Communities of Color Creating Healthy Environments to Combat Childhood Obesity

Abstract

Ethnic and racial health disparities present an enduring challenge to community-based health promotion, which rarely targets their underlying population-level determinants (e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens prescription for using community organizing to treat these determinants in communities of color based on the Robert Wood Johnson Foundation’s Communities Creating Healthy Environments initiative, the first national project to combat childhood obesity in communities of color using community organizing strategies. The lenses—Social Justice, Culture–Place, and Organizational Capacity–Organizing Approach—assist health professional–community partnerships in planning and evaluating community organizing–based health promotion programs. These programs activate community stakeholders to alter their community’s disease-causing, population-level determinants through grassroots policy advocacy, potentially reducing health disparities affecting communities of color.

Community organizing is an understudied public health approach for reducing ethnic and racial health disparities^1,2 that is designed to empower low-income communities of color to promote community health by improving local policies and environments.³ However, minimal literature exists to guide health professionals and their community partners in conducting effective, community organizing–based health promotion in communities of color. We address this literature gap by presenting a 3-lens prescription for framing and evaluating culturally responsive, community organizing–based health promotion derived from the Robert Wood Johnson Foundation’s (RWJF) Communities Creating Healthy Environments (CCHE) initiative, the first national program to apply community organizing to address the population-level determinants of childhood obesity in communities of color.

For individuals living in communities of color, health disparities are strongly associated with inequalities in the social and built environment (e.g., the overburden of poverty, incarceration, poor-performing schools, and neighborhood blight) that contribute to the unequal distribution of health protective resources (e.g., knowledge, money, power, health care).^4,5 These inequalities, in turn, affect both population- and individual-level health determinants,^6,7 limiting both community capacity⁸ and individuals’ ability to make healthy personal choices.⁹ Specifically, population-level health determinants consist of community and neighborhood contextual factors such as ethnicity, education, unemployment, problems in the built environment (e.g., poor access to healthy food, potable water, housing, and recreational spaces), and broad public policies that create inequitable social conditions (i.e., structural inequities).^7,10 Individual-level health determinants—consisting of personal health behaviors and risk factors—are also affected by structural inequities, which precipitate increased allostatic load^5,7—the cumulative biological stress response to environmental demands that dysregulates physiological systems and contributes to disease pathology.¹¹

Collectively, population- and individual-level health determinants increase disease burden in communities of color, requiring community-based health promotion approaches that systematically involve community stakeholders to develop environmental and behavioral-based solutions to modify population and individual determinants of health.^3,12,13 These approaches are traditionally initiated by public health entities (e.g., local health departments) that mobilize stakeholders to support multicomponent programs composed of established treatments¹⁴ (e.g., behavioral, screening, educational) that intervene across multiple levels of influence (i.e., population, individual) to increase overall treatment potency.¹⁵

Evidence suggests that community-based programs implementing environmental and policy interventions to stimulate healthier behavior can reduce health-related risk factors and, possibly, disease prevalence. These programs have led to improved population-level health, including (1) reduced alcohol-related harms by limiting alcohol access via legislative bans, increased excise taxes, government monopolization of alcohol sales, and control of alcohol-outlet density^14,16–18; (2) decreased tobacco use and secondhand smoke exposure through litigation and adoption of smoke-free policies^19–21; (3) enhanced skin protective behaviors through public provision of sunscreen and shade, and awareness–educational interventions in primary school, recreational, and tourism settings²²; and (4) increased physical activity through community and street-scale changes to urban environments such as increased bicycle paths, safe passages to parks, and streetlighting.^23,24 Yet, despite these promising health improvements, data are mixed regarding their sustainability.²⁵

This may be partially because changes in population-level health outcomes caused by modifying social conditions^26,27 take longer to achieve than the lifespan of most health professional–community partnerships²⁸; as a result, community stakeholders must sustain progress by continuing health promotion activities once program funding ends.⁷ Previous community-based programs frequently placed stakeholders in advisory rather than active roles, while health professionals determined the problem and intervention strategy before seeking community input and support.^7,14,28 This approach has occasionally yielded positive short-term population-level health change. To accomplish long-term health improvement in communities of color, however, we propose that health promotion should utilize the principles and practices of community organizing by (1) having issues and strategies emerge from community stakeholders to ensure cultural responsiveness and acceptability, (2) acknowledging and building on existing community strengths, and (3) increasing residents’ and grassroots organizations’ capacity to address population-level health determinants through popular education, leadership development, and policy advocacy.^1,2,29,30

COMMUNITY ORGANIZING AROUND ETHNIC AND RACIAL DISPARITIES

The goal of community organizing–based health promotion is to strengthen community participation, empowerment, and action in accordance with the prevailing public health understanding that the social and built environments in which people live, work, and play have a profound impact on their health.³¹ This approach views community health as a community responsibility in the form of healthier public policies and social and built environments,³² while recognizing the importance of individual responsibility in the form of healthier personal choices.

