This month’s blog series on health equity has introduced what health equity is and why it matters, particularly in child health, and has described the role that hospital and health systems play in achieving health equity. This blog post will focus on the importance of health systems partnering with communities to improve health equity. Specifically, we discuss a model for developing community-driven solutions, how to translate this model into action, and provide some examples of health system and community partnerships.
The definition of health equity, “the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance,” can only be achieved within a community setting. And yet, the outcomes of health inequity show up in our health care organizations in the forms of infant mortality, increasing rates of chronic disease, substance abuse and addiction, trauma and the like. Research is clear that the factors influencing health are many and do not fall neatly in the purview of any one organization or discipline. But health care systems have an important and distinct role to play in connecting how lived experiences in communities have direct and measurable impact on the health of community residents. A steady partnership between communities and health care organizations is necessary to ensure all citizens attain their fullest health potential.
In this partnership, the status of community members must go deeper than symbolic participation in roundtables or committees. Progress towards health equity requires listening to one another, and creating cross-discipline partnerships through shared goal setting. The National Academies of Sciences, Engineering and Medicine Communities in Action: Pathways to Health Equity report describes three core elements in developing community driven solutions:
1. Making health equity a shared vision and value
2. Building community capacity
3. Fostering multi-sector collaboration
It is critical that the community’s voice anchor work to improve health equity. From the beginning, partnerships must hold space and time for relationship building with community residents, community leaders, and organization representatives through conversation and listening, and commit to this dialogue as an ongoing practice. Multiple models and strategies to establish and facilitate these conversations exist. Genesis Health Consulting often utilizes The World Café Model in our work.
The premise of The World Café Model is to help build relationships, community capacity and shared vision among partner organizations and groups. The Café is held in the community, with community members. The model explicitly recognizes residents as experts on their community’s culture, opportunities and challenges. It works by facilitating discussion around a key question among small groups clustered around round tables. After a set period of time, participants rotate to new tables and new groups of people share and learn new perspectives on the key question. The iterative and collaborative design of the Café results in community-identified priorities that inform the next steps in a partnership.
Once these community priorities are established, it is time for community leaders, residents and health systems to develop an action plan. In our experience, it is important that this work is guided by clear, shared principles for collaboration, which directly counter the typical roles that different stakeholders find themselves playing.
For example, it’s important to acknowledge and appreciate the various expertise around the table, and to resist deference to those with certain titles or credentials. Are the right stakeholders and voices around the table, and represented in equitable numbers?
Or, consider how place and language may open or restrict honest dialogue amongst partners. Meeting locations should alternate between community-based and health system-based sites. Does the seating arrangement and room layout support engagement of everyone in attendance? Are participants encouraged to check for understanding, resist assumptions, and assume good intent when entering dialogue?
Additionally, we encourage partners to thoughtfully assess which individuals or organizations will be the most effective messengers to engage stakeholders in change, and which individuals or organizations are best positioned to be accountable to ensuring changes occur. Acknowledge that all stakeholders are building capacity to engage in this new type of work. Transparently sharing information, successes and failures will go a long way to strengthening these new capacities and fostering trust amongst stakeholders.
Examples of Health System and Community Partnerships for Children’s Health
School Based Health Partnerships: Knopf and colleagues in conjunction with the Community Preventive Services Task Force reviewed 46 studies of school based health centers and found that they were associated with both increased educational AND health outcomes, and therefore are a valuable asset in advancing health equity. Increasingly health systems and schools are partnering to address health in local communities. Previously we have blogged about the Whole School, Whole Child model. Recently Children’s Hospital Association held a webinar outlining work along this model in Akron Children’s Hospital and Greenville Health Systems.
Magnolia Community Initiative: Over 70 organizations have partnered to create a “Community Level Change Model” with the ultimate goal of improving health outcomes for children residing in a five-square mile block radius in Los Angeles. Early outcomes have included a reduction in the proportion of children visiting emergency rooms as their first place of care.
National Association of Medicine’s Accountable Communities for Health model: This initiative recognizes that investment in children and families changes the trajectory for long term health outcomes and that innovative investments be made to build strong clinic-to-community connections. Accountable Communities for Health are “structured collaborations among health care, public health and other partners to improve health, safety and equity within a defined geographic area through comprehensive, coordinated strategies”. Select communities in California has used this model to address asthma, youth violence and trauma.
Genesis Health Consulting has deep experience in the facilitation of community and health system partnerships. Please email us at email@example.com to learn more about our work in this area.