Module 2: Partnership

1. Module 2: Partnership Create or Enhance Your Partnership Partnership creation Partnership capacity

2. Create or Enhance Your Partnership • Topics in this module: • What are partnerships? • Why are partnerships necessary? • Strengths and challenges of partnerships • Ensuring partnership success • Building partnership capacity • Maintaining your partnership

3. What are partnerships? • Strategic relationships between two or more individuals, groups or organizations committed to pursuing an agenda or goal of mutual benefit • Partnerships come in many shapes and sizes. For this section, consider the coalition members that you have organized into a partnership. Reference: Nelson J. et al (1999)1

4. What are partnerships? Examples: A group of employees who meet once a week during lunch to discuss ways to improve healthy food options at their worksite A group of concerned citizens who work together to circulate a petition in their community to get sidewalks on neighborhood streets A coalition of individuals and organizations who work to improve health and the conditions that influence health in racial and ethnic minority communities

5. Why are partnerships necessary? No one group can accomplish the many tasks required for changing the social, economic and environmental conditions that impact health. Pool and leverage resources to maximize the impact of your efforts Increase community understanding of community needs and maximize community assets Promote community-wide change through coordination and diversity of participants Create a sustainable impact and change References: Alter C. et al (1993)2; Berkowitz B. (2000)3; Butterfoss F. et al (1996)4; Green L. et al (2001)5; Nelson J. et al (1999)6

6. Strengths of a Partnership A partnership can bring/offer: opportunities for co-learning and active participation shared risks and benefits shared accountability an ability to adequately respond to the community’s changing needs Reference: Alter C. et al (1993)2

7. Challenges of a Partnership Partnerships can be challenging because of: differences in or changes in beliefs, experiences, cultures, languages, interests, political or personal agendas and partners the inability to communicate with, engage and motivate partners fluctuating or limited resources and influence in the broader community limited commitment, availability, expertise or skills a lack of effective leadership or trust among partners

8. Ensuring Partnership Success Who to include: People who experience health inequities in the community and their family members People who are committed to the community or to improving conditions in the community Multiple sectors (e.g., policymakers, transportation, city planning, health care) of your community Perceived adversaries and/or those not supportive of past efforts

9. Ensuring Partnership Success • Identify what assets each partner brings to the table (e.g., skills, resources). • Establish and adapt (as needed) communication, decision-making, conflict resolution and leadership transition processes. • Share decision-making and delegate responsibilities. • Develop and follow ground rules and partnership principles. • Provide opportunities for active participation from community representatives, especially those who experience inequities. • Identify what is currently being done in your community and build on existing efforts.

10. Partnerships Principles • Develop trust: show respect, follow through, attend to each other’s interests and needs • Provide leadership: shared leadership, delegation, task/maintenance functions • Develop processes for shared power and influence: equity, mutual influence, co-learning, balance of power • Address conflict: necessary part of group process, identify reasons for conflict, establish norms for conflict management Reference: Israel B.A. et al (2005)7

11. Partnerships Principles • Establish shared decision-making processes: determine how decisions will be made and enable all members of the group to be engaged as appropriate • Willingness to acknowledge our own limitations. • Willingness to revisit principles and bring in new partners. References: Israel B.A. et al (2005)7; NCC Annual Retreat, NC (2009)8

12. Building Partnership Capacity What is partnership capacity? The individual, organizational, and structural resources that influence your partnership’s ability to carry out its activities

13. Building Partnership Capacity What is partnership capacity? The individual, organizational, and structural resources that influence your partnership’s ability to carry out its activities Why is it important? To identify areas where your partnership is doing well in addition to areas that need improvement

14. Building Partnership Capacity Consider the following: • What is the demographic makeup of your partnership? • Have you and your partners clearly described what you want to do? • Does your partnership speak with a unified voice? • Does your partnership have physical space and other resources for day-to-day activities?

