Community Engagement, Mental Models, and Systems Transformation

Community engagement is widely acknowledged as an essential component of public health and systems change work. Equitable community engagement:

  • Acknowledges that decisions made about policies, public benefits, and the distribution of resources will have the most impact if made in partnership with the people they affect;
  • Affirms that communities of focus have the skills, experiences, and knowledge that are vital to develop a public health system that meet their needs; and
  • Strives to design and deliver high quality and culturally appropriate services, build leadership capacity, reduce health inequities, and improve health outcomes for all residents. (Boston Public Health Commission)

For equitable community engagement to occur, communities closest to the pain or those most affected by inequities must be engaged to define the roots of the problem, illuminate the insidious ways that systems do not work for them, and build transformative solutions. This type of engagement requires power shifting, where decision makers deeply listen to, collaborate with, and defer to communities.

Equitable community engagement is possible! As we shared in a previous blog post, exciting examples of equitable decision making are taking place between municipalities and residents to inform local investments through the American Rescue Plan Act. Yet, equitable and inclusive community engagement is often the exception to the rule, where community engagement might be transactional (e.g., information is extracted from communities with little follow-up or perceived benefit to the community), inauthentic (e.g., communities are engaged to “check-the-box,” without meaningfully integrating their input or perspectives), and/or superficial (e.g., communities are tokenized without being able to meaningfully contribute in processes or decisions that they care most about). The reasons for these pitfalls are many – equitable community engagement takes time, resources, deep listening, self-reflection, power sharing, and trust-building, and our systems are not always set up to facilitate this.

A New Tool: Foundations of Community Engagement Toolkit

Yet these challenges are not insurmountable. To advance equitable community engagement more broadly, HRiA, in collaboration with the National Network of Public Health Institutes and several public health institutes across the country, launched the Foundations of Community Engagement Toolkit. Developed specifically for health departments implementing CDC’s National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, this toolkit can be applied broadly across sectors to provide a common framework and build capacity for equitable community engagement.

This toolkit defines core concepts related to health equity, systems change, mental models, and power mapping, and applies those learnings to community engagement activities with the goal of broadening public health practitioners’ capacity to integrate approaches that intentionally include community voice and build community power. The toolkit also includes one population-specific module focused on youth development and participation as a focus of equitable community engagement. The interactive toolkit is free to use. You can access the toolkit at engagementforequity.org

A Peek into the Toolkit: Equitable Systems Change to Facilitate Equitable Community

The Foundations of Community Engagement Toolkit grounds users in FSG’s Six Conditions of Systems Change framework to guide them through exploring equitable community engagement approaches. As seen in the Systems Transformation Iceberg, HRiA’s visual adaptation of FSG’s framework, six interdependent conditions are critical to address to advance equitable systems change – and these conditions have varying degrees of visibility.

The Systems Transformation Iceberg. Image from the Equity and Community Engagement Toolkit (2023). Adapted from FSG, The Waters of Systems Change (2018). https://engagementforequity.org

Above the surface of the water – the tip of the iceberg – we see policies, practices, and resource flows. These structural conditions are critical to advance systems changes, as they can be documented and measured, and their impact can be sustained over time. Moving down the iceberg, right below the surface of the water, are relationships and connections and power dynamics. As the water moves around the iceberg, these relational conditions are sometimes visible to the naked eye, while other times they are hidden below the surface. Relational conditions – who knows whom, who has the power to decide, and so on – can inform who is in the room, who has influence, and who is left out of conversations. When we finally move deep below the surface of the water, we get to the bulk of the iceberg – the mental models that we collectively hold. Mental models underpin our relationships and connections, policies, practices, and resource flows. Our mental models, when examined, can bring foundational stability and sustainability for equitable policies and practices; without examination, they can also hold inequities in place.

We may most naturally place equitable community engagement in the “relational change” layer of the framework. However, the toolkit posits that to really push ourselves and our systems toward equitable community engagement practices, we must first and foremost explore the mental models that we hold around community engagement. When it comes to dismantling the root causes of systemic inequities, beliefs matter. As it pertains to equitable community engagement, these beliefs — or mental models — influence:

  • How we understand the roots of the inequity we are trying to resolve and who is impacted;
  • Who we engage in problem-identification and solution-making, and how we engage them; and
  • Who should influence and make decisions around policies, practices, and resource flows to solve the inequity we are trying to resolve.

As public health practitioners, we all have a role to play in removing obstacles and barriers to health through community engagement. This work demands that we interrogate our own mental models as well as those embedded within our systems. As Dr. Heather McGhee insightfully observes, “…Laws are merely expressions of a society’s dominant beliefs. It’s the beliefs that must change in order for outcomes to change. When policies change in advance of the underlying beliefs, we are often surprised to find the problem still with us.” Transforming mental models is essential to system transformation.

Next steps

Access the toolkit at engagementforequity.org and join us at the National Network of Public Health Institute’s Annual Conference to learn more. Let’s challenge ourselves and each other to transform systems through equitable community engagement!

This project was a collaboration among several public health institutes. We are grateful to all those who supported and contributed to this incredible resource.

If you use the iceberg, please share your experience by contacting us. Please use the following attribution as appropriate:

The Systems Transformation Iceberg. Image from the Equity and Community Engagement Toolkit (2023). Adapted from FSG, The Waters of Systems Change (2018). https://engagementforequity.org