[Applause]
thank you I understand I am what
separates you all from happy hour today
but I’m a faculty member I could talk
forever so you got to hope that I’m
paying attention to the time there and
it’s really hard to follow Marlon but
what I want to talk to you about a
little bit today is kind of flipping the
ready for everything by building
community capacity by really encouraging
civic engagement or community
participation I have a Margaret Mead
quote here those of you who are social
media savvy you probably see this come
up on your Facebook feed all the time
right it’s an inspirational quote that
says that the world is changed by a
small group of committed citizens I find
it inspiring I think it’s kind of a
feels like an American ideal I have a
second quote for maybe a less famous
person on a similar speaker this is how
Speaker Paul Ryan saying that basically
every successful individual is
surrounded by a community of people that
brought them there I think this is a
almost a uniquely American idea that
Democratic participation in all aspects
of society is how we reach long term
sustainable Democratic Change we look at
it in our government we look at it in
our civil society we look at it in in
our churches we look at it in a variety
of places in our lives where we don’t
always look at it is is in health care
and I want to talk to you a little bit
today from the perspective of a nurse
and a public health nurse about why I
see this as important in health care if
you don’t already know it and many of
you are in health care so you already do
we spend more money than anybody else on
the planet on our health care system and
we don’t really achieve much in the way
of outcomes our outcomes are not
horrible but they’re mediocre
the Institute of Medicine about three
years ago did a study where they
compared us health outcomes with 17
other countries that are at similar
levels of Economic Development with us
so countries that you would expect us to
compete with in the health care arena
and indeed we did well in some things
but we didn’t do well in a whole variety
of things and a couple of them are
really notable even if you’re not a
health care person one is life
expectancy so infant born today how long
on average can they expect to
and the second is infant mortality
infant born today how many of them will
make it through the first year of life
those are two really key outcome
indicators that tell you something about
how healthy a community is we were dead
last in both of those when you compare
us to the 17 peer countries so to kind
of really critical indicators that we
don’t do so well despite the fact that
we spend all kinds of money on this we
also know that we have problems in
health care even with our outcomes with
disparities between groups racial ethnic
disparities talk about health inequity
disparities by where you live
disparities by gender gender orientation
we know that so even our outcomes as
they are are not equitable across the
country we also know we have a variety
of other kinds of health care problems
we have chronic diseases that again more
telling in minority communities and
communities of low income not only do
those communities have higher death
rates and lower life expectancy but the
quality of life for people in those
communities as they deal with chronic
illness like diabetes heart disease
obesity is really much diminished we
know we have new and infectious diseases
coming out Ebola and Zika in the last
couple of years that we’re going to have
to deal with as a society we know that
in many communities and Chicago has
become the poster child we have a big
problem with interpersonal and community
violence both in the homes and out in
the street we know that we have a
variety of health policy challenges and
I could list them forever but the ones
that are most recent and really caught
our attention because I thought we had
fixed these a while back is if you’ve
noticed that northeastern Indiana is
having a big problem with lead in their
water and the people in Flint Michigan
still don’t have safe and clean drinking
water and that’s coming up on two years
so we have a large variety of health
issues what does community engagement
mean for those issues what does it bring
to the table so I’ll tell you why I came
to this interest I told you I was a
public health nurse researcher educator
and many years ago before I got into
public health I started in acute care in
nursing
as many new nurses do and this was a
long time ago and people stayed in the
hospital for a long time and I would get
to know my patients and I would spend
time with them and I would tell them how
they were going to take their medicine
and how they were going to test their
blood sugar and activity levels and what
their diet should be like and then I
would send them home and a week two
weeks three weeks a month many of them
came back in the door with the same
problem that we had thought we had fixed
and sent them home with and as a fairly
new nurse who had really put a lot of
time and effort into that I was
astounded what had gone wrong how come
they didn’t listen to my great advice
and somehow fix themselves up when they
got home what was happening in those
communities so I left acute care and
went and worked in home health care for
about a decade where I went in to where
people lived and worked and played and
it was a great humility lesson for me
