Our public health frameworks are failing us - here’s the one thing we’re missing

Our public health frameworks are failing us.

They're true. AND they're failing us.

Let me explain why.

I had the pleasure of giving a Lightning Talk at the National Network of Public Health Institutes Open Forum conference in Pittsburgh earlier this month (it was a balm to the soul to be in the company of fellow community-based public health practitioners!)

Here’s how and why our public health frameworks are failing us, the one thing we're missing, and what we need instead:

Now, let me break down each of these ways to begin treating building community power as a public health imperative.

Way #1: Cultivating community connection

• The status quo: What our former surgeon general Vivek Murthy calls a loneliness epidemic. We have an individualistic lens, an obsession with self-care and self-help.

• What we need instead: A sense of COMMUNITY. Ways to work, play and simply be together. Third spaces to hang out. Mutual aid. Land use planning that prioritizes connections. Group care and group help. What Priya Parker calls Group Life.

• An on the ground example (in Pittsburgh, where NNPHI's conference took place!) - Pittsburgh's wedding cookie table!

• A public health example - community coalitions of course!

• Ways to cultivate community connection in YOUR work: look for low-lift opportunities + think strategically about convening (What could you change if you teamed up with others that feels impossible alone? Bring folks together around a specific goal.)

Way #2: Strengthening the foundations for civic organizing

• The status quo: Our civic muscles have atrophied. Direct involvement in local politics, union membership, and civic activity beyond voting have all declined.

• What we need instead: Stronger foundations for civic organizing that can advance health-transforming policies. This requires: community connection as the foundation for effective organizing; strong local news to know what's happening and hold officials accountable; strong community organizing infrastructure

• An on the ground example: Pittsburgh's "Our Water" Campaign, led by Pittsburgh United.

• A public health example: The Public Health for Community Power Coalition (whose members include Health in Partnership (HIP), Public Health Institute, Prevention Institute, ChangeLab Solutions, Berkeley Media Studies Group, and others)

• Ways to strengthen the foundations for civic organizing through YOUR work: For organizing/advocacy groups - long-term, consistent organizing across topics is key. For those with limits on direct advocacy - there's still so much you can do! Convene people and make intros across your government and community partners, and build storytelling and other skills among community members that make effective organizing more likely.

Way #3: Fostering narrative change

• The status quo: Individualistic, "blame myself and shame on you" narratives about what shapes our health.

• What we need instead: a narrative recognizing what lies further upstream and the role of community power. We need a new narrative – that gets explicit about the political and corporate forces shaping the policies and systems that shape our health. And then, beyond better messaging, we need actual narrative infrastructure to construct and sustain narratives over time, through things like community partnerships, research, legal advocacy, and institutions of meaning-making like schools, mass media, and museums.

• An on the ground example: Healthy Start’s infant health equity coalition in Pittsburgh, who we here at PoP Health have been so grateful to work with over the years! They’ve crafted a community-driven narrative by funding local organizations to gather member stories, hosting town halls featuring community stories, and training community members as health advocates who speak to systemic issues.

• A public health example: My new project, GASLIT (Gaslit by Corporations / Ignited by Community). I launched GASLIT to explicitly name corporate power as a root cause of public health harms and center community power in the fight for our health, planet, and future. Please sign up for the GASLIT newsletter if you’re interested in receiving action steps you and your neighbors can take to ignite change, stories of communities reclaiming their power, and investigations into corporate gaslighting.

• The foundations for fostering narrative change in YOUR work: Think about the narrative itself: Revisit how you talk about root causes of health. Are you going upstream enough? And build narrative infrastructure: Build community members' skills to tell their stories, create spaces for them to speak directly to decisionmakers. Engage with institutions of meaning-making to shape narratives about health.

So, what's next?

Which of these ways fits in most directly with your work?

What steps are you hoping to take next?

Drop me a line and let me know.

And if I can help, whether that's through a keynote talk on community power as a public health imperative; training, tools, and coaching for your coalition, or simply answering a question via email, please reach out!

