Community organizing in public health
Public health groups can partner or collaborate with community organizing groups, or use community organizing methods, or both, to advance public health. Community organizing, based on the principle that power is rooted within communities, often works to address structural and social determinants of health in local neighborhoods1, 2. Such work can be a strategy to improve community conditions and change systems that are causing health inequities, and goals may overlap with and inform priorities in the public health sector. Public health can align with evidence-based movements3, seek intersectoral collaboration to advance health equity4, and share power with community organizing such that communities’ priorities come first2.
Public health is a science focused on protecting and improving health through health promotion and disease and injury prevention5. Work focuses on local communities or larger populations, such as a state or region, and can include implementing programs, policy recommendations, administering services, and research5. Collaborations and partnerships are a common and important way to advance public health priorities and can include the private or philanthropic sectors5.
Community organizing refers to people coming together around a shared purpose or identity, to build relationships, identify shared issues, collectively analyze these issues and develop goals, and to use strategies and tactics which can help reach those goals1, 6. Community organizing groups are usually in the non-governmental sector and work is led by community organizers, who are activists skilled and trained in facilitating community organizing methods. Such methods include developing leadership skills within a group, expanding group membership, direct action and campaigning, and building power – both within the group and larger community – to influence decisions, set agendas, and shift worldviews1, 6.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
- Increased public health effectiveness
- Increased community power
- Increased social connectedness
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
- Increased civic engagement
What does the research say about effectiveness?
Public health groups using community organizing methods, partnering with community organizing groups, or a combination is a suggested strategy to advance health equity and may sustain health promotion efforts and benefits beyond specific interventions2, 7. Experts note that community organizing frameworks have long been used to guide community-based health initiatives, which appears to positively affect intended health outcomes2, 7, at least in the short term2. Available evidence suggests community organizing in public health may improve physical and mental health outcomes among populations intended to benefit7. This approach may also increase participants’ perception that public health interventions are effective, and that the public health sector is responsive to community needs7. Communities may have increased access to health information and research findings because of community organizing initiatives7. Public health practitioners and researchers may shift priorities and agendas in response to community organizing partnerships or methods, toward greater focus on communities and equity. Community organizers’ may find that new avenues for engagement with health data and research informs priorities7.
Community power. Experts suggest that public health sector actions can support building community power, through sharing decision-making responsibilities, funding and supporting community organizing work that relates to health equity, and including communities during all stages of science and research7. For example, community organizing partners can shape or define research questions, strategically involve their networks for outreach and recruitment, and support evaluation and ethical practices7. Policy wins suggest that increased engagement and learning between public health and community organizing enhances efforts to address social and structural determinants of health, across health topics including health insurance, housing and shelter, food systems, paid leave, and environmental protections7. Efforts to partner with or include community organizing in public health often focus on environmental health and justice. Access to university faculty and research expertise can support communities’ capacity to address environmental issues7. Social capital can also be enhanced through efforts to include community organizing in public health. Individuals and groups may form new relationships, networks, and coalitions, which can contribute to increases in reported sense of belonging and feeling connected to others in a community7.
Civic engagement. Programs which aim to increase civic engagement may also increase social capital and benefit community health7, 8. Colorado State University’s Extension program operates the Family Leadership Training Institute (FLTI), a 20-week training for residents from communities across Colorado focused on leadership and civic skills development, civic education, and networking with local leaders8. Program trainers and coordinators also represent communities engaged in the program. A study of FLTI’s impacts measured civic literacy and empowerment; civic knowledge (for example, how state laws and budgets are made); current skills and activities which can affect community change, as well as specific civic engagement activities (like attending board meetings or volunteering locally); and satisfaction with social support and sense of belonging in one’s community, which can also indicate mental health. The study suggests participants had significant gains in all areas in the short-term, with increases in civic engagement activities sustained for as long as 5 years8.
Challenges for public health groups when collaborating with community organizing partners can include administrative barriers, such as funding, timeline constraints, difficulties in defining roles and responsibilities, and hiring. Approaches may differ between public health and other sectors regarding values and expectations, language, and communication styles. These differences can negatively affect power dynamics on projects7. People in public health should also consider that advocacy work and partner engagement, such as between sectors, can be resource-intensive and emotionally demanding for people in community organizing7, 9.
