1Community Participation, Civic Capacity & Neighborhood Identity Findings from Focus Groups and Written ElicitationsApril 3, 2008Commissioned byThe Center for Health Equity,Louisville Metro Department of Public Health & Wellness
2PURPOSE OF COMMISSION A social marketing campaign Increase the community participation of west Louisville residents by …………..Reducing the barriers and,Highlighting the benefits according toThe specific needs, values, beliefs, practices and interests of the residents.
3Investigative Framework To improve health and reduce health inequities requires changes in public policy and the arrangements in society that support inequality.If residents of the City [State, Nation] understand and support policy goals, change and progress are more likely.To change policies and societal arrangements that support inequality communities must have the capacity to engage civically.We currently have group differences in the civic capacity of some communities and sectors, i.e., corporations, high income vs. low income communities, etc.How do we rectify imbalances in civic participation and civic power?
4Civic Engagement Participation Formal and informal Social and PoliticalOrganized community lifeThe capacity of people to organize in ways that bring about dialogue with and/or challenge a system.May include individual or group actsAttending public meetingsWriting a letter to the paper or government officialSigning a petition, etc.VotingCivic engagement and participationConfront & organize to address community issuesLead to the ultimate goal of community practices for social justice.
5Civic Capacity Building Strengthens the ability of community organizations and groupsBuild their knowledge, structures, systems, people and skills so they are better able to define and achieve their objectivesTraining, education, resource identification and resource building, organizational and personal developmentPromotes sustainability and strengthens internal and external or bridging and linking social capitalSocial capital refers to connections among individuals—social networks and the norms of reciprocity and trustworthiness that arises from them; Both private and public goodRefers to both networks and people, as well as the relationship between people and institutions.Involves extensive and dense ranges of relatively weak ties—channels of communication with a large number of people both inside and outside a community.
6Goals Civic Engagement Mobilize residents to become civically engagedIdentify issuesExamine issuesAsk questionsOrganizeTake actionBe responsible for what they can control
7MEASURING CIVIC CAPACITY Political EfficacySocial CohesionSocial CapitalCollective Self Efficacy
9Policies that Reduce Policies that Reduce Availability of Affordable QualityHousingPolicies that ReduceAvailability ofFinancial ResourcesGovernment PoliciesStress AssociatedWith Income andHousing InsecurityDirect Material Effects of IncomeDirect Material Effects of Poor Quality HousingHealth Status:Increased Morbidityand Mortality
10Strategy and Research Part One Exploring current “landscape” of public understanding (focus groups, written elicitations)Part TwoMessage development (new “lenses” on the issue - explanations in particular)Message testing - evaluating effectiveness (online, and in-person
11Research QuestionsHow do Louisvillians currently think about community participation?What role does neighborhood identity play?What are the key obstacles to increasing participation?Are there promising directions for moving forward?
12Methods Links between topics Topics that aren’t thought about Focus groupsRecorded, transcribedWritten elicitationsLooking for shared thinking patterns, e.g.:Links between topicsTopics that aren’t thought aboutIdeas that seem importantDifferences between how we want people to think and what they think
13Subjects Louisville residents Non-experts, non-activists 13 women and 7 men9 conservative, 10 liberal, 1 moderate12 White, 6 Black, 1 Hisp, 1 Nat.Am.Mix of ages, educational backgroundsFrom lifetime residents to newcomers
14FORMAT & SUBJECTS Focus groups Six groups 2 hours Incentive $50 Videotaped, audio taped, transcriptPre-ScreenedFocus Group questionnaireHomeowners 8Low Income 7N.E. Christian 6Portland 5St. Stephen’s 6Youth
18GROUPS 1 group of young adults Ages 18-24 African American 1 group from Northeast ChristianAdults1 group from St. Stephen’s1 group of adults from PortlandWhite2 groups of adults from W. LouisvilleAfrican AmericanLow incomeMiddle income
19Expert View: External Factors Health OutcomesSocial determinants play a key role in determining health.
