4.1 Be ready to redirect discussion from unequal outcomes (or biomedical and behavioral explanations for them) back to inequities in the policies, systems, and power relationships that generate unequal outcomes. 

4.2 Help audiences appreciate how these issues affect them. 

4.3 Provide specific opportunities for audiences and participants to become involved. Communicate possibility.

Health equity doesn’t need to be a “new issue” to worry about. Consider it a framework, a lens through which to view the forces and policies shaping our economic, social and built environments.

Start with the issues and programs your organization already addresses (such as health care, access to affordable housing, land use, urban development, public health, healthy food access, transportation, education, research, or racial justice) and ask yourselves:

• How does our current work impact the health of different population groups? What evidence is there to illustrate this impact?
• What does a health equity frame imply for our own organization’s priorities, work flow, allocation of resources, and outreach? What changes might we have to make? Are there tradeoffs in accepting this frame?
• How can we communicate the positive impacts of our work on population health to increase support for our efforts among our constituencies, other organizations, the public, the media, and policymakers?
• What opportunities does the health equity frame provide for alliance building?  Who are our obvious – and not-so-obvious – partners? How are community members engaged and empowered, and is their capacity for tackling inequities enhanced?
• What role can we play in building a larger movement for a more equitable society that provides resources and opportunities for health for all, especially historically excluded populations?
• Can we, by law, or independent action, apply a health equity lens to ensure that public and private initiatives, actions, and laws are assessed by their impact on health equity, or that health equity objectives are incorporated into the city / county strategic plan?
• What existing struggles, initiatives, or social policies show promise for reducing health inequities? How can we support them?
• How can we help the media, the public and policymakers understand the health equity implications of an issue currently receiving public attention?

If your own leadership, program and support staff, members, and board don’t fully understand and support the framework, it will be hard to undertake effective outreach and alliance building with others.

Internal screenings followed by discussion allow organizations to:

• Build a shared language and understanding of the social determinants of health equity, including the historical forces of racism and segregation, among all staff, leadership and (if relevant) members
• Assess the organization’s capacity
• Address the questions raised above regarding the relevance of health equity to current and future work.
• Develop structures that will allow the organization to operationalize its commitment to health equity

Consider different and novel ways to integrate screenings into your organizational development programs: Include the series in new hire / membership orientation. Provide continuing education credits for attending screenings and discussions. License closed-network streaming rights that allow personnel to log in and view episodes on-line on their own schedules. 

The Unnatural Causes Action Toolkit, Discussion Guide and other materials available at www.unnaturalcauses.org contain ideas for planning and structuring internal dialogs.

Unnatural Causes is only a tool. A film screening, no matter how compelling, is but a gesture towards social change unless paired with the hard work of a thoughtful and self-critical group dialog, consideration of next steps, and organizing for action.

When planning a screening, discuss and articulate with your team:

• What are your goals? 
• What pre and post-viewing discussions and activities will best contextualize the screening? 
• What preconceptions, default understandings, and resistances do you anticipate the group will bring to the screening?
• What “next steps” do you hope to see emerge from your event?

Whether working internally or externally, your screening will be more effective if your organization invests time and resources into planning how the event fits into your larger strategies.

For guidelines on event planning, see the Action Toolkit at www.unnaturalcauses.org or Promoting Health Equity, from the Centers for Disease Control, at http://www.cdc.gov/nccdphp/dach/chaps/pdf/SDOHworkbook.pdf.

4.1 Be ready to redirect discussion from unequal outcomes (or biomedical and behavioral explanations for them) back to inequities in the policies, systems, and power relationships that generate unequal outcomes. 

Many people who identify as progressives view unequal outcomes as self-evident indications of injustice. But for most Americans, unequal outcomes merely reinforce their normative understandings of a hierarchical world: If some groups have worse health than others, it’s the result of unhealthy choices, lack of will-power, or just bad luck (or genes). Unequal outcomes may be unfortunate, but they are not necessarily unfair or unjust.

It is helpful, therefore, to keep the discussion focused not on unequal health outcomes themselves, but on the underlying inequities that generate those outcomes, what Michael Marmot calls, “the cause of the causes.” Not only are the choices people make constrained by the choices people have, exposures to many health threats (and promoters) have nothing to do with individual choices whatsoever. Health inequities refer to those unequal outcomes that are systemic, socially produced, and avoidable and thus inherently unfair. And, by implication, changeable.

Find resources for facilitating these discussions (such as 10 Things to Know about Health, the Discussion Guide, and Handouts) at www.unnaturalcauses.org.

 

4.2 Help audiences appreciate how these issues affect them. 

When possible, provide local data and examples that link health outcomes to social determinants. Demonstrate the patterning of health outcomes in your community according to the distribution of health-producing resources along class and racial lines. Use data, maps, and examples when possible.

• Link the ways class and racism (not race) operate in your community to shape exposure to health promoters – or health threats – and affect levels of chronic stress.
• Identify inequities in other non-health arenas (access to pre-school and good schools, high reward / high control jobs, quality affordable housing, paid vacations, affordable nutritious food, etc.) that drive health inequities in your community.
• Communicate possibility, how actions large and small can advance policies that decrease inequality, decommodify access to health-promoting resources, and deepen democracy by empowering communities and excluded voices.

