Community Power Building Helps to Address Social and Structural Determinants of Health

July 17, 2024 | Deloris Walker, Samantha Wells, Eddy Pierre, Chelsei Granderson

In recent years, community power building and community organizing have become more utilized in public health research, especially in enhancing racial and health equity. Lead Local, a collaboration funded by the Robert Wood Johnson Foundation, defines community power as “the ability of communities most impacted by structural inequity to develop, sustain, and grow an organized base of people who act together through democratic structures to set agendas, shift public discourse, influence who makes decisions, and cultivate ongoing relationships of mutual accountability with decision makers that change systems and advance health equity.” This underscores the pivotal role that public health professionals can have in achieving health equity.

Given the comprehensive definition and ongoing initiatives, community power building has emerged as a practical tool for transformational community engagement, which can enhance overall racial and health equity. It can be accomplished through various means, such as raising awareness, providing education, directly addressing health determinants, and putting community power building into practice.

Defining Community Power Building

Community power building refers to empowering individuals to collectively address social, economic, and political issues. This includes fostering collaboration, organizing resources, and leveraging networks to influence positive change from the grassroots level. Behind any crisis—whether democratic or related to housing, climate, or health—is an imbalance in who holds and wields power. Organizing people most impacted by a problem is at the root of community power building strategies, and evidence now shows that putting more power in the hands of the community—including those most impacted by structural inequities—results in systemic changes in how people make decisions that benefit all.

Transformational community power building emphasizes the development of leadership and capacities within underserved communities. It recognizes that transformative change requires empowered leaders who effectively mobilize their communities, express their needs and aspirations, and advocate for their rights. By investing in leadership development, skill-building, and capacity-building initiatives, power building efforts encourage individuals to become agents of change within their communities and beyond. Transformational community power building also recognizes the alignment of social struggles and promotes solidarity across diverse communities. It acknowledges that different forms of oppression are interconnected and seeks to build alliances across lines of difference.

​​​Addressing Structural Determinants of Health

Transforming how the government engages with communities requires acknowledging the power imbalance at the root of social drivers of health outcomes. Most public health practitioners are familiar with social determinants of health, the conditions in the environments in which people are born, live, learn, work, play, and worship that influence a person's health. However, more recently, public health practitioners have recognized the root causes of social determinants of health, also known as structural determinants of health.

​​​Building community power is a strategy to address and shift root causes that uphold the social determinants of health. A guiding principle of community power building acknowledges that community members are the experts of their own experiences and conditions and should drive the strategies to improve their conditions. Lead Local suggests employing the following three activities to impact social and structural determinants of health through community power building:

• Catalyze (set an agenda) by bringing attention to the issues, developing shared analyses and solutions, and building momentum.
• Create (achieve an agenda) by developing and passing policies and legislation, win or protect funding, programs, and services, and establish alternative models.
• Sustain (govern an agenda) by developing leaders for key decision-making positions, building mutual accountability, and shifting public discourse. ​ ​

​​​​​​The University of Southern California’s Equity Research Institute​ highlights a few stories of transformational community engagement using these three components.

Community Power Building in Practice

Setting an Agenda

In Portland, ME, the Southern Maine Workers Center trained and mobilized its members to describe living without paid sick time at hearings during the development of what became LD 36, which includes paid sick time and paid time off.

Achieving an Agenda

In Detroit, groups including the Detroit People’s Platform, Community Development Advocates of Detroit, Coalition on Temporary Homelessness (COTS), and the United Community Housing Coalition came together to advance a housing trust fund that would provide affordable homes for low-income families and families at risk of displacement due to development. As a result, the city must allocate 20% of all commercial real estate sales taxes every year to the housing trust fund.

Governing an Agenda

Lead Local states that a vital part of this component is changing the composition of who is in power and the values upon which they are making decisions. This might look like encouraging people with lived experience who are from the impacted communities to amplify their expertise as elected officials or members of appointed boards. It could also mean establishing community participation in crucial task forces and committee hearings. ​​​​In Washington, volunteers who had trained community power building organizations helped elect​ Pramila Jayapal,​ a local immigrant rights group leader to Congress who has become a prominent U.S. Congress member.

Conclusion

There are opportunities to execute the components of community power building within each area of the essential public health services. Addressing the social and structural determinants of health is crucial to improving the complex challenges and health-related issues facing public health, and it is imperative to understand the impact of authentic, transformational community engagement as the pathway to achieving and sustaining equity for all. Community engagement serves as a mechanism to uplift community voice and ensure community members' knowledge, experiences, and expertise are used to drive equitable change. This process empowers community members to be the influencers and decision-makers regarding initiatives that improve their health.

A community engagement approach shifts public health programs and practitioners from working for the community on their behalf to working with the community within the scope of their priorities. A quote from a disability rights movement in South Africa says, “Nothing about us, without us, is for us.” While this was initially stated to support initiatives for individuals with disabilities, the message holds for all communities and populations to ensure that policy and programmatic decisions are not made without intentional engagement and authentic inclusion of groups most impacted by the initiatives. It is vital that public health practitioners employ the Lead Local framework, identify groups for governmental-community partnerships, build trusting relationships, and mobilize resources that facilitate shared power and advance health equity within our communities.