In the public health context, we define community organizing as grassroots movements that empower and mobilize individuals to act in their own collective self-interest to address community health problems by altering the balance of power, resource distribution, and policy decision-making in their environments. Thus, community groups are united to identify, nurture, and realize their shared health-related values, interests, and goals.³⁰ Community organizing is based on strengths, in that the foundation for collective community action and increased resident participation in decision-making affecting their local institutions and environments³³ is grounded in the community’s networks, strengths, and values, and in individuals’ emotional and historical ties to their communities.

Effective community organizing campaigns are designed through careful analysis of the local cultural, health, economic, and political landscape—including relevant power dynamics—and are geared toward executing key sets of organizing strategies (e.g., developing objectives, community outreach, coalition building, direct actions) and cultivating leaders to direct organizing campaigns within traditionally disempowered communities.^30,34 As proposed by Paulo Freire,²⁹ enhanced community and leader “critical consciousness” (i.e., awareness of the structural causes of poor community health gained through personal experience, popular education, and collective dialogue) is essential for determining a successful course of action.^30,35,36 These campaigns (1) lead to empowered community members equipped with greater self-efficacy, meaningful purposiveness, and cognitive restructuring toward civic responsibility,^37,38 and (2) instruct community members in the art (e.g., relationship building, intuitiveness, passion) and science (e.g., planning, analysis, research) of community organizing³⁹ to pressure decision-makers to transform ineffective policies restricting equitable access to health protective resources.^10,40–44

Although community organizing is an empirically supported strategy for social change,^45,46 its systematic use in public health has rarely been documented.⁴⁷ Previous programs such as the Communities Mobilizing for Change on Alcohol and the Central Costa Health Services’ Healthy Neighborhoods projects, which either hired part-time organizers or trained residents to become organizers, have generally reported positive environmental outcomes, including decreased youth alcohol consumption and alcohol-related arrests, creation of a community health center, and enhanced neighborhood safety via speed bumps and street lighting.^26,48–50 Although these early program findings are encouraging, traditional power structures (i.e., academics and health professionals) initiated and managed community participation. In the CCHE initiative, by contrast, community stakeholders conceptualized and governed all facets of grassroots health promotion, including intervention targets, organizing strategies, and policy campaigns; academics, health professionals, and the RWJF adopted support roles as advisors, evaluators, and technical assistance providers.

THE COMMUNITIES CREATING HEALTHY ENVIRONMENTS INITIATIVE

The CCHE initiative sought to combat the obesity epidemic among children of color^50–52 living in social conditions rife with multiple obesity-causing risk factors.¹⁰ Such factors, which preclude children’s healthy behavioral choices,⁹ include low-income status, overconsumption of calorie-dense, nutrient-poor food and drinks, lack of recreational spaces limiting physical activity, and poor health care access.^53–61 The initiative targeted 2 primary obesity-causing population-level risk factors through community organizing: food insecurity and physical inactivity. Food insecurity is reduced access to affordable, nutritious, culturally appropriate food caused by structural inequities.^62,63 Combined with income deprivation^64–68 and the targeted marketing of unhealthy foods toward people of color,⁶⁹ it has been repeatedly shown to be a principal obesity driver in the nutritional habits of children of color.^70,71 Children’s physical inactivity or sedentary activity (e.g., television watching) is heavily influenced by environmental barriers common in communities of color; these include poorly built, underresourced, or closed parks, playgrounds, and recreational facilities; inadequate public transportation and street lighting; lack of wide sidewalks and bicycle lanes; and crime and safety concerns.^31,68,72 Physical inactivity has also been closely linked to childhood obesity.^73–76

