Of the many wicked problems in communities, institutions, and government, virtually all of them are rooted in histories of broken connections, damaged trust and eroded respect that have driven increases in inequality in the first place. To ensure health and well-being for everyone, we need ways to address these problems and build more social and political consensus.
Local, multidisciplinary partnerships that engage communities over time are a key foundation on which to build. They serve as microcosms of civic renewal and learning labs for rebuilding our nation’s social contract. As organizations that affect social determinants of health (SDOH) within communities collaborate more closely with residents and with each other, they are challenged to re-examine their thinking. In order to truly learn about and from each other, better map reality, and find lasting, effective solutions, all parties have to stretch their minds, extend their hearts, and build new skills to work across differences or gaps in understanding. In doing this, they are better able to leave behind the ideology, prejudgment, cynicism, and siloed thinking that hold them back. There’s no substitute for this interpersonal process. Bureaucratic and technical innovation will not change minds and hearts.
This transformative work is occurring in all kinds of communities. In Flagstaff, AZ, community health workers and an organizer employed by a health clinic worked with residents and other partners to prevent displacement from their mobile homes. In Greensboro, NC, cross-cultural organizing is helping drive collaborative efforts on healthy housing, gardening, and employment. In Stamford, CT and Bithlo, FL, partnerships found that engagement and addressing the social determinants of health helped advance neighborhood transformation in a way that supported and strengthened the existing community. And in Cincinnati, OH, a spike in asthma attacks led a hospital’s lawyers to ask residents, “Who’s your landlord?” The hospital is now learning to co-create solutions with residents and community organizations.
Large-scale initiatives have also emerged to support the development of local SDOH-related partnerships with funding, resources, and learning networks. These include BUILD Health Challenge, 100 Million Healthier Lives, Building Healthy Communities, Invest Health, SPARCC, and Moving Health Care Upstream. Each of them aspires to meaningful, ongoing exchange with residents in communities.
Of course, even with generous philanthropic investment, these partnerships won’t thrive without resources and good working relationships that extend beyond their local community. A recent blog from Dr. Charlie Homer and ReThink Health describes how human services help communities make the most of safety net programs, as well as federal and state policy, intermediary organizations, and other non-local supports that are required to support community change strategies on the ground.
Redesigning our systems to produce health in all communities was always going to be hard—especially at a time of upheaval in the healthcare system, grotesque inequality, political mistrust, and a flagging federal commitment to invest in what works. Despite all these barriers, we are still making progress.
In the midst of all the fear, anger, and hurt, and the noise, distraction, and chaos, we seem to be piecing together the components of a more just and healthy future. It starts with an understanding about SDOH. It grows by including everyone, forging better connections, and expanding our experience of “we.” These partnerships are showing us the way.