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4 questions on the path to action

I’ve been sitting with some hard truths lately.

Systems are complex. Dynamic. Interconnected.

Working together in a coalition to change those systems is hard. Slow. Complicated.

That’s just the reality of what we’re trying to do.

So for anyone else who’s feeling stuck, but not ready to give up (I’m definitely not!) - I thought I’d share some simple questions I go back to when I’m trying to dig myself out of the ditch and get us back on a path to action. (And let me be clear, I mean the questions are simple - the process of answering them and the answers themselves are unlikely to be.)

For whatever system you’re trying to change:

1. What's working? What are the strategies, models, and examples that are working that we can learn from?

2. What’s not working? What are the gaps, challenges, and complaints we need to address?

3. What should be tried next? What specifically should be continued or started, changed or stopped?

4. Who has the authority/capacity/expertise to execute those next steps? And what might we or our partners or our communities be able to do to influence, equip, or support those people to take those steps?

I hope these questions can help you climb back onto the path to action if you’ve fallen off, or keep you going on it if you’re still making your way.

And if you're looking for some extra support on that front, we're here to help! PoP Health's capacity building packages for community coalitions and their partners include training workshops, tools, and templates that will help you walk through the systems change questions I've shared above in a way that's driven by both community and coalition member perspectives. Plus, we'll support you with ongoing coaching and technical assistance that'll make sure you take those actions to the finish line. Here’s a brief summary, email me if you want to chat further!

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4 options in the face of collapsing systems

If you, like me, are distressed about what’s happening at the CDC, what’s happening around vaccines, what’s been happening with public health grants and research being terminated, and more - I see you.

I shared my thoughts in the wake of the shots fired at the CDC here, and even just since then, we’ve seen top CDC officials resign after their director was ousted.

When systems are collapsing around us, it can be even harder than usual to answer the question of: what next? What should we DO? Not to mention, what CAN we do, especially if we are grappling with fewer resources and an uncertain future?

While I don’t have magic answers, I do have some options that might be helpful to consider. I found this piece on grappling with systems collapse very relevant to the community coalitions we work with here at PoP Health, who are focused on systems change - and thus especially impacted by systems collapse (hat tip to I2I, which drew my attention to this piece in their newsletter).

Let me summarize the options the authors of this piece lay out for what impact might look like in collapsing systems.

We can:

• Protect. This model “builds and leverages power to counteract the worst harms, strengthen community resilience, and preserve values of care and belonging to carry people through crisis.” E.g., mutual aid

• Block. “If a collapsing system seems likely to give way to an even more dysfunctional or inequitable alternative, then the blocking impact model may be an appropriate response. This model can slow down both the pace of collapse and the emergence of worse alternatives.” E.g., providing know-your-rights training.

• Disrupt. This model “achieves impact by embracing the fact that as the legacy system deteriorates it is possible to shed the constraints, rules, and norms that do not serve the social sector.” E.g., boycotts and strikes.

• Create. “With the system awash in uncertainty, there is an opportunity—even a responsibility— to pursue truly transformative impact. This means exploring the larger context in which the system sits….What ideas or projects can be tested or nurtured? Which leaders have been marginalized by existing systems, but…are uniquely positioned to step up in this moment?” E.g., participatory governance.

​The full article adds a lot of important nuance about the conditions you need to maintain to push forth with each of these options.

Three bonus questions they ask at the end of their piece, and I’ll now ask you:

What can we let go of, what do we want to carry with us, and what do we want to build?

Here at PoP Health, we’re:

• letting go of being the best (and being this instead),

• carrying with us all we’ve learned from coalitions on the ground doing the work, and

• seeking to build the capacity of more coalitions to translate their vision and resources into tangible action.

→ On that front, PoP Health is now offering capacity building packages for community coalitions working on systems change (training workshops, tools and templates that will save you time and get you to action much more quickly, along with ongoing coaching and technical assistance that'll make sure you take those actions to the finish line). Here’s a brief summary, email me if you want to chat further!

