Ultimately, the website and its contents seek to reframe the way West Virginians think about and address population health less automatically as individual responsibility shaped by access to healthcare and more as the outcome of intentional policy decisions that leaders make about the places where people live, work, and play.(1)
Some may say that the language of public health is numbers and reports filled with data. That may be true but long before we get to the numbers, the formulas and the data analysis a community must make meaning out of the phenomena, information, images and stories that it encounters.
Place & Health: The Formula
First, the website asks and attempts to answer the question, “How do the narratives, images and cultural toolkit of a place inform what we call good or poor health?”
To explore this question the website uses those very same narratives, images, and stories.
The formula that drives and compels this work forward is the following:
Places and their policies, rules, regulations, institutions and systems shape population health.
In fact, places can cement social status or confirm social status. Places are socially constructed.
The process of social construction of a place is region specific and born out of the cultural toolkit of that place.
The cultural toolkit is comprised of beliefs, narratives, discourse, and values that are used to interpret and socially construct place.
To change population health, one must alter places and to alter places one must map the cultural toolkit and begin at that point to alter the images, narratives, belief and values that drive that cultural toolkit.
These changes in the cultural toolkit are hard to compel. Changes to the cultural toolkit may sputter and die out, meander or surge forward to shape policies that make up places. Examples of “hard to change” ideas in our toolkit that drive current policy decisions include the definition of “hard working”. The belief that health is about individual responsibility for one’s behavior. Or the idea that healthcare is largely responsible for how healthy we are. Everything that we encounter….narratives, images, our values —reinforce these ideas.
Evidence as A Qualitative Public Health Assessment
This website poses and answers the question of what counts as evidence. Taken together, the contents of the website make up a qualitative public health assessment using the lived experiences of underserved groups in West Virginia to examine the connection between place and health.
The photos, narratives, and video records encountered on this website were contributed by or portray some of the most vulnerable, underserved groups in West Virginia. The lives and challenges as told by and through the stories of underserved groups serve as digital records that allow us to see the connections between lived experiences and larger historical, social, and structural forces of a place.
The digital records are valid evidence because they have been co-constructed in the dialogue between the researcher and the community member to learn about and lift up lived experiences of the underserved in our community.
These digital records aide in determining how we will make meaning of those experiences and use them to develop the policies, systems, and practices that shape a place, drive a community, and create population health.
Telling other’s stories is a big responsibility. This work employs these stories in two ways for maximum impact.
This website may contribute to changing the cultural toolkit of a place. Our narratives, stories and images don’t just entertain us, they shape the way we think and what our community produces to serve as the guidelines, regulations and policies that our institutions and systems reinforce.
It is the goal of the website to make it easier to craft social justice values and narratives (Table 1) using the stories and images depicting lived experiences.
A claim being made is that narratives are a form of social reproduction challenging inequity. Narratives are legitimate evidence along side numbers or quantitative evidence Narratives make it easier to center social justice values as a driver of policy making in comparison to market place justice where there is limited government involvement and each individual is responsible for him or herself with little thought spared for the common good.
In addition to advocacy this website activates the narratives, images and video records as research evidence in peer reviewed publications that communicate with other public health researchers. One outcome of this scholarship is to contribute to efforts to analyze problems and generate evidence based solutions to population health problems of underserved groups.
1. Achieving Health Equity: from root causes to fair outcomes. 2007.