Community Organizing to Promote Health Equity: A Viable Grassroots Approach to Addressing the Structural Determinants of Ethnic/Racial Health Disparities

Background and Purpose: Residents living in low-income communities of color endure profound ethnic/racial health disparities, including elevated rates of chronic medical conditions (e.g., diabetes, heart disease) and early mortality. Many of these disparities have proven resistant to traditional public health approaches, which have typically focused on changing individuals' health behaviors (e.g., diet, exercise) rather than disparities' true root causes: structural inequities in the social and built environment (poverty, food deserts, inadequate healthcare, discrimination) that prevent residents in low-income communities of color from practicing healthy behaviors. Unfortunately, few evidence-based community-level interventions exist for addressing these root causes. This paper presents new evidence supporting the effectiveness of community organizing-based health promotion: an innovative but underexamined grassroots approach that engages, empowers, and mobilizes marginalized residents to generate environmental and policy solutions to the health disparities affecting their communities.

Methods: Case studies will present program evaluation data from two large-scale health promotion initiatives (funded by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, respectively) targeting the structural determinants of poor health in diverse communities of color (e.g., Hispanic/Latino, American Indian, African American) using community organizing strategies (e.g., community outreach, public message reframing, leadership training, protests/direct action). Data were collected via community and program surveys, key informant interviews, and naturalistic observations (e.g., site visits).

Findings: By applying the principles and practices of community organizing, the community-based organizations participating in these initiatives: (1) substantially strengthened community capacity/power (e.g., increased number of trained resident youth and adult leaders), (2) mobilized residents to advocate for, and achieve, environmental and policy changes that promoted healthy eating and active living (e.g., convinced school board to replace nutrition poor foods in school lunches with local, healthy produce), and (3) placed community stakeholders in seats of local decision-making influence (e.g., appointment to Mayor's City Food Task Force).

Conclusions and Implications: Study data indicate that community organizing may be an effective public health strategy for addressing health disparities in low-income communities of color by empowering and mobilizing residents to achieve structural changes that improve community access to healthy foods, safe physical activity opportunities, and quality health care; potentially leading to sustainable community health improvements. In this way, community organizing-based health promotion may support Social Work's Grand Challenge of closing the US health gap by providing social workers with a social justice-oriented method for reducing ethnic/racial health disparities and promoting health equity in communities of color.