Spectrum of Community Engagement to Ownership for Health Equity

I stand off to the side beaming as my co-facilitator, Rosemary Soto, facilitates a panel of community organizers sharing the essence of their work with a room full of Monterey County staff and some of their community partners. This is the 3rd workshop in a 4-workshop series on the Spectrum of Community Engagement to Ownership as a framework for strengthening community-government partnerships for health equity. “When I was growing up there were Black leaders in our community who guided me. Now with displacement many of those leaders are gone, and I realize it is up to me to be that person for the generation coming up,” imparts Da’Ja Robinson of the Monterey County Black Caucus. Each of the panelists in their own way speaks to this kind of commitment to meeting the needs of people and changing the conditions that are leaving people with needs unmet. I can feel the tenderness of genuine listening in the room.

So often, the work of 'community engagement’ is reduced to its technical aspects such as methods and data analysis. Not to say these are not important elements of the work, but they lose their potency when they are employed without attention to the elements being emphasized by this panel of community organizers: 

These three elements are key to advancing along the Spectrum of Community Engagement to Ownership and are central to our workshops series with public agencies looking to operationalize the framework. 

In Monterey County, the vast majority of those without adequate health care access are farmworkers– the men and women who plant, tend, and harvest strawberries, lettuces, broccoli, cauliflower, brussel sprouts, and other crops that make up a multi-billion dollar agricultural economy in our county. That’s almost forty thousand people in our small county who regularly forgo health care when they need it, or may become financially devastated by an illness or injury. Why are inequities like this allowed to persist, especially among workers so essential to the success of our regional economy? The root of the problem can be traced back to who in our County has decision-making power and who is pushed to the political margins. For generations, Black and Brown essential workers have been left out of policies that have afforded benefits to the working class. The Social Security Act of 1935 for example excluded domestic and agricultural workers who at the time were predominantly African-American. Racist decisions like this lock people out of critical economic resources and result in generational wealth gaps that undergird persistent inequities.

Organizing to build and assert political and economic power is the only way Black and Latine communities have been able to make progress towards rectifying the impacts of disinvestment and denial of services. As a recent example of this in Monterey County during the height of the COVID19 pandemic, community-based organizations such as Building Healthy Communities, COPA, Mujeres en Acción, Centro Binacional para el Desarrollo Indígena Oaxaqueña, and The Village Project, successfully advocated to the county for $4.9 million in COVID19 relief to be invested into a community-driven COVID-response effort called VIDA (Virus Integrated Distribution of Aid). Ten participating organizations hired and trained community health workers to ensure the basic needs of impacted residents were met and distributed resources to help with rent and utilities, wages lost, and funeral expenses. They helped essential workers access the COVID vaccine and testing, mental health services, and advocated to employers for protective personal equipment. It is unlikely that this kind of support would have reached agricultural and service workers had it not been for the organizing and advocacy of community-based organizations. Many of the resident leaders who participated in the advocacy efforts to secure this investment then supported the implementation phase by serving as community health workers. 

If we are going to make progress on persistent health inequities, we need to understand the vital role that community power-building plays in: 

Understanding and supporting community power-building first takes a shift in the dominant view of power. If we see power as our capacity to control people and situations, then we must hold tightly to it. But if we see power as our capacity to affect change and transformation (so desperately needed for the health of our communities) then we understand that power grows when we consciously share it with those who are dedicated to that same purpose.

Guided by a vision of transformative community power, Facilitating Power’s workshops on the Spectrum of Community Engagement to Ownership as a framework for advancing health equity, bring community-based organizations and government staff together to unpack what is needed to break down barriers to community participation and to build our shared capacity for community ownership of health equity solutions. We find a there is strong desire for collaboration, appreciation for shared language and frameworks for co-designing community involvement plans and practices, and a readiness to name structural changes that are needed for the practices generated in these workshops to become common practice. It is clear that the next phase of this effort must be focused on supporting county leadership to implement concrete changes that will support the conditions frontline staff need to authentically collaborate with impacted communities to advance shared visions and solutions for health equity.

Health equity is about more than health care access for all; it is about working with leaders like Da’Ja Robinson and the Monterey County Black Caucus to help ensure they have what they need to lead for health equity in the Black community. It is about collaborating with community-based organizations like Centro Binacional para el Desarrollo Indigena Oaxaqueña to bring culturally relevant health outreach to indigenous farmworker communities in the languages they speak. In sum, it is about investing in the leadership of impacted communities to address the root causes of the health inequities we face and in so doing cultivate community-driven leadership to steward transformative health equity solutions.