For me personally, I’m:

• letting go of the desire to see results quickly (because the fight for our future, our health, our planet, our democracy - it’s all long-term and multigenerational),

• carrying with me a focus on hope and action, and

• seeking to help build community power, in my own community and beyond.

→ On that front, check out my new project GASLIT by Corporations/IGNITED by Community, at www.gaslitbycorporations.com.

What about you? What are you letting go of, carrying with you, and wanting to build? Drop me a note and let me know.

As the authors of this piece on systems collapse note, “this moment requires us to engage in repair and reimagination”.

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Jane Fonda on how "community means power"

As agencies, nonprofits, families, and individuals make contingency plans upon contingency plans in face of all the uncertainty of this moment, I wanted to share some words - courtesy of Jane Fonda - of both hope and action (which were PoP Health’s wish + invitation for 2025…which, two months in, feels like it has already lasted about two years).

I’m not really up on pop culture or Hollywood, but I’ve been deeply impressed with Jane Fonda ever since I heard a podcast interview with her a couple years ago - what a life, what energy, and what commitment. In an industry where it is especially easy to ignore, pay lip service to, or throw a few pennies at societal problems, she’s been on the ground trying to fight for change.

So, I didn’t hesitate to click on the video of her speech at the SAG awards a week ago, where she received the Life Achievement Award (transcript here for the readers out there). And I’m so glad I did.

Here are my key takeaways:

• “Community means power.” - She talked about how unions have our backs and give us power, and I’d add to that all the other ways of coming together in sustained, structured ways - community coalitions, co-ops, neighborhood associations and groups. Create them, join them, sustain them.

• “Empathy is not weak or woke.” - This statement stands by itself, but Fonda had more to say about empathy. First, she connected it to the job of actors - “...we don't manufacture anything tangible. What we create is empathy.” Indeed, I’m a big believer in storytelling and its importance in creating empathy as well as inspiring and persuading. Which brings us to Fonda’s next point about empathy - “And even if they’re of a different political persuasion, we need to call upon our empathy and not judge, but listen from our hearts and welcome them into our tent, because we are going to need a big tent to resist successfully what’s coming at us.” I could not agree more. To sneak in some words from Rebecca Solnit, who I’ve been turning to often over the last couple months, “You need to pitch a big tent and welcome everyone who might come in, even if they came over recently and weren't always there. No one knows what it is going to take to overcome the current crisis…I do know that it's going to take a lot. The more the better.” As Solnit goes on to point out, “unwelcoming committees from people more interested in being right than effective” are self-destructive to the causes we support.

• “We are in our documentary moments. This is it. And it’s not a rehearsal.” - Fonda urged us to take this seriously, be brave, stay in community, and take action. And it’s not enough to just be against things. Fonda underscored, “We must find ways to project an inspiring vision of the future. One that is beckoning, welcoming, that will help people believe.”

As Fonda went on to say, “Let’s make it so,” Reader.

In your coalitions and your work, how are you projecting an inspiring vision of the future, widening your tent, staying empathetic, and building community power? Drop me a note and let me know. And let me know if you disagree about what we need right now too - disagreements are always welcome here.

And, for those looking for more concrete advice on how your coalitions, organizations, and agencies can take action in your communities to transform health - a quick save the date: April 2nd, noon ET, on Zoom, join PoP Health for a free action planning webinar. You'll learn about the #1 missing ingredient that's preventing your action plan from getting the results you want + details on how to follow our 5-step action planning process to go from feeling stuck to feeling like a superhero. Register here!

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Taking action when everything is on fire

Whew, it's been a couple weeks, hasn't it?

Public health is being further threatened than it already was in every direction - halting of foreign aid work; an attempted coup in the form of a spending freeze; an anti-vaccine skeptic nominated to lead the nation's health agency; the list - sadly - goes on.

And the opposition to these threats? It's been weak, slow, and completely insufficient. I don't mean opposition as in people ranting about and posting about and discussing these problems. I mean opposition as in actually taking action.