because what I found out was what I had
been telling those patients for all that
time was pretty much irrelevant in their
lives and they had been very nice to me
and they’ve been patting me on the hand
and smiling at me and going home and
doing what they could do given their
resources their capacity their community
their home environment so when I went
into homecare I found that the little
old man that I said don’t eat canned
food because you want to really watch
your sodium intake because sodium will
cause you to retain fluids and that will
put excess burden on your heart he was
unable to get up and down his
third-floor walk-up and he had a
neighbor who shopped for him once a
month so if you get food in your house
once a month it’s going to be canned
food and that’s what you’re going to eat
the little old lady who took care of her
elderly husband and he needed a lot of
care and so I would remind her take care
of yourself too when I got into the home
and met them
she had no backup she was 24/7 she
couldn’t even get a good night’s sleep
much less a chance to take a walk around
the block or get her hair done or go to
church or anything else that might have
been re-energizing for her the woman
that I setup and said here’s what you
need to do during the day here’s when
you need to take your medications here’s
the activity level you should have found
out later that her family was glad to
have her living with them but they had
to work 10-hour days and so what they
did because she couldn’t get around on
her own was they put her in a chair in
front of the television set at 8:00 in
the morning with her food her pills or
water
and then they came and helped her again
at 6:00 at night because that’s all they
could do so besides the humility which
was obviously well needed for me I
thought of two things that I took out of
that experience one was that I had spent
time with my patients but I hadn’t
engaged with them at all
I had just talked at them I didn’t
really listened to them and what was
relevant to them and what was real and
what their lived experience was like so
that we could work out together what
they might do to improve their health
and the second thing was a lot of what
did people’s health happened outside of
the clinical setting here I thought I
was in the center of the universe I was
in an acute care setting and doctors and
nurses are relatively irrelevant to most
of what makes people healthy or not
healthy most of what happens to people
with regard to their health happens
where they live work play and pray so I
decided after that that I was going to
go into public health to find out a
little bit more about all of these
things that happen outside of the of the
healthcare system this is the health
impact pyramid I learned about it many
years ago as the social determinants of
health now in healthcare everyone talks
about the social determinants of health
but actually public health people have
been having these conversations for 40
years nobody would listen to us this
health impact pyramid is from dr. Tom
Frieden who was the head of CDC until
about until the new administration so
about four months ago and it’s hard to
see from here but the bottom of the
health impact pyramid so the pyramid the
things at the bottom have greater impact
on the health of populations and
communities the things at the top
require greater resources so the bottom
is things like socio-economic factors
because really health is greatly
impacted by the resources you have
available whether you have a job an
income
it’s greatly impacted by your
educational level there’s a really
strong correlation between education
level and health it’s greatly impacted
by weather you have safe of housing and
whether you have affordable food
affordable healthy food the second one
here it says changing the context to
make individuals default decisions
healthy turn that into making the
Healthy Choice the easy choice what can
we do that makes it easier for people to
make healthy choices so one thing would
be we put recessed back in the Chicago
Public Schools recently so kids are able
to get activity on a regular basis don’t
have to go and start
special programs it’s part of their
daily life or we’ve made cigarettes more
expensive and made it harder we can’t
smoke in public buildings so that we
make that unhealthy choice a little bit
harder for people so these really um
high-impact relatively low-cost things
are where we don’t spend as much time
where we put a lot of our energy as
clinical interventions and counseling
and education where those patients need
to know more about what they do now
those are good things and they’re
impactful but they’re very resource
intensive particularly compared to the
to the outcomes you get from them so the
more I learned about this I took this
into my practice as a public health
nurse in the community there’s a variety
of challenges trying to make this happen
and I’m just going to talk about a few
of them
the first challenge I found was
conflicting priorities so I go in as the
public health nurse I was working in
Robert Taylor homes which was a public
housing complex on the south near South
Side in Chicago until a few years back
and I would go and I would talk to women
about the infant mortality rate in
Robert table homes and it was horrible
and the women were concerned and they
thought that wasn’t a good thing but it
