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Creating Inclusive Community Organizations: Addressing the Social Determinants of Health

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I Introduction

In November 2004, the Ontario Healthy Communities Coalition (OHCC)
launched Inclusive Community Organizations: A Tool Kit. This tool kit
outlines a step-by-step organizational change process to increase the
level of diversity of small to mid-sized organizations, at all levels
of the organization, and to make them more aware, responsive, and
inclusive of the populations they serve. The organizational change
process is a planned approach to developing and implementing inclusive
policies, programs, and practices adapted to the needs of a diverse
community.

In January 2005, a participatory action research project was undertaken
to test the process outlined in the tool kit with four community-based
organizations in different parts of the province. Using the tool kit as
a guide, these organizations have been actively engaged over the last
year in a facilitated organizational change process designed to
increase their level of diversity and inclusion. This article frames
inclusion as a social determinant of health and presents an overview of
the tool kit, the project, and its learnings, as a way of demonstrating
how other community organizations can approach inclusion and work to
address some of the social determinants of health.

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II Inclusion:  A Social Determinant of Health

In a healthy community all members are able to participate fully within
their families, organizations, and society. Those who are excluded,
whether based on poverty, ill health, gender, race, or lack of
education, do not have the opportunity for full participation in the
economic and social benefits of society. This exclusion has a strong
negative impact on individual health and well-being and is seen as a
major contributor to chronic diseases, such as heart disease, stroke,
and diabetes.

People feel valued when

  • their particular gifts, abilities, and challenges are recognized;
  • they have opportunities for growth and development;
  • they are involved and engaged in community activities; and
  • when they have all of their basic needs met (housing, food, clothing).

Individuals of all backgrounds and socio-economic circumstances have
concerns and ideas about creating healthy communities. They not only
want to be heard and participate in processes that affect their lives
and the communities in which they live, but they also have a right to
do so.

Community organizations are the foundation of local democracy and play
a vital role in the health of their communities and society at large.
Every day, across the province, community groups make Ontario a better
place to live, work, and play. To be successful, these organizations
need to reflect the needs and views of all members, users, and
stakeholders in their communities. Much of their strength lies in their
ability to be both representative and inclusive.

There are significant direct benefits for individuals when they
participate in community organizations. Involvement in a community
organization can provide a person with increased technical,
communication, and leadership skills; opportunities for networking;
employment references; social contact; information about other
community resources; emotional support; and increased self-esteem. It
can lead to paid employment and new friendships. For some, it may even
be a stepping stone to other types of community involvement. For
example, many local politicians started their public life by
volunteering in community organizations.

Organizations and marginalized groups can gain much from working
together. On the one hand, some groups lack the necessary resources and
networking opportunities to ensure that they are heard and their ideas
are reflected at the community level. On the other hand, many community
organizations that are sincerely interested in involving a wide
spectrum of the community lack the information and innovation required
to connect in a positive way. By developing strategies that promote
inclusion, community organizations become better equipped to respond to
individual and community-based needs. Increasing the diversity of
boards, staff, members, and volunteers in community organizations also
has a positive impact on the individual, the organization, and,
potentially, the community as a whole.

To be truly effective, community-based organizations need to educate
themselves about issues of race, ethnicity, class, economic status,
sexual orientation, age, gender, and disability. They should not only
accommodate and respond to those who show interest but also actively
seek out others who might have the motivation to become involved. Often
an organization can provide greater access and accommodation to others
by shifting the perspectives and understandings of its existing
members. By essentially wearing a diversity and inclusion "lens,"
members of a community organization can improve their vision.

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III The Inclusive Community Organizations Tool Kit

Through its research, the OHCC discovered that there are a number of
training manuals, educational resources, and consultation services
available to assist groups to enhance their sensitivity and
responsiveness to diverse communities. However, these resources are
mainly targeted at professionally staffed, service-providing
organizations and are not the type of training resources needed by
smaller community groups and organizations.

For instance, most of these resources refer to the need for an
organization's human resources department to play a key role in an
inclusivity initiative. Yet, many smaller community groups and
organizations do not have human resource departments and may not even
have full-time, permanent staff. Given that much of the work that these
groups do is voluntary in nature, the types of resources that were
available simply weren't appropriate. Moreover, because these groups
tend to operate with very restricted budgets, they are unable to hire
diversity consultants to assist with their work and usually have to
achieve their aims using whatever resources are currently available to
them.

Therefore, the OHCC created its Inclusive Community Organizations tool
kit with the purpose of supporting diversity and improving inclusivity
within small to mid-sized, volunteer-based, not-for-profit
organizations. The tool kit provides the necessary foundation for
community organizations to develop a critical lens that will allow them
to reflect on their organization's current position and respond
effectively to ensure that they reflect local demographics. The
suggestions offered enable community organizations to develop and adapt
initiatives that are appropriate to their individual circumstances.

The tool kit includes

  • concrete suggestions for getting started regardless of organizational capacity
  • a self-assessment tool to examine current policies, procedures, and/or structures;
  • a step-by-step process for planning an organizational change process to increase diversity and inclusion;
  • tips for implementing and evaluating organizational plans; and
  • a list of resources and contacts for further assistance.

Within the tool kit, "diversity" refers to the differences that exist
among individuals and groups within a population and includes both
visible and invisible differences. Dimensions of diversity include but
are not limited to race, ethnicity, age, disability, citizenship,
religion, marital status, gender, sexual orientation, literacy level,
income, and employment status. Welcoming diversity means acknowledging
and respecting differences and recognizing the value of every
individual to their communities and to society at large.