And why is that? I think there are two key issues here:

1. Actually taking action isn't a central part of enough our organizations’, agencies’, and coalitions’ (not to mention politicians') ethos, frameworks, and plans. Speeches and reports and "awareness raising" and "information sharing" are not ACTION. And here’s the thing - nothing changes until we act.
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2. We aren't organized!! And it's not entirely our fault. Our civic infrastructure has been ravaged by everything from land use policy (which prevents the kind of community building we need to foster the trust, conversation, and connection that is foundational to organizing) to restrictions on 501c3 lobbying (while leaving corporate lobbying, political influence, and in a word, corruption, unchecked) to the decimation of local news (which is needed to hold local policymakers and others accountable, foster community action, and more) to the weakening of community, labor, and other organizations that could actually put weight behind advocacy demands and see them to fruition.
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So we can call our congresspeople or join protests, but without actual, meaningful, and long-term organizing, we're not going to be nearly effective enough.

I've been giving both the action and organizing points above a lot of thought, even before the chaos of the last couple weeks.
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On the action front, PoP Health will be offering a FREE live class for community coalitions sometime this Spring, all about why every community health coalition needs a strong action plan - and the process they need to get there. Community-rooted work is more important than ever right now, and with a strong planning process, your coalitions can deepen your impact and build community power.
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On the organizing front, we've got some wheels in motion, but it's early yet - stay tuned for more details, and please reach out if you have ideas to share or want to be involved. Also please drop me a note if you've seen examples of or are involved in taking organized action against the current threats to public health.

As Grant Ennis notes in his book Dark PR, historical protests that led to meaningful policy change did not involve “individuals brandishing banners stating scattered goals” but rather “organized citizens focused on political action” with banners that “listed their demands and the names of the groups they represented.”

And as I heard in a conversation about the role of democracy in population health yesterday, protests and other forms are direction are a component of organizing, but they are the not the entirety of organizing. There's a lot more to organizing effectively - stay tuned for the next Community Threads newsletter for more on that.

Everything that's happening right now is a LOT, but I still have hope we can find ways to come together to not just act in opposition, but to proactively put forth different - and more compelling - narratives, values, and ways of shaping our policies and our communities.

We can do this.

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Why we must ACT in 2025

I opened the new year inviting you to join PoP Health at the intersection of hope and action to transform health in our communities.

Earlier this month, we dove into the idea of hope.

Today, we’re focused on ACTION.

I’m all about capturing data to understand community needs - but does it sometimes feel like all we’re doing is defining (and redefining) the problem, listing challenges and barriers, and adding proof points that the problem exists?

I think sometimes we get paralyzed thinking we need more - more information, more resources, more time - instead of figuring out how to ACT in the here and now, with what we have.

I heard a great example of this at a workshop this past Fall, from an organization called Beyond Housing in St. Louis. Their CEO shared the simple framework they use to guide their work: Ask, Align, Act. “We ask for the community’s input to identify priorities, align resources, and act toward fulfilling a common vision.”

It sounds SO simple. Yet, many organizations and agencies aren’t doing this.

Part of that, of course, is because it isn’t actually simple to identify priorities or align resources, much less act. There are so many complexities and challenges, and I don’t want to diminish those.

Yet, that’s only part of the story. Many organizations and agencies aren’t even trying to act, at least not in a meaningful way.

I think the first step towards taking meaningful action is doing what Beyond Housing has done - make ACTION a central component of your organization’s ethos, framework, plan.

The results can be impressive. Just check out what Beyond Housing has done - https://beyondhousing.org/about/our-work/.

Here’s the thing - nothing changes until we act.

We also can’t learn what works - and perhaps more importantly, what doesn’t work - until we act.

It’s in this spirit of taking action that we here at PoP Health will be offering a FREE live class for community coalitions this Spring, all about why every community health coalition needs an action plan - and the process they need to get there. Stay tuned for more details!

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Why we must HOPE in 2025

How is the start of your year?

I hope it is off to a great start, but I know too that many across the country are experiencing hard times just weeks into the new year.

Regardless of where on the spectrum your year so far falls, I stand by what I shared last week: I believe wholeheartedly that it is at the intersection of hope and action that we can work together to transform health in our communities. So in this issue and the next, I’d like to break down each of those concepts.

