Citizenship for Health Program

By Marc W. Kruman

Health disparities in cities such as Detroit continue to be a significant problem in which racial and ethnic minorities carry a disproportionately heavy burden of poor health and early mortality. Community engagement efforts, especially those addressing health disparities, have demonstrated some successes, but disparities remain a large problem. Most of those efforts, while well intended, prioritize researchers’ interests and rely on community institutions as representatives for citizens. The Center for the Study of Citizenship at Wayne State University suggests that what has been missing in those efforts—and what could be pivotal in health equity efforts at the community level—is a focus on community members’ (citizens’) engagement with each other on their shared community health problems. In addition to engagement with organizations and institutions, what is needed now are methods and models that promote the development of citizens’ habits of engagement in their own health issues through democratic deliberation. To do so will make public discussion and learning about health issues a shared social habit that begins to transform communities, their capacities to confront health problems, and their health trajectories.

 The Citizenship for Health Program is implementing a model of citizen engagement in health through a process of ‘deliberative democracy’ focused on health issues that citizens name, frame, deliberate, and act upon. To promote citizen empowerment and control over health disparities in their communities, the Program is working in HOPE Village neighborhood, using a model based on the approach established through scholarship and practice at the Kettering Foundation and Everyday Democracy. Program staff was trained in a yearlong program held at the Charles F. Kettering Foundation and funded by the Foundation.

The process is illustrated in the figure above and is conducted by community citizens in a series of meetings (at least one for each step depending on progress), facilitated by program staff. Importantly, citizens begin and control the process by naming the health issues of importance to them. During this ongoing project, members of the community have named and framed the issues, made decisions deliberatively, and identified resources needed to implement their plans. To the surprise of experts, residents determined that the crucial public health issue is the absence of effective communication about health-care services in the neighborhood and are now establishing a robust health-communication hub.

Expected long-term outcomes include:

1. A growing group of citizens and communities involved in deliberative democracy practices focused on health and well-being.
2. Citizen and community capacity for addressing health issues is applied and sustained.
3. Increasing numbers of citizens and students are trained to carry out the model locally and nationally.
4. Reports of lessons learned and outcomes attained are shared in venues across the U.S.
5. Community and population health are improved.
6. And, perhaps more importantly, recognition that the public has a crucial role to play in public health.

Marc W. Kruman is director of the Center for the Study of Citizenship and professor of History at Wayne State University