Community power: A missing piece for health policy

Can community empowerment solve persistent population health disparities that other strategies have failed to fix? Dr. Anthony Iton, Dr. Robert Ross, and Pritpal Tamber, authors of a new Health Affairs piece, think so. Dr. Iton is a lecturer of health policy and management at the University of California, Berkeley, and Senior Vice President at The California Endowment. Dr. Ross is the president and CEO of the California Endowment. Tamber is an independent researcher and consultant and serves on the Lown Hospitals Index Metrics Advisory Council.

What is community power, and why is it important for health? Community power is when people facing similar circumstances organize together, increasing their ability to set policy agendas and influence government decisions. By organizing, communities can use policy to change socioeconomic conditions such as the environment, income, working conditions, etc. that have been shown to impact long-term health. 

Community Power + Policy = Progress

Why is community power needed? Currently, many of the strategies that aim to improve health focus on individual change–what Iton et al. call “technocratic” strategies. These can only go so far, because — our behavior is constrained by what is available and accessible.  For example, it’s not easy to go for a daily walk if there are no sidewalks or parks. Being told to “eat healthier” is a challenge if you live in a food desert and have no time to cook. Who has time to meditate when they’re working two jobs just to make ends meet? 

Clearly, it’s not enough to try and change individuals’ health behaviors without addressing the underlying socioeconomic factors that impact these behaviors. With that in mind, researchers have started to focus on policy changes, what the authors refer to as “democratic” strategies. The idea here is not to impact behaviors on an individual level but to change the conditions in communities to make it easier for people to live healthier lives. However, often these policy changes are undertaken without substantive input from the people in the community who are most impacted. Iton et al stress that community advocacy is the missing piece to make health policy most effective.

Community power has the unique ability to influence well-being on both the structural and personal levels. Take the example used by the authors: parks in Fresno, California. Residents were asked, “If you had all the money in the world, what would you change about your neighborhood?” A significant amount of residents identified parks and open spaces. Residents and city leaders then engaged in a campaign and alliance called Parks4All, which was successful in its goals to have the city create more parks and ultimately secured $2 billion in funding over the next thirty years in order to maintain the new spaces.

Policy without community power is just another prescriptive measure.

Leveraging the community’s local politics allowed for the development of green park space in an area previously deprived of nature. This improvement was simultaneously a step towards mitigating the impacts of income and racial bias while also serving as a new space to exercise, play, and spend time with other community members, further strengthening the bonds between the community.

By allowing the community to drive changes based on its own identified needs, triaging problems and solutions becomes significantly easier. From building more parks to replacing school officers with restorative justice practices to raising the minimum wage, the opportunities for community-led policy progress are countless. Those impacted by changes know best, as they are the ones living day in and day out with the good or bad consequences. Policy without community power is just another prescriptive measure. In 2023, may our communities lead the way.