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Community Participation,Civic Capacity & Neighborhood
Identity
Findings from Focus Groups and Written Elicitations
April 3, 2008Commissioned by
The Center for Health Equity, Louisville Metro Department of Public Health & Wellness
PURPOSE OF COMMISSION
• A social marketing campaign
• Increase the community participation of west Louisville residents by …………..
• Reducing the barriers and,
• Highlighting the benefits according to
• The specific needs, values, beliefs, practices and interests of the residents.
Investigative Framework1. To improve health and reduce health inequities requires
changes in public policy and the arrangements in society that support inequality.
2. If residents of the City [State, Nation] understand and support policy goals, change and progress are more likely.
3. To change policies and societal arrangements that support inequality communities must have the capacity to engage civically.
4. We currently have group differences in the civic capacity of some communities and sectors, i.e., corporations, high income vs. low income communities, etc.
5. How do we rectify imbalances in civic participation and civic power?
Civic Engagement Participation
Formal and informal Social and Political Organized community life
The capacity of people to organize in ways that bring about dialogue with and/or challenge a system.
May include individual or group acts Attending public meetings Writing a letter to the paper or government official Signing a petition, etc. Voting
Civic engagement and participation Confront & organize to address community issues Lead to the ultimate goal of community practices for
social justice.
Civic Capacity Building Strengthens the ability of community
organizations and groups – Build their knowledge, structures, systems,
people and skills so they are better able to define and achieve their objectives
Training, education, resource identification and resource building, organizational and personal development
Promotes sustainability and strengthens internal and external or bridging and linking social capital
Goals Civic Engagement– Mobilize residents to become civically
engaged• Identify issues• Examine issues• Ask questions• Organize• Take action• Be responsible for what they can control
MEASURING CIVIC CAPACITY
• Political Efficacy
• Social Cohesion
• Social Capital
• Collective Self Efficacy
How Does this Affect Health?
Policies that Reduce Availability of
Affordable QualityHousing
Stress Associated With Income and
Housing Insecurity
Health Status: Increased Morbidity
and Mortality
Policies that Reduce Availability of
Financial Resources
Government Policies
Direct Material Effects of Poor
Quality Housing
Direct Material Effects of Income
Strategy and Research
• Part One– Exploring current “landscape” of public
understanding (focus groups, written elicitations)
• Part Two– Message development (new “lenses” on the issue
- explanations in particular)
– Message testing - evaluating effectiveness (online, and in-person
Research Questions
• How 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?
Methods
• Focus groups
– Recorded, transcribed
• Written elicitations
• Looking for shared thinking patterns, e.g.: – Links between topics – Topics that aren’t thought about– Ideas that seem important– Differences between how we want people to
think and what they think
Subjects
• Louisville residents• Non-experts, non-activists• 13 women and 7 men• 9 conservative, 10 liberal, 1 moderate• 12 White, 6 Black, 1 Hisp, 1 Nat.Am. • Mix of ages, educational backgrounds• From lifetime residents to newcomers
FORMAT & SUBJECTS
• Focus groups– Six groups – 2 hours– Incentive $50– Videotaped, audio
taped, transcript• Pre-Screened• Focus Group
questionnaire
• Homeowners 8• Low Income 7• N.E. Christian 6• Portland 5• St. Stephen’s 6• Youth 18-24 3
SUBJECTS
• Ages– 18-24 three– 30-50 fourteen– > 50 eighteen
• Gender– Female 19– Male 16
• Home ownership– Own 19– Homeless 1– Rent 13– Unknown 2
• Race– African American
25– White
9– Hispanic
1
SUBJECTS
• Education Levels– College graduate
6– Graduate degree
5– High school
15– Professional degree
1– Some college
6– Unknown
2
• Income• > $75 3• $50-75 4• $35-50 6• $10-15 2• $15-20 2• $20-25 4• $25-35 6
GROUPS• 1 group of young adults
– Ages 18-24 African American• 1 group from Northeast Christian
– Adults• 1 group from St. Stephen’s
– Adults• 1 group of adults from Portland
– White• 2 groups of adults from W. Louisville
– African American – Low income– Middle income
Health OutcomesExternal Factors
Expert View: External Factors
Social determinants play a key role in determining health.
Health Outcomes
DiabetesCancer
Blood pressureObesity
…
External Factors
HousingEconomic opportunity
EducationWork status
…
Expert View: External Factors
Social determinants play a key role in determining health.
Actual Interpretation: Right Choices
Public assumes a different causal story: RIGHT CHOICES
CHOICES
Character, Knowledge, Culture, Priorities, Values
Healthier
Less Healthy
GROUP A
GROUP B
GROUP C
CHOICES
Actual Interpretation: Right Choices
A “User-friendly” Conceptual Model: simple, easy to understand – seems like the whole story
A Moral Model: Not just how things do work, but how they should work – outcomes seem fair
HEALTH OUTCOMES
A Limiting, Distorting Lens
HEALTH
OUTCOMES
Q: 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
A 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 31
Note: Choices matter, but they’re not the whole story.
