How to Address Disparities? Develop Local Leadership, Listen to Communities.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Marni Kuyl, RN, MS, interim health and human services director in Washington County, Oregon, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Kuyl is an RWJF Executive Nurse Fellow.
When I was first asked to consider this question, I pondered the issues by describing theoretical approaches, including the need to address social determinants, use a social-ecologic framework, and take a life course perspective. I threw in the need to use evidence-based practices and research. I gave this first draft to someone and asked ... So what do you think? She very politely asked: Are you in outer space?
I continue to believe that addressing inequality in our country requires that we recognize, understand, and commit to changing its root causes which include racism, inadequate affordable and safe housing, inadequate access to quality education (pre-to post graduate), and grossly uneven wealth distribution. These are deeply rooted in our political and economic structures and must be fundamentally changed if we truly want to build a culture of equality and health for all.
Moving this complex inter-related and interdependent socio-political system toward equity requires redistribution of resources among all. The powerful structural forces that support the status quo make this change an enormous challenge. So how can we get there?
I believe the changes will start in our neighborhoods, faith-based communities, our schools, and all of the places we live, work, worship, and play. Those affected by discrimination, injustice, and inequality, those living in unsafe neighborhoods, parents who are concerned about the schools, parks, and neighborhoods where their children play, have the answers! We need to build leadership within churches, schools, and neighborhoods. Developing local resident leadership and placing value on the ideas and solutions they present not only has immediate impact, but also the potential to improve lives through long-term changes to housing, educational attainment, and income potential. We should incorporate strategies that provide affected populations with the training, education, and support they need to improve the places where they live, work, worship, and play. A few examples could include:
Recruit, train, support, and empower diverse neighborhood-level leaders impacted by the social, political, and environmental factors and structures that contribute to inequality. Appoint the community members to key high-level board positions, such as transportation, community development, and hospital boards.
Strengthen community-based participatory research efforts to include affected communities in the design, implementation, and evaluation of innovative solutions.
Use health transformation as an opportunity to train community health advocates from within affected populations and ensure living wages, child care, and other support systems are included. These community health workers (CHWs) are not only helping those they serve, but they have skills they can build upon and market to local health care systems. CHW programs should be accessible in local community colleges and on-line and they should lead to access to higher levels of training and education in health care fields such as nursing, health education, or medicine.
These are just a few ideas, but if we ask communities facing inequality, many more innovative solutions will be offered. In my book, a comprehensive life course approach to health that takes social determinants of health seriously is the only true “health care transformation” that has the potential to build a culture of health for all!