Why Community Power Is Fundamental to Advancing Racial and Health Equity

June 13, 2022

This three-part series highlights learnings from Lead Local: Community-Driven Change and the Power of Collective Action, a collaborative effort funded by the Robert Wood Johnson Foundation that convened well-respected local organizations and leaders in the fields of community organizing, advocacy, and research to examine the relationship between health and power building. Building on the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Community Power in Population Health Improvement workshop in January 2021, priority areas for action are shared to make progress toward, and further an understanding of, community power building for health and racial equity.

This commentary, which opens the series, unpacks how and why community power building is more durable than community engagement for transforming local community conditions and advancing health and racial equity. The discussion paper shows how the power-building ecosystem works in practice, showcasing examples of state and local power-building organizations and campaigns nationwide and reflecting on how actors who exist beyond the organizing ecosystem (e.g., researchers) can play a critical role in advancing movement aims (Pastor et al., 2022). The closing commentary reinforces the essential principles and values for effective and authentic partnering with the field, emphasizing the intersections between health, structural racism, and power (Farhang and Morales, 2022).

Introduction

Health researchers, leaders in health care and public health, and funders have long valued the concept of community engagement, when residents authentically connect on issues or amplify their voices to drive policy decisions affecting the health and well-being of their community and neighbors. The Robert Wood Johnson Foundation (RWJF) has funded past work at the National Academies to assess meaningful community engagement in health and health care programs (Organizing Committee, 2022). Until recently, leaders in health and health care, including RWJF, have been less familiar and less comfortable with the concept of community power and the fundamental role it plays in advancing racial and health equity and dismantling structures that perpetuate inequity.

Powerlessness is a structural barrier, like racism and sexism, to advancing health equity. Power imbalances are at the root of the structural issues that produce an unfair and unequal distribution of the social, economic, and environmental benefits that influence health. Behind any crisis—whether democratic or related to housing, climate, or health—there is an imbalance in who holds and wields power. Different from community engagement, at the root of community power building are strategies to organize people most impacted by a problem.

Evidence now shows that putting more power in the hands of more people, including those most impacted by structural inequities, results in systemic changes in the ways people make decisions that benefit all (Pastor et al., 2020). The authors of this manuscript know from our own work with mobilizing domestic workers, caregivers, and voters, and through work supported by RWJF, that community engagement is distinct from community power in multiple ways.

First, campaigns to expand Medicaid and place moratoriums on evictions are examples of efforts that activate communities most impacted by structural inequities around issues they care about. However, the only way to translate motivation to sustained action is to support communities in deepening their understanding of and ability to tackle the root causes of these inequities—strategies like base building and leadership development that are core to community power building. The authors have learned that building community power is not only instrumental to advancing meaningful change on an issue, but also fundamental for creating long-term transformative and structural change.

Community Power Is about Building a Base or Constituency

Patterns of voter suppression, housing segregation, and wage discrimination reinforce the impacts of systemic racism, classism, and sexism. Community power building helps people most impacted by these structural inequities disrupt these patterns. A core strategy to community power building is supporting the development of a base or constituency to make connections across people’s lived experiences; creating the understanding of each individual’s problems as connected to systemic challenges; and mobilizing communities across race, class, gender, age, abilities, and cultures to work together to improve their lives and the communities where they live and work. Community power is about building a sense of collective agency—that people can be more powerful together and harness that collectivism to change the conditions of their lives and our neighborhoods.

When people consistently see themselves through this lens, it can lead to community-level change and systemic transformation. Core to the strategy is the belief in the leadership of individuals and communities who experience the effects of structural inequity every day.

For example, domestic workers are an essential workforce primarily made up of women of color that has, for too long, been undervalued and underpaid. When domestic workers are at the forefront of community power efforts, and through domestic worker stories being told in films like Roma and Maid and in the halls of power, the public and legislators’ understanding of what is considered essential work expands (Pazmino, 2021; Poo, 2021; Dargis, 2018). This is best illustrated by the growing base of domestic workers leading community power-building efforts and illuminating the care that domestic workers provide. Their work is increasingly viewed at state and federal levels as critical infrastructure to invest in and support, alongside roads and housing, that can result in improved quality of life for children, aging loved ones, and workers alike.

Similarly, when Black, Indigenous, Latinx, and Asian American communities are well organized, the act of voting can disrupt the status quo and create a shift to the art of the possible, helping to shape the powers that govern their lives. For example, when schools were failing in one of the most disinvested areas of rural Alabama, residents took power into their own hands. Rather than wait on the state to fix their schools, they formed a nonprofit coalition and worked together to intentionally organize, vote, and put people in positions of power like superintendent and school board members who were committed to healthy, safe schools and fair and just education (CARE, n.d.). With the people most impacted organizing to take action, a poor-performing school in one of the most impoverished counties in the state became a Blue Ribbon School within three years. This grassroots community power-building effort sparked the creation of the Alabama New South Coalition, a 501(c)(4) that advocates for political candidates to move the people’s agenda and shift centers of power to the community (Alabama New South Coalition, Inc., 2022).

