Why Community Power Is Fundamental to Advancing Racial and Health Equity.

Abstract

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 inequiThis 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.