20Expert View: External Factors HousingEconomic opportunityEducationWork status…Health OutcomesDiabetesCancerBlood pressureObesity…Social determinants play a key role in determining health.
21Actual Interpretation: Right Choices HealthierLess HealthyCHOICESGROUP AGROUP BGROUP CCharacter, Knowledge, Culture, Priorities, ValuesPublic assumes a different causal story: RIGHT CHOICES
22Actual Interpretation: Right Choices HEALTH OUTCOMESA “User-friendly” Conceptual Model: simple, easy to understand – seems like the whole storyA Moral Model: Not just how things do work, but how they should work – outcomes seem fair
23A Limiting, Distorting Lens HEALTH OUTCOMESQ: Some people say the city of Louisville should do more to close the gap between those who are in good health and those in ill health. What do you think?A: I think people need to eat better, exercise more, I think that’s a big issue here in Kentucky. The way we live. The way we eat. The way we don’t exercise, a lot of it is [contributing] to being overweight.Conservative African-American woman, age 64
24A Limiting, Distorting Lens HEALTH OUTCOMES[You] need to choose a different outlook and then from that different outlook that will perhaps guide you towards a healthier life ... If people understood they actually do have some amount of power – some amount of control in their lives, then that would be a healthier place to start – a healthier viewpoint.Liberal white man, age 31Note: Choices matter, but they’re not the whole story.
25A Limiting, Distorting Lens HEALTH OUTCOMESQ: If you had to take a guess on what groups of people in Louisville would be healthier and what groups would be less healthy, what do you think?A: The couch potatoes would be less healthy.Conservative white woman, age 71
26A Limiting, Distorting Lens HEALTH OUTCOMESBlacks don’t take care of themselves right. That’s why there’s more health problems with Blacks than Whites, because they just don’t take care of themselves right. They don’t eat right. They don’t exercise. They don’t go to the doctor like they should. That’s the problem with Blacks.Conservative African-American woman, age 44
27A Limiting, Distorting Lens HEALTH OUTCOMESEating habits is one of the biggest things that’s causing most of the diabetes and stuff like that, because unfortunately the Black race has a rich diet. It’s got a bunch of grease in it and that’s causing cholesterol and all those stuff. Once we get educated on it we will be able to do better.Conservative African-American man, age 60
28A Limiting, Distorting Lens HEALTH OUTCOMESI think it has a lot to do with [African-American] culture. I’m being stereotypical, but based on what I know, they are OK with the bodies that they have. Some Black people have great bodies. Other Black people are bigger … but they’re okay with themselves, and I think White people have a harder image of what they need to live up to. There’s more of a pressure on White people, because we’re the dominant race.Liberal White woman, age 22
29A Moral LensQ: Do you think we as a society owe every person some kind of help for being healthy? Is something like that a right to have?A: No. Not as a society, because see a lot of times people cause their health problems by the way they live.Conservative African-American man, age 60It’s your own personal responsibility to do what you can to improve your health and keep yourself healthy ... If I’m going out, [if] I smoke a lot, if I’m carrying on excess weight or if I have four or five alcoholic drinks every day – I’m making that decision. That’s my choice, so I’m hurting myself. I think there’s too much of people not taking responsibility for their actions and just letting it go and thinking, well, you know, let somebody else take care of me.Moderate White woman, age 75
30Response to Causal Claims External FactorsHousingEconomic opportunityEducationWork status…Health OutcomesDiabetesCancerBlood pressureObesity…
31Response to Causal Claims Health OutcomesDiabetesCancerBlood pressureObesity…External FactorsHousingEconomic opportunityEducationWork statusExternal factors as outcomes, not causes (people create their own poverty, racial isolation)A lot of discrimination is self-imposed ... [Blacks] get 25 years old and they don’t have an education, they don’t know how to speak properly. Mainstream isn’t going to take them in, because they’re not mainstream.Conservative White man, age 29