How Lead Local Has Defined Community Power

To help others better understand how community power catalyzes, creates, and sustains conditions for healthy communities, Lead Local, a collaboration funded by RWJF, was created (Lead Local, 2022). Lead Local: Community-Driven Change and the Power of Collective Action convened community power-building organizations and a core set of partners who developed research resulting in a definition of community power and evidence showcasing the ways community power creates systemic change in and across local communities.

Lead Local’s definition is grounded in best practices in local, grassroots community organizing for long-term structural change, and reads: “Community power is 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.”

The Lead Local collaborative worked to understand how organizing and power-building strategies improve racial and health equity in and across local communities. How community power catalyzes, accelerates, and changes conditions for healthy communities was the learning question that drove Lead Local and is the basis for the key topics covered in this commentary and its two accompanying pieces (Pastor et al., 2022; Farhang and Morales, 2022).

Through Lead Local research and the authors’ experiences as organizers and leaders, we have learned that community power building uses different theories of change, strategies, and tools. The authors have learned that collective power, or the shifting of power, is almost like an insurance policy to hold decision makers and systems accountable to the vision and demands of communities. While there are various theories and models, the key to community power building is developing and sustaining an organized base of people impacted by structural inequities.

This is one of the distinct differences between community power and community engagement. Both center on those most affected by a system’s historical and current patterns of exclusion and marginalization; however, community power building is driven by a base of people who are most impacted by structural inequities. Community power-building organizations like Black Voters Matter and the National Domestic Workers Alliance organize residents and workers most impacted by structural inequities in setting an agenda for changing systems and build their members’ leadership, skills, and expertise to achieve and oversee that agenda (Black Voters Matter, n.d.; National Domestic Workers Alliance, n.d.). These organizations work within an ecosystem of other community organizing groups and actors who offer a range of assets including research, advocacy, policy, and legal support to build power along multiple sectors and use diverse methods. For the ecosystem to be effective, Lead Local research and the authors’ experiences show that building and organizing a base or constituency is the heart of the work and therefore must be at the center.

Based on the research and learning through Lead Local and our own experiences, the authors of this commentary believe that the following are the key approaches to effectively support and build community power:

• 1.Value and prioritize power building over the long term. There is a tendency among government leaders, philanthropy, and researchers to focus on narrow investments, immediate research projects, or policy victories and short-term wins. Alliances and partnerships often come together around tactical opportunities and form transactional relationships, but these partnerships do not speak to the efforts of community power building if local groups are not supported to develop and grow their bases outside of a transactional relationship. For example, philanthropy is learning how important it is to fund community power building over the long term, not just when there is a crisis (Grassroots Solutions, 2018). This continued investment changes people’s hearts and minds and leads to lasting change and accountability.
• 2.Support, strengthen, and partner with existing community power-building organizations. Too often well-meaning advocates, researchers, and public officials wrongly assume that communities have little capacity to commit to building power or that community power-building organizations do not exist. However, community power building is often unseen because it occurs in community centers, faith institutions, and people’s homes. It is, however, always present. Long-term organizational infrastructure, leadership development, and capacity building often take place across one campaign, like securing voter rights, and then carry over to the next campaign, like promoting access to clean water. It is critical that organizations working with community power-building groups understand the dynamics on the ground and do not disrupt an ecosystem that has formed over time by advancing other efforts that are not in alignment with community power strategies. Instead, sharing tools and lessons from other communities and giving credit to and elevating the successes of community power organizations are ways to support ongoing efforts without derailing them.
• 3.Community power informs all social determinants of health. Those of us who work in public health know the social determinants of health and how much they impact individual and community health. Recent research also affirms that community power-building strategies developed and led by those communities most impacted by structural inequities are critical to addressing all social determinants and improving the overall health of communities (Lead Local, 2022).

Conclusion

The many simultaneous crises spawned by the CO-VID-19 pandemic that resulted in economic upheaval and even deeper political divisions in the United States also create an opening for building power in communities to deliver real change. Health and health care leaders have a unique opportunity to take the current crises and present community-driven solutions, grounded in the visions and agendas of communities across the country who have been organizing to build power, and collaboratively push for solutions that advance racial and health equity and justice. Building community power will result in stronger systems, access to more ideas and solutions, more inclusive policies, and better outcomes for all.

Actors within the broader ecosystem of change—leaders and providers of health care; leaders in academic institutions; legislators and administrators in local, state, and federal government; philanthropists; and public health advocates all have a role in building community power. Since so many influence and, in some cases, control resources and decision making that can impact health, there are diverse approaches to consider that can support local community power building agendas and vision for equity. Whether it’s joining a table that the community creates, deploying research and data capacity to support the efforts of a local community, supporting the leadership and initiative of community power-building groups, helping communities do the case-making for solutions they develop, or amplifying the experience of directly impacted communities, there is a unique moment now to work together to address the root causes of structural inequities and make real change toward a healthier, more equitable world where everyone can thrive.

Funding Statement

The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Support for Lead Local was provided by the Robert Wood Johnson Foundation. The projects described in this commentary were not all funded by the Foundation, and the references cited here do not necessarily reflect the views of the Foundation.