Exploring Equity in Multisector Community Health Partnerships Proceedings of a Workshop (2018) / Chapter Skim
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2 Community-Driven Approaches to Building Healthy Communities
2 Community-Driven Approaches to Building Healthy Communities
Pages 11-26
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From page 11... ...
1 at The California Endowment, provided his views on how the nation got to where it is with regard to health inequities and how The California Endowment is addressing these inequities. Andrea Manzo, a hub manager for BHC in East Salinas, California, and Kanwarpal Dhaliwal, the co-founder and community health director at RYSE2 in Richmond, California, then described programs that are translating theory into practice in two California communities.
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From page 12... ...
BHC's strategy involves capacity building, narrative change, partnerships, and policy advocacy to produce health equity and measurable results. While he and his colleagues at The California Endowment created the specifications of this program, people such as
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From page 13... ...
. Iton also quoted the late Supreme Court Justice Antonin Scalia, who during oral arguments in a case involving affirmative action at The University of Texas cited claims that some African Americans are harmed academically by attending elite universities such as The University of Texas, and that they may be better served by attending "lesser schools."4 As a final example of the historical context for his work, Iton recited the third stanza of the Star Spangled Banner.
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From page 14... ...
"It just tries to pull apart the spectrum of opportunity for intervention and allow us to see where there may be meaningful opportunities to intervene." The framework, he explained, recognizes that the traditional medical model talks about how individual behavior produces disease, which produces premature mortality, and that the medical model then offers health education, clinical care, and emergency departments to try to contend with these challenges. Iton and his colleagues recognized that to get upstream, they had to determine where they could intervene in order to have an effect on health.
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From page 15... ...
for those resources." The exclusionary narrative, he added, argues for a rosy, nostalgic past and a future full of fear and anxiety. Overcoming the exclusionary narrative, Iton said, requires reweaving a social compact to create real social, political, and economic power -- rather than social vulnerability -- in a critical mass of people living in disadvantaged communities.
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From page 16... ...
Manzo and her colleagues' project, Healing Informed Governing for Racial Equity (Dieng et al., 2016) , is a power-building and healinginformed approach grounded in a set of core shared values and principles, and it emphasizes capacity building in the struggle to dismantle structural racism in Salinas.
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From page 17... ...
The government needs to do its part to invest in residents, while residents need to constantly organize and exert their collective power to ensure that the government meets its own responsibilities concerning issues that affect their well-being and their overall health, Manzo added. Manzo recounted the first time she was bothered by the idea of centering the community's problems around gang violence.
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From page 18... ...
Her community, she said, has evolved in its thinking to not only fix the bridge that leads to health inequities, but to look at who is building the bridge, how it is built, who has access to the bridge, and whether the bridge is actually saving people and improving health outcomes. Concluding her presentation, Manzo asked the workshop participants to think about a policy- and systems-change approach using a racial equity lens.
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From page 19... ...
"They were thinking about legacy, and it is in this spirit that I honor and offer what I have to share," she said. Before describing RYSE, Dhaliwal asked the workshop participants to consider one idea: If the population health field continues to look at the issues of equity and social determinants of health from a white, middleclass, overeducated perspective, it will continue to be culpable for the inequities these communities face.
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From page 20... ...
Dhaliwal said that her perspective is grounded in lived experience and the process of understanding the structural forces at work in the community. Dhaliwal shared an illustrative story about a hospital-linked violence intervention program run under a contract with the regional trauma c enter, which is located 24 miles from Richmond in an affluent white community.
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From page 21... ...
As a result, the organization's members are looking at the idea of developing a syndemics framework of research and data to enable them to conflate factors in a way that would help them understand the synergy and relationship among those social factors instead of doing regression analysis. In closing, Dhaliwal suggested that workshop participants visit the RYSE website8 and watch some of the videos that illustrate what the young people in the Richmond community are doing to address the social determinants of health and create a system of racial justice and anti-oppression.
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From page 22... ...
"Many organizations in East Salinas are emerging organizations, organizations that did not exist before BHC," she said, "but we have seen tremendous wins with these folks in these organizations because they are grounded in lived experience." The key here, Manzo added, is having the resources to invest in and take a chance with those who have lived experiences and have good ideas on how to address the problems that affect their communities. Part of that capacity building, she added, is helping these nascent organizations understand what they need to do in order to secure additional funding once the initial pot of money is gone.
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From page 23... ...
Instead, she and her colleagues took the data and findings as they were getting them and held discussions about what these data and findings meant with stakeholders, community benefit organizations that are part of the Healthy Richmond Community, and public systems. For example, the main coping mechanism for young people was to smoke marijuana, and if her organization, which she said is the only harm reduction agency in Richmond, took a behavioral intervention approach, it would have started funding marijuana cessation classes.
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From page 24... ...
She explained that she has not worked as much with service-based providers. Marthe Gold from The New York Academy of Medicine asked the panelists if they had started thinking about how they were going to hold governments accountable, given that the signals from the most recent election cycle suggests that local governments may be spending less money on these types of programs.
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From page 25... ...
Nonetheless, this prospect does not change the approach The California Endowment is taking to address these problems, which is to build power in the state's underserved communities. As an example, Iton mentioned that there has been success in getting the California justice system to make one million people eligible for having felony convictions reclassified into misdemeanors, which means that those individuals would no longer have to check a felony conviction box when applying for a job or housing.
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