Framing of the CCHE initiative toward these risk factors began in 2006, when the Praxis Project—a national, nonprofit institution of color supporting local, regional, and national community organizing movements—noted growing interest among grassroots organizations to lead local food and recreational movements linking community health with human and civil rights.⁷⁷ In light of this community interest, the RWJF funded the CCHE initiative to address the glaring lack of affordable healthy foods and access to safe places where children could be physically active.^78–80 In 2008, the Praxis Project convened a National Advisory Committee of 15 renowned academics and community organizers with expertise in food, public health, parks and recreation, and criminal justice policy development to help steer the initiative. This leadership team instituted a community organizing–based approach to recruiting that resulted in approximately 300 and 600 applications received in 2009 and 2010, respectively. This approach consisted of (1) outreach (e.g., multilingual informational sessions) to networks of grassroots organizations, indicating that CCHE would fund nontraditional applicants not typically competitive for national grant initiatives; and (2) technical assistance, including grant-writing support.⁷⁷ Twenty-two grassroots organizations or federally funded tribal nations (i.e., “grantees”) serving African American, Hispanic, Asian American, or American Indian/Alaska Native communities received 3-year grants to grow their communities’ capacity to advocate for childhood obesity-related policy, systems, and environmental changes. Two cohorts of grantees implemented their policy change strategies between 2010 and 2012 (cohort 1; 11 grantees) and 2011 and 2013 (cohort 2; 11 grantees).

With support from the Praxis Project, the RWJF, and Strategic Concepts in Organizing and Policy Education (SCOPE; technical assistance partner), grantees applied their deep knowledge of their communities’ social environments (e.g., ethnocultural demographics, racial and political histories, power dynamics) and organizing expertise to

1. identify priority food and recreational issues in targeted communities,

2. formulate and launch grassroots health promotion targeting policy change around these issues,

3. develop community leaders and relationships with like-minded organizations,

4. build and mobilize their resident base to advocate to decision-makers, and

5. win administrative and legislative changes regarding these issues.

By anchoring their health promotion efforts for policy change in the culture, history, and political dynamics of their target communities, grantees ultimately obtained more than 70 policy wins across 21 communities of color, making it the first documented national public health initiative to successfully use community organizing to alter the underlying social conditions driving childhood obesity in communities of color.⁸¹

THE 3 LENSES FOR HEALTH PROMOTION

We introduce and outline an innovative 3-lens CCHE prescription—Social Justice, Culture–Place, and Organizational Capacity–Organizing Approach—for planning and evaluating culturally responsive, community organizing–based health promotion (Figure 1), an approach lacking established guidelines and evidence-based practices.^12,31 The lenses are grounded in the Freirian model, which emphasizes critical reflection and dialogue of the structural causes of a social problem from the community’s perspective before intervention.²⁹ Applying these lenses therefore requires that program development and implementation be led by grassroots organizations belonging to the affected community’s social fabric, rather than by health professionals. This approach provides programs with the necessary contextual grounding and community access to effectively treat the local, structural causes of the target health problem.

FIGURE 1—

Lens Protocol for Designing Community Organizing–Based Health Promotion Programs: Communities Creating Healthy Environments

Development of the 3-lens prescription involved a community-based participatory research process⁸² in which the study authors, who possessed community psychology and grassroots program evaluation expertise, consulted extensively via in-person, telephone, and electronic mail presentations and communications with the Praxis Project, the National Advisory Committee, and SCOPE to select and define the lenses as part of a broader CCHE change model and evaluation frame.⁸¹ These lenses provided an analytic tool to measure and interpret the diverse processes, outcomes, and impact of the CCHE programs by revealing how (1) grantees’ social justice values affected their programs throughout the change process, (2) target communities’ culture- and place-based dynamics influenced grantees’ intervention strategies (i.e., organizing campaigns), and (3) selected intervention strategies—influenced by grantees’ organizational capacity and organizing approach—affected program benchmarks, intermediate outcomes, and policy achievements. Furthermore, in using the lenses to analyze each program’s processes and outcomes, it became evident that the lenses could also guide future program development by indicating key health-oriented policy targets and intervention strategies. The following sections describe the 3 lenses for community organizing–based health promotion and provide examples of their implementation in the CCHE initiative.