A Limiting, Distorting Lens
HEALTH
OUTCOMES
Q: 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
A Limiting, Distorting Lens
HEALTH
OUTCOMES
Blacks 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
A Limiting, Distorting Lens
HEALTH
OUTCOMES
Eating 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
A Limiting, Distorting Lens
HEALTH
OUTCOMES
I 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
A Moral Lens
Q: 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 60
It’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
Response to Causal Claims
Health Outcomes
DiabetesCancer
Blood pressureObesity
…
External Factors
HousingEconomic opportunity
EducationWork status
…
Response to Causal Claims
• External 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
Health Outcomes
DiabetesCancer
Blood pressureObesity
…
External Factors
HousingEconomic opportunity
EducationWork status
…
Response to Causal Claims
• External 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
Health Outcomes
DiabetesCancer
Blood pressureObesity
…
External Factors
HousingEconomic opportunity
EducationWork status
…
RIGHT CHOICES Summary
• Comfort with disparities• Resistance to Causal Claims• Right Choices as a powerful lens with no real
competition
Where “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
“Right Choices” in the News
• Media “tells the story” through choice of stories, language, images, etc
• Right Choices as a natural reading, even when it’s not stated directly
Troutman, 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
Opportunities
This report has so far focused on the “bad news.”
The research also suggested very promising ways of moving forward.
Opportunities
Approaches with the potential to bring about a shift in thinking
• Health gradient– It’s about everyone – avoids traps about groups– Potentially a clear and concrete idea– A totally new idea - potential for “aha!” effect?
• Very clear causal stories– i.e. that can “compete” with Right Choices
Opportunities
• Frame social determinants as Opportunities for health
• Convey a “Positive Vision”
– Clear, practical image of interventions that can succeed
Opportunities
• Familiar case studies
– where it’s impossible to pin blame on individuals
– E.g. lack of green space? lack of full service grocery stores? Rubbertown?
Recommendations 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
Recommendations So Far
• Make causal stories as concrete and irresistible as possible
Building Civic Capacity, Engagement, and Action
What 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 Health
• Tackling these conditions- social determinants health- underlying causes of poor health can contribute to improving health and health equity.
Central 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 discussion• Local economy• Neighborhoods• Your family• Jobs, wages• Educational opportunities
What 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?
Why Do Individuals Elect Not To Participate?
Because They Can’t……– Legal restrictions
• Intimidation, fear, road blocks– System makes participation/voting difficult
• Internalized powerlessness or racism Because They Don’t Want to…
– Will this do any good?• Is this effective in achieving economic or non-economic benefits? • Self-interest • Is there a perceived benefit?
– Can I trust the people in power?– Attitude influences participation
Because Nobody Asked– Mobilization 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 sophistication– Mobilization 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
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 strategy Preliminary ideas for evaluation
Be prepared to grow, change, and make midcourse
corrections based on our observations.
Expected Outcomes
RecruitmentHow & Who?
• 1 group of young adults – Ages 18-24 African American
• 1 group of adults from Portland– White
• 2 groups of adults from W. Louisville – African American – Low income– Middle income
Deliberation• An exchange of views
– What is my position and experience on this?• Jointly digesting and reflecting on information, facts• Dialogue
– Reflect on common good– Offer reasons why others should change their
minds• May be unable to find a common position
• Only if worldviews are incompatible• And reasonable
THEORY Old TheorySES Model
Attitudes Behavior
Resources-time, money, skills Political Action
New Theory and IdeasMobilization Model
•The quality and type of participation affects another kind of participation
•SES still affects action & behaviors but we now know that ….
Participation Political Attitudes & Efficacy
•Mobilization mediates the effects of SES and attitudes on participation.
Mobilization
•Mobilization accounts for approximately half of the decline in voter turnout since 1960.
Civic Engagement
Agency A Voice
Deliberative Discussions
Participation
Both externally and internally driven
Attitudes, resources – time, money skills- mobilization, informal political discussion, etc.
Leighley, J. Attitudes, Opportunities and Incentives: A Field Essay on Political Participation, Political Research Quarterly, Vol. 48, No. 1 Mar. 1995, 181-209.
Not simply voting –consider context, kinds of actions, over what period of time and constraints….may be organizing, mobilizing for collective action…
THEORY (cont’d)
Building Civic Capacity
Teach and demonstrate the importance of democratic practices at the community level
Premise: people--citizens of their own communities, can and must be the driving force and the principal agents of change for social justice and democratic practices
Method:– Format: Issue-driven– Basis: Social change discourse & deliberation– Community Dialogues- meetings, selected readings, deliberation,
critical thinking, scenario driven role-playing
Evaluation- longitudinal, data-driven, with a control group [maybe] to measure social change practices, actions, and participation
Civic Capacity Building
Community competence
– Confront its own problems Strengthens the ability of community
organizations and groups
– Build their knowledge, structures, systems, people and skills so they are better able to define and achieve their objectives
Training, education, resource identification and resource building, organizational and personal development
Promotes sustainability and strengthens social capital
Social Capital As a Process Towards Community Practice
Connections among individuals, other communities, the government– Intercommunity– Intra-community– structural– cognitive
One 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.
Connect the Dots
Down Stream--------------------------Up Stream
DiabetesObesityLung CancerInfant Mortality
Do We Care About What They Care About?
Relationships
Self-Interests
A MessageBehavioral Risk FactorsLifestyle
Structural Change
Public Policy Process
Rational Public Policy Process
Problem Identification
Gain Agenda Status
Policy Formulation, adoption, funding
Policy Implementation
Policy Evaluation Adjustment, Termination
Goals, 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.