15. Module 4: Approaches

16. Module 4:Approaches Social action Consciousness- raising Media advocacy Community development Structural change Health promotion Selecting your Approach for Change

17. Selecting your Approach Consciousness Raising: How do social determinants of health connect with my individual experience Community Development: How can we enhance community power within change processes How do we actually create changes Health promotion and policy and environmental change Media advocacy Social action

18. Forms of Community Involvement and Decision-Making • Community-driven: community members collectively leading decision-making processes to plan and implement actions • Community mobilization: organizing community members and leveraging resources for collective action; may or may not be led by local champions or “outsiders” • Community engagement: engaging the community in the decision-making process at different levels to address an issue

19. Consciousness Raising What is consciousness raising? A process through which a common understanding of the relationship between individual or group experiences or concerns and the social or structural factors that influence them is created Why do you use consciousness raising? To increase dialogue about the underlying factors and causes To increase community-wide support for addressing specific health inequities

20. Consciousness Raising When do you use consciousness raising? When group members have a different understanding of how social and structural factors influence health When the partnership is developing goals and objectives for changes in specific social determinants When bringing groups together for action

21. Consciousness Raising How do you implement consciousness raising? Share experiences Present hypothetical situations Generate discussion Encourage critical reflection References: Minkler M. et al (2002); Rothman J. (1970); Speeter G. (1978)

22. Community Development A community-led set of processes or efforts to create community change at the local level through strengthening social ties, increasing awareness of issues affecting the community and enhancing community member participation in addressing these issues What is community development? Photo provided by the CDC REACH program: CHA, Sharon Burns, distributes information to seniors in North Charleston.

23. Community Development Why do you use community development? To establish mechanisms through which group members enhance their recognition of and their ability to use their power to create a change in a common concern Photo provided by the CDC REACH program: CHAs Sharon Burns and Virginia Thomas with Jenne Batten Golden Girls in North Charleston at a community center. • When do you use community development? • When using a more participatory approach as opposed to one that relies on public health or other outside experts taking the lead

24. Community Development How do you implement community development? Community members take the lead “Outsiders” (e.g., public health practitioners, researchers and organizers) assist community members in the process References: Minkler M. et al (2002); Rothman J. (1970); Speeter G. (1978)

25. Community-Based Participatory Approaches (CBPA) A process that equitably involves community members, organizational representatives, and research and health professionals in all aspects of program and evaluation activities Minkler and Wallerstein (2003)

26. Community-Based Participatory Approaches • Acknowledge community as a unit of identity • Build on strengths and resources within the community • Facilitate a collaborative, equitable partnership engaging in power-sharing processes that attends to social inequities • Foster co-learning and capacity building among all partners • Integrate and achieve a balance between knowledge generation and intervention for the mutual benefit of all partners • Focus on the local relevance of public health problems and on ecological perspectives that attend to the multiple determinants of health • Involve systems development using a cyclical and iterative process • Disseminate results to all partners and involve them in the wider sharing of lessons learned • Involve a long-term process and commitment to sustainability Reference: Israel, et al (2005)

27. Health Promotion What is health promotion? Activities designed to help people improve their health or prevent illness and that acknowledge the interaction of environments, lifestyle and behavior If targeting social determinants, focus on organizational, policy or environmental changes that facilitate positive health outcomes Photo provided by the CDC REACH program

28. Health Promotion Why do you use health promotion? To raise awareness in your community To improve access to quality resources and services To build supportive policies and environments Photo provided by the CDC REACH program

29. Health Promotion • When do you use health promotion? • When there are individual (e.g., knowledge, attitudes, skills) social and environmental (e.g., access to healthy and affordable foods) determinants that influence behavior and health outcomes

30. Health Promotion How do you implement health promotion? Work with partner organizations to provide opportunities for economic development Enhance cultural competency among health educators Increase access to interpretive services Impact the social and built environment to facilitate health enhancing behaviors Use participatory approaches to work with the community

31. Health Promotion Consider the following: Quality of existing social ties and culture within and among organizations and how new social ties can be created Physical environment Availability of resources Reference: Green L.W. et al (1991)

32. Policy and Environmental Change What is policy change? Any change in the formal and/or informal rules or regulations that govern our collective daily life (may be organizational, local, state, regional, national or international) What is environmental change? Any change in the physical or built environments that influence our behavioral choices and/or health

