Communities across the country have addressed local public health challenges by collaborating across systems and sectors. This ensures that the needs of different groups are taken into account and that potential, sometimes unexpected, impacts are taken into account. These efforts also highlight how many of these issues are rooted in complex issues that require responses on multiple fronts.
Katrina Korfmacher, associate professor of environmental medicine at the University of Rochester Medical Center, studies the role of science in policy-making, particularly how community groups generate, access and use information. His 2019 book, Bridging Silos: Collaborating for Environmental Health and Justice in Urban Communitiesexamines how local entities have addressed different environmental health disparities in Rochester, New York, Duluth, Minnesota, and Southern California.
She recently answered questions about how the process can work. This interview has been edited for clarity and length.
Q. What are some of the first steps for communities facing public health issues?
A. In each of the cases in the book, community members identified an environmental public health problem and sought help from government professionals, academics, and/or nongovernmental organizations to understand what was causing the problem. who it affected and what gaps in policies and programs allowed it to continue. Addressing the gaps effectively required changing policies, systems or environments. Working together to reframe a long-standing environmental health issue as an equity issue brought new stakeholders to the table who provided the energy needed to develop a new approach. So there was an iterative process to increase understanding of the problem and engage new stakeholders to find solutions.
Q. What are some of the key challenges to advancing cross-sector collaborations and how have the communities highlighted in the book addressed them?
A. Public health professionals generally recognize the importance of collaboration in advancing health equity goals, but the reality of sustaining effective collaborations is often challenging. For example, it is difficult to find dedicated funding to bring people together and support their work outside the scope of their home institution. Additionally, institutions with limited resources may not have the time to devote to collaboration. There may also be internal barriers such as staff incentives, training, cultures and conflicting goals. Overcoming these challenges requires energy, commitment and perseverance. In each of the initiatives examined, there was at least one partner whose mission was to promote partnerships. This dedicated capacity was modest but essential to finding and mobilizing support from various sources.
Q. Have Health Impact Assessments (HIAs) or a Health in All Policies (HiAP) framework contributed to these initiatives?
A. The idea that promoting health often requires changing policies that are not usually considered health policy was important in all three cases. In Rochester, the Coalition to Prevent Lead Poisoning recognized early on that it was a health issue with a housing solution, so he focused on changing the local rent inspection policy. Similarly, partners working around the ports of Los Angeles and Long Beach, California, wanted to increase the consideration of health in all decisions related to goods passing through the ports and committed to a formal HIA of a major freeway expansion project.
Work on the built environment in Duluth benefited from three HIAs conducted in partnership with the Minnesota Department of Health. Thus, while the formal role of HIA varied, all three initiatives were grounded in the concept that changing systems to better reflect health in non-health decisions is essential to achieving environmental health equity.
Q. What can funders, academics and agencies do to support environmental health initiatives?
A. Each of these cases highlights how grassroots initiatives can drive systemic change with relatively small changes in the normal functioning of funders, academics, and agencies. For example, many funders focus on results-based projects, but several foundations have provided critical support to mobilization efforts in Los Angeles. Most scholars need to focus on research to thrive in their academic careers, but in Los Angeles and Rochester, universities had core funding from the National Institute of Environmental Health Sciences that supported engagement. community. Faculty and staff from these academic centers have played a key role in local partnerships.
Due to limited resources and state mandates, many local health departments focus narrowly on surveillance, education, and immunization. In Duluth, however, the state’s health improvement program has encouraged local health departments to expand their reach to work in partnership with communities to drive lasting, lasting change.
These examples show that even small institutional changes can go a long way to supporting more effective local environmental health initiatives.
Q. What “lessons learned” might help other communities address health equity in other types of challenges?
A. One of the surprises in researching this book was the diversity of local and national resources exploited by each group. There was no single, common recipe for success. None of these efforts began with a large funding commitment by a single organization; rather, they made creative use of small amounts of staff time, funding, and technical expertise from a variety of sources. They did a lot with little, but they all started with something. This suggests that modest and sustained investments in the ability of communities to come together, plan and collaborate can go a long way. On the other hand, communities with the fewest resources – those that can deal with the most severe environmental injustices – may not have the capacity to initiate such collaborations.
So while the book focuses on the potential to better support local initiatives, it also highlights the importance of mainstreaming their innovations through state and national organizations so that all communities can benefit. This requires new ways to promote learning from local initiatives. For example, the Health Impact Project’s HIA map enables communities to learn directly from each other and provides an encyclopedia of approaches that agencies and funders can promote elsewhere. Without these resources, it is difficult for communities to learn from each other’s stories.
At the same time, the cases clearly showed that collaboration at the local level created networks between stakeholders that were essential to sustaining system changes over time. These networks have fostered new collaborations outside of the initiatives’ original objectives, emphasizing the importance of supporting the continued engagement of local groups in the adaptation, implementation and evaluation of solutions.
Q. How can success be tracked and measured?
A. Measuring, even defining, the success of initiatives like these is tricky. For example, evaluation often focuses on whether measurable objectives have been achieved. However, in these initiatives, the collaborative exploration of community concerns has led to new problem definitions, goals and strategies over time. In other words, the objectives have changed. Similarly, the long-term viability of an organization is also commonly used as an indicator of success. But these initiatives were intended to “bankrupt themselves” by changing existing organizations, policies and practices so that they were no longer needed.
Efforts like these take place in complex and evolving political systems where change cannot be attributed to a single actor. One of the challenges of environmental health initiatives is that health outcomes can be affected by many factors over a long period of time. Measuring changes in the physical environment may be closer, but documenting changes in policies, processes and social networks is also essential. For these reasons, in-depth case studies are essential to understand the full impact of such initiatives. One of the main purposes of this book is to provide a useful framework for designing, supporting, and evaluating other efforts by sharing the “hard facts” of how long-term local collaborations struggle, change, interact and progress over time.