magnan, president and chief executive officer of the Institute for Clinical Systems Improvement, contrasted Baxter's contention that successful movements rest more on values than on specific goals with Calonge's observation that while movements can change attitudes, they are unlikely to alter values.
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However, despite shifting ideologies at the state level, movement momentum can be maintained by connecting with local health departments on issues that matter to them. George Isham remarked on the contrast between Twiss's nonpartisan approach and Calonge's single-party focus.
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"I view that as a great moment rather than a problem," Baxter said, and he suggested that it can serve as a valuable example for those who are looking to create change in population health.
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