Transparency Talk

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Part 1: Aha Moments on the Road to Building Healthy Communities
June 24, 2013

(Robert K. Ross, M.D. is President and CEO of The California Endowment.)

Ross-100We are now two-plus years into the implementation of The California Endowment’s 10-Year Building Healthy Communities plan, and I can safely say that it has been the two most exciting years of my career in community and public health. It has already been quite a ride.

This is the first of periodic reports we will produce to share our progress, observations, mistakes, and lessons along the way as we support the efforts of community leaders to create healthier environments for young people in distressed and underserved communities.

Building Healthy Communities – we call it BHC for short – is a commitment of our Board of Directors to a two-pronged strategy. We have “dropped anchor” in fourteen distressed California communities for a 10-year period to work in partnership with community leaders to improve the health and life chances of young people. In addition, we are supporting change at the regional and state levels through funding advocacy, organizational capacity building, and communications on our key health issues.

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It is our intent to have these place-based and "bigger than place" strategies complement one another, and for the moving parts to develop a powerful synergy. At the local level, the BHC communities are engaging multiple sectors to develop innovative efforts to advance health. As these innovative strategies emerge, we’re looking for ways to scale the ideas up through policy change and communications at the state and regional levels. Through acting on multiple levels with complementary strategies, we expect to make a greater contribution than if we were to work only at the place level or only through supporting statewide advocacy. This is central to our theory of change. In a sense, it is fair to consider BHC as a “place-based plus” community change campaign.

In the spirit of the knowledge sharing that is one of the central aspects of Glasspockets and Transparency Talk, I will lift up three “aha” moments we’ve had so far, followed tomorrow by a second post listing key lessons for philanthropy.

Aha #1: The message matters
As we all know, when one talks about the “social determinants” -- the roles that poverty, education, and housing play in health status -- outside the public health world, eyes glaze over. We experienced this communication gap early as local communities strived to decipher our jargon-laden list of 10 targeted outcomes and 4 Big Results. Our communications team, inspired by the engagement of community leaders and residents in the planning process, took this obstacle head-on, and have created what I believe is one of the first successful decodings of the social determinants research: Health Happens Here.

Health-happens-here-250Health doesn’t just happen in a doctor’s office; health happens where we live, work, learn and play.

If you put the phrase Health Happens Here on a photo of a healthy school lunch, or a bike path, or a father and daughter hugging each other, we immediately communicate the norms change we are promoting. We took this message a step further by incorporating it into our internal structures. In looking at our grant-making, we found that 80% of our grants were focused around three areas: neighborhoods, schools and prevention. This led us to create three themes – Health Happens in Neighborhoods, Health Happens in Schools and Health Happens with Prevention – that have become the essential building blocks for our work. In fact, we call them campaigns, another use of language that communicates our intent as a foundation to use our brand to push for policy and systems change. And we are investing in aggressive media strategies to promote this message—through television, radio, print and social networking and through partnerships with influential messengers including First Lady Michelle Obama, Dr. Oz, and Jamie Oliver. A simple, compelling message carried by influential messengers, can shape a new narrative of change.

Aha #2: Trust young people to lead
Early in our BHC process, we chose to bring young people into leadership roles in BHC. Little did I know that this decision would not only impact community efforts but would impact how we view our work. Young people and adults view health issues differently, and it makes perfect sense to engage young people directly in developing strategies to improve their health. It makes sense but in the past, we didn’t. We operated like most adult organizations and didn’t engage young people in our thinking.

We’ve seen first hand that young people can be powerful leaders for social change. When they tell their stories through the arts, spoken word, social networking and journalism, they compel action. They are not only about our future; they are leaders of today.

Now that we have taken this step, we’re learning a lot. Young people brought to our attention the scandalous epidemic of suspensions and expulsions in our schools, and helped us understand how this issue connects to their health. Young men of color led us to a greater understanding of the role of trauma in the lives of youth growing up in homes and neighborhoods plagued with violence and gangs, and lifted up the need for social/emotional health and healing. And we’ve seen first hand that young people can be powerful leaders for social change. When they tell their stories through the arts, spoken word, social networking and journalism, they compel action. They are not only about our future; they are leaders of today. We’re evolving into an organization informed by adult and youth perspectives.

In addition to the numerous youth organizing and development efforts in the sites, I’ve created a “President’s Youth Council,” consisting of 14 youth leaders across the state, who meet with me at least twice annually in my role as President & CEO. In this way, I have the privilege of  hearing directly from youth leaders themselves about the progress and struggles of BHC, and how our foundation can be more responsive to and supportive of young people’s distressed neighborhoods. I believe this represents a fundamental culture change that will influence our work in the years to come.

As of this writing, BHC youth leaders, working in coalitions with the organizations that support them, have begun to rack up a series of policy victories that will put a check on the epidemic numbers of school suspensions, calling for alternative, common-sense discipline practices (like restorative justice approaches) that keep kids in school. This was an issue, by the way, that was nowhere on our radar screen in the early planning of BHC. It emerged from the youth voices in the BHC sites.

Aha #3: Build power, not just knowledge and innovation  
Frederick Douglass said that power concedes nothing without demand. The world doesn’t change because of the release of new data. It responds or concedes when people demand change.

Institutional philanthropy tends to worship at one of two altars: new knowledge, and innovation. Both are overrated, over-hyped, and over-subscribed to in our field.

Institutional philanthropy tends to worship at one of two altars: new knowledge, and innovation. Both are overrated, over-hyped, and over-subscribed to in our field. It can be argued that the primary value of philanthropy to civic society is the issue of problem-solving at scale. In a wonderfully linear, logical, and intellectually-driven world, good data, research, and new knowledge would be king. But that is not the world we live in. Recently, I noted that the state legislature in North Carolina effectively banned the use of scientific projections on global warming-induced tidal changes because they stand to impede the path of business development. More recently, the NRA-led prohibition against gun violence research by the CDC was recently challenged by President Obama after Newtown. I wish these represented isolated events, but history has shown that good science is frequently set aside by political and economic forces to the detriment of civic society.

The best public health example of this issue is the 80-year-plus war against big tobacco. The medical and public health communities have had the science about the detrimental effects of tobacco use since the 1920’s; but big tobacco had the power. We lost the battle decade after decade, and it was not until we discovered the merits of political and grassroots advocacy which, in combination with the science, led to a strategy where we began to rack up some victories.

On a related front, philanthropy seems hopelessly in love with “innovation” as well.  In the corporate, for-profit world, innovation quickly scales through profit – the I-phone being a classic example. In the social sectors, innovation rarely paves the way towards scale on its own merits. Too many politically powerful forces are in play. Power, voice, and advocacy matter, and matter greatly. Data and innovation, without the recognition of political power and advocacy, is in vain. The school suspensions battle was a perfect illustration of this point, as youth leaders and youth advocacy organizations utilized suspension data that demonstrated a disproportionate impact on African-American and Latino young men as a result of the practices.

In Building Healthy Communities we’ve decided to be clear; we want to help community leaders and residents build the power they need to promote healthier places for young people. We want to support people and organizations that think power, act with power and demand change. Power concedes nothing without demand, and as Douglass added, it never has and it never will.

Tomorrow, in part 2 of this series, Dr. Robert Ross discusses 10 lessons learned on the path to community engagement.

--Robert K. Ross, M.D.

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Thank you for not only leading by example, but sharing lessons and practices with a wider audience.

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