really didn’t feel relevant to their
lives what felt relevant is this was the
late 80s the crack cocaine epidemic was
a big deal there was a lot of gang
warfare about who was going to sell
crack cocaine what felt relevant to them
was that they sometimes had to walk
their children to school and walk past a
chalk outline because someone had been
shot outside their building or they
couldn’t send their kid out to the
vacant lot to play or down to the corner
for a gallon of milk because of the
level of violence in the community so
how do you juxtapose those two things
the data is correct there is a problem
but the lived experience is also correct
there is a problem that people need to
deal with every single day the second
set of challenges I found was commitment
and sustainability in my community work
and I’m sure this has happened to any of
you who’ve done this as well I can’t
tell you how many times people said to
me who is getting their PhD from this
what are you doing here and who is going
to get their degree from this work
because people in the communities I
worked in were a little bit jaded they
had seen people particularly people from
universities come in do a project
collect data and leave
and then the next group came in and the
neck how many times are you going to you
know drink the kool-aid with the folks
that came in no matter how nice they
seemed to be and so I had to think about
being honest with people about what my
work was and how long I was going to be
there and I had to think about what I
was going to leave behind so is it doing
something and walking away or is it
doing something with people so that
they’ve developed new skills and they
this is where they live can continue the
work after we leave and that gets into
whole conversations about ownership and
what participation is it is relatively
easy to get a bunch of people together
and say we want to hear from you about
your issues it’s a little bit more
challenging to say to those people let’s
get together about how you can impact
those issues not suggesting that we
don’t need government hospitals
healthcare organizations churches etc
but you are the missing part of the
equation here and how can we get you
meaningfully meaningfully involved in
setting the direction of what’s going to
happen to make this community a
healthier better place the third thing
was to look at assets versus needs John
McKnight from Northwestern helped with
this when he said you know we go into
communities and we do community health
needs assessments and what you do is you
leave the community with a whole laundry
list of needs when you leave people with
a whole laundry list of needs what they
feel like is that they are passive
consumers who need help to fix their all
of their needs John McKnight said let’s
take a look at the assets in communities
as well and help them think about how
they can bring their assets to address
their needs and all communities have
assets it may be the park it may be the
closeness to CTA to public
transportation it may be the public
library which is a clean safe space
that’s open to everybody it may be
individual capacities maybe somebody
bakes a great pie maybe somebody can fix
cars how do we help communities see all
of those things they have and bring it
together to help them address their
needs in ways that work and are
sustainable in our capacity building and
the last challenge I want to talk about
is the idea of resilience versus
capacity so the Department of Defense
and the RAND Corporation have been doing
a lot of research on community
resilience how come you have two
communities they look a little bit alike
a disaster happens one
comes back and the other really just has
a hard time recuperating I want to
switch that around and say how do we
build community capacity so that yes if
a disaster occurs god forbid they’re
able to recoup but that they have
capacity on a daily basis to help
improve the health and well-being in
that neighborhood to help get stronger
and better every day the California
Endowment has this quote on their
website where they say if you can plug
the community into the right kind of
political power grid it’ll do more to
create health and wellness than any
other single intervention it is the
untapped thing we do a little bit of
talking about communities but mostly
it’s to get them to participate in the
things that those of us in health care
have already decided to do mostly it’s
to say oh we asked for your opinion and
we got your opinion and now we’re still
going to go ahead it’s not serious civic
engagement of the type that I think
Margaret Mead and hopefully Paul Ryan
we’re talking about so the last thing I
want to talk about a little so what I’ve
done more recently in this work is I had
sabbatical last year it’s a lovely thing
and I looked at the concept of community
engagement and spent some time in the
literature as we like to do and then I
went and interviewed people around the
country who have done successful
community health and development
projects and I said how did you involve
people at the grassroots level what
worked what didn’t what challenges did
you find what wisdom do you have to
share and I’m in the midst of analyzing
that data right now so I don’t have
anything definitive but I have a few
themes that I wanted to share with you
as kind of a positive thing one thing
they said is strong civic participation