The concept of "inclusion" relates to the fact that the dominant
culture in any society largely determines the social and economic
environment in which all individuals live and interact. People who are
on the fringe of society, who are devalued in terms of their culture,
language, or other personal attributes, are referred to as being
"marginalized." They may lack access to appropriate services and often
their needs are not even known. An inclusive society "creates both the
feeling and the reality of belonging and helps each of us reach our
full potential" (Count Me In: an Inclusion Toolkit for Ontario
Communities, Michael Fay et al, Ontario Prevention Clearinghouse, OHPE
Bulletin, Friday, 23 April 2004). An inclusive organization includes
the active and meaningful involvement of people who reflect the
diversity of the community.

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IV Creating Inclusive Community Organizations: A Participatory Action Research Project

With funding from the Public Health Agency of Canada, a research
project was undertaken in January 2005 to test the process outlined in
the tool kit. The objectives of the Creating Inclusive Community
Organizations project were to

  • Engage four community organizations within four regions of the
    province in a process of organizational change that leads to an
    increase in the diversity within the organization and the people it
    serves;
  • Increase awareness of community demographics, patterns of civic
    engagement, concepts of social inclusion and exclusion, and visible and
    invisible barriers to community participation;
  • Identify barriers within organizations to effective participation
    by community members, particularly those from marginalized segments of
    the community;
  • Develop and begin to implement strategies to increase the degree
    of community representation at various levels of the organization
    and/or in other community activities;
  • Evaluate project process and outcomes; and
  • Produce and disseminate a report of the project results and participants' learning.

A provincial advisory committee was formed and four community
organizations were selected to embark on a facilitated organizational
change process designed to increase their level of inclusion. The four
organizations that participated in the project were

  • Blue Hills Child and Family Centre, Aurora
  • Community Living Meaford, Meaford
  • Perth County District Health Unit, Stratford
  • Sandy Hill Community Health Centre, Ottawa

OHCC Community Animators provided facilitation services to the
participating organizations and assisted in documenting the results of
the project at the local level. In addition, each organization
developed a steering committee that established terms of reference and
developed goals and objectives for the duration of the project.

All of the organizations' steering committee members received copies of
the tool kit, participated in an introductory workshop, and completed
an initial questionnaire to help determine the direction of the
project. While the participatory action research project was to span
one year, groups were asked to think in terms of planning for a two to
three year process.

Over the course of the last year of the project, the steering
committees held regular meetings to review progress and reflect on the
process. Monthly advisory committee meetings were also held to help
guide the project as a whole.

A number of activities were undertaken by the different organizations
which led to changes in policy and decision making, human resources
practices, and programs and services. For example

  • one group developed an organizational Code of Ethics and assessed all of its policies and procedures using an inclusion lens,
  • two of the organizations incorporated their diversity work into
    their strategic plans and are looking into alterations to their by-laws
    to ensure that they imbed inclusionary practices,
  • another organization conducted an organizational assessment of
    the degree of inclusivity in the area of programs and services and is
    using this information to develop an action plan, and
  • two of the organizations undertook strategic recruitment for
    board and front line staff to better represent community demographics.

Throughout the project, members of the participating organizations
reflected on the process and evaluating the results of their inclusion
initiatives. A final evaluation of the project is currently underway
and will be completed in March 2006. Yet, there are a variety of
learnings that have come out of the project to date, including the
following.

  1. Reviews of governance, structure and/or leadership can provide
    opportunities for undertaking inclusive organizational change, e.g.,
    undergoing an accreditation process.
  2. Organizational readiness is necessary for undertaking this type
    of work; consider both the historical and current contexts and issues
    such as resources, time, interpersonal skills, morale, and community
    perceptions.
  3. Ensure there are common definitions of diversity and inclusion and a clear organizational vision regarding inclusion.
  4. Organizations benefit from appropriate and accessible educational materials, as well as external hands-on guidance and support.
  5. Education and training must be consistent, inclusive, and continual.
  6. Input and involvement from members of diverse/currently excluded
    groups is extremely valuable from the outset, as opposed to later on in
    the process.
  7. Engage diverse communities in a collaborative way and recognize
    their strengths and potential contributions, e.g., they have their own
    infrastructures and resources.
  8. Incorporate a commitment to inclusion into strategic priorities, communications, and allocation of resources.
  9. Participation from various levels of the organization is essential.
  10. Working as a multidisciplinary team has many benefits, e.g., it can provide creativity and innovation.
  11. Reflection, evaluation, and analysis are required throughout the process so as to make necessary changes or adjustments.
  12. Be sure to celebrate your successes (no matter how small).

Participating organizations have also found that they are being more
proactive around inclusivity, are expanding their involvement in
different opportunities, and are being invited to attend more events
relating to diversity as a result. While the participatory action
research has come to an end, the participating groups are continuing to
develop and implement their strategies and action plans for becoming
more inclusive. OHCC also continues to make the Tool Kit available, as
well as communicate project results and learnings to interested parties
through workshops and presentations. After all, inclusive
organizational change is ongoing.

For more information contact Lisa Tolentino, Community Animator and
CICO Project Coordinator for the Ontario Healthy Communities Coalition,
at Lisa@healthycommunities.on.ca or (416) 414-8778.