Social Justice Lens

The first CCHE lens, Social Justice, refers to the understanding that all people should be treated fairly, have equal access to goods and resources, and have the right to self-determination and cultural expression. This lens prompts program developers to ground their interventions in the particular social justice perspective of the grassroots organization spearheading health promotion. For example, an organization possessing a place and infrastructure justice perspective (i.e., improving community health requires targeting structural inequities in the built environment) may view the target health problem as a consequence of the lack of safe recreational spaces for physical activity. Such a lack may result from limited media, political, or economic attention to the recreational and health needs of community residents. Consequently, health promotion would not prioritize changing residents’ health behaviors but instead emphasize building residents’ sustained power to advocate for equitable allocation of recreational resources (e.g., recreational programming, enforcement, and security in parks) using media, community engagement, and leadership-training interventions. These interventions could complement more traditional health interventions (e.g., exercise prescriptions, health education) and built-environment interventions (e.g., walking trails, playgrounds) to address the community’s immediate and long-term recreational needs.

Different social justice perspectives (Table 1) often emphasize different structural causes of health disparities. Therefore, it is imperative that grassroots organizations, which possess the greatest understanding of their communities’ needs, guide decision-making about appropriate intervention targets. By crafting their interventions around grassroots organizations’ social justice perspectives, programs will appropriately target the principal social and environmental conditions underlying the target health problem, thereby strengthening community buy-in, engagement, and program success. After identifying the structural causes of the health problem using the Social Justice lens, interventions must be fitted to the specific community context via the Culture–Place lens.

TABLE 1—

Primary Social Justice Perspectives of Grassroots Organizations in the United States

Lens	Social Justice Targets for Organizing	Resultant Ethnic and Racial Health–Social Disparity
Civil and human rights justice	Discrimination,a immigrant and refugee rights, lesbian, gay, bisexual, and transgender rights	Restricts social mobility, suppressing income and ability to meet basic health needs
Climate, energy, and environment justice	Toxic waste exposure,a access to clean air, water, and soil	Results in elevated rates of chronic medical conditions (e.g., asthma, cancer)
Economic justice—business	Unfair business practices in service,a manufacturing, agriculture, and banking and financial sectors	Closes small businesses selling healthy cultural foods to make way for large corporations, creating food deserts and unhealthy nutritional habits
Economic justice—labor	Living wages,a jobs, working conditions, job security and benefits, advancement	Low income suppresses ability to meet basic health needs
Education and learning justice	Education and teacher quality,a equitable funding and facilities, restorative justice	Poor education quality and opportunities suppress income and ability to meet basic health needs
Food justice	Healthy, affordable food access,a genetically modified organisms, community gardens	Poor diet and resulting obesity lead to chronic medical conditions (e.g., diabetes, cardiovascular and cerebrovascular disease)
Government justice	Prison industrial complex,a juvenile justice, voting	High incarceration rates of people of color create single-parent households with limited ability to meet children’s basic health needs
Health justice	Health care system—policies and equitable services and resources,a health coverage	Results in untreated chronic medical conditions (e.g., cancer, cardiovascular disease)
Place and infrastructure justice	Recreation access,a community development, land use, transportation, affordable housing, gentrification	Physical inactivity causes obesity, which leads to chronic medical conditions (e.g., metabolic disorders, diabetes, cardiovascular disease)

^aThe resultant ethnic and racial health disparity refers to these social justice targets.

Culture–Place Lens

In community organizing, the characteristics and scope of the target community must be delineated.^20,24 The Culture–Place lens cues programs to define the target community’s culture (i.e., the total way of life of a people, including values, rituals, patterns of thinking, and group identity) and place characteristics (i.e., local geographic environment situated within its cultural, historical, economic, and political context). Specifically, intervention strategies are made realistic and culturally responsive by contextualizing them in the (1) varied health needs of, and interactions between, the community’s affected ethnocultural groups (culture); and (2) geographic, political, and social contexts of the community’s built environment (place; e.g., geographic distribution, political climate, recreational accessibility). For example, shaping culturally and geographically responsive cancer prevention interventions for Alaska Natives in a tribal community requires analyzing the following culture–place elements: (1) ethnocultural composition (e.g., exclusively Alaska Native or combined Alaska Native and nonnative populations), (2) cultural impact on health behaviors (e.g., Alaska Native traditional beliefs about cancer-suppressing screening rates), (3) geographic distribution (e.g., 1 tribal group vs a nation of 5 dispersed tribal groups), and (4) historical place-based influences contributing to elevated community cancer rates (e.g., excision from tribal homelands to areas with underdeveloped health facilities).

By addressing the previously diagnosed structural cause of a community’s target health problem, the Culture–Place lens grounds organizing interventions in a community’s culture- and place-based characteristics to ensure they are culturally, historically, politically, and geographically responsive. The succeeding lens finalizes the program intervention strategy by analyzing the community-based organization’s organizational capacity and organizing approach.