you really need to get people involved
from the get-go
a woman in Maine says she does something
called community circles where she
brings groups of people together summer
community residents some might be
professionals or church leadership
around an issue and she said sometimes
it doesn’t work sometimes they’ll meet
once or twice and say you know we got
nothing for each other we’re going to
disband but some of them have been very
effective
so her mental health community circle
has been meeting every six weeks now for
four years and they have actually
developed some things that they’ve
implemented in this small rural
community to help people with mental
illness cope better and to help the
community figure out how to support them
better and
how to live congenial e together the
second thing that people my interviewees
have told me what’s wrong said wrong
with thing is that engagement starts at
home and you got to start by knowing
your neighbors and I think that’s true
for all the communities we belong in not
just the ones that I work in but the
ones that I live in as well the Westside
health authority here in the Austin
neighborhood in Chicago has a project
they’ve been working on called um every
black sub village and what they’ve tried
to do is take blocks and say let’s
connect people on a block cuz you can
get your head around your block it’s not
that huge let’s find out what the assets
and the needs are and see if we can
connect people on this block to solve
those immediate problems but also to
create ongoing social connectedness so
if this is the retired couple at one
side of the block who has a little bit
of extra time maybe they can do
childcare for the young family here who
the parents have to work and they could
use some less expensive childcare and in
return the young couple will come and
cut grass and shovel snow and maybe take
them to the doctor occasionally so it’s
a lovely model to start at the very
small to create connections across
community in very concrete ways civil
discourse is another thing my
interviewees talked about it’s really
important that we learn how to talk to
each other in a civil way I think we’ve
particularly lost that in the last year
or so in this country we’re going to
disagree we’re good I we probably
couldn’t all agree on what to order for
dinner if we got together and someone
offered to buy us all dinner in this
room so how do we spend the time and
energy it takes and use conflict
resolution skills and use communication
skills so that we can get to know one
another we can recognize our differences
but try to find some larger commonality
that we could work on together and
through the course of doing that get to
know each other and trust each other and
maybe be a little bit better at
addressing some of our differences the
one thing all of my interviewees agreed
on is it takes time there’s no shortcut
for this it just takes time and
attention and commitment one of the
stories that people told me was
community health centers have to have
51% of their board as community members
and she said they would always have
dinner before the board would meet and a
lot of times the professionals wouldn’t
come to dinner
they didn’t have time they were busy
they would just come for the meeting
what they found out is when everyone
showed up for dinner the later business
meeting was much more productive because
people had a chance to develop
relationships and start to trust and
then they were able to work more
effectively together the last thing my
interviewees shared with me is Community
Action strategies we have to figure out
ways and some of them had some methods
like my community circles lady and
hopefully as I get into the data will
find more we have to find ways to
develop mutual goals again even beyond
our disagreements and then how to
develop structures for action it’s not
enough to set goals if we don’t do
anything about them and our structures
for action have to be inclusive so that
people feel like their participation is
meaningful to the overall effort and to
their expenditure of their time so how
do we develop those inclusive structures
and knowing that people are going to ebb
and flow in their participation you may
be at a time when you have an ill family
member and you can’t spend as much time
in your community other people may be at
a time when they’ve retired and they
have more time so knowing that we’re
going to have that ebb and flow how do
we keep those structures going the last
thing all of my folks talked about was
we need to think about the long term
horizon so we need some short-term
outcomes like setting up a X getting a
clinic to come into our community or
cleaning up a vacant lot or getting a
playground but we need to have the long
horizon we need to think we’re in this
to improve the health of this community
and well-being for the duration and that
means a commitment and a long-term set
of outcomes and that means we need to
talk to our government and philanthropy
people about a long term a long timeline
for outcomes as well so the last quote I
want to leave you with is a hero of mine
Marian Wright Edelman who says the
challenge of social justice is to evoke
a sense of community that we need to
make our nation a better place just as
we make it a safer place and I would say
and a healthier place so have a good
weekend and go talk to a neighbor
[Applause]
thank you I understand I am what
