The process by which individuals, communities, organizations, institutions, and societies develop abilities to perform functions, solve problems and set and achieve objectives.
3 Levels of Capacity Building1
- Capacity to execute the components of an intervention
- Capacity to continue the intervention once the supporting institution is no longer involved
- Capacity to identify and intervene upon other health issues
Capacity Building Approaches2
- Involving community leaders
- Organizational collaboration
- Staff training
- Reorient established services for other problems
How does capacity building promote health equity?
Involving individuals from impacted communities and organizations throughout the development and implementation of a health-based intervention can empower individuals to continue to make and maintain changes. By increasing the capacity of a community to preform program and advocacy activities, they have the ability to continue programming and take ownership of their own health and the health of other members in their community.
- Hawe, P., Noort, M., King, L., & Jordens, C. (1997). Multiplying health gains: the critical role of capacity-building within health promotion programs. Health policy, 39(1), 29-42.
- Crisp, B. R., Swerissen, H., & Duckett, S. J. (2000). Four approaches to capacity building in health: consequences for measurement and accountability. Health promotion international, 15(2), 99-107.
Maintaining partnerships and health benefits of a program over time.
- Work to obtain buy-in and support from key decision-makers and community members
- Develop and maintain adequate leadership, communication, and funding
- Continuous evaluation and re-evaluation to serve the evolving needs of the community and partnership
How does sustainability promote health equity?
Sustainable partnerships and programs work toward meaningful, lasting change in health status, especially among marginalized populations. To promote sustainability, programs should not be treated as a single intervention, but rather a sustainable collaboration and structural change to improve health for all.
- Centers for Disease Control and Prevention. A Sustainability Planning Guide for Healthy Communities.
- Rifkin, S. B. (2003). A framework linking community empowerment and health equity: it is a matter of CHOICE. Journal of health, population and nutrition, 168-180.
Incorporates a lifelong commitment to self-evaluation and self-critique, to redressing power imbalances, and to developing mutually beneficial and respectful partnerships with diverse communities.
Self-Evaluation and Self-Critique1
- Examine and recognize our personal assumptions and beliefs, (i.e., understanding what you assume from others based on their culture). What do you expect them to be like based on the way they look, based on where they say they are from, etc.
- Be aware of our assumptions and be aware of how they might impact us as we work with others, because misunderstandings, false assumptions, and lack of communication can arise.
- Recognize that we play the role of student and must learn about the culture and what is culturally appropriate from those who live that culture.
Redressing Power Imbalances2
- Ask whether or not we see individuals and community groups as the teachers and experts on their culture and community life. By doing so, we can empower the individuals and community groups and help create a sense of ownership in decision making.
- View ourselves as the student, we must learn about the culture from those who live that culture. However, we are also partners who have access to resources and knowledge. We should be able to contribute to the conversation, provide advice or input based on our knowledge, and share resources.
Create Mutually Beneficial relationships1,3
- Focus on the needs of those you are working with (client-focused approach).
- Empower community to direct the project and have a sense of ownership
- Examine similarities and differences between our own and the community’s priorities, goals, and abilities
- Exchange of resources and knowledge
How does Cultural Humility differ from Cultural Competence?
- Cultural humility does not require us to be competent in others’ cultures.
- We do not have master a list of different cultural health beliefs and behaviors.
- It challenges us to be self-critical, recognize our cultures and our assumptions of others.
- It challenges us to play the role of student and learn from those within the culture we are working with.
- It involves developing a respectful partnership with diverse individuals and communities. Creating relationships that benefit all involved and empower those we are working with.
How does cultural humility promote health equity?
Health programs that incorporate cultural components can harbor a greater trust between community members and researchers. The reach and efficacy of a research programs can be enhanced through input from community members to ensure materials and activities are culturally appropriate and relevant to meet the needs of the target population.
- California Health Advocates. (2007). Are you practicing cultural humility? – The key to success in cultural competence.
- Siroka, A. (2011). Cultural humility.
- Alameda County of Public Health Department. (n.d.). Public Health 101 Module II: Cultural Competency and Cultural Humility.
An approach to problem solving by viewing “problems” as parts of an overall system rather than reacting to specific parts, outcomes or events in isolation.
Health issues or behaviors do not exist in a vacuum; there are many outside factors influencing individual behavior. Systems thinking has a strong emphasis on the study of relationships, specialized studies, working across organization boundaries, and the use of mixed methodologies. By using an interdisciplinary way of thinking, we can better understand health issues.1
A key model to think systematically about impacting health equity is the Social Ecological Model.2
How does systems thinking promote health equity?