32Response to Causal Claims Health OutcomesDiabetesCancerBlood pressureObesity…External FactorsHousingEconomic opportunityEducationWork statusExternal factors as obstacles that should be overcome (many examples of people doing fine)You can still make a way if you try. I’ve seen people do it It’s all based on your choices.Liberal White woman, age 30
33RIGHT CHOICES Summary Comfort with disparities Resistance to Causal ClaimsRight Choices as a powerful lens with no real competition
34Where “Right Choices” Comes From Natural tendency to think “Little Picture”American emphasis on Individualism, Personal Responsibility (to exclusion of other views)Reinforcement in the media
35“Right Choices” in the News Media “tells the story” through choice of stories, language, images, etcRight Choices as a natural reading, even when it’s not stated directlyTroutman, who is nationally known for his work fighting racial health disparities, said there are complex factors behind the problem such as poverty, access problems and discrimination.Jesse Penick, a 41-year-old African American getting a checkup at the Portland clinic this week cannot resist eating such foods as pork chops and fried chicken. "It's kind of hard to eat right," he said.Courier-Journal, 12/24/05
36Opportunities This report has so far focused on the “bad news.” The research also suggested very promising ways of moving forward.
37Opportunities Health gradient Approaches with the potential to bring about a shift in thinkingHealth gradientIt’s about everyone – avoids traps about groupsPotentially a clear and concrete ideaA totally new idea - potential for “aha!” effect?Very clear causal storiesi.e. that can “compete” with Right Choices
38Opportunities Frame social determinants as Opportunities for health Convey a “Positive Vision”Clear, practical image of interventions that can succeed
39Opportunities Familiar case studies where it’s impossible to pin blame on individualsE.g. lack of green space? lack of full service grocery stores? Rubbertown?
40Recommendations So Far Ask the following question about every communication:Does it allow people to focus on individual choices/behaviors?Don’t bother focusing on disparities per se.Talk about practical and effective changes/interventions
41Recommendations So Far Make causal stories as concrete and irresistible as possible
45What are We Dealing With? Many of the inequalities in health- are due to inequalities in the social conditions in which people live and work.Valentine, et. al, PloS Medicine 2006; 3(6): e106. TH commission on the Social Determinants of HealthTackling these conditions- social determinants health- underlying causes of poor health can contribute to improving health and health equity.
46Central Questions? Why are you civically active? Why are you not civically active?What is your view of west Louisville?What issues concern you?Parameters for this discussionLocal economyNeighborhoodsYour familyJobs, wagesEducational opportunities
47What Ideas or Theories Do We Want To Explore? What are their views of West Louisville?What Issues concern them?Why do they participate or not participate?
48Why Do Individuals Elect Not To Participate? Because They Can’t……Legal restrictionsIntimidation, fear, road blocksSystem makes participation/voting difficultInternalized powerlessness or racismBecause They Don’t Want to…Will this do any good?Is this effective in achieving economic or non-economic benefits?Self-interestIs there a perceived benefit?Can I trust the people in power?Attitude influences participationBecause Nobody AskedMobilization Theory- participation is based on contextual cues and political opportunities in the environment of the individual- media messages, campaign spending, conversations with friends/neighbors, etc.Participation influences political attitude, efficacy, and sophisticationMobilization mediates the effects of SES and attitudes on participation.Mobilization accounts for approximately half of the decline in voter turnout since 1960.Sidney Verba, Kay L. Schlozman, Henry Brady and Norman Nie, “Resources and Political Participation,” paper prepared for the 1991 annual meetings of the American Political Science Association
49Expected Outcomes A report: How people in west Louisville think about civic participation [in comparison to…..]A look at the issues that concern themHow they think about west Louisville Recommended messages and activitiesPreliminary ideas for a communication strategyPreliminary ideas for evaluationBe prepared to grow, change, and make midcourse corrections based on our observations.