separates you all from happy hour today
but I’m a faculty member I could talk
forever so you got to hope that I’m
paying attention to the time there and
it’s really hard to follow Marlon but
what I want to talk to you about a
little bit today is kind of flipping the
ready for everything by building
community capacity by really encouraging
civic engagement or community
participation I have a Margaret Mead
quote here those of you who are social
media savvy you probably see this come
up on your Facebook feed all the time
right it’s an inspirational quote that
says that the world is changed by a
small group of committed citizens I find
it inspiring I think it’s kind of a
feels like an American ideal I have a
second quote for maybe a less famous
person on a similar speaker this is how
Speaker Paul Ryan saying that basically
every successful individual is
surrounded by a community of people that
brought them there I think this is a
almost a uniquely American idea that
Democratic participation in all aspects
of society is how we reach long term
sustainable Democratic Change we look at
it in our government we look at it in
our civil society we look at it in in
our churches we look at it in a variety
of places in our lives where we don’t
always look at it is is in health care
and I want to talk to you a little bit
today from the perspective of a nurse
and a public health nurse about why I
see this as important in health care if
you don’t already know it and many of
you are in health care so you already do
we spend more money than anybody else on
the planet on our health care system and
we don’t really achieve much in the way
of outcomes our outcomes are not
horrible but they’re mediocre
the Institute of Medicine about three
years ago did a study where they
compared us health outcomes with 17
other countries that are at similar
levels of Economic Development with us
so countries that you would expect us to
compete with in the health care arena
and indeed we did well in some things
but we didn’t do well in a whole variety
of things and a couple of them are
really notable even if you’re not a
health care person one is life
expectancy so infant born today how long
on average can they expect to
and the second is infant mortality
infant born today how many of them will
make it through the first year of life
those are two really key outcome
indicators that tell you something about
how healthy a community is we were dead
last in both of those when you compare
us to the 17 peer countries so to kind
of really critical indicators that we
don’t do so well despite the fact that
we spend all kinds of money on this we
also know that we have problems in
health care even with our outcomes with
disparities between groups racial ethnic
disparities talk about health inequity
disparities by where you live
disparities by gender gender orientation
we know that so even our outcomes as
they are are not equitable across the
country we also know we have a variety
of other kinds of health care problems
we have chronic diseases that again more
telling in minority communities and
communities of low income not only do
those communities have higher death
rates and lower life expectancy but the
quality of life for people in those
communities as they deal with chronic
illness like diabetes heart disease
obesity is really much diminished we
know we have new and infectious diseases
coming out Ebola and Zika in the last
couple of years that we’re going to have
to deal with as a society we know that
in many communities and Chicago has
become the poster child we have a big
problem with interpersonal and community
violence both in the homes and out in
the street we know that we have a
variety of health policy challenges and
I could list them forever but the ones
that are most recent and really caught
our attention because I thought we had
fixed these a while back is if you’ve
noticed that northeastern Indiana is
having a big problem with lead in their
water and the people in Flint Michigan
still don’t have safe and clean drinking
water and that’s coming up on two years
so we have a large variety of health
issues what does community engagement
mean for those issues what does it bring
to the table so I’ll tell you why I came
to this interest I told you I was a
public health nurse researcher educator
and many years ago before I got into
public health I started in acute care in
nursing
as many new nurses do and this was a
long time ago and people stayed in the
hospital for a long time and I would get
to know my patients and I would spend
time with them and I would tell them how
they were going to take their medicine
and how they were going to test their
blood sugar and activity levels and what
their diet should be like and then I
would send them home and a week two
weeks three weeks a month many of them
came back in the door with the same
problem that we had thought we had fixed
and sent them home with and as a fairly
new nurse who had really put a lot of
time and effort into that I was
astounded what had gone wrong how come
they didn’t listen to my great advice
and somehow fix themselves up when they
got home what was happening in those
communities so I left acute care and
went and worked in home health care for
about a decade where I went in to where
people lived and worked and played and
it was a great humility lesson for me
because what I found out was what I had
