This blog contains a list of 75 common challenges experienced in community health co-creation and transformation efforts. These were compiled from research into program successes and failures, and from numerous and ongoing discussions with program leaders and participants in the US and UK. If you have any additional challenges and / or perspectives on the list, do let us know.
Changing and activating mindsets
1. How do we build a shared mindset about what we are trying to do?
2. How can we identify and overcome ways of thinking that are counterproductive to what we are trying to do?
3. How can we envision a future reality that is realistic yet potent to overcome stuck mindsets?
4. How can we avoid using language that creates resistance or disengagement from a future vision?
Framing the problem space
5. Which lead issue do we choose to anchor a community health programme? e.g., cardiac disease, domestic violence prevention?
6. How to set the frame / boundaries of a problem, e.g., local, community, state, national?
7. How to decide on an ethical frame to guide the scope of intervention?
8. Can we undo deep structural factors or just push them away? E.g., racism, market capitalism, gender inequality, etc.
9. What do we target within a problem? The risk factors, the structures, the protective factors?
10. What are the different contexts of all the above? How must we adapt our approaches to the different context?
11. Is the problem always local to context? Or are there meta-problems that transcend individual communities? Do some problems replicate across communities, across the state? If so, how can we find them?
Setting purpose to build engagement
12. How do we set realistic goals or purpose to create engagement, at what level?
13. How far back / down do we go into the causes of the problem? The further we go down/back, the more we hit the bedrock of human condition and its essence?
14. When is a purpose attractive to different actors?
15. How to make or brand a purpose so it is attractive to encourage engagement?
16. How to avoid resistance from incumbent system actors?
17. How do we accommodate alternative interpretations of problems, and their political nature? E.g., domestic violence
18. How to overcome feelings of impotency when faced with complex problems?
19. How to overcome test and learn mentality when faced with complexity?
Understanding people’s lives in (poor) health
20. What are the daily experiences of people in communities in relation to health?
21. How to better see and understand the connections that produce health?
22. How do the evidence, measures and indicators we use inform our view of health and its experience, and how we act?
23. How do we reach those most excluded / marginal from their self-agency?
24. Are community / social agents always best equipped to tackle the most marginal groups?
25. How can we help community / social agents and ourselves more deeply understand actual lived experiences? Can we be more intimate to actual experience?
Finding valid and worthwhile opportunities
26. How to justify the value of prevention when the value is in “nothing happening”?
27. How to reveal valid opportunities for action?
28. How to prioritise opportunities in terms of their value and systemic effect?
29. How to get people on-board with valid opportunities?
30. How do we describe an opportunity?
Choosing the right actors
31. How to leverage non-traditional actors and assets into the domain of action?
32. How to demonstrate the systemic nature of health so actors can see their role in (affecting) the system?
33. How to sustain interest and engagement of actors, beyond the initial interest?
34. What is the power distribution of incumbent actors?
35. How do we understand power and how to overcome it?
36. How can we leverage positive power of certain actors? If so, which?
37. How to help actors see the value of collaboration?
38. How to avoid a collaboration-is-enough mindset?
39. Do we always need formal networks of actors?
40. How to go outside formal networks?
Taking action and defining programmes
41. How do we define action? Can big impact be realised from cumulative small actions of a system, or from a few big actions and actors?
42. How to overcome a tendency to experiment at small-scale, leading to small-scale improvements?
43. Are those closest to the actual experience always the best equipped to improve their experiences?
44. Can we engender and boost more trans-local approaches across multiple communities?
45. What capabilities are absent that we need to put in place?
46. What is the capability mix of particular communities?
47. How do we develop and assess capabilities?
48. What tools are needed? Are there common tools that all communities working on all problems can use?
Assessing and convincing impact
49. What are we measuring? Outcomes, experiences, health, lives, etc.?
50. How do our measures inform our view of health and changes?
51. What new data assets might be leveraged to assess impact?
52. How to evidence impact of community-level programmes?
53. How do we convince actors of an indirect / non-linear impact effect?
54. What timescale do we need to prove impact?
55. Is data enough? What about qualitative evidence of impact?
56. How to assess the use of policy? Was it implemented coherently, or gamed?
57. How to take different messages to different actors, to prove impact?
58. How can assessments of impact spur others to action?
59. How can we keep people engaged to sustain change?
60. How can we replicate and/or scale impacts?
61. Can we cross-fertilize between communities to effect shared learning and greater impact?
Funding and resource allocation beyond the norm
62. Are there opportunities to move beyond funding to incentives / rewards mechanisms?
63. How to fund/incentivize non-traditional assets into the system to take action?
64. Do traditional ROI models / thinking apply in this context?
65. How can we undo ROI – exchange thinking and “what’s in it for me?” mindset?
66. How can we build a systemic model of community health and interventions to reveal the dynamic connections of actions, resources and investments?
Role of transformation strategy
67. How to define, explain and justify transformation approaches and strategies
68. How to overcome resistance during transformation?
69. Can we map a blueprint or only nudge along incrementally?
70. If we only nudge along, how do we retain interest of non-traditional actors?
71. How can we get actors to buy-into a transformation strategy?
72. Can we transform to a successive system completely, or does it happen incrementally, and then one day we find we are in it?
73. Can we / how do we brand a strategy to leverage community transformation?
74. What is the role of a social movement in accelerating transformation?
75. Can a social movement be more effective in the right contexts?
by Chris Lawer, originally written in April 2019