Systems thinking allows one to account for the plethora of factors that may influence the health of a person and can help to identify factors that are associated with health inequity or disparities. A targeted and comprehensive approach to improving the health of communities can be taken by understanding the dynamic interactions between the socioecological levels and system factors.
- Trochim, W. M., Cabrera, D. A., Milstein, B., Gallagher, R. S., Leischow, S. J. Practical challenges of systems thinking and modeling in public health. (2006). American Journal of Public Health, 96(3), 538-546.
- Bronfenbrenner, U. (1979). Contexts of childrearing: Problems and prospects. American psychologist, 34(10), 844.
Social Justice Foundation
Improving the social determinants of health that impact health negatively so that all individuals are given an equal opportunity to achieve excellent health.
- A social justice approach considers upstream causes in health disparities (i.e., school, stores, employment) in downstream traditional public health interventions (i.e., screening, insurance).
- Social Justice can be shown in a graphic that has social and physical environmental factors such as housing, community, and infrastructure on a platform. This platform has a steep drop off that represents a person falling ill or losing their health.
- Prevention efforts and a person’s capacity to access preventative measures for disease and illness can be a blocker or a barrier protecting a person from plunging into illness.
- An additional buffer to further consequences of ill health come in access to and quality of secondary prevention efforts if primary efforts fail to prevent illness. An underlying buffer to all of these factors is the equability of quality, cost, and access to medical services and treatments.
- By providing equitable access to prevention efforts to all people, social justice in health can be achieved.
How does a social justice foundation contribute to health equity?
Understanding that health is determined by factors beyond individual control and that these factors are unequally distributed across populations is the foundation of health equity. A social justice foundation and approach identifies the inequitable distributions of factors in order to intervene and promote health equity.
Reciprocity and Accountability
We value partnership in which all parties are responsible for their own actions and mutually held to a high standard in order to achieve shared goals and objectives.
- Reciprocity is an approach to research that focuses on shared goals and responsibility of the research project. It is a “co-learning and empowering process that facilitates the reciprocal transfer of knowledge, skills, capacity, and power.”1
- Accountability is the commitment to providing justification for or information about decisions that are made. Types of accountability include financial (i.e. budgeting), performance (i.e. resource allocation), political (i.e. transparent decision making).
How do reciprocity and accountability promote health equity?
When designing and implementing interventions in communities, maintaining a relationship that reciprocates trust can ensure that all voices are heard and accounted for in community-based research decisions. A large part of this built trust is when all parties involved are accountable for their actions and make sure to complete tasks and be involved to the level at which was agreed upon as a group. Accountability ensures that all parties are held responsible as groups progress towards meeting goals around health equity.
- Israel, B. A., Shulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: assessing partnership approaches to improve public health. Annual review of public health, 19(1), 173-202.
- Bastida, E. M., Tseng, T. S., McKeever, C., & Jack, L. (2010). Ethics and community-based participatory research: perspectives from the field. Health Promotion Practice, 11(1), 16-20.
- Brinkerhoff, D. W. (2004). Accountability and health systems: toward conceptual clarity and policy relevance. Health policy and planning, 19(6), 371-379.
A collaborative process between the community and researchers to strengthen the well-being of the community.
- Researchers may focus their research in a community without addressing the needs of the community. Communities seldom feel they receive the benefits of such research.
- Community-Engaged research allows for a real world setting with more practical applications that will improve human health.
- At the heart of community-engaged research is authentic community-academic partnerships that break down traditional power hierarchies to work on projects of interest to the community.
- There are barriers to conducting community-engaged research. Community members may expect results quickly but the nature of community-engaged work and research makes it difficult for academic researchers to turn around results. To appropriately engage the community in research requires thought, time, and patience.
- A community-engaged research frame increases accountability and equality between partners.
How does community-engaged research promote health equity?
An authentic community-engaged approach to research will produce programs and systems that are more likely to be sustainable and impactful, benefiting both community and academic scientists and help to increase health equity.
- MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., Strauss, R. P., Scotti, R., Blanchard, L., & Trotter, R. T. (2001). What is community? An evidence-based definition for participatory public health. American Journal of Public Health, 91(12): 1929-1938
- Askin, E. & Moore, N. (2012). The health care handbook: A clear and concise guide to the United States Health Care System. 2nd Ed. St. Louis: Washington University in St. Louis.
- Mary Anne McDonald, Community & Family Medicine, Duke University Medical School. Duke Center for community Research. www.dtmi.duke.edu/dccr/community-linked-research. Published 2004-2015 Assessed April 29, 2016