been telling those patients for all that
time was pretty much irrelevant in their
lives and they had been very nice to me
and they’ve been patting me on the hand
and smiling at me and going home and
doing what they could do given their
resources their capacity their community
their home environment so when I went
into homecare I found that the little
old man that I said don’t eat canned
food because you want to really watch
your sodium intake because sodium will
cause you to retain fluids and that will
put excess burden on your heart he was
unable to get up and down his
third-floor walk-up and he had a
neighbor who shopped for him once a
month so if you get food in your house
once a month it’s going to be canned
food and that’s what you’re going to eat
the little old lady who took care of her
elderly husband and he needed a lot of
care and so I would remind her take care
of yourself too when I got into the home
and met them
she had no backup she was 24/7 she
couldn’t even get a good night’s sleep
much less a chance to take a walk around
the block or get her hair done or go to
church or anything else that might have
been re-energizing for her the woman
that I setup and said here’s what you
need to do during the day here’s when
you need to take your medications here’s
the activity level you should have found
out later that her family was glad to
have her living with them but they had
to work 10-hour days and so what they
did because she couldn’t get around on
her own was they put her in a chair in
front of the television set at 8:00 in
the morning with her food her pills or
water
and then they came and helped her again
at 6:00 at night because that’s all they
could do so besides the humility which
was obviously well needed for me I
thought of two things that I took out of
that experience one was that I had spent
time with my patients but I hadn’t
engaged with them at all
I had just talked at them I didn’t
really listened to them and what was
relevant to them and what was real and
what their lived experience was like so
that we could work out together what
they might do to improve their health
and the second thing was a lot of what
did people’s health happened outside of
the clinical setting here I thought I
was in the center of the universe I was
in an acute care setting and doctors and
nurses are relatively irrelevant to most
of what makes people healthy or not
healthy most of what happens to people
with regard to their health happens
where they live work play and pray so I
decided after that that I was going to
go into public health to find out a
little bit more about all of these
things that happen outside of the of the
healthcare system this is the health
impact pyramid I learned about it many
years ago as the social determinants of
health now in healthcare everyone talks
about the social determinants of health
but actually public health people have
been having these conversations for 40
years nobody would listen to us this
health impact pyramid is from dr. Tom
Frieden who was the head of CDC until
about until the new administration so
about four months ago and it’s hard to
see from here but the bottom of the
health impact pyramid so the pyramid the
things at the bottom have greater impact
on the health of populations and
communities the things at the top
require greater resources so the bottom
is things like socio-economic factors
because really health is greatly
impacted by the resources you have
available whether you have a job an
income
it’s greatly impacted by your
educational level there’s a really
strong correlation between education
level and health it’s greatly impacted
by weather you have safe of housing and
whether you have affordable food
affordable healthy food the second one
here it says changing the context to
make individuals default decisions
healthy turn that into making the
Healthy Choice the easy choice what can
we do that makes it easier for people to
make healthy choices so one thing would
be we put recessed back in the Chicago
Public Schools recently so kids are able
to get activity on a regular basis don’t
have to go and start
special programs it’s part of their
daily life or we’ve made cigarettes more
expensive and made it harder we can’t
smoke in public buildings so that we
make that unhealthy choice a little bit
harder for people so these really um
high-impact relatively low-cost things
are where we don’t spend as much time
where we put a lot of our energy as
clinical interventions and counseling
and education where those patients need
to know more about what they do now
those are good things and they’re
impactful but they’re very resource
intensive particularly compared to the
to the outcomes you get from them so the
more I learned about this I took this
into my practice as a public health
nurse in the community there’s a variety
of challenges trying to make this happen
and I’m just going to talk about a few
of them
the first challenge I found was
conflicting priorities so I go in as the
public health nurse I was working in
Robert Taylor homes which was a public
housing complex on the south near South
Side in Chicago until a few years back
and I would go and I would talk to women
about the infant mortality rate in
Robert table homes and it was horrible
and the women were concerned and they
thought that wasn’t a good thing but it
really didn’t feel relevant to their
