Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA.
Bridge Maryland, Baltimore, Maryland, USA.
Am J Community Psychol. 2024 Jun;73(3-4):390-407. doi: 10.1002/ajcp.12708. Epub 2023 Oct 9.
To achieve health equity, there is a need to act on the social determinants of health. This reality is now understood more widely, and in greater detail, than ever. Amid this movement toward health equity, there has been a natural gravitation to community organizing, which has long worked to produce more equitable systems and policies. Community organizing builds power through cycles of listening, participatory research, collective action, and reflection. One manifestation of this power is that organizing initiatives can often influence which issues are up for public debate, and the terms of those debates. This dimension of community power is often described by practitioners as narrative change work, and involves intervening on, complicating, and resisting dominant societal narratives that hinder action on the systems that perpetuate inequity. This article reports results from a study of organizing initiatives in Detroit, MI and Cincinnati, OH which both engaged in intentional narrative change work around health and health equity. We analyzed data from interviews with 35 key leaders across both cities. Results describe the organizational processes and activities taking place in both sites, with an emphasis on one issue in each city: educational equity in Cincinnati and water equity in Detroit. We then use coded interview data to examine how narrative change work took place in organizing around these issues during the COVID-19 pandemic, a challenging time for organizing initiatives. Results provide insights into adaptations taking place in community organizing during this time, as well as various approaches to narrative change work as part of holistic efforts to build and exercise community power to alter social determinants of health.
为了实现健康公平，需要针对健康的社会决定因素采取行动。这一现实比以往任何时候都更加广泛和详细地被人们所理解。在向健康公平迈进的过程中，人们自然而然地倾向于社区组织，因为社区组织长期以来一直致力于创建更公平的制度和政策。社区组织通过倾听、参与式研究、集体行动和反思来建立权力。这种权力的一种表现形式是，组织倡议通常可以影响哪些问题可供公众辩论，以及这些辩论的条件。社区权力的这一方面经常被从业者描述为叙述性变革工作，它涉及干预、复杂化和抵制阻碍针对造成不公平的制度采取行动的主导社会叙述。本文报告了密歇根州底特律和俄亥俄州辛辛那提的组织倡议的研究结果，这两个城市都围绕健康和健康公平进行了有意的叙述性变革工作。我们分析了来自两个城市 35 位主要领导人的访谈数据。结果描述了两个地点的组织过程和活动，重点介绍了每个城市的一个问题：辛辛那提的教育公平和底特律的水公平。然后，我们使用编码访谈数据来研究在 COVID-19 大流行期间，围绕这些问题的组织中如何进行叙述性变革工作，COVID-19 大流行对组织倡议来说是一个充满挑战的时期。结果提供了在这段时间社区组织中发生的适应变化的见解，以及作为构建和行使社区权力以改变健康的社会决定因素的整体努力的一部分的各种叙述性变革工作方法。
