Imagine if every decision in life, regardless of the effort you put in, was based on the flip of a coin – heads you have something and tails you do not. In unit one, we learned about the coin model and that “there are norms, patterns and structures in society that work for or against certain groups of people, which are unrelated to their individual merit or behaviour” (Nixon, 2019, p2). These norms, patterns and structures unfortunately have significant impact on health, resulting in healthcare inequities within each of our communities (Nixon, 2019). As healthcare leaders, I believe it is our responsibility to minimize these inequities so that each of our patients, and their families, receive the care they require, every single time.
Community engagement, as defined by the World Health Organization (WHO), is “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes” (WHO, 2020). Reflecting on the coin model, two terms that stand out for me are privilege and oppression. Privilege was identified as the top of the coin, representing you have an advantage that you did not earn, because of who you happen to be (Nixon, 2019). Whereas oppression was identified as the bottom of the coin, representing you have a disadvantage that you did not earn, because of who you happen to be (Nixon, 2019). Raising my awareness of the impact our processes have on the patients we serve, both positively through intended outcomes, and negatively because of unintended consequences, has been one of the most impactful learnings so far.
What if stakeholder selection was completed by the flip of a coin? Heads you can be part of the working group, tails you are excluded from the discussion – is this an acceptable approach to community engagement in health promotion? As we undertake health promotion activities, it will be essential that we engage stakeholders from both sides of the coin, as there will be lessons to be learned from their experiences. Being a process driven individual, I agree with the WHO when they state that community engagement is a process and an outcome (WHO, 2020). We need to carefully consider who all our stakeholders are, including both the privileged and the oppressed, and include them in the planning and implementation of health promotion activities. By proactively doing this, we will be able to develop relationships that can build the foundation for future activities to achieve the health outcomes we deserve, and not leave it to chance by flipping a coin.
References
Nixon, S. A. (2019). The coin model of privilege and critical allyship: Implications for health. BMC Public Health, 19(1), 1–14. https://doi.org/10.1186/s12889-019-7884-9
World Health Organization. (2020). Community engagement: a health promotion guide for universal health coverage in the hands of the people. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240010529
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