Strengthening Community Capacity in Detroit to Influence Policy Change for Health Equity

Abstract

Policy and systems change is essential to attaining public health equity, and involving communities disproportionately experiencing health inequities is critical. Successful policy mobilization requires specific community capacities, many of which exist in marginalized communities but can be strengthened and amplified. Yet attention to strengthening capacity of communities historically excluded from the policy process has been limited. This study applies a community capacity framework to analyze Neighborhoods Working in Partnership (NWP), a multiyear, community-based participatory initiative to strengthen skills and capacity of Detroit residents to equitably engage with diverse partners in all aspects of the policy process. Findings indicate NWP strengthened key dimensions of policy capacity, including skills, participation, leadership, and community power. We discuss strengths and limitations of NWP, and implications for strengthening capacity of disenfranchised communities to engage in local policy action toward the long-term goal of community well-being and equity. "The most important thing about the training is knowing that I have power that will positively impact my neighborhood and that now I know how to use it." (Workshop participant) Background There is considerable evidence that stressors in the social and physical environment and lack of access to resources contribute to poorer health and widening racial/ethnic and economic inequities (Braveman, Cubbin, Egerter, Williams, & Pamuk, 2010; Israel et al., 2010; Link & Phelan, 1995; Schulz, Williams, Israel, & Lempert, 2002). Low-income urban communities and communities of color are disproportionately affected, for example, through exposure to deteriorated housing and neighborhood conditions such as blight and crime, and limited access to jobs and quality services and amenities that can help to protect health (Schulz & Northridge, 2004; Williams & Collins, 2001). These structural conditions are influenced by state and national as well as local and organizational policies, and so policy change is an important strategy to have a more sustained impact on community well-being (Phelan, Link, & Tehranifar, 2010; Williams & Jackson, 2005). Thus, addressing the underlying social determinants of health equity requires the capacity to work effectively with policy and decision makers to address factors such as housing, neighborhood conditions, education, and employment opportunities foundational to the attainment of public health. A successful policy advocacy campaign requires an essential set of skills or capacities (Freudenberg, Rogers, Ritas, & Nerney, 2005; Minkler, Vasquez, Tajik, & Petersen, 2008; Ritas, 2003). Successful models for influencing policy emphasize the need to engage communities that have historically been marginalized or excluded from this process (e.g., low-income communities, communities of color) in policy campaigns (Freudenberg & Tsui, 2014; Themba-Nixon, Minkler, & Freudenberg, 2008). Engagement of community members in policy change efforts can lead to increases in power through translation of concerns into concrete action and identification of policy solutions to issues inadequately addressed by current policy (Cheezum et al., 2013; Ritas, 2003; Roe, Minkler, & Saunders, 1995; Themba-Nixon et al., 2008; Themba, 1999). Many communities regularly engage in policy advocacy efforts, often with a great deal of skill and success. However, relatively few examples exist of initiatives designed to both build on and strengthen dimensions of community capacity, with particular attention to policy advocacy to address determinants of public health and equity (for exceptions, see Minkler, Vasquez, Chang, & Miller, 2009; Sharpe et al., 2015). The recognition that many of these capacities already exist within marginalized communities, and that they can be strengthened and amplified, is central to community-based participatory approaches to research and action, and underlies the efforts described here. …