Clinic-based community organizing

Addressing the health impacts of racism and other structural inequities requires addressing power inequities that exclude people from influencing the policies and practices that affect their health. Relational community organizing is a set of practices and skills that can be applied to build community power — a concept emphasizing the sustained and collective influence of people most affected by a practice or policy — to advance health equity. It has been argued that building community power is a key and often overlooked component of transforming structural harms. Although community organizing is often used to improve health issues, rarely is it integrated into health systems. The authors describe their experience with the Health Equity And Leadership (HEAL) initiative, a relational community-organizing program, created by leaders at Oregon Health and Science University, and embedded in a health clinic setting. This setting offers unique opportunities to influence clinical practice and build effective collaborations beyond the clinic walls. Through applying a four-step relational organizing model that emphasizes listening to lived experience, convening core teams rooted in trust and love, developing community-organizing skills, and taking collective action, the program has created change in local clinical practice and quality improvement efforts that improve conditions for systemically harmed communities. The program’s community core teams — composed of patients and community members with lived experiences of oppression — have also led local and state policy efforts on issues that reflect their health priorities, including housing and language access. The authors share an evaluation model developed to understand the impacts of policy or system-change work and apply it to demonstrate impact on both individual and collective community power, as well as broader health factors (such as loneliness and isolation). The authors also discuss and provide actionable solutions for challenges encountered while implementing and sustaining HEAL.