Black Hawk County Health Department
WATERLOO/CEDAR FALLS, IOWAWhat forces account for the current level of equity, or lack thereof, within our communities?
CALL TO ACTION
Reclaiming and advancing their narrative
In November 2018, a Wall Street Journal article described Waterloo and Cedar Falls, Iowa as “the worst place to be Black in America.” The content of the article was deeply troubling, but was a reality that Black residents lived on a daily basis.
Nafissa Cisse Egbuonye, the Public Health Director of Black Hawk County Public Health Department, described the designation as “painful, but a wake up call.” To her, it was clear that the challenges in Waterloo and Cedar Falls were a result of an interconnected system of beliefs, behaviors and structural elements that continue to produce outcomes that most people don’t want.
Despite the systemic challenges and fatigue they caused for community members, there was energy. The drive to reclaim – and advance – their narrative galvanized the community to build on existing initiatives and empowered them to have difficult conversations about equity.
OUR PARTNERSHIP
The Black Hawk County Health Department, with funding from the Kresge Foundation’s Emerging Leaders in Public Health, partnered with Engaging Inquiry to host a series of conversations with key actors from across the system. Using systems thinking tools and participatory methodologies, participants mapped the forces driving current inequities. This process helped them build their awareness of the historical and systemic foundations of inequity, all the while centering on the community as a connected, powerful system, capable of fostering transformational change.
The conversations were challenging, asking people to confront long-held beliefs and examine systems boldly and with humility. Participants worked side-by-side, “zooming in” to understand details and “zooming out” to recognize patterns. The resulting equity map is a tool that visualizes the key drivers of inequity in the community, as well as high-impact opportunities for disrupting them. With targeted engagement, key actors were able to utilize the map tool that they co-created to build understanding, alignment and trust within their own sphere of influence and have difficult conversations about race and privilege.
In the midst of a global pandemic and a national movement for racial justice, the community leaders of Black Hawk County witnessed the patterns of their map come into focus in a new way. Building on this momentum, a cross-disciplinary Systems Thinking Task Team was developed, solidifying the map as community owned and activated.
Together with Engaging Inquiry, this group hosted a series of virtual participatory engagements to understand key leverage points within the system where a relatively small input could achieve an outsized impact on the overall health of the system. Assessing the current energy, obstacles, and opportunities present in the system, participants recognized that tackling fear, building a sense of belonging for distributed leadership and community-driven investment have the potential to ignite the transformational change they seek.
Deep Structure
The map brought to light a variety of pain points across the community. The Deep Structure, a central feedback loop that begins the comprehensive and cohesive map narrative, tells the story of a community separated from each other. In Waterloo and Cedar Falls, this has led to the perpetuation of harmful, uninformed beliefs and biases about different segments of the community, resulting in an “us versus them” mentality. This narrative shapes decision-making – both consciously and subconsciously – and results in inequality and unequal distribution of opportunity and access to resources. While some people in the community thrive, others struggle – creating fear and mistrust. All of this undermines the ability of the community as a whole to thrive.
Recognizing that systemic inequity has been built over generations in Waterloo and Cedar Falls, the community is persistent in their hope. As Reverend Abraham Funchess Jr noted, “We believe that if we work together, interrupting the patterns that are not leading to equity, we can transform the system into a more just, equitable and sustainable one. Instead of imposing change in parts of the system that are stuck, we can unlock change. There is energy that can be leveraged to create a community where everyone has equal opportunities and resources to lead healthy and fulfilled lives.”
“We believe that if we work together, interrupting the patterns that are not leading to equity, we can transform the system into a more just, equitable and sustainable one. Instead of imposing change in parts of the system that are stuck, we can unlock change. There is energy that can be leveraged to create a community where everyone has equal opportunities and resources to lead healthy and fulfilled lives.”
EARLY IMPACTS / EMERGING OPPORTUNITIES
With new partnerships, community engagement and a visualization of the key patterns driving system behavior, the Black Hawk community has been able to secure new funding from both national and local foundations to continue and expand community-led racial justice work. Additionally, a regional Public Health Training Center has put resources into developing an Equity Training Program that will be available to the Black Hawk County Health Department, as well as communities across their four-state area.
Through this practice, the Black Hawk County Health Department has identified Systems Thinking as a high-priority area for development in their Community Health Needs Assessment. As a result, a cross-disciplinary team of engaged partners has been established with the shared objective of deepening and expanding this work across the breadth and depth of the system.
The community has also received national attention for their leadership and commitment to furthering conversations around systemic inequity across sectors and lines of difference. They are well poised to provide a model for combining systemic strategy and community engagement to shift deeply rooted patterns and mental models upholding inequity and systemic racism.
STORIES AND HIGHLIGHTS
Health Equity in Black Hawk County
Black Hawk County Health Department
This comprehensive website features Black Hawk County Health Department’s systems mapping journey with Engaging Inquiry and shares critical information with community members about how inequity, in the form of racism and discrimination, is a public health crisis that must be addressed at systemic level.
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