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. We suggest that what has been missing in those effortsand what could be pivotal in health equity efforts at the community levelis a focus on community members' (citizens') engagement with each other on their shared community health problems. See Michigan Civic Health Index Report.

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.

About the program

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, the neighborhood served by Focus: Hope, using a model based on the approach established through scholarship and practice at the Kettering Foundation and Everyday Democracy. Our staff was trained in a year-long program at the Kettering Foundation (funded by Kettering).

Citizen engagement model

• Identify or name the issues; that is, in terms of what is most valuable to them 
• Frame issues so that a range of actions are considered and the trade-offs required are evident
• Make decisions deliberatively, which means weighing the trade-offs, to turn hasty reactions into sound judgment
• Identify resources that are available even intangible ones like enthusiasm and commitment 
• Organize actions in a complementary fashion
• Encourage constant collective learning to keep the actions going

The process illustrated above 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. Members of the community have named and framed the issues, made decisions deliberatively and identified resources.

Expected outcomes

• A growing group of citizens and communities involved in deliberative democracy practices focused on health and well-being
• Citizen and community capacity for addressing health issues is applied and sustained
• Increasing numbers of citizens and students are trained to carry out the model locally and nationally
• Reports of lessons learned and outcomes attained are shared in venues across the U.S.
• Community and population health are improved
• The WSU model becomes validated, replicated and used in various settings nationwide

Why this program, why here and now and why us? 

Citizens are much too commonly disengaged from deliberative practices with their neighbors because of personal, family and community hardshipsmany of which are directly related to the socio-economic troubles of Detroit over the last six decades. Those hardships have eroded social capital among other assets and in turn, many citizens have lost the habit and support for civic engagement. Recognizing those problems, community institutions have experimented with various community engagement strategies, but they have not been systematically implemented or evaluated.

The model we are implementing in Hope Village is novel in its underlying philosophy, the core principles and methods and the possible outcomes. Such an approach should augment other community-based efforts by helping citizens build habits and practices of community engagement through the process of deliberative democracy.

The Citizenship for Health Program is a collaboration between the Center for the Study of Citizenship, Wayne State University's School of Social Work, Integrative Biosciences Initiative and Focus: HOPE's Urban Learning and Leadership Collaborative (ULLC).