lives what felt relevant is this was the
late 80s the crack cocaine epidemic was
a big deal there was a lot of gang
warfare about who was going to sell
crack cocaine what felt relevant to them
was that they sometimes had to walk
their children to school and walk past a
chalk outline because someone had been
shot outside their building or they
couldn’t send their kid out to the
vacant lot to play or down to the corner
for a gallon of milk because of the
level of violence in the community so
how do you juxtapose those two things
the data is correct there is a problem
but the lived experience is also correct
there is a problem that people need to
deal with every single day the second
set of challenges I found was commitment
and sustainability in my community work
and I’m sure this has happened to any of
you who’ve done this as well I can’t
tell you how many times people said to
me who is getting their PhD from this
what are you doing here and who is going
to get their degree from this work
because people in the communities I
worked in were a little bit jaded they
had seen people particularly people from
universities come in do a project
collect data and leave
and then the next group came in and the
neck how many times are you going to you
know drink the kool-aid with the folks
that came in no matter how nice they
seemed to be and so I had to think about
being honest with people about what my
work was and how long I was going to be
there and I had to think about what I
was going to leave behind so is it doing
something and walking away or is it
doing something with people so that
they’ve developed new skills and they
this is where they live can continue the
work after we leave and that gets into
whole conversations about ownership and
what participation is it is relatively
easy to get a bunch of people together
and say we want to hear from you about
your issues it’s a little bit more
challenging to say to those people let’s
get together about how you can impact
those issues not suggesting that we
don’t need government hospitals
healthcare organizations churches etc
but you are the missing part of the
equation here and how can we get you
meaningfully meaningfully involved in
setting the direction of what’s going to
happen to make this community a
healthier better place the third thing
was to look at assets versus needs John
McKnight from Northwestern helped with
this when he said you know we go into
communities and we do community health
needs assessments and what you do is you
leave the community with a whole laundry
list of needs when you leave people with
a whole laundry list of needs what they
feel like is that they are passive
consumers who need help to fix their all
of their needs John McKnight said let’s
take a look at the assets in communities
as well and help them think about how
they can bring their assets to address
their needs and all communities have
assets it may be the park it may be the
closeness to CTA to public
transportation it may be the public
library which is a clean safe space
that’s open to everybody it may be
individual capacities maybe somebody
bakes a great pie maybe somebody can fix
cars how do we help communities see all
of those things they have and bring it
together to help them address their
needs in ways that work and are
sustainable in our capacity building and
the last challenge I want to talk about
is the idea of resilience versus
capacity so the Department of Defense
and the RAND Corporation have been doing
a lot of research on community
resilience how come you have two
communities they look a little bit alike
a disaster happens one
comes back and the other really just has
a hard time recuperating I want to
switch that around and say how do we
build community capacity so that yes if
a disaster occurs god forbid they’re
able to recoup but that they have
capacity on a daily basis to help
improve the health and well-being in
that neighborhood to help get stronger
and better every day the California
Endowment has this quote on their
website where they say if you can plug
the community into the right kind of
political power grid it’ll do more to
create health and wellness than any
other single intervention it is the
untapped thing we do a little bit of
talking about communities but mostly
it’s to get them to participate in the
things that those of us in health care
have already decided to do mostly it’s
to say oh we asked for your opinion and
we got your opinion and now we’re still
going to go ahead it’s not serious civic
engagement of the type that I think
Margaret Mead and hopefully Paul Ryan
we’re talking about so the last thing I
want to talk about a little so what I’ve
done more recently in this work is I had
sabbatical last year it’s a lovely thing
and I looked at the concept of community
engagement and spent some time in the
literature as we like to do and then I
went and interviewed people around the
country who have done successful
community health and development
projects and I said how did you involve
people at the grassroots level what
worked what didn’t what challenges did
you find what wisdom do you have to
share and I’m in the midst of analyzing
that data right now so I don’t have
anything definitive but I have a few
themes that I wanted to share with you
as kind of a positive thing one thing
they said is strong civic participation
you really need to get people involved