Recommendations. Power differentials between public health and partners or collaborators can be addressed through project design (for example, using subcommittees) and researchers’ efforts to avoid technical language7. Community organizing groups engaged by public health should also represent the community7. Experts recommend incorporating key components into initiatives which involve public health and community organizing stakeholders, such as (1) creation of partnerships and coalitions, (2) community integration and resilience, (3) joint problem-solving, (4) bottom-up approach, (5) community ownership, (6) community empowerment, and (7) capacity building2. Community-based participatory research (CBPR) methods and principles are also recommended to raise awareness and support networking and coalition building -- especially using shared decision-making about research products and disseminating research findings9.
Some strategies can sustain community organizing activities beyond specific projects, including resources for community leaders and members to engage and maintain action, continuing meetings between stakeholders that aim to build and maintain trust, and using a systems-based approach, which engages local government and non-governmental organizations in addition to public health and community organizing groups2. Project outcomes that include a focus on public policy change and garnering government support can also support sustained positive change2.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Community organizing in public health is a suggested strategy to decrease disparities and advance health equity, especially when public health and community organizing efforts are aligned to focus on structural determinants, health equity, and justice2, 7. Measures that suggest community organizing in public health may decrease disparities include policy wins which promote equity in areas affecting health including health insurance, food systems, transit and housing, paid leave, and environmental exposures and protections7. More research is needed which compares the strengths of different approaches in incorporating community organizing methods, structuring partnerships, or both, as well as more research which compares methods under the umbrella of community organizing.
Health outcomes. Experts suggest that community organizing in public health may improve health outcomes among the populations intended to benefit7. A study of community health workers’ engagement as co-researchers and organizers in community-based participatory research (CBPR) suggests this engagement increased the community health workers’ leadership skills and sense of efficacy, supporting positive health outcomes in the Latina/o community served25. CBPR involves community members, practitioners, and academic researchers equitably in research design and processes, aiming throughout to build community capacity to address priorities26. A Santa Barbara, California-based study involving a partnership between two grassroots organizations (CAUSE and MICOP) and the county health department suggests that this partnership facilitated prioritizing Latina/o and farmworker communities in COVID-19 response, increasing leverage and support to pass protective health orders27. A small study in New Zealand where a district health board engaged Pacific Island youth in a community organizing program, suggests this improved individuals’ sense of agency and self-reported mental health; this population experiences inequities in health exposures and significant disparities in mental health measures like depression, anxiety, and suicidality28.
Indigenous communities in North America also experience inequitable health burdens29. A study of an Indigenous health coalition, Menominee Wellness Initiative, which included community organizers, found this inclusion increased the coalition’s focus on language, culture, collective values, and other Indigenous ways, and encouraged the coalition to include these components in health and well-being promotion29. This appeared to increase community members’ engagement with activities designed by the coalition29. At coalition meetings, normalizing discussion of historic and contemporary racism and injustices experienced by the Menominee Nation appeared to reinforce shared understanding of root causes and health implications related to these experiences, which focused solutions on structural determinants of health29. Other evidence also suggests that re-connecting with and centering cultural identity, language, and traditional practices can promote health and well-being, and may contribute to addressing intergenerational trauma29.
Environmental health. Community organizing efforts often focus on environmental factors impacting health – among a range of priorities – as environmental threats disproportionately affect communities with fewer economic resources and communities with more residents with racial or ethnic minoritized backgrounds30. Sources of pollution are often sited closer to these communities, increasing residents’ exposure to environmental harms; threats include noise, air, water, and other pollution from major roadways, airports, manufacturing facilities, energy plants, toxic waste sites30, and industrial farms31. A Minnesota-based case study of a faith-based community organization, which developed into a much larger coalition comprised of 90 organizations, suggests this approach can produce sufficient leverage to achieve desired outcomes, though it may require years of relationship-building and cross-sectoral work to illustrate policies’ health and social consequences to policymakers. In this case, the coalition’s work supported building a new light rail system with stops in neighborhoods with high proportions of residents from racial and ethnically marginalized backgrounds, which had historically been excluded from transit improvements32. A Baltimore-based case study suggests environmental justice initiatives that use a human rights framework can promote solidarity among diverse participants and develop community consciousness and leadership skills33. Experts also suggest that community organizing evaluations measure sustained impacts on participants and community capacity, which can last beyond achieving near-term policy goals33.
