Mi Gente, Nuestra Salud: Protocol for a People's Movement for Health Ownership.

BACKGROUND: Community-based participatory research (CBPR) is an increasingly recognized approach to address health inequities. Although in CBPR all processes occur within the community context, its diagrammatic model places the intervention/research outside of the community rather than conceptualizing it as an event in a complex web of system components. OBJECTIVES: We sought to 1) introduce a systems-oriented community ownership conceptual framework that integrates a systems perspective with CBPR and 2) to describe an application of this framework in the form of the Mi Gente, Nuestra Salud initiative, a research-based, action-oriented collaboration between Cal Poly investigators and community partners in Santa Maria and Guadalupe, California. METHODS: We conducted a stocktake of community assets and partnerships in Santa Maria and Guadalupe, among California's poorest and most medically underserved cities; created marketing materials; launched the initiative in December 2020; and collected survey and interview data on community health concerns. An advisory board guides direction of the work. Activities are intended to affect partnerships (who is involved in actions and decisions) and processes (what actions will be taken), as well as resources (e.g., building human and social capital by changing narratives of local, historically rooted power dynamics and offering peer learning opportunities on advocacy and health care interactions). Implementation challenges within this framework are also discussed. CONCLUSIONS: By de-centering specific interventions and conceptualizing them as single events in a complex web, our system-oriented community ownership model brings the focus back to the system itself, and to system-based processes and solutions, while still guided by CBPR principles.

"We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut.

Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.

Movement Pandemic Adaptability: Health Inequity and Advocacy among Latinx Immigrant and Indigenous Peoples.

The COVID-19 pandemic exacerbated longstanding inequities in resources and healthcare, stacked on top of historical systems that exploit immigrants and communities of color. The range of relief, mutual aid, and advocacy responses to the pandemic highlights the role of social movement organizations in addressing the ways that immigration status creates systemic barriers to adequate health and wellbeing. This paper conceptualizes what I call, "movement pandemic adaptability," drawing from a decolonial-inspired study including participant-observation (September 2018-September 2020), interviews (n = 31), and focus groups (n = 12) with community members and health advocates. Data collection began before the COVID-19 pandemic (September 2018-February 2019) and continued during its emergence and the initial shelter-in-place orders (March 2019-September 2020). Movement pandemic adaptability emerged as a strategy of drawing from pre-existing networks and solidarities to provide culturally relevant resources for resilience that addressed vulnerabilities created by restrictions against undocumented people and language barriers for communities that speak Spanish and a range of Indigenous languages. This paper presents how the relationship between immigration status and health is influenced by the local context, as well as the decisions of advocates, policymakers, and community members.