from the get-go
a woman in Maine says she does something
called community circles where she
brings groups of people together summer
community residents some might be
professionals or church leadership
around an issue and she said sometimes
it doesn’t work sometimes they’ll meet
once or twice and say you know we got
nothing for each other we’re going to
disband but some of them have been very
effective
so her mental health community circle
has been meeting every six weeks now for
four years and they have actually
developed some things that they’ve
implemented in this small rural
community to help people with mental
illness cope better and to help the
community figure out how to support them
better and
how to live congenial e together the
second thing that people my interviewees
have told me what’s wrong said wrong
with thing is that engagement starts at
home and you got to start by knowing
your neighbors and I think that’s true
for all the communities we belong in not
just the ones that I work in but the
ones that I live in as well the Westside
health authority here in the Austin
neighborhood in Chicago has a project
they’ve been working on called um every
black sub village and what they’ve tried
to do is take blocks and say let’s
connect people on a block cuz you can
get your head around your block it’s not
that huge let’s find out what the assets
and the needs are and see if we can
connect people on this block to solve
those immediate problems but also to
create ongoing social connectedness so
if this is the retired couple at one
side of the block who has a little bit
of extra time maybe they can do
childcare for the young family here who
the parents have to work and they could
use some less expensive childcare and in
return the young couple will come and
cut grass and shovel snow and maybe take
them to the doctor occasionally so it’s
a lovely model to start at the very
small to create connections across
community in very concrete ways civil
discourse is another thing my
interviewees talked about it’s really
important that we learn how to talk to
each other in a civil way I think we’ve
particularly lost that in the last year
or so in this country we’re going to
disagree we’re good I we probably
couldn’t all agree on what to order for
dinner if we got together and someone
offered to buy us all dinner in this
room so how do we spend the time and
energy it takes and use conflict
resolution skills and use communication
skills so that we can get to know one
another we can recognize our differences
but try to find some larger commonality
that we could work on together and
through the course of doing that get to
know each other and trust each other and
maybe be a little bit better at
addressing some of our differences the
one thing all of my interviewees agreed
on is it takes time there’s no shortcut
for this it just takes time and
attention and commitment one of the
stories that people told me was
community health centers have to have
51% of their board as community members
and she said they would always have
dinner before the board would meet and a
lot of times the professionals wouldn’t
come to dinner
they didn’t have time they were busy
they would just come for the meeting
what they found out is when everyone
showed up for dinner the later business
meeting was much more productive because
people had a chance to develop
relationships and start to trust and
then they were able to work more
effectively together the last thing my
interviewees shared with me is Community
Action strategies we have to figure out
ways and some of them had some methods
like my community circles lady and
hopefully as I get into the data will
find more we have to find ways to
develop mutual goals again even beyond
our disagreements and then how to
develop structures for action it’s not
enough to set goals if we don’t do
anything about them and our structures
for action have to be inclusive so that
people feel like their participation is
meaningful to the overall effort and to
their expenditure of their time so how
do we develop those inclusive structures
and knowing that people are going to ebb
and flow in their participation you may
be at a time when you have an ill family
member and you can’t spend as much time
in your community other people may be at
a time when they’ve retired and they
have more time so knowing that we’re
going to have that ebb and flow how do
we keep those structures going the last
thing all of my folks talked about was
we need to think about the long term
horizon so we need some short-term
outcomes like setting up a X getting a
clinic to come into our community or
cleaning up a vacant lot or getting a
playground but we need to have the long
horizon we need to think we’re in this
to improve the health of this community
and well-being for the duration and that
means a commitment and a long-term set
of outcomes and that means we need to
talk to our government and philanthropy
people about a long term a long timeline
for outcomes as well so the last quote I
want to leave you with is a hero of mine
Marian Wright Edelman who says the
challenge of social justice is to evoke
a sense of community that we need to
make our nation a better place just as
we make it a safer place and I would say
and a healthier place so have a good
weekend and go talk to a neighbor
[Applause]
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