Theory in Action: Public Health and Community Power Building for Health Equity.

CONTEXT: Within the field of public health, there is growing awareness of how complex social conditions shape health outcomes and the role that power plays in driving health inequities. Despite public health frameworks lifting up the need to tackle power imbalances to advance equity, there is little guidance on how to accomplish this as an integral part of health promotion. OBJECTIVE: This article addresses the need for public health professionals to better understand power and identifies opportunities for shifting power to achieve more equitable outcomes. First, it defines power and community power building. Next, it reviews a pragmatic theoretical framework that organizes power into 3 faces: (1) exercising influence in formal decision-making processes; (2) organizing the decision-making environment; and (3) shaping worldviews about social issues. Finally, it connects each face of power to community power-building practices using concrete examples. IMPLEMENTATION: This article highlights real-world case examples to demonstrate how theory translates to action by describing how public health practitioners in government, academic, and nonprofit settings incorporate the 3 faces of power into their work. The case examples illustrate how public health organizations and practitioners can partner with those most impacted by inequities to help shape decision making, agenda setting, and worldviews to influence policy and practice toward more equitable outcomes. DISCUSSION: The public health field can learn from and build on these innovative examples to establish new practices, scale up promising approaches, and evaluate what works to shift power for the greater good.

Building power through reindigenization: Sharing the story of Menikanaehkem.

Culture shapes and animates how community organizing is understood and carried out in specific contexts. Many frameworks for examining organizing, however, do not effectively attend to the influences of culture. Greater understanding of how culture can be imbued in organizing can help to ground it in the social realities of organizing participants and can advance approaches to organizing that honor the past and present of specific cultures. This study details local culturally grounded community organizing work rooted in Indigenous, and specifically Menominee, culture. First, it provides a description of the formation of the organization Menikanaehkem in the Menominee Nation and includes examples of how current organizing practices of Menikanaehkem build from long-standing Menominee cultural practices. It then highlights the reinvigoration of cultural practices, or re-indigenization, as an important goal for community power building in Menikanaehkem. It ends with a discussion of the importance of culture in frameworks for understanding, analyzing, and promoting organizing as an endeavor to advance well-being in a way that also interrupts cycles of structural oppression, such as legacies of settler colonialism.

What Do We Know About the Drivers of Health and Equity? A Narrative Review of Graphic Representations.

Purpose: Frameworks can be influential tools for advancing health and equity, guiding population health researchers and practitioners. We reviewed frameworks with graphic representations that address the drivers of both health and equity. Our purpose was to summarize and discuss graphic representations of population health and equity and their implications for research and practice. Methods: We identified publicly available frameworks that were scholarly or practice oriented and met defined inclusion and exclusion criteria. The identified frameworks were then described and coded based on their primary area of focus, key elements included, and drivers of health and equity specified. Results: The variation in purpose, concepts, drivers, underlying theory or scholarly evidence, and accompanying measures was highlighted. Graphic representations developed over the last 20 years exhibited some consistency in the drivers of health; however, there has been little uniformity in depicting the drivers of equity, disparities or interplay among the determinants of health, or transparency in underlying theories of change. Conclusion: We found that current tools do not offer consistency or conceptual clarity on what shapes health and equity. Some variation is expected as it is difficult for any framework to be all things to all people. However, keeping in mind the importance of audience and purpose, the field of population health research and practice should work toward greater clarity on the drivers of health and equity to better guide critical analysis, narrative development, and strategic actions needed to address structural and systemic issues perpetuating health inequities.

Exploring relationships among organizational capacity, collaboration, and network change / Exploración de las relaciones entre la capacidad organizativa, la colaboración y los cambios en la red

Is the collaborative activity of organizations in a network associated with the capacity of individual organizations? How might the structure of collaborative activity and the location of high capacity organizations in a network be related to the network's overall ability to influence community conditions? This article explores these questions among 23 local organizations providing women and new mothers with health care, advocacy, and other services in a single US city. Changes in the interorganizational network of collaborations are depicted in four time periods spanning 12 years and analyzed over time using both whole network and local network measures. Organizational attributes associated with dimensions of organizational learning and organizational effectiveness are examined in relation to interorganizational network changes over time. Results indicate that more adaptable organizations and those with higher capacity were not necessarily central in the network. Overall, findings suggest that increases in cohesion across a structurally diffuse network, relatively well dispersed high capacity organizations, and strategic relational investments may have influenced the reduction in health disparities for infants and expecting mothers. Although community-level interventions often focus on building a strong, central group of high capacity organizations, these findings suggest a need to also take into account the strategic action of a range of individual organizations, their local networks, and how they may advance change in the broader network over time

¿Se asocia la actividad de colaboración de las organizaciones en una red con la capacidad de las organizaciones individuales? ¿Cómo se relaciona la estructura de la actividad de colaboración y la ubicación de organizaciones de alta capacidad en una red con la capacidad global de la red para influir en las condiciones de la comunidad? Este artículo explora dichas cuestiones con 23 organizaciones locales que proporcionan servicios de salud y otras prestaciones a mujeres y madres primerizas en una única ciudad de los Estados Unidos. Los cambios en la red interorganizativa de colaboración se representan en cuatro periodos a lo largo de 12 años y se analizan a lo largo del tiempo utilizando medidas de la red completa y de la red local. Los atributos organizativos asociados con las dimensiones de aprendizaje y efectividad organizacional se examinaron en relación con los cambios en la red interorganizativa a lo largo del tiempo. Los resultados mostraron que las organizaciones más adaptables y aquellas con mayor capacidad no eran necesariamente centrales en la red. En general, los resultados sugieren que el aumento de la cohesión en una red estructuralmente difusa, las organizaciones con altas capacidades relativamente dispersas, y las inversiones relacionales estratégicas pueden haber influido en la reducción de las desigualdades de salud de los bebés y las mujeres embarazadas. Aunque las intervenciones comunitarias con frecuencia se centran en la construcción de un grupo central fuerte de organizaciones con grandes capacidades, estos resultados sugieren la necesidad de tomar también en consideración las acciones estratégicas de una serie de organizaciones individuales y sus redes locales, y cómo pueden promover el cambio en la red más amplia a lo largo del tiempo

Channeling power across ecological systems: social regularities in community organizing.

Relational and social network perspectives provide opportunities for more holistic conceptualizations of phenomena of interest in community psychology, including power and empowerment. In this article, we apply these tools to build on multilevel frameworks of empowerment by proposing that networks of relationships between individuals constitute the connective spaces between ecological systems. Drawing on an example of a model for grassroots community organizing practiced by WISDOM­a statewide federation supporting local community organizing initiatives in Wisconsin­we identify social regularities (i.e., relational and temporal patterns) that promote empowerment and the development and exercise of social power through building and altering relational ties. Through an emphasis on listening-focused one-to-one meetings, reflection, and social analysis, WISDOM organizing initiatives construct and reinforce social regularities that develop social power in the organizing initiatives and advance psychological empowerment among participant leaders in organizing. These patterns are established by organizationally driven brokerage and mobilization of interpersonal ties, some of which span ecological systems.Hence, elements of these power-focused social regularities can be conceptualized as cross-system channels through which micro-level empowerment processes feed into macro-level exercise of social power, and vice versa. We describe examples of these channels in action, and offer recommendations for theory and design of future action research [corrected] .