Existing frames resist change. Healthy community partnerships often must address strongly held beliefs or perceptions of reality that challenge the progress of their agenda. This can happen at any level of the work. Healthy community approaches rely on an understanding that environments and systems influence health behavior and that the social determinants of health influence health outcomes. Yet strong existing frames and mental models define and support the status quo. They need to be identified and consistently challenged.
Unaddressed concepts of individualism and limited government can discourage community action for change. Resident leaders, community stakeholders, professionals from various disciplines and elected officials can all potentially hold an unchallenged belief that health is an individual responsibility and that change must focus only on health promotion. This belief can make it difficult for them to appreciate the role of policy, environments and culture in supporting healthy behavior and community-wide health and to see their place in making such changes. Individualism also encourages most people to think of equity in terms of interpersonal fairness and to not acknowledge the patterns of structural racism, spatial disadvantage, income inequality or other social determinants that affect health. In some places, residents, elected officials or powerful institutional stakeholders can hold a belief that government is ineffective or untrustworthy. This can make it difficult for them to support the policy approaches, or governmental investment and reform, required to build healthier communities. Recognizing these existing frames is an important first step to developing carefully crafted, consistent messages that can promote productive dialogue.
Specialized professional disciplines also have different priorities and blind spots to health in their training. Each profession also has its own perspective that influences its priorities and level of openness to certain kinds of change. For example, a traffic engineer, whose training is centered on moving automobiles quickly with less regard to other users of the road, may not initially embrace planning or facilities that support pedestrians or bicyclists. Likewise, a nutritionist or recreation supervisor trained to deliver educational information or run activities may tend to see healthy eating or physical activity only as a programming issue. Productive partnership with these professionals requires the ability to recognize and help broaden these points of view.
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