Community-based participatory research (CBPR) is a collaborative approach that, when used as part of community organizing in public health, appears to enhance environmental public health efforts26. A Detroit-based study focused on reducing risk environmental factors for asthma, and increasing protective factors, suggests that CBPR approaches can support community-led policy advocacy and successful leveraging of data to oppose public works projects that could increase environmental health hazards26. A Boston-based study used a CBPR approach to support collaborative community development; one neighborhood used relationships with local leadership to advocate for sound walls to protect residents from harmful traffic noise30.
What is the relevant historical background?
Improvements in population health in the U.S. and worldwide have been linked to social movements for change for hundreds of years, with significant milestones since the 1800s34. Community members and community-based organizations have long identified public health challenges resulting from inequitable and unjust resource distribution and organized to improve environmental, occupational, and social conditions34. Well-known examples include reformers and associations in New York City in the late 1800s, who mapped urban housing conditions which contributed to illness. Reformers used this evidence to gather public support at conventions and to pressure city politicians to ensure communities had access to improved sanitation, like public drinking water and bathing facilities34. Other notable environmental health examples include community-driven efforts to change conditions contributing to tuberculosis outbreaks in the 1910s and 1920s and lead poisoning in the 1960s34.
Public health has been active in social justice movements, including labor, civil rights, and disability rights2, 7, 34. Since the 1970s, public health has often named community empowerment as a strategy, focusing on increasing community participation in efforts to build power and agency among members to understand problems, define solutions, and guide community development7. Some experts suggest that post-1990s, organizations have become less insular and more adept at forming inter-organizational networks, which can be more powerful in a globalized context32.
Much evidence has established that a robust public health system is linked with increased social stability, economic development and biosecurity34. Experts suggest that success in recent health initiatives can be attributed in part to increased community participation and organizing, with community trust and local leadership as key components2. Experts also note that public health can advance health equity by allying with contemporary evidence-based, anti-racist, anti-colonial, and anti-imperialist movements7.
Equity Considerations
- How can local public health agencies, practitioners, and researchers include community organizing methods in their approach to improving community health?
- How can community organizing groups lead and engage in public health initiatives focused on the priorities of their members, including those focused on the structural and social determinants of health? How will these collaborations’ success be measured? What resources and motivations exist to develop and maintain collaborative relationships?
- What resources are needed for local community organizing groups to sustain their work, including potential partnerships or engagement with the institutional public health sector? What resources can public health provide (e.g., funding, research capacity on specific topics, etc.)?
Implementation Examples
Numerous collaborative projects explore the relationship between community health and community power building. The National Collaborating Centre for Determinants of Health (NCCDH) offers guidance for the public health sector to shift power and build relationships with the community organizing sector10, 11. The NCCDH series Let’s Talk includes a framework for public health reflection and action, and in its definition of public health roles, describes partnering with other sectors as an essential part of public health practice4. Examples include Lead Local, which involved leaders in community organizing, advocacy, and research, and continues to offer a website with resources on the project’s approach and outcomes12. Human Impact Partners’ (HIP) Power-building Partnerships for Health pairs community power-building organizations (e.g., grassroots organizing groups, movement-building organizations, community organizing or base-building groups) and local health departments. The structure aims to develop shared understandings between partners, strengthen relationships and trust, and to enhance both partners’ ability to strategize and take actions which advance health equity and racial justice13.
Overviews of community organizing in public health note that shifting power requires the work to be community-led14. Examples of state- and city-based organizations with expertise in community power building and intersectoral work include Alabama Arise15, Cover Alabama16, and Communities Creating Opportunity (CCO)17 in Kansas City, MO14. National organizations include Community Change18 and Center for Popular Democracy14, 19. Many such organizations’ priorities include health care access, Medicaid expansion, and raising awareness about health disparities; Community Catalyst20 advocates for health as a right for all. Faith-based organizations can also develop coalitions to exert greater policy influence at the local and regional level; Isaiah is one such organization which connects racial and economic justice issues with community health outcomes21. Colorado State University Extension hosts the Family Leadership Training Institute (FLTI) which offers intensive trainings to build local residents’ capacity for meaningful civic participation and collaboration with decision- and policy-makers around social, health, and economic issues22. Additionally, the Native Organizers Alliance advocates for and leads initiatives focused on Indigenous sovereignty and rights23.