Organizational Capacity–Organizing Approach Lens

The Organizational Capacity–Organizing Approach lens matches the culture- and place-grounded organizing interventions with the practical strengths, limitations, and interests of the grassroots organization implementing them. “Organizational capacity” refers to the human, physical, financial, political, and information resources of an organization to accomplish program interventions. “Organizing approach” refers to the organization’s preferred community organizing strategies (e.g., leadership development, direct actions and protests, strategic mapping, action research) and their alignment with the intended health promotion parameters and goals (e.g., project scope, budget).

Performing an Organizational Capacity lens analysis reveals the organization’s available resources to perform interventions grounded in the Culture–Place lens (e.g., growing leader base, mobilizing community base, reframing policy messaging); those exceeding the organization’s capacity must be modified or eliminated. For instance, policy interventions targeting large geographic territories (e.g., state vs district) must be scaled down if community partners possess small or less-experienced staff, or a limited number of strategic allies. Finally, the Organizing Approach lens analysis determines which remaining interventions align with both the organization’s values, interests, and expertise—to ensure interventions are enacted with the organization’s will and enthusiasm—and the initiative’s scope, budget, and desired health outcomes, leading to the final intervention strategy.

Lenses Overview

To review, the Social Justice lens isolates the structural causes of the target health disparity. The Culture–Place lens identifies culturally and geographically meaningful and responsive interventions to address these structural causes. The Organizational Capacity–Organizing Approach lens pinpoints the most efficacious overall intervention strategy on the basis of a participatory analysis of the grassroots organization’s capacity and interest in executing the culture- and place-grounded interventions within initiative parameters.

COMMUNITIES CREATING HEALTHY ENVIRONMENTS GRANTEE IMPLEMENTATION

To demonstrate the 3-lens prescription applied to real-world community organizing–based health promotion programs, we discuss case examples of 2 CCHE grantees.

Southwest Organizing Project

The Southwest Organizing Project (SWOP), a CCHE program in Albuquerque, New Mexico, is the city’s oldest, largest, and most successful grassroots association organizing low-income families to advocate for healthy, sustainable social environments. The program is a case example of food justice–oriented health promotion. SWOP applied a food justice perspective to determine that the structural cause of Albuquerque’s childhood obesity problem was children’s limited access to affordable, locally grown, healthy foods (due to lost cultural farming and gardening practices) and the exclusion of fresh produce from school meals. Accordingly, SWOP directed its CCHE program toward restoring children’s and parents’ cultural gardening practices (i.e., having them grow food and reconnect with the land) by transitioning vacant city properties to urban community gardens, and integrating healthy foods into school meals.

The Culture lens analysis indicated that potential organizing interventions to increase children’s healthy food access should be tailored to the cultural demographics of SWOP’s 2 target communities: (1) Albuquerque’s Hispanic population and (2) the Albuquerque International District’s blended Hispanic and American Indian populations. The Place lens analysis further revealed that (1) traditional Hispanic and American Indian farming and gardening interventions would generate International District support given its historical farming culture, (2) the transient, predominantly immigrant International District population would necessitate short-term multilingual interventions, and (3) policy interventions to increase healthy school lunches throughout Albuquerque should target the state legislature (rather than the Albuquerque city council or school district) because of strong support from several state legislators.

The Organizational Capacity lens analysis revealed SWOP’s capacity as (1) 10 adult and 3 youth leaders, (2) key alliances with 3 community organizations, (3) established city and state council relationships, and (4) limited school decision-maker relationships. Finally, the Organizing Approach lens analysis, which matched SWOP’s identified organizational capacity and expertise in utilizing food justice organizing approaches with the 3-year CCHE funding, illuminated how and why SWOP elected to use the following interventions to address childhood obesity: (1) build its parent and youth leader bases by launching an urban community garden on city-owned property and instituting on-site parent leader trainings and a youth leader apprenticeship program, (2) build its resident base by conducting community outreach (e.g., workshops, door knocking, social media) to educate residents in cultural farming, gardening, and healthy eating practices and policies, (3) build its ally base by forging new alliances with key stakeholders (school decision-makers, community-based organizations), and (4) mobilize the resident, leader, and ally bases to advocate to the state legislature for healthier school lunches. These interventions culminated in a $1.44 million appropriations bill for public schools to purchase locally grown produce being included in the New Mexico governor’s 2014 state fiscal budget.

