Summer 2010 Collaborative Solutions Newsletter:
In this issue: Health Equity and Social Justice
The Center for Health Equity and Social Justice at the
For my Summer 2010 Newsletter, I’d like to tell you about the work of the Center for Health Equity and Social Justice at the Boston Public Health Commission. For the past five years, my work with this center has been an especially exciting engagement. The simple fact that a big U.S. city health department has an office named the Center for Health Equity and Social Justice is surprising, and attests to the exciting and cutting-edge vision that is being manifested by the people in this organization. (http://www.bphc.org/programs/healthequitysocialjustice/Pages/Home.aspx)
I began my work with this innovative grassroots program when it was called Boston REACH 2010 and was a CDC-funded initiative that focused on racial disparities in breast and cervical cancer survival rates for Black women in Boston. REACH, which stands for Racial and Ethnic Approaches to Community Health, provides an excellent example of what a community can accomplish when it acknowledges the issue of racism in health and then creates a comprehensive social-change effort to address inequalities. The outstanding quality of the work of Boston REACH 2010 allowed the group under the skilled leadership of Nashira Baril, Meghan Patterson, Courtney Boen and Erline Achille to continue its work and to expand its scope. The REACH collaborative now receives CDC funding as a Center of Excellence in the Elimination of Disparities. In this capacity, the group has built on its initial accomplishments and has also gone on to fund and support a large number of other communities in New England that have followed their example and created community responses to promote health equity.
1. Addressing institutional and structural racism
The center has an explicit approach to addressing institutional and structural racism. The Boston Public Health Commission (BPHC) operates with the understanding that racism is at the root of racial and ethnic health inequities. Racism affects health directly by causing stress and anxiety, and it also affects health indirectly by its impact on the social determinants of health. Every community that receives a grant, following the lead of the BPHC itself, engages in a three-day Undoing Racism workshop (People’s Institute Undoing Racism and Community Organizing Workshops™) for its core team and for community members . The BPHC understanding of racism is based on the brilliant work of Camara Phyllis Jones and her conception of levels of racism. http://www.scribd.com/doc/11917990/Racism-a-Gardeners-Tale.
2. Focus on social determinants of health
As the REACH 2010 group moved to become a Center of Excellence, they also expanded their approach to include an explicit focus on the social determinants of health. These social determinans are factors that have an exceptionally strong and well-demonstrated influence on health, such as education, socioeconomic status, housing, jobs, economic opportunity, transportation, food access, safety, environmental exposures, and so on. These aspects of life actually have a much more profound impact on people’s overall health than does access to health care. By looking at community health from the perspective of the social determinants, groups can examine the ways in which institutional racism plays out in each realm. As the powerful TV series Unnatural Causes makes clear, your zip code may be more important than your genetic code in determining your health (http://www.unnaturalcauses.org).
3. Grassroots community engagement
The center’s approach is based on a core belief that grassroots involvement is essential to solving problems. Barbara Ferrer, the Commissioner of Public Health for the City of Boston, has this to say on the topic:
“The role of a public health department is to create a space for residents to come together to define a problem, to define the solutions, and then enter into a dialogue with us—not the other way around. Not we define the problem, we define the solution, and then we invite you in to help us implement the solution, which is what we’re most comfortable doing. We felt like part of the solution lay in being able to get a broad-based coalition that would tackle issues like racism. And that would bring together the provider community with the resident community to tackle those issues.” (In “Creating a Health Equity Coalition: Lessons from REACH Boston 2010,” Boston Public Health Commission, 2010.)
4. Policy change
The project has an explicit focus on creating long-lasting policy and social change that will endure as a legacy in each participating community. This follows the lead of the CDC’s new director, Tom Frieden (see his “A Framework for Public Health Action.”2010). With this intention in mind, the approach goes beyond creating better understandings of health disparities and new programs. It also insists that communities explore policy changes that will improve community health. Examples include zoning changes to allow for construction of a new supermarket in a low-income community, or advocating with the legislature to find summer jobs for teens. All grant-recipient communities are required to develop and implement policy-based solutions for addressing racism and the social determinants of health.
5. Focus on a shift from social service to social change
For traditional nonprofit agencies that work with the center, the greatest challenge often is found in the explicit shift in focus from social service to social change. The center is not interested in the creation of new education programs for Black men at risk of diabetes. Instead, it wants to promote efforts that will change the institutional racism in housing, food access,and employment policies that put Black men at higher risk for diabetes. The goal is to prevent the illness, not provide palliative treatment. For nonprofits accustomed to delivering social services, this is a huge change in emphasis.
