The National Collaborating Center on Determinants of Health holds that community engagement is essential to health equity (2021). As outlined in PART of the LET'S TALK SERIES LET'S TALK (2021), public health involves communities at multiple levels, including explaining initiatives, inviting input, developing solutions in collaboration, and partnering from the beginning. These levels of community engagement directly impacts health and social outcomes. Inequities can negatively affect health and social outcomes. It is essential to include communities living with inequities when engaging communities in order to improve physical and psychosocial health and well-being. Achieving health equity requires authentic engagement with community members who live with inequities. Community members should be viewed as partners and stakeholders rather than service recipients (PART of the LET'S TALK SERIES LET'S TALK, 2021). Inequity affects the health, well-being, and daily lives of those who experience it. Racism and other structural inequities must be confronted to correct power imbalances in community engagement. In order to do this, we must share truths, apologize, and commemorate past harms in public (PART of the LET'S TALK SERIES LET'S TALK, 2021). Underrepresented voices and communities will be genuinely represented if we integrate their perspectives into the community engagement process.
Figure: The Coin Model (Nixon, 2019).
Undoubtedly, health inequities persist and are rooted in socio-economic and political factors. Transformative change is hindered by framing these inequities as unfair outcomes of social structures that give disadvantages to some while ignoring that those same structures also give others unearned advantages and privileges (Nixon, 2019). Society has certain norms, patterns, and structures that privilege some social groups over others, such as sexism, heterosexism, racism, ableism, settler colonialism, and classism (Nixon, 2019). In the Coin Model by Nixon (2019), each system of inequality is conceptualized as a coin. In society, coins are norms or structures that give advantages or disadvantages regardless of whether individuals want them or are even aware of them. The coins represent different systems of inequality. These structures, or coins, give unearned advantages to some people according to one's relationship with another; one may have an advantage or disadvantage in that particular system. Disadvantaged people in this social structure are viewed as being at the bottom of the coin. As a result of these same social structures, other groups of people receive advantages and are perceived as being on top (Nixon, 2019). Focusing on the top of the coin is essential because inequity is relational: those at the bottom are disadvantaged compared to those at the top. Despite this, health equity issues are often seen as problems that only affect the bottom of the pyramid (Nixon, 2019). In order to effect transformative change in the health sphere, we must identify and transcend widespread, willful oblivion regarding the harms of privilege (Nixon, 2019). We must work together to advance the cause of solidarity across the coin. Liberation should be available to all, regardless of their position, top or bottom of the coin (Nixon, 2019).
Reference
National Collaborating Centre for Determinants of Health. (2021). Let's Talk: Community engagement for health equity. National Collaborating Centre for Determinants of Health. https://nccdh.ca/images/uploads/comments/Lets-Talk-Community-Engagement-EN.pdf
Nixon, S. A. (2019). The coin model of privilege and critical allyship: implications for health. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7884-9
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