Collecting and comparing community indicator data on health promoters and health threats neighborhood-by-neighborhood (e.g., access to liquor stores vs. supermarkets or green space vs. brown lots) can be an informative, engaging, and alliance-building group activity.

For examples of how to conduct an informal community health indicators assessment, see the “Place Matters” lesson plan and the report of the Community Health Councils of South Los Angeles at www.unnaturalcauses.org.

 

4.3 Provide specific opportunities for audiences and participants to become involved. Communicate possibility.

Leaving action ideas and follow-up suggestions “up to the community” sounds democratic but can be a non-starter. Audience members want to know that something can be done. Otherwise, momentum can be lost and the screening may simply become a one-off thought exercise.

Provide examples of actions, policies and initiatives (existing or proposed) that can advance health equity, invite dialogue and feedback, and use the screening as an opportunity to build towards further engagement.

See the Unnatural Causes Action Toolkit, Policy Guide, Inspiring Stories, the CDC’s Promoting Health Equity, the Prevention Institute’s Thrive Tool, The Praxis Project’s Public Policy is Not Out of Reach, and other action ideas listed on or linked from www.unnaturalcauses.org.

Consider providing immediate, mid-term, and long-term goals and actions when offering audience members ways to get involved:

The immediate short-action item can be done by anyone in the audience that very day, such as:

• subscribe to the Unnatural Causes eNewsletter;
• commit to join a follow up conversation or committee;
• identify a list of potential allies, health equity champions, and local initiatives that can improve health equity;
• define how your organization’s own work impacts health equity;
• identify other venues where the series should be screened;
• post on your blog or comment on other blogs;
• share video clips, handouts, and fact sheets from the unnaturalcauses.org web site via Facebook or other social sharing sites;
• write a letter to a government official or the newspaper drawing attention to local health inequities.

The mid-term action item will require a bit more time commitment, such as:

• host an internal screening;
• join an existing health equity coalition;
• support local organizing efforts around racial and economic justice issues that can improve population health (housing, land use, living wage, tax and spending, education, etc.);
• reach out to bloggers and web sites;
• engage non-traditional partners
• conduct a community health indicators survey;
• compile evidence for how the organization’s work promotes health equity;
• write and release a brief or report.

The long-term action item demands deeper level of engagement, such as:

• initiate internal dialogues to define what a health equity framework means for your organization and develop an action plan;
• build a cross-sectoral health equity coalition to develop a health equity policy agenda;
• pressure local government to adopt an ordinance requiring that legislation and public and private development initiatives be assessed by their impact on health equity;
• develop and promote regular use of health impact assessments;
• ensure that the municipal or county “strategic plan” targets health inequities.

Unnatural Causes has proven itself an effective tool for injecting consideration of health consequences into many “non-health” arenas. Some organizations – such as Black Women’s Agenda and the SEIU – have adopted and promoted use of the series specifically because it adds a health lens to their existing work, be it racism or labor rights. In Minnesota, 15 cross-sectoral partnerships for healthy and sustainable communities have been organized with significant interfaith and labor involvement.  New Mexico now has a statewide health equity coalition whose members regularly provide public commentary on the health effects of public policy.

Still, most “non-health” organizations aren’t accustomed to seeing their work as health work and may need an extra push to get them to the table (or screening) in the first place.

Identify and contact your counterparts in other organizations and offer to host screenings and discussions with them to help everyone understand how “their” issue (housing, living wage jobs, schools, etc.) is a health equity issue.  Similarly, encourage government officials to reach across agencies and departments (housing, commerce, appropriations, etc.) and invite them to co-sponsor internal and inter-agency events and dialogs. Some public health departments, foundations, government agencies, businesses, civic organizations, even school districts are distributing DVDs to chapters, partners, grantees, and board members to further understanding and support for health equity.

Reach a broader public through your web site and blogs, listservs, newsletters, Facebook page, and other venues. Invite others to comment or post their own impressions, suggestions, and ideas for new audiences.

Organizations are using Unnatural Causes in many different ways, and one of their best sources of inspiration, lessons, and guidance is each other. Send a note about what actions you have taken and lessons you have learned to health@unnaturalcauses.org, so that we may post it on the Inspiring Stories page, www.unnaturalcauses.org/inspiring_stories.php.

Invite journalists and bloggers to learn how inequities in your community can become embedded in the body to affect health, and alert them to initiatives that could reverse those inequities. Many organizations have received local TV, radio, and print coverage of their events, raising their profile and triggering larger discussions about the issues.

Identify and cultivate relationships with individual health policy reporters. Tell them about your work. But also reach out to “metro” journalists, local columnists, talk show hosts, and producers and talk to them about how specific social and economic policies – the location of a park or diesel depot, the opening of a supermarket or fast food joint, a new “redevelopment” project or the outsourcing of a business – is helping or hindering your community’s chances for health. Provide them with local data, maps, and figures that tie differential population health outcomes to inequities in other arenas. Draw attention to initiatives that can make a difference.