Finally, the center understands that in order to
accomplish systems changes of this large scope a community must
develop a broad-based coalition of residents and agencies that will
work together collaboratively.
A new manual describing the work of the BPHC Center
for Health Equity and Social Justice will be available later this summer.
I have had the honor of co-authoring this publication, and it gives
me great joy to be part of this acknowledgment of the center’s trailblazing
work and to put its accomplishments in a form that will help even more
communities achieve health equity. Entitled Creating a Health Equity
Coalition: Lessons from REACH Boston 2010, the manual will be available
Another view of this transformative work is available now at :
Jones, Camara Phyllis. “Levels
of Racism: A Theoretic Framework and a Gardener’s Tale.” American
Journal of Public Health 90, no. 8 (August 2000): 1212–1215. http://www.scribd.com/doc/11917990/Racism-a-Gardeners- Tale.
What does support of other communities by the center look like? I’d like to make the model concrete by telling the story of one local coalition that is being supported by the center. Jamaica Plain (JP) is a fascinating neighborhood in Boston. It includes an affluent white community along with low-income Black and Latino communities — there are really two JPs, the rich one and the poor one. Accompanying this economic division are social, and health, inequities. To address the gap, the Southern JP Health Center has become the sponsor for the development of the Jamaica Plain Youth Health Equity Collaborative.
The collaborative chose to focus on youth for two big reasons: a strong base of agencies working with young people already existed, and the group understood that youth issues are inseparable from community and family issues. By centering their efforts on health equity for young people, the group was able to narrow its field of attention (but not much).
The group’s guiding concept, based on a framework that takes into account the social determinants of health, envisions the following life qualities for healthy youth in JP:
The goals for the JP Youth Health Equity Collaborative were to:
The collaborative is led by a remarkably skilled organizer, Abigail Ortiz, in partnership with many local agencies that have made a serious commitment to ensuring that this collaborative succeeds.
In its first year of planning, the collaborative held a series of interactive Youth Health Equity meetings, called “bucket meetings.” Each bucket meeting involved a cluster of young people and focused on one social determinant of health. The purpose of the meetings was to gather youth perceptions on that social determinant of health. Collaborative members presented each small group of young people with a case example; the examples were variations on real stories about community members. Here’s the type of story the young people were asked to consider: “Claudia is 16 and living with her mom in public housing in JP. She has been trying unsuccessfully for two years to get a job. She is always turned down. She is getting discouraged, and spends more time watching TV and with her boyfriend who is dealing weed.” The facilitators then asked the small discussion groups the following questions:
The ”bucket meetings” were well attended by JP young people, who had no difficulty addressing these questions for each bucket. Young members of the community implicitly understand the issue of social determinants of health and institutional racism.
Following the bucket meetings, the collaborative held a Youth Retreat.The more than 20 young people who participated chose jobs as the ”bucket” area that they wanted to address first. During the retreat, facilitators asked the young people to indicate which JP institutions affect the health of a typical JP youth. As these organizations were mentioned, they were put on a list. When the list was complete, the facilitators wrote each named institution on a sheet of paper and asked the young participants to rate each entity, using colored dots, as being supportive of the health of JP youth, detrimental to their health, or neutral. The group then stepped back to view the whole and engaged in a discussion of the map of institutional racism in JP that they had created.
Since those initial, clarifying meetings, the JP Youth Health Equity Collaborative has been hard at work addressing the issue of jobs for young people. First, the collaborative has organized a series of work groups on multiple aspects of youth employment:
As part of the collaborative’s work on youth jobs, the group helped plan and took part in a youth-led protest rally at the State House urging the legislature to reinstate funds for summer jobs for young people. The orderly yet powerful rally of 700 young people caught the attention of both the media and the legislators.
Finally, the project issued a report on health in young people in JP. Titled “02130 Health and Youth,” it has a picture of a “teeny” on the cover and the phrase, “If you know what this is, this report is for YOU.” A “teeny” is a drink that contains no positive nutritional value—it’s just sugar, water, and coloring. It is readily available in the stores that cater to African-American and Latino youth. Stores in the white neighborhoods of JP sell fresh juice instead.