One U.S. collaboration between 45 community-based organizations and public health researchers, aimed to share findings beyond academic spaces and audiences. The project outcomes included organizational profiles with data and community and cultural context; these “snapshots” were shared via intermediary organization Praxis Project, to support the featured organizations’ networking and coalition building9, 24. Praxis Project is a national non-profit which works with national, regional, state, and local partners to support them in organizing and policy advocacy efforts24.
Implementation Resources
‡ Resources with a focus on equity.
NCCDH-PH in Comm Org 2024 - National Collaborating Centre for Determinants of Health. (2024). Public health speaks: Public health’s role in community organizing.
Garcia 2020 - Garcia K, Olimpi EM, Karp DS, Gonthier DJ. The good, the bad, and the risky: Can birds be incorporated as biological control agents into integrated pest management programs? Journal of Integrated Pest Management. 2021;11(1):1-11.
Footnotes
* Journal subscription may be required for access.
1 Minkler 2019a - Minkler, M., Rebanal, R. D., Pearce, R., & Acosta, M. (2019). Growing equity and health equity in perilous times: Lessons from community organizers. Health Education & Behavior, 46(1_suppl), 9S-18S.
2 Kadariya 2023 - Kadariya, S., Ball, L., Chua, D., Ryding, H., Hobby, J., Marsh, J., Bartrim, K., Mitchell, L., & Parkinson, J. (2023). Community organising frameworks, models, and processes to improve health: A systematic scoping review. International Journal of Environmental Research and Public Health, 20(7), 5341.
3 Fairchild 2010 - Fairchild, A. L., Rosner, D., Colgrove, J., Bayer, R., & Fried, L. P. (2010). The EXODUS of public health what history can tell us about the future. American Journal of Public Health, 100(1), 54–63.
4 NCCDH-PH roles - National Collaborating Centre for Determinants of Health (2013). Let’s talk: public health roles for improving health equity.
5 CDC Foundation-Public health - Centers for Disease Control (CDC) Foundation. Who we are: What is public health? Retrieved February 17, 2025.
6 Pastor 2020 - Pastor, M., Ito, J., Wander, M., Thomas, A. K., Moreno, C., Gonzalez, D, et al. (2020). A primer on community power, place, and structural change. University of Southern California, Dornsife, Equity Research Institute.
7 Jimenez 2025 - Jimenez, C., Heller, J.C. (2025). Community organizing and public health: A rapid review. BMC Public Health. 25(1):669.
8 MacPhee 2017 - MacPhee, D., Forlenza, E., Christensen, K., & Prendergast, S. (2017). Promotion of civic engagement with the family leadership training institute. American Journal of Community Psychology, 60(3–4), 568–583.
9 Garcia 2020 - Garcia K, Olimpi EM, Karp DS, Gonthier DJ. The good, the bad, and the risky: Can birds be incorporated as biological control agents into integrated pest management programs? Journal of Integrated Pest Management. 2021;11(1):1-11.
10 NCCDH-Oickle 2021 - Oickle, D. (February 26, 2021). Movement building as intersectoral action to achieve health equity. National Collaborating Centre for Determinants of Health (NCCDH) Blog.
11 NCCDH-PH in Comm Org 2024 - National Collaborating Centre for Determinants of Health. (2024). Public health speaks: Public health’s role in community organizing.
12 Lead Local-Findings - USC Dornsife Equity Research Institute. (n.d.). Leading locally: A community power-building approach to structural change. Key findings and reports. Lead Local. Retrieved February 17, 2025.
13 HIP-PBPH - Human Impact Partners (HIP). (n.d.) Power-building partnerships for health. Retrieved February 17, 2025.
14 Bylander 2023 - Bylander, J. (2023). How communities are building power to improve health: Article examines how some communities are attempting to shift the balance of power to improve their health. Health Affairs, 42(8), 1038–1044.
