Too often, health is framed simply as an individual's physical well-being. Individuals, alone, are assumed to be responsible for bettering their health. And when a community experiences high rates of illness or disease, a question often asked is “what is wrong within the community?” rather than “why are these poor health outcomes occurring?”

Claiming health as only an individual's responsibility distracts from the fact that structural forces shape our lives, while pointing to what is "wrong" fails to recognize the very assets and gifts within communities that may hold the solution to complex health challenges.

Disrupting these dominant narratives is the first step toward building a Culture of Health.

Ambassadors as Change-Makers

Beginning in the spring of 2019, the Ambassadors for Health Equity (AHE) worked to shift dominant narratives about health in pursuit of broader policy and systems change. Led by PolicyLink in partnership with FSG, and funded by the Robert Wood Johnson Foundation (RWJF), the second round of the AHE program brought together 20 multi-sectoral leaders from outside the health field for a year-long fellowship to share ideas and forge new alliances to create conditions for better health, especially for low-income people and people of color. 

Throughout the year, fellows explored how narrative change is a crucial first step in creating a Culture of Health. As Jeff Chang, AHE alum and vice president of narrative, arts, and culture at Race Forward explained during a program webinar, “Culture moves before politics. Culture moves before a policy.”

The path to health equity, the central tenet of a Culture of Health where all people live long healthful lives, begins with first shifting how we think about health. We must understand health as optimal well-being, access to opportunity, and healthful options. Advancing health equity requires that all people have access to affordable housing, good jobs, and healthful food and it also calls for ending mass incarceration, closing the racial wealth gap, and making it easier for people to exercise their civil liberties. Advancing health equity means building a more just and liberatory world in which everyone can reach their full potential.

Marco Davis, Ambassador and CEO of the Congressional Hispanic Caucus Institute, insisted that health equity requires us to first recognize health as overall well-being rather than the absence of physical illness. "The conversation around health has to be broader than medical care and the pharmaceutical industry,” he explained. “We have to talk about social determinants of health.”

We must also inform and mobilize the people who shape the social determinants — the structures, systems, and conditions that influence health — to act in the interest of well-being for all people. No decision maker is exempt. CEOs, corporate board members, policymakers, elected officials, researchers, entertainers, and business owners all play a role.

Leading by Example

Through the program, Ambassadors also discussed how they can use their roles as decision makers to build a Culture of Health by expanding mainstream framings of health and thinking in terms of assets rather than deficits. 

“While deficit-framing defines people by their problems and seeks to ‘fix’ them, asset-framing defines people by their aspirations and contributions and seeks to remove the unjust systemic barriers that stand in their way,” said Ambassador and founding CEO of BMe Community, Trabian Shorters. “You can’t lift people up by putting them down. If you want to build equity, you have to use asset frames. If you want to stigmatize people then keep using deficit frames,” he added. 

Labeling communities with terms like “at-risk,” “high-crime,” and “disadvantaged” reinforces harmful stereotypes and perpetuates racist and stigmatizing narratives. On the other hand, defining people with more accurate depictions of their aspirations, contributions, and realities primes change-makers to address deep-rooted, systemic issues that impact the daily lives of individuals.

Other Ambassadors talked about how they could integrate this asset-framing into their work. Ambassador and StriveTogether president and CEO Jennifer Blatz explained, “We are coaching our community partnerships to use asset framing to put data into context and tell the story of the inequities in today’s systems that place a disproportionate burden on children of color and families experiencing poverty.” 

Gretchen Beesing, Ambassador and CEO of Catalyst Miami, noted a similar need to center asset-framing in their work. “During the final convening, I had a mind-blowing moment; I realized we needed to fix Catalyst's mission statement. It will take time, and still we know we have to reframe the way we position the organization to be more asset-based rather than deficit-focused.” As Catalyst Miami’s mission statement guides all of their work addressing climate impacts for communities of color, this change could have long-lasting impacts. 

The quest for a Culture of Health requires both an asset-focused and a holistic understanding of health. Sarah Eagle Heart, Ambassador and co-founder of Return to the Heart Foundation, is working to do this through philanthropy. “I chose to co-found Return to the Heart Foundation to raise visibility and create avenues for funding holistic solutions through Indigenous women-led initiatives. If philanthropy focuses on centering holistic solutions, we can create lasting systems change.” 

Moving toward a future of health equity requires we shift dominant frames and our culture — recognizing the power of the collective and the wisdom of people most impacted by structural inequities are key to optimal health for all.