Thus the “teeny” is
a great symbol of the health inequity campaign. Inside the report,
each social determinant is examined, and the coverage includes youth
stories, youth quotes, data, and ideas on what actions can be taken.
The report, authored by Meghan Wood, is available on the BPHC web site: http://www.bphc.org/programs/healthequitysocialjustice/toolsandreports/
I have recently been struck with how similar the priority areas of the Center for Health Equity and Social Justice are to the six key principles I’ve written about in The Power of Collaborative Solutions. The center’s work illustrates the six key principles in action. Let me demonstrate, using examples from some of the center’s communities that I have had the privilege of working with:
Principles for Collaborative Solutions and Health Equity
1.Encourage true collaboration as the form of exchange.
The relationship between the Boston Public Health Commission and the community coalitions, as articulated by Barbara Ferrer and enacted in the coalition activities, is truly at the level of collaboration where all participants are “enhancing the capacity of the other.
2. Engage the full diversity of the community, especially those most directly affected.
The JP Youth Health Equity Collaborative certainly illustrates having those most affected by the issues (the JP youth of color) at the table and setting the agenda.
3. Practice democracy and promote active citizenship and empowerment.
The Boston REACH coalition begins its meetings by going around the room with introductions, during which all members say their names and their neighborhoods. This reflects a conscious decision to put all members on equal footing and to eliminate fancy titles and institutions as part of the introductions. In addition, the Boston REACH Coalition is co-chaired by two community members, who get coaching and training to guarantee their success in their roles in collaborating with each other and in guiding the rest of the group in collaboration.
4. Employ an ecological approach that builds on community strengths.
The whole approach, emphasizing the social determinants of health and operating through bucket meetings, is designed to help residents understand their health in the context of their environment. The success of this approach becomes clear when women note that the meetings bring them a sense of huge relief, because they previously always felt that everyone was blaming them for being the cause of their own illness.The tag line that your zip code may be more important than your genetic code in determining your health is the best line I have ever heard for explaining an ecological approach.
5. Take action by addressing issues of social change and power on the basis of common vision.
In Springfield, Massachusetts, the local project is focused on health equity and food access. Here one major area of attention has involved zoning changes that will permit the opening of a supermarket in the “food desert” of the Mason Square area of Springfield.
6. Engage spirituality as your compass for social change.
I began my work with BPHC by working with the Boston REACH Coalition when its focus was limited to the incidence and treatment of breast and cervical cancer in Black women in Boston. The group of women who worked on leadership, team building, and sustainability with me were passionate, caring, and committed to making a difference in their community. They epitomize the spiritual principles of acceptance, appreciation, deep compassion and interdependence. I am so grateful to have had the opportunity to know and work with them.
The release of The Power of Collaborative Solutions has meant a busy time here at Tom Wolff and Associates! I’ve been doing book presentations and signings large and small, and love meeting with people and talking about collaborative solutions. I was invited to present at the Canadian Community Psychology Conference in Ottawa in May, and I also held a book signing there. Then in June I facilitated a two-day workshop on collaborative solutions for the Third International Community Psychology Conference, held in Puebla, Mexico.
In the coming months, I’ll be doing talks and readings in, among other places, Madison Wisconsin; San Diego; Los Angeles (as part of a Presidential Panel at the APA Convention); Brattleboro,Vermont; Milwaukee,Wisconsin; and locally here in Massachusetts. Being able to share my experience with people through the medium of a book release is certainly a learning experience for me, and I’m enjoying it.
Many of the individual readers I have talked with have made special mention of the book’s emphasis on spirituality, and how refreshing and helpful they find that to be. It took a leap of faith to include the material in the manuscript, because I wasn’t sure how it would be received. However, to leave it out would have been to overlook an essential part of community-building for all of us. The role of spirituality in social change is the area that I hope to spend most time examining over the coming years.
I have been very pleased to hear from many of my academic colleagues that they will be adopting The Power of Collaborative Solutions for their course offerings in the fall. This is happening not only across the United States but also in Canada, Puerto Rico, and Portugal. I couldn’t be happier to hear of the widespread enthusiasm for the book as a resource for students, as well as professionals, around the world. With enough of us involved, we can build healthy communities, from the ground up, across the globe.
Health Equity and Social Justice
Tom Wolff & Associates 413-253-2646 or email
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