Trust, Participation, and Power: Community Perspectives from the Equity in Public Health Initiative

Area of Science:

• Public Health
• Health Equity
• Community Engagement

Background:

• Health disparities are rooted in unequal power dynamics affecting resource allocation and governance.
• Community power is crucial for addressing and mitigating health inequities.
• Understanding power structures is essential for developing inclusive governance strategies.

Purpose of the Study:

• To examine the operation of visible, hidden, and invisible power within a U.S. county.
• To inform the development of inclusive governance practices that address health disparities.
• To identify strategies for strengthening community power and agency.

Main Methods:

• Qualitative study using seven focus groups with Black and Hispanic residents (n=68) and sixteen semi-structured interviews with officials and leaders in Greenville County, SC.
• Thematic analysis guided by Heller et al.'s Three Faces of Power framework.
• Collaborative coding of transcripts using NVivo software.

Main Results:

• Visible power manifested as inequitable resource distribution, lack of transparency, and participation barriers.
• Hidden power operated through community organizations and social media, facilitating connections between residents and decision-makers.
• Invisible power, influenced by race, ethnicity, socioeconomic status, and language, shaped residents' agency and trust.

Conclusions:

• Participants advocated for participatory structures shifting from consultation to shared authority and sustained engagement.
• Strengthening community power via structural reforms and inclusive governance can reduce health disparities.
• Future research should explore scalable co-governance models to enhance community agency and health outcomes.