The Things I Know For Sure: Reflections from 16 years building a healthier community

In May of 2002, I arrived at Contra Costa Health Services (CCHS) to work as a coordinator for a public health program called Healthy Neighborhoods. After nearly three decades of working in community health education, promotion and programming, I was ready to further my career and knew that CCHS —  a health system in my own neighborhood — was where I wanted to invest my time and knowledge. That program only lasted three years, but CCHS’s community health programs have grown since then.

For the past 13 years, I’ve guided the Re-Entry Health Conductors — a group of experts in lived experience who partner with recently-released men and women to connect to the resources they need to live healthy lives. Since I started in this position, the focus on community health and appreciation of the value of peer workforces has grown in unexpected ways. So what can we expect — and what do we need — for the community health field in the next 13? No one can predict exactly what the future will hold, but here are the things I know for sure:

 

1. We need to broaden our definition of “experts”.

We once had a client who, after years of sleeping alone, couldn’t sleep with his wife. He just wasn’t used to sharing the bed with another person. That’s not a detail you share with your doctor. But his re-entry conductor had the trust and understanding of a shared lived experience to know his need for human connection was just as real as the need for food assistance. We need to consider more than just individual resource needs like food, shelter and clothing; we need to consider the things that qualify and solidify our existence. For this man, that meant sleeping peacefully with his partner.

People that have lived experience — whether incarceration or immigration or just growing up in the same neighborhood— recognize the things that allow people to really thrive in our community. The fact is, not everybody’s going to go to college or medical school, but does that mean that they don’t have or can’t contribute to the best of our thinking? No, it doesn’t. That’s why at CCHS, we invest in “experts in lived experience.”

2. Measures of success — and our databases — need to capture the qualitative story.

Success is still very quantitative. How many people attended the appointment? How many signed up for health coverage? In our resource referral system, cases are marked red until the client connects with a resource. Of course, it’s wonderful when we make a resource connection, but what did it take to get there? Re-Entry Health Conductors will stay in touch with clients and their families sometimes for years, because when a person returns home after 40 years, they’re thinking about their mother who died and being able to place flowers on her grave. Our conductors are there to make sure it happens. They know that some things need to come first before a job placement program or a check up, but that also means it takes a lot of miles with someone to make that resource connection. The relationships we build are the intervention in anything that we do. Where is that recorded?

3. Community-led programs equal the playing field.

When I first started at CCHS, I supervised Community Organizers whose charge was to go into communities in need of advocacy for housing and development. The community members ran the agenda. They went to the city council, held meetings with landlords. The Community Organizers always knew landlords had power, but then they saw that they had power too. Involving the community in the design and execution of programs goes beyond the impact of the program itself. It changes mindsets on all sides of the table. It shifts the paradigm, the power dynamics within a community, permanently.

4. We need to be open enough to ask others to get in the car and steer with us.

Leadership is really important to push forward changes in how we do our work. But if all of us working in healthcare really want to “do no harm,” then we have to be a lot more conscious and a lot more willing to identify our biases. We live in a society that puts a certain title, label and context on each individual. Investing in peer workforces means paying attention to the journey, not just the final destination. It means creating career pathways and opportunities for that workforce to move into positions of leadership. Power has to grow. When power stands still, change is stagnant.

 

In the end, community health programs aren’t just about a doctor knowing that their patient is hungry or lives in a certain zip code. They’re about the doctor seeing the person behind the chart–and the patient being able to see the human in the white coat behind it too. That impact continues, even if the individual program doesn’t.

Tiombe Mashama is the Senior Health Education Specialist and Program Coordinator for the Re-Entry Health Conductors at Contra Costa Health Services in California.

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