Today, we’re focused on HOPE.

Especially as we’re coming up on inauguration, following an election that demonstrated just how polarized communities across our country are, holding on to hope feels even more important - and yet, even harder - than before.

But hope we must.

Like many others, I found much hope in Rebecca Slonit’s words post election.

I encourage you to read her brief post in its entirety, but here are three pieces that stood out to me:

"You are not giving up, and neither am I. The fact that we cannot save everything does not mean we cannot save anything and everything we can save is worth saving."

"People kept the faith in the dictatorships of South America in the 1970s and 1980s, in the East Bloc countries and the USSR, women are protesting right now in Iran and people there are writing poetry. There is no alternative to persevering, and that does not require you to feel good."

"Take care of yourself and remember that taking care of something else is an important part of taking care of yourself, because you are interwoven with the ten trillion things in this single garment of destiny that has been stained and torn, but is still being woven and mended and washed."

Within her words, there are three important lessons about hope:

• Hope does not mean we hold onto an unfounded belief that we can save everything - but it does mean embracing the reality that we can save SOME things and those things are worth saving.

• Hope does not mean you feel good. I think we conflate feeling hopeful with feeling good in the moment, right now. It’s possible to have hope even when you’re feeling heartbroken, even when you’re feeling furious, even when you’re feeling deflated, even when you’re feeling skeptical. In fact, it is especially important to hold on to hope when you’re feeling these other emotions.

• We hope because we - all of us, our lives, our dreams, our destinies - are connected and while the threads that connect us are “stained and torn”, they are also perpetually being “woven and mended and washed”.

So thank you, for weaving and mending and washing these Community Threads with us. Let’s keep at it.

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Movements need weavers and warriors

What a week.

In the last issue of Community Threads, I spoke about how voting isn’t enough - that we need to organize movements. That remains true regardless of who wins an election or which political party is in power.

We need to come together - in a highly organized, long-term, consistent way - to make collective demands for concrete changes. We need movements.

And movements need both weavers and warriors.

Weavers that bring separate threads together to create a collective fabric - that bring organizations and individuals together for a common purpose, that build stronger connections, that persuade more people to join together, that reach across aisles, that take collective action.

Warriors that fight for the changes they want to see - that go up against power, that resist what they know is not right, that protest against injustice.

I’ve always considered myself a weaver - everything from the name of this newsletter (Community Threads) to PoP Health’s logo (which emphasizes interconnectedness) go back to the ideas of working together for collective impact. It’s why I love working with community coalitions and collaboratives.

And yet, I find myself venturing more into warrior territory these days. PoP Health has a new initiative coming down the pike (in Spring 2025) that’s focused on putting political and economic power back in the hands of communities, as opposed to corporate interests. And it has me fired up.

It makes me wonder if those of us who have both weavers and warriors in us - and those spaces where weavers and warriors can come together - could be valuable to the work of organizing movements.

Because a few things are clear.

A lot of weaving in the community health space has involved admiring the problem, as opposed to solving it. A lot of weaving has focused so much on achieving consensus with everyone (even the corporate interests that are working against public health goals) that the end results have been weak and watered down actions.

On the flip side, a lot of warriors in the community health space have failed to widen their tent and expand their coalition. A lot of warriors have failed to coordinate and coalesce around concrete demands in consistent, sustained ways.

Movements need weavers and warriors (and those who see both in themselves). Who are you? A weaver, a warrior, both? And has your answer changed over time, like mine? Drop me a line and let me know!

Ultimately, successful movements need weavers that build agreement and collective, sustained action around the concrete demands of warriors.

As I said last time, history shows us it’s possible. Let’s get to work.

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Why voting isn’t enough

With election day fast approaching, I’ve been thinking a lot about voting. 

At an event I was at a few weeks ago, someone brought up the distinction between technocratic strategies and democratic strategies - that technocratic strategies focus on policy (which is necessary, but not sufficient, to transform health in our communities) while democratic strategies focus on politics (which is all about POWER). 

