Public health practitioners in government, academia, and nonprofits are developing innovative approaches to shifting power and building community power, addressing a fundamental cause of health inequities.

Public health scholars and organizations are recognizing power as a fundamental driver of health inequities. Power imbalances manifest as social injustices across multiple determinants of health, including housing, education, employment, and criminal justice. We are witnessing the impact of these injustices amidst the multiple crises that communities currently face—the layered effects of COVID-19, its variable impacts across race and place, renewed social unrest and struggles over civic exclusion, heightened debates about the role of government, and insufficient resourcing of essential public agencies.

This moment presents unique opportunities for public health to practice in new ways. Given increased calls to address power, public health professionals can benefit from concrete guidance and examples of what that looks like in action. In our practice report, we introduce a pragmatic framework for understanding power and highlight case examples of how public health practitioners in government, academic, and nonprofit settings are working to shift power and build community power.

What do we mean by power and community power?

Power can be defined as the capacity to act, individually and collectively, to shape our world. Power imbalances underlie structures of oppression, such as systemic racism, leading to persistent inequities. We use the term community power to mean “the ability of communities most impacted by structural inequity to develop, sustain, and grow an organized base of people who act together through democratic structures to set agendas, shift public discourse, influence who makes decisions, and cultivate ongoing relationships of mutual accountability with decision makers that change systems and advance health equity.” (See Leading Locally: A Community Power-Building Approach to Structural Change)

There are many potential approaches to building and shifting power. We describe the Three Faces of Power framework as a helpful way to understand actions to shift power according to three faces:

1. Exercising influence in formal decision-making processes;

2. Organizing the decision-making environment; and

3. Shaping worldviews about social issues.

Concrete examples illustrate how public health professionals can play a role in shifting conditions of power to create more equitable outcomes.

What does shifting power and building community power look like in public health practice?

The first face of power involves organizing people and resources to influence public or formal decision-making processes through direct action to achieve a particular outcome. One example we highlight includes partnerships between Human Impact Partners, a public health nonprofit, and coalitions of community organizers to conduct health impact assessments on paid sick leave. Using the findings, they drew media attention to the issue, advocated for policy change, and supported community organizers by testifying at legislative hearings in several states. These joint efforts contributed to paid sick leave policies being passed in jurisdictions across the country.

The second face of power involves influencing who can access decision making and what issues are considered by decision-making bodies. This involves building long-term civic infrastructure that helps shape public agendas and resource distribution. We describe examples from criminal justice reform efforts in Wisconsin, including partnership between community organizers and academic researchers to reframe criminal justice issues through a health lens in state policy conversations. These efforts established lasting networks of public health, criminal justice, and organizing partners that continue to shape public agendas around criminal justice reform in the state.

The third face of power involves shaping information, beliefs, and worldviews about social issues. This happens through uplifting public narratives—collections of deeply rooted stories in our collective consciousness that transmit values and ideas about how the world works. We share examples including how the Minnesota Department of Health developed equity narratives on a range of social and economic issues and trained over 1,500 public health professionals and partners in narrative strategy. Narratives were incorporated into the State Health Improvement Plan and helped advance state minimum wage legislation and local paid leave policies.

Why is this important?

To truly move the needle on equity, we must take action to shift power and build community power. Public health organizations, leaders, and professionals can learn from and build on these existing, innovative approaches to establish new practices. The time is ripe to commit to the difficult and long-term community power-building work that is required to achieve equitable outcomes.

For more discussion and examples of community power building in action, read our full practice report in the Journal of Public Health Management and Practice:

• Theory in Action: Public Health and Community Power Building for Health Equity