Bridging the Gap Between Transformative Practices and Traditional Public Health Approaches.

Abstract

The release of the 24/7 Wall Street publication in November 2018 labeling the Waterloo-Cedar Falls, Iowa, community as the worst city for Black Americans to live in the United States sparked conversations and calls to action across the community-from the kitchen table to the boardroom. It became clear that this was a critical moment for innovative leadership from public health. To bring together these individual efforts, and diverse perspectives, toward deeper understanding and system transformation, Black Hawk County Public Health, with support from Engaging Inquiry, adopted a participatory action approach of dynamic system mapping and systemic strategy design. Using participatory methodologies and tools for systems analysis, stakeholders developed a system map visualizing the patterns driving inequitable outcomes, but also the bright spots and resiliencies, identified and experienced across the community. This map, populated with local stories and data, represents a "theory of context," and offered a foundation of understanding and connectivity upon which high-impact opportunities for engagement could be identified and developed. By working across sectors and building on existing energy and resources present within the community, systemic strategies were designed to foster critical shifts toward a healthier community. A developmental evaluation approach is applied throughout the mapping process to maximize rapid learning and adaption of a complex challenge when stakeholder engagement and trust building is essential. Participatory systems mapping shows promise as an adaptive approach to allow public health departments to go beyond the traditional roles of public health practice, to collaborate with nontraditional partners, and implement strategies, initiatives, and/or policies that explicitly address inequity and the social determinants of health. Adaptive strategies provide opportunities for the local public health system to identify community health improvement strategies that align with Public Health 3.0.