15 AL-Arise - Alabama Arise. (n.d.). Accessed February 17, 2025.
16 Cover AL - Cover Alabama Coalition. (n.d.). Accessed February 17, 2025.
17 CCO - Communities Creating Opportunity. (n.d.). Accessed February 17, 2025.
18 Community Change - Community Change. (n.d.). Accessed February 17, 2025.
19 CPD - Center for Popular Democracy. (n.d.). Accessed February 17, 2025.
20 Community Catalyst - Community Catalyst. (n.d.). Accessed February 17, 2025.
21 Isaiah MN - Isaiah, Minnesota. (n.d.). Building a just and abundant Minnesota through faith in action. Accessed February 17, 2025.
22 CSU Ex-FLTI - Colorado State University Extension (CSU Ex). (n.d.). Family Leadership Training Institute. Accessed March 4, 2025.
23 NOA - Native Organizers Alliance (NOA). (n.d.). Retrieved February 17, 2025.
24 Praxis Project - The Praxis Project. (n.d.). Accessed February 17, 2025.
25 Farquhar 2008 - Farquhar, S. A., Wiggins, N., Michael, Y. L., Luhr, G., & Jordan, J., Lopez, A. (2008). Sitting in different chairs: Roles of the community health workers in the Poder Es Salud/Power for health project. Education for Health (Abingdon), 21(2):39.
26 Parker 2010 - Parker, E. A., Chung, L. K., Israel, B. A., Reyes, A., & Wilkins, D. (2010). Community organizing network for environmental health: Using a community health development approach to increase community capacity around reduction of environmental triggers. The Journal of Primary Prevention, 31(1–2), 41–58.
27 Gaydos 2022 - Gaydos, M., Do-Reynoso, V., Williams, M., Davalos, H., & López, A. J. (2022). Power-building partnerships for health: Lessons from Santa Barbara about building power to protect farmworker health and advance health equity. Journal of Public Health Management and Practice, 28(Supplement 4), S166–S170.
28 Han 2015 - Han, H., Nicholas, A., Aimer, M., & Gray, J. (2015). An innovative community organizing campaign to improve mental health and wellbeing among pacific island youth in South Auckland, New Zealand. Australasian Psychiatry, 23(6), 670–674.
29 Hilgendorf 2019 - Hilgendorf, A., (Guy Reiter), A., Gauthier, J., Krueger, S., Beaumier, K., Corn, R., Moore, T. R., Roland, H., Wells, A., Pollard, E., Ansell, S., Oshkeshequoam, J., Adams, A., & Christens, B. D. (2019). Language, culture, and collectivism: Uniting coalition partners and promoting holistic health in the Menominee nation. Health Education & Behavior, 46(1_suppl), 81S-87S.
30 Sprague Martinez 2020 - Sprague Martinez, L., Dimitri, N., Ron, S., Hudda, N., Zamore, W., Lowe, L., Echevarria, B., Durant, J. L., Brugge, D., & Reisner, E. (2020). Two communities, one highway and the fight for clean air: The role of political history in shaping community engagement and environmental health research translation. BMC Public Health, 20(1), 1690.
31 Wing 2008 - Wing, S., Horton, R. A., Muhammad, N., Grant, G. R., Tajik, M., & Thu, K. (2008). Integrating epidemiology, education, and organizing for environmental justice: Community health effects of industrial hog operations. American Journal of Public Health, 98(8), 1390–1397.
32 Speer 2014 - Speer, P.W., Tesdahl, E.A., Ayers, J.A. (2014). Community organizing practices in a globalizing era: Building power for health equity at the community level. Journal of Health Psychology. 19(1):159-169.
33 Shdaimah 2025 - Shdaimah, C.S., Postan-Aizik, D., Mattocks, N. (2025). “Maybe it’s not always to great effect, but there’s some serious hustle”: Community organizing in response to environmental harms in Baltimore, MD. Journal of Human Rights and Social Work.
34 Brown 2014a - Brown, T.M., Fee, E. (2014). Social movements in health. Annual Review of Public Health, 35:385-398.
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