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5/17/22blog post

why community voices matter for advancing health equity

how authentic community engagement can change health outcomes

Dayton Children's Hospital is focused on the health inequities that continue to affect racial and ethnic minority populations both in our community and beyond. As we have seen these unjust differences in health outcomes persist, recognition of the impact community-wide social, economic, and physical conditions as well as societal policies and norms can have on the health of individuals and communities has grown. In recent years, the COVID-19 pandemic exposed the negative influence of systemic racism and structural barriers on health outcomes on an undeniable scale. As a result, calls for interventions that address these social and structural determinants of health to eliminate inequities are now front and center. 

Communities of color have been excluded from decision-making on the policies and practices that impact their health through generations of systematic exclusion and disinvestment. It is clear from the scientific literature that the people most directly affected by structural barriers and inequities are best positioned to identify the solutions and actions needed to drive change. Successfully improving the health and wellbeing of communities of color and advancing health equity requires us to work with communities – to engage more authentically. 

what is authentic community engagement? 

Authentic community engagement means working with a community consistently and persistently for the purpose of establishing a foundation of partnership, trust, and empowerment. It involves not just listening to community members who experience health inequities and racism, but truly valuing what it is said as evidence and learning from their lived experiences. Engaging communities authentically keeps community members at the forefront in all stages of planning, implementation, and evaluation to ensure their knowledge informs the right solutions to truly meet community needs – centering equity. This model of engagement centers equity and shifts power to community members who have been underrepresented, helping them regain control over their health. 

what does this mean for us at Dayton Children’s Hospital?  

As we work to achieve optimal health for every child within our reach and uphold Equity as our newest value, we must consider how we can authentically elevate community voices in our work.  

  • We must be accountable. Advancing health equity is about justice and it requires action. When we commit to doing something with the community, we must be transparent about the intent of our actions and accountable for their outcomes. It is how trust is established and progress is made. 
  • We must ask for input – on both the problems and the solutions. For example, how might we integrate community voices into strategic planning processes from the beginning? How might listening to patient/family partners without judgement and valuing their input improve clinic workflows and practice? 
  • We must get (and stay) uncomfortable. If we are truly committed to advancing health equity, elevating community voices in our decision-making is a must. This requires us to get comfortable with being uncomfortable – to stay at the table when it’s hard, to take part in tough conversations, and not push back on the difficult truths people share. 

what is the best way to get started working authentically with communities?  

Collaborating with our Center for Health Equity, which specializes in authentic community engagement. Unintended harm can be caused by engagement that is framed as empowering, but is ultimately inconsistent, burdensome, or gives community members minimal influence in decision-making. This can reinforce a sense of powerlessness for communities, leading to feelings of stress, consultation fatigue, tokenism, and distrust as well as withdrawal from the engagement altogether. Preventing unintended harm from community engagement activities requires genuine connection with communities, experience, and skill.  

The Center for Health Equity focuses on elevating community voices to work collaboratively along with other key stakeholders toward addressing health inequities and improving patient outcomes. The team in the Center for Health Equity brings decades of experience and skill to our longstanding community outreach programs and our newly developed research program which focuses on community-based participatory research (CBPR) and health services research. Our team is well-positioned to help consider potential health equity challenges, ways community voice might inform your work, and plan an approach for authentic community engagement.    

Shannon Nicks, PhD, MPH

Associate Director of Health Outcomes Research
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