HA TOOL 1 – Shift Health Accelerator

Grounding: Situating your healthcare accountability journey

Toolkit: HIA1-Gr

Healthcare Accountability Initiative toolkit

Grounding

Situating your healthcare accountability journey

Introduction

This reflection is a quick way to surface what often stays hidden: the narratives, tactics, and institutional forces that prevent power-sharing, and the real examples of community creativity that healthcare could choose to resource instead. We recommend the frame of nightmare and hope to center the point and counterpoint pathways that allow you to make visible the dominant forces and opportunities to disrupt the status quo. Use it to move beyond abstract commitments and identify the specific dynamics your team will need to interrupt.

Nightmare

What narratives or tactics prevent your organization from sharing power with community? Why are they effective?
Who typically deploys them? What is your own role/relationship to those tactics and narratives?
How are they shaped by internal forces v. external forces?

Hope

What do you see happening in community that represents creativity and innovation that you would like to see your institution support?
When have you been able to overcome these tactics in your institution?

The current state of population and community health also exists along a continuum, and each system’s approach is differentiated by how it centers the community. Every system or intervention has the ability to produce harm, however, the response to the harm is what creates the lasting effect and represents the opportunity to advance more equity-forward and liberatory models of accountability and shared power. System types in the image are adapted from the National Institute for Children’s Health Quality.

Part Two

Intro to the 4 D’s

The “4D” framework helps teams name common narratives and tactics that block equity and power-shifting in population/community health work: Deny (minimizing the problem), Distance (deferring responsibility), Distort (using misleading frames like narrow ROI logic), and Delay (stalling or slow-walking change). From there, we shift toward the “5th D”: dismantling harmful systems through concrete changes in governance, investment, and data practices.

1

Deny

Race should not be a focus of discussion or public policy

Opposing the collection of racial data gathering

2

Distance

Focusing on a non-racial identity that is subject to discrimination.

Focusing on personal hardships instead of race.

3

Distort

Focusing on implicit bias training solely despite evidence showing neutral or negative effects on people’s attitudes toward Black, Indigenous, People of Color.

4

Dismantle Unjust Systems

Counter distortion with a vision grounded in justice.

Move beyond a return on investment (ROI) case.

Prioritize long-term equity and justice over the possibility of short-term losses.

Adapted from: https://sloanreview.mit.edu/article/fighting-backlash-to-racial-equity-efforts/