Chapter 17. Analyzing Community Problems and Solutions | Community Tool Box

• What is a problem?

• Why is a group process particularly important?

• What is the problem-solving process?

"We must try to trust one another. Stay and cooperate."  - Jomo Kenyatta, (1891 - 1978), former president of the Republic of Kenya

Imagine for a moment that your coalition's mission is to encourage development in a downtown neighborhood that has historically experienced economic hardship. Your first goal is to recruit members, but you find a lack of interest among area residents. So you work for months to convince people to join, and meet with some modest success. Then, at your first all-coalition meeting, you find that members don't want to work together. The students you have recruited don't trust the police officers who have shown up; the police officers, in turn, pay no attention to the students; and an argument has broken out in one corner of the room between a few conservative Christians and LGBTQ+ rights advocates. Your head is in your hands. You are halfway through your grant, and it seems that you haven't made any headway whatsoever towards your stated goal. What are you going to do now?

Problems are a fact of life at home, at play, and at work. Unfortunately, problems aren't always isolated cases. They tend to be like onions - you peel away one problem only to find another, and then another, and you can't solve the problem you were first interested in until you solve a variety of related problems. For example, you can't increase safety at a crosswalk until you hire more crossing guards. And nobody will apply for the job until you can increase the salary.

In short, we will always be confronted with problems, so the importance of problem solving can't be overstated. That's why this chapter of the Tool Box is focused wholly on the subject. Because most of us labor in groups or coalitions that are working together on an issue, we will focus primarily on the group problem-solving process.

What is a problem?

So, what's a problem? How would you define one? We usually define a problem fairly negatively: a problem is a hassle, it's a pain in the neck. This is often true, but more generally, a problem can be considered the difference between what is, and what might or should be. And believe it or not, problems have their advantages, too. What are some of the good things about problems?

• Most problems are solvable (or partially solvable, or at least improvable). We can do something about them. The task may seem overwhelming (it surely did when David fought Goliath, or when women’s suffrage activists worked to give women the right to vote), but it's not hopeless. Our optimistic assumption is that we can change the world.
• Problems are opportunities to make some good things happen. If it weren't for problems, what would be our motivation to create change?
• Problems are also challenges. They call upon the best of our abilities, and ask us to go beyond what we thought we could do. They make life interesting, and, at least sometimes, fun. Without problems, life could be pretty boring.

You don't agree? Think of all of the games based on problem solving. Chess is thousands of years old and is still as popular as ever, based on the number of books you might find on it at your local bookstore. The Rubik's Cube was a national rage some years back. True, the stakes may be very different between a chess game and finding a way to connect with local young people. But both can present a challenge that stretches us in the same ways.

With all this in mind, what is "problem solving?" A good definition can be found in Lead on! The complete handbook for group leaders. The authors define problem solving as "an individual or collaborative process composed of two different skills: (1) to analyze a situation accurately, and (2) to make a good decision based on that analysis."

Why is a group process particularly important?

Why are we focusing on a collaborative process in this chapter? Well, for several reasons. You probably already do a lot of individual problem solving, and there's a good deal of merit in that. But many of the problems and challenges we face as members of our organizations affect everyone in the group. It makes sense then, that everyone is part of the solution. And, as the saying goes, two heads are better than one - so just imagine what can be accomplished with a room full of dedicated people!

Now, let's change the emphasis for a moment