6b. Community Mobilization is not "One-Size-Fits-All"  

 Although much of the extant literature tends to define community mobilization (a.k.a. community organization or community development) as a single category of intervention, the practice of community mobilization does not follow a standard, “one-size-fits-all” formula: approaches to community mobilization vary according to the level of community involvement/participation in defining the health issue(s) of interest and identifying appropriate solutions.

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Approaches to Defining Community Participation 

Arnstein’s “ladder of citizen participation” is the oldest, possibly most widely recognized, taxonomy of involvement in community engagement initiatives.¹ The ladder, based on levels of citizen involvement in U.S. urban planning during the 1960s, depicted in Figure 1, comprises eight levels of participation, ranging from non-participation (a.k.a. “manipulation”) to full citizen control. These levels are grouped into three ranks of citizen control: “non-participation” (no power), “tokenism,” and “citizen power.”

The model demonstrates how different levels of participation involve varying degrees of power and control, beginning with essentially “non-participative” ways in which those with power engage those without, to “citizen control,” in which power to direct is wielded by participants. True “participation” begins once power is delegated, with the other levels of engagement being dismissed as “tokenism” and “non-participation.”¹

Adapted from Arnstein, S. R. (1969). A Ladder of Citizen participation, Journal of the American Institute of Planners, 35:4, 216-224, DOI: http://www.tandfonline.com/action/showCitFormats?doi=10.1080/01944366908977225
Image Description

Figure 1. Arnstein's Ladder of Citizen Participation

Other theorists have drawn on the ladder metaphor of citizen engagement as the basis for articulating distinct modalities of practice. Perhaps the best known of these is the three approaches to community organization developed by Rothman.² In practice, practitioners often rely on a blend of two or more of Rothman’s models.³

1. Locality development is a process-oriented approach that aims to build a sense of group identity and community. Community workers applying locality development organize a broad cross-section of people into small, task oriented groups to address shared priorities.
2. Social planning, a task-oriented method, stresses rational problem solving through the use of outside change agents, who gather facts about community problems and recommend “evidence-based” solutions.
3. Social action, by contrast, is both task- and process-oriented: while increasing the problem-solving capacity of communities, social action also seeks to redress systemic power imbalances between marginalized groups and the larger society.²
   

A simpler, more practice-oriented approach to distinguishing levels of community engagement and power in decision making was developed by Ron Labonte, a noted Canadian health promotion theorist.⁴ This approach is summarized in Table 1.

Community-based strategies link programs and services to community groups. With community-based strategies, the priority health issue under consideration is identified by a sponsoring organization (e.g., a local public health agency or community health centre). Interventions are then implemented according to defined timelines, and decision-making power rests with the sponsoring organization, not community participants.

Unlike community-based strategies that target a community, community development happens when the community controls the selection of problems and the development of interventions to address them. The process of planning and implementing the community development initiative is ongoing, based on continual negotiations between organizations and community groups. Community development emphasizes enhanced community capacity — that is, collective problem-solving skills, not measurable changes in health risk factors — as the desired outcome.⁴

Can Public Health Facilitate Participant-Centred Community Mobilization?

By now, you may be wondering if it’s even possible for public and community health organizations to be involved with more participatory approaches to community mobilization where decision-making power rests in the hands of community members themselves.

Due to a range of bureaucratic and organizational constraints, it is often not possible to practice “true” community development. For example, government funders often support community projects directed at specific issues, such as preventing falls among seniors, rather than community development approaches that support seniors in defining and addressing shared health priorities.

It’s also important to remember that it’s difficult for communities, especially socially disadvantaged communities, to exercise decision-making power over the broader, macro-level factors that may be affecting their health, such as equitable access to income, transportation, food, employment, and housing. Community-focused solutions to these factors, while meeting community needs, are sometimes criticized as “band-aid” solutions that don’t get at the “upstream” root causes of health problems. For example, collective kitchens, community gardens, or school feeding programs don’t address the relationship between income inequality and lack of access to affordable, nutritious food.⁵

Public health agencies can and do go beyond the parameters of “band-aid” solutions to assist communities seeking more equitable access to the social determinants of health. A large number of relevant resources and case studies are accessible through the National Collaborating Centre for Determinants of Health.