33. Policy Change Why do you use policy change? To improve the quality of programs and services To improve equitable access to opportunities for healthy choices When do you use policy change? When you want to impact groups of people rather than individuals When there is an inequitable distribution of infrastructures and resources

34. Policy Change • How do you implement policy change? • Develop a list of key decision makers to contact based on their interest in the issue or their political position • Identify a champion for policy change • Educate decision makers about how policy initiatives can promote health equity • Encourage community members to advocate for change • Engage decision makers and organizations in implementing change

35. Policy Process

36. EnvironmentalChange Why do you use environmental change? To improve equitable access to opportunities for healthy choices To eliminate environmental toxins or pollutants harmful to health When do you use environmental change? When you want to impact groups of people rather than individuals When there is an inequitable distribution of infrastructures and resources

37. Environmental Change • How do you implement environmental change? • Develop a list of key decision makers to contact based on their interest in the issue • Identify a champion for environmental change • Educate decision makers about how environmental initiatives can promote health equity • Encourage community members to advocate for change • Engage decision makers, organizations, and community members in implementing change • Ensure that the construction designs and plans are created • Ensure that sufficient funds are allocated

38. Media Advocacy What is media advocacy? Strategic use of media coverage to encourage social, economic or environmental change Why do you use media advocacy? To influence norms, policies and collective responses by the community To reach large audiences and capture attention of decision makers

39. Media Advocacy When do you use media advocacy? When increasing public understanding of specific health issues When reframing public health concerns as the result of community rather than individual causes or problems When high visibility is desired and debate or discussion is useful

40. Media Advocacy How do you develop a media advocacy campaign? Identify your goals, objectives and main audience Develop and tailor messages to your specific audience with input from community members and partners Invite media representatives to become involved in the process Consider the most appropriate media outlets Identify the problem and offer strategies to address it Continue media efforts through additional outlets Reference: Wallack L. et al (1993)

41. Social Action What is social action? An approach that focuses on altering social relationships or resources by explicitly highlighting inequities in social factors related to health Why do you use social action? To influence attitudes and emotional responses and to effect a solution When do you use social action? When bringing attention to a problem

42. Social Action How do you implement social action? Provide accurate, relevant information and data to help develop the messages conveyed through social action activities Identify appropriate audiences for a particular message Organize media coverage of the event Ensure public officials are made aware of the event References: Minkler M. et al (2002); Rothman J. (1970); Speeter G. (1978)

43. Selecting your Approach(es) You may consider one approach or the combination of several approaches to increase the likelihood of change. Prioritize the approaches with your partners – you may choose to use different approaches at various times.

44. Selecting your Approach(es) Consider the following: Which of the approaches are appealing? What is the benefit of using each approach? What are the potential drawbacks to each approach? What approaches have a good fit with our goals and objectives, setting and community? Do the experiences, resources and other supports in our partnership point to a specific approach? Which approach seems best suited to address your issue and the context within which you are working (e.g., history, current and past relationships among groups, community interest, energy, availability)?

45. Questions and Discussion

46. References Green LW, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. Mountain View, CA: Mayfield Publishing Company; 1991. Harrington C, Estes C. Health Policy. 4th Edition. Boston: Jones & Bartlett Publishers; 2004. Israel BA, Eng E, Schulz AJ, Parker EA, editors. Methods in Community-Based Participatory Research for Health. San Francisco: John Wiley & Sons; 2005. Minkler M, Wallerstein N. Improving health through community organization and community building: a health education perspective. In: Minkler M, editors. Community Organizing and Community Building for Health. New Brunswick, NJ: Rutgers University Press; 2002:30–67. Ottawa Charter for Health Promotion. First International Conference on Health Promotion, 1986. Available at http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf Rothman J. Three models of community organization practice. In: Cox F, Erlich J, Rothman J, Tropman J, editors. Strategies of Community Organization: Macro Practice. Itasca, IL: Peacock Publishers Inc; 1970:20–35. Speeter G. Power: A Repossession Manual - Organizing Strategies for Citizens. Amherst, MA: University of Massachusetts at Amherst; 1978. Wallack L, Dorfman L, Jernigan D, Makani T. Media Advocacy and Public Health: Power for Prevention. Newbury Park, CA: SAGE Publications; 1993.