50Recruitment How & Who? 1 group of young adults Ages African American1 group of adults from PortlandWhite2 groups of adults from W. LouisvilleAfrican AmericanLow incomeMiddle income
51Deliberation An exchange of views What is my position and experience on this?Jointly digesting and reflecting on information, factsDialogueReflect on common goodOffer reasons why others should change their mindsMay be unable to find a common positionOnly if worldviews are incompatibleAnd reasonable
52THEORY Old Theory SES Model Attitudes Behavior Political Action Resources-time, money, skillsNew Theory and IdeasMobilization ModelThe quality and type of participation affects another kind of participationSES still affects action & behaviors but we now know that ….ParticipationPolitical Attitudes & EfficacyMobilizationMobilization mediates the effects of SES and attitudes on participation.Mobilization accounts for approximately half of the decline in voter turnout since 1960.
53THEORY (cont’d) Deliberative Discussions Civic Participation EngagementParticipationA VoiceAgencyBoth externally and internally drivenAttitudes, resources – time, money skills- mobilization,informal political discussion, etc.Not simply voting –consider context, kinds of actions, over what period of time and constraints….may be organizing, mobilizing for collective action…Leighley, J. Attitudes, Opportunities and Incentives: A Field Essay on Political Participation, Political Research Quarterly, Vol. 48, No. 1 Mar. 1995,
54Building Civic Capacity Teach and demonstrate the importance of democratic practices at the community levelPremise: people--citizens of their own communities, can and must be the driving force and the principal agents of change for social justice and democratic practicesMethod:Format: Issue-drivenBasis: Social change discourse & deliberationCommunity Dialogues- meetings, selected readings, deliberation, critical thinking, scenario driven role-playingEvaluation- longitudinal, data-driven, with a control group [maybe] to measure social change practices, actions, and participationThe model of communication for social change [CFSC] describes an iterative process where community dialogue and collective action work together to produce social change in a community that improves the health and welfare of all of its members.
55Civic Capacity Building Community competenceConfront its own problemsStrengthens the ability of community organizations and groupsBuild their knowledge, structures, systems, people and skills so they are better able to define and achieve their objectivesTraining, education, resource identification and resource building, organizational and personal developmentPromotes sustainability and strengthens social capitalSocial capital refers to connections among individuals—social networks and the norms of reciprocity and trustworthiness that arises from them; Both private and public goodRefers to both networks and people, as well as the relationship between people and institutions.Involves extensive and dense ranges of relatively weak ties—channels of communication with a large number of people both inside and outside a community.
56Social Capital As a Process Towards Community Practice Connections among individuals, other communities, the governmentIntercommunityIntra-communitystructuralcognitiveOne person may possess social capital but it doesn’t take place unless there is more than one person.Channels of communication with a large number of people both inside and outside a community.Developing collective vs. individual action, building upon weak or neglected ties, looking for ways of getting people to plan and act togetherBridging—inclusive, outward looking and encompass people from diverse groups, better for linking to external assets and for information diffusion.Bonding—exclusive, inward looking and reinforce exclusive identities and homogeneous groups, good for specific reciprocity and mobilizing solidarity.
57Connect the Dots Down Stream--------------------------Up Stream Do We Care AboutWhat They Care About?DiabetesObesityLung CancerInfant MortalityA MessageBehavioral Risk FactorsLifestyleRelationshipsSelf-InterestsPublic Policy ProcessStructural Change
58Rational Public Policy Process Problem IdentificationGain Agenda StatusPolicy Formulation, adoption, fundingPolicy ImplementationPolicy Evaluation Adjustment, Termination
59Goals, Objectives & Theory To increase civic engagement – collective action and mobilization- at the community level through the use of dialogue, deliberation, and action.Redefine the factors that determine civic participation- attitudes, SES.Broaden the outcomes of civic engagement beyond simply voting.Motivate citizens to engage in dialogue, group will-making and collective action resulting in social change.