Supporting Equitable Communities Through Technical Assistance

What is an “equitable community?” What role do social determinants of health, and inequalities or disparities in health, housing, education, justice, access to services, or in affordability, appropriateness, safety and stability play in building and maintaining an equitable community? Where does equitable and timely access to information fit in? And how does Change Matrix (CM) respectfully inspire sustainable community growth and change, build on expertise in the community, and keep power in the community?

“Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say ‘We have done this ourselves.” -Lao Tzu

Since the 1979 publication of “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention,” the US Department of Health and Human Services (USDHHS) has focused on the reduction of health disparities. Nearly 40 years later, many of the same health disparities mentioned in that report persist. In fact, the National Academies of Sciences, Engineering and Medicine’s Committee on Community-based Solutions to Promote Health Equity in the United States, recently noted that, “racial and ethnic disparities are arguably the most obstinate inequities in health over time, despite the many strides that have been made to improve health in the United States.”

(NOTE: We are broadly defining “community” – for example, a geographic community, an organization or institution, a diverse population, or a population that shares the same culture.)

Contributing to some of the observed health disparities is a racial divide in the US, where non-white populations – particularly African American communities – bear the brunt of individual, community and institutional biases, discrimination and racism. In such an environment it is unlikely that disparities will be eliminated. Rather, research demonstrates that toxic stress, such as that experienced when people encounter racism and implicit or overt bias, can lead to poor health outcomes and exacerbate disparities.

Knowing health and other disparities exist at disproportionate rates for some communities in our country, what are we doing about it? One thing (CM) offers is technical assistance (TA) to communities and programs – many of which have experienced and/or work to address the disparities described above.

For those who have limited interactions with the federal government, the term TA may not resonate. We have been asked if our work in TA is related to information technology (IT) services, or some other high-tech field. Actually, our work is grounded in local, state, tribal and territory communities and exists to support their goals and anticipated outcomes. We make an effort to meet people where they are at. We go to them, we listen and learn from them and we help them grow, while often sharing in that growth experience.

The way TA is delivered and the way it is received can and does look different for each individual program or community. For example, one program may require assistance locating information/resources on evidence-based, best practices in their field. For this type of request, the TA delivered is straightforward and relatively quick to deliver. Another program may require assistance developing a sustainability plan for their work. This type of request is much more involved and requires the TA provider to learn about the program’s current structure, staffing and services and their vision for the future. It also requires an understanding of the social, political and fiscal environments, project scope, key stakeholders, community buy-in/involvement, etc. – all of which can have an impact on sustainability and any related planning.

TA depends not only on a community’s needs, but also on its culture, as well as on a consideration of how the community itself wants and best receives information and support. Regardless of the need, request, or delivery, the most successful TA is received voluntarily, where a community or program truly asks for and wants it, and is willing and able to invest time and resources.

Consistent with CM’s core values and guiding philosophy, we believe that to be effective and sustainable, TA needs to be respectful, honest, responsive, and provided in partnership with the recipient. To work in partnership with a community or program, TA needs to be approached with humility, equality, and transparency. Humility that enables everyone to learn from each other; equality in power and expertise that values the community or organization as the experts about themselves, their context, their experiences, and that values the TA provider for their experience and skills; and transparency with information and expectations, and a fundamental principle of transparency is unfiltered honesty. TA needs to be bidirectional: not only can the community benefit from what TA has to offer, but TA providers can learn and grow deeply from the expertise and magic within a community.

Any other approach to providing TA, any other perspective about the necessary transparency involved in providing TA truly disempowers the community/recipient. It assumes that the community isn’t on equal footing, can’t “handle” certain information, or doesn’t deserve to or isn’t capable of making an informed decision about what is best for them. In fact, it is culturally destructive. Any lack of transparency in sharing information about or related to the community in a timely fashion serves to perpetuate and control a power differential. There is a saying, “how you do anything (or one thing) is how you do everything.” At CM we try not to make a distinction between our professional and personal philosophy — that philosophy is based on humility, equality, and transparency, and we aim to practice this philosophy in all we do, including TA.

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