Safe Streets/Strong Communities

The CCHE program Safe Streets/Strong Communities (SSSC) is an example of recreational justice-oriented health promotion. It is a grassroots organization in New Orleans, Louisiana, historically successful at campaigning to redistribute public resources away from policing and incarceration toward community resources and recreational opportunities. To develop this program, SSSC used a place and infrastructure justice perspective, which indicated that increasing recreational opportunities for children and youths of color could reduce childhood obesity.

A Culture lens analysis revealed that, given SSSC’s prior success at organizing low-income African American residents, the ideal program target would be the historically disinvested, predominantly African American 9th, 10th, and 15th wards. A Place lens analysis revealed that (1) after Hurricane Katrina, these wards received the lowest levels of environmental pollution cleanup in the city, rendering local parks critically underresourced, unsafe, or unusable; (2) the rebuilding process failed to equip these wards with adequate health resources, including restored parks and recreational facilities; and (3) the recently formed policies of the New Orleans Recreation Development Commission (NORDC)—responsible for allocating public recreation and private endowment funds throughout the city—had created a closed decision-making process, resourced only 15 of 146 city parks, and resulted in ward residents being charged more to participate in recreational programming than higher-income community residents. This data supported SSSC’s decision to direct its CCHE health promotion toward advocating for more equitable NORDC policies for the target wards.

An Organizational Capacity lens analysis identified SSSC’s capacity as (1) 15 adult and 3 youth leaders, (2) established partnerships with 15 community organizations, and (3) low support for recreational justice issues from elected officials, including the mayor, deputy mayor, and city councilman at large. An Organizing Approach lens analysis indicated that SSSC’s expertise lay in organizing residents of color and that, because of CCHE’s 3-year funding, interventions should focus on building residents’ capacity to advocate for change beyond this term. The combined findings of these 2 analyses illuminate why SSSC employed the following CCHE interventions: (1) build its adult and youth leader bases by conducting adult leadership development–political education trainings hosted by SSSC and allied organizations, and school-based leadership trainings and summer intern programs for youths; (2) build its resident base through community outreach that reframed recreational justice as affecting other community priorities such as improving community health, lowering crime, and reducing incarceration of African American males; (3) solidify its ally base by leading the formation of a recreational justice coalition that hosted community rallies and generated significant public presence at NORDC meetings; and (4) assemble residents, leaders, and coalition members to advocate at NORDC meetings for increased recreation equity. These efforts eventually led the NORDC to agree to form a community advisory board as well as to rely on SSSC for guidance on recreational issues.

CONCLUSIONS

Using the 3-lens prescription allows health professionals to support grassroots organizations and community partners in developing community organizing–based health promotion in communities of color. On the basis of CCHE grantee experiences, 3 conclusions can be drawn. First, applying the lenses requires health professionals to be open to (1) addressing health disparities in communities of color by targeting its structural causes in lieu of, or in addition to, individual health behaviors; (2) empowering community-based organizations to lead program planning and operations; and (3) targeting seemingly non-health–related issues (e.g., gentrification displacing low-income residents and small businesses selling cultural foods) to effect health change. Second, funding streams from governmental entities and nonprofit foundations cannot be used to lobby elected officials for policy changes. As a precaution, CCHE grantees’ lobbying activities were evaluated quarterly to ensure that they either (1) advocated exclusively to government departments and agencies (e.g., school districts, zoning commissions, parks and recreation departments) and not to elected officials or (2) used non-CCHE funds to reach elected officials. Third, programs benefit from being flexible in focus, scope, and organizing approach, as unforeseen community changes (e.g., election or appointment of new decision-makers, natural disasters, concurrent local social or racial movements) are common and can hinder rigid programs or bolster agile ones.

Transitioning from conventional community-based health promotion strategies that engage communities but remain orchestrated by health professionals to community organizing–based health promotion empowers communities of color to take direct, long-term action against the unequal social and environmental conditions underlying ethnic and racial health disparities.^{1,2,5,6,10,27} Health professionals also benefit from being a co-journeyer in the grassroots health promotion process, thus gaining a deepened understanding of the trajectory and contextual realities of health disparities from the community’s perspective. In conclusion, the 3-lens prescription for shaping and evaluating health promotion in communities of color provides health professionals with a viable tool for partnering with community stakeholders to utilize community organizing practices that challenge the structural causes of public health problems,^10,27 potentially advancing community health and well-being through environmental and policy change.^60,83,84