We can’t transform health in our communities without democratic strategies that center power.  And as Frederick Douglas said, “Power concedes nothing without a demand.” If we don’t demand change, power concedes nothing, and we’re left where we started. 

And up until recently, I thought about voting as one of the only ways I personally could demand change. 

Yes, I could call my legislators or sign a petition or join a protest, but those things never seemed all that effective to me. 

And I finally figured out why. 

I just finished the book Dark PR, by Grant Ennis (highly recommend, and you’ll be hearing more about it from me!), and he lays out both why “just voting” isn’t enough and why other political actions in the modern day “fall flat”. 

Ennis talks about “just voting” as a “harmful narrative”. 

“If we are deceived into believing that citizenship begins and ends with voting, we risk losing sight of the fact that a healthy democracy requires citizen association and political action in addition to voter participation. Democratic participation involves starting, actively organizing, and participating in citizen groups that continuously demand change. Democracy is in danger if we fail to understand that it requires much more than ‘just voting’.” 

And the citizen association piece is the key to why the political actions I had available to me (call my legislators, sign a petition, join a protest, and so on) always seemed ineffective. 

Ennis writes, “Citizens ‘just protest’ at the expense of meaningful citizen organizing and targeted political action.” It’s not that protests are always ineffective, but if we are mobilizing without organizing, if we are mobilizing without concrete and substantial demands, then we are engaging in “aggregate individual behavior” as opposed to a true collective movement. 

He contrasts how historical protests that led to meaningful policy change did not involve “individuals brandishing banners stating scattered goals” but rather “organized citizens focused on political action” with banners that “listed their demands and the names of the groups they represented.” 

Don’t get me wrong, I remain a proud voter, and think everyone eligible should absolutely vote in every election. And that changes are needed to make it easier to vote. 

But it’s not enough. 

And neither are individually calling our legislators or showing up to a one-off protest. 

We need to organize movements.  We need to make it so we call our legislators and sign petitions and join protests in ways that ARE effective because they are organized, collective demands for concrete changes that are long-term and consistent. History shows us it’s possible. 

More on movements soon. In the meantime, let’s vote! 

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The difference between cynicism and skepticism

Are you a pessimist or an optimist?

I’m optimistic (almost to a fault, my family would tell you).

But…I’m also pretty skeptical. Whether it’s someone trying to sell me on a business idea or life insurance package or supplements or pretty much anything - they’ll be met with a lot of questions and not-particularly-well-hidden skepticism (I’ve got no poker face, y’all - something I share with my daughter).

Doesn’t it seem somewhat counterintuitive to be both optimistic and skeptical? If you’re optimistic and believe the best in people, shouldn’t you also believe in the ideas people are putting forward? 

Well, in an issue of Well from the New York Times last month, they quoted the director of the Stanford Social Neuroscience Lab, Jamil Zaki, making a distinction between cynicism and skepticism, and it was a real “light bulb moment” for me - 

“Cynicism…is a lack of faith in people, while skepticism is a lack of faith in our assumptions.” 

Ding, ding, ding! When I read this, I immediately thought, YES, this is exactly it. I believe in people (ok, not every single person, but generally speaking, I believe most people have good intentions and are trying their best). But I reject many of the assumptions that underlie our society. 

Dr. Zaki suggests that a cynical worldview - believing people are “generally selfish, greedy and dishonest” - can make you feel safer and smarter, but can also have a negative impact on your health and lead to beliefs that are untrue. He “encourages readers to become “hopeful skeptics” who think critically about societal problems while recognizing how kind and generous others really are.” 

And this, I think, is at the heart of public health and the work of coalitions in pursuit of transformational change to the health and well-being of their communities. 

We should be highly skeptical of the assumptions that underlie our current policies and systems. 

But we should not lose our faith in people, or our faith in the idea that people can come together to change our policies and systems for the better. 

What do you think? Does this resonate for you? Are you a cynic or a skeptic or both or neither? And how do you think cynicism and skepticism “show up” in our work?

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