Ratio Talks

In this episode, Pritpal sets the scene on what is community power and why it is so important. He mentions the following: 

• Control and Health: An Epidemiological perspective: A 1990 book chapter by S. Leonard Syme





• How could differences in ‘control over destiny’ lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment: A 2016 research article by Margaret Whitehead and colleagues 





• Social determinants of health: WHO’s definition that mentions the “forces and systems” that shape daily life





• Health Equity Guide: A project of Human Impact Partners (Oakland, CA, USA) showcasing strategic practices to confront the power imbalances that are at the root of health inequities





• Power, control, communities and health inequalities I: theories, concepts and analytical frameworks: A 2021 research article by Jennie Popay and colleagues that describes the inward and outward gaze of community power 





• Communities of Opportunity: The project in King County (Washington State, USA) in which the health department is working towards making itself accountable to communities 

Pritpal’s full definition of community power builds on the work of the USC Dornsife Equity Research Institute (see below) and was developed with Anthony Iton and Robert K Ross of the California Endowment. It is the ability of people facing similar circumstances 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 who change systems and advance health equity. 

Related reading: 

• For an excellent discussion of systemic and structural bias (such as racism), see this 2022 article by Paula A Braveman and colleagues 





• For a deeper understanding of community power-building, including a definition of base building, see this 2020 report by the USC Dornsife Equity Research Institute (second report on the page)

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We conclude this series of podcasts linked to the publication How To Be Wrong with Don Berwick, renowned health policy maker and scientist. Don’s short paper Era 3 for Medicine and Health Care was the catalyst for the network that produced the How To Be Wrong paper. In this podcast, Don reflects on the paper, its reception and the prospects for new ways of thinking about learning.

Mentioned in this podcast:

Don Berwick's Era 3 paper 

Change from the Inside Out, Health Care Leaders Taking the Helm

COVID has Made the Office Visit a Dinosaur 

Frank Oberklaid is a paediatrician at the Royal Melbourne Children’s Hospital where he founded the Centre for Community Child Health. 

During the podcast Frank referred to several pioneers in the field of paediatrics:

Robert Haggerty’s work includes Stress, Risk, and Resilience in Children and Adolescents, a book edited with Lonnie Sherod, Norman Garmezy and Michael Rutter in 1994 long before the word resilience became in vogue.

Mel Levine was Professor of Pediatrics at the University of North Carolina Medical School in Chapel Hill. Here (embed the link) is a brief video of him talking about ripple effects, the way in which one problem in childhood leads to, and reinforces another. 
https://childrenofthecode.org/interviews/levine.htm

In his obituary the New York Times described Berry Brazelton as “America’s most celebrated baby doctor since Benjamin Spock and the pediatrician who revolutionized our understanding of how children develop psychologically”. Here he is talking about his concept of ‘touchpoints’.

Alexander Thomas and Stella Chess used the New York Longitudinal Study, beginning in 1956, to understand the role of temperament on child well-being. They classified children according to their temperament into three groups: easy -reacting to difficult situations without too much stress”; difficult -tending to withdraw from or find it hard to adapt to difficult situations; and slow warmers -low energy children who found it hard to maintain a positive outlook.

Nick Chater is Professor of Behavioural Science at the Warwick Business School, and author with George Loewenstein of The i-Frame and the s-Frame: How Focusing on Individual-Level Solutions Has Led Behavioral Public Policy Astray. The i-frame refers to science and policy focused on changing individuals. The s-frame concentrates on everything around the individual. As Nick explains in this episode, our hunger in the last decades for the i-frame has diverted our attention from the benefits of the s-frame. 

References

DellaVigna and Linos (2022) evidence from 2 nudge units

Hagmann , Ho , and Loewenstein (2019) nudging out support for carbon tax

Sarah Davidson is Chief Executive of Carnegie UK Trust. Echoing Patrick McCarthy in the last podcast, Sarah brings to the work of the Trust her experience as a senior civil servant in Scottish Government. Carnegie Trust is focused on Collective Well-being. In this episode Sarah discusses the shifting culture of funding and learning within the Trust and pushing beyond ‘performance’ to authentic accountability.

Patrick McCarthy is past President of the Annie E. Casey Foundation, the largest funder of social change for children and families in the United States. The Foundation is strongly invested in disadvantaged communities. Not all of those investments have paid off, but a commitment to evidence means there is always a legacy of learning. Patrick takes us through some of the lessons he has learned in over 30 years of public service, with a particular eye to the do's and don’ts of working in place.

Ann Johnson and Dan Hastings are the focus for place based work in Telford and Great Yarmouth. Their efforts are the result of a new way of working for the Lloyds Bank Foundation. Not so much about money. Or power. More about acting as the catalyst for new conversations about public policy. The work is new. It started in the pandemic. In this episode Ann and Dan give an honest, straightforward description of progress and setbacks. Read more about the Lloyds Bank work at: https://www.lloydsbankfoundation.org.uk/we-develop/transforming-and-strengthening-services/people-and-communities

Nick Davies is co-author of a report on the use of government targets. In this podcast he gives a series of examples of targets saving people’s lives and targets not only getting in the way of learning but acting as a source of deception.

Ken Masser leads a large organisation delivering Sport and Leisure services. But he is also learning how to make place the focus of learning about how to get more people involved in physical activity. That means looking well beyond gyms and pools and soccer pitches. Sport England programme is building a movement around of people like Ken and places like Rossendale. See examples of their work here.

Jill Baker from the Lloyds Bank Foundation, Richard Haigh from The Key and Laura Seebohm from the Maternal Health Alliance are all members of the How To Be Wrong network. They reflect on the network discussions and the impact it has had on the work they lead.