From Roots to Results: A Qualitative Case Study of the Evolution of a Public Health Leadership Institute Building Capacity in Collaborating for Equity and Justice

Abstract

Policy, systems, and environmental change are now widely accepted as critical to sustaining improvements in community health. Evidence suggests that such systems-level change is most effective when driven by community-based partnerships. Yet, after more than three decades of building community-based partnership work, health inequities have continued to deepen. To address health inequities, current and historical distributions of power are increasingly recognized as important considerations in efforts to ensure all individuals have the opportunity to attain their full health potential (i.e., achieving health equity). Building on social determinants of health literature, social injustice and powerlessness are put forth as fundamental causes of health inequities. Focusing on power as a root cause of health and health equity through application of Wolff and colleagues’ six principles requires substantial changes in contemporary public health practice. This case study uses document analysis of a single case, the Community Teams Program, to assess the evolution of a statewide public health leadership program’s efforts to build the capacity of coalition-based teams to catalyze community change in line with Wolff and colleagues’ principles. Deductive, selective coding of the materials surface four themes in the program adaptations: (1) the need to focus on power as a root cause, (2) shifting power through relationship building, (3) storytelling as a way to shift narrative, and (4) building mechanisms into the curriculum that hold coalitions accountable for applying and sustaining learned skills. The themes demonstrate philosophical, pedagogical, and organizational changes to center power building approaches in health promotion. Findings are triangulated by reflections from the program director and recorded reflections of participants captured in existing evaluation data.

Psychological sense of community and motivation toward collective social change among community coalition members of color in the southwestern United States

“…Several studies have specifically positioned community coalitions as a setting to fight racism, socioeconomic inequities, and health disparities (Cooper & Christens, 2019;Johnston et al, 2019). Some research has also focused on the role of coalition partnership dynamics, shared leadership (Reid et al, 2019;Wolf et al, 2019), and the ways coalitions even begin to be created and maintained to fight inequities in the community (Bermea et al, 2018;Lardier, Bergeson, et al, 2018;Peterson et al, 2019;Powell & Peterson, 2014). Few have, however, examined coalitions through dimensions of psychological sense of community, particularly to make meaning around coalition capacity development.…”

“…Unfortunately, strengthening collaboration between coalitions has gone relatively unrecognized. Previous research has noted the importance of shifting power through community collaboration such as explicitly addressing structural racism and issues of social and economic injustice (Wolf et al, 2019). However, other foundational principles such as employing strategic community organizations to facilitate the connection between communities have largely focused on the interaction between the private sector and community stakeholders and neglected the idea of coalitions joining to further their agendas.…”

United for health to improve urban food environments across five underserved communities: a cross-sector coalition approach

“…Since structural racism, public and private disinvestment, and historic injustices heavily shape resource allocation and distribution and negatively impact local community and leadership capacity, community politics and structural/power dynamics should also be examined in coalition work [ 30 ]. Future efforts may need to explicitly include mentoring or training components to advance leadership development or use strategies to address unequal power dynamics between members to promote sustainability [ 13 , 22 , 25 ].…”

“…Interventions to modify local food environments that are aligned with community perspectives can help to address nutrition-related health disparities [ 8 – 10 ]. Shifting focus away from individual-level health promotion interventions to promote policy, systems and environmental interventions using a community-engaged research approach that involves cross-sectoral partners [ 11 ] can lead to effective and sustainable population health improvements in racial/ethnic minority communities [ 12 , 13 ]. Adequate implementation requires investing in the development of cross-sector partnerships with existing and trusted local community-based organizations (CBOs).…”

Coalition Building and Food Insecurity: How an Equity and Justice Framework Guided a Viable Food Assistance Network

“…Coalition building and community organizing are critical components of working toward Policy, Systems, and Environmental (PSE) changes that can ultimately lead to improved health outcomes [ 11 ]. Literature also points to the importance of coalition building in food policy and systems change, advocating for collaboration among food system actors and the need for bridging between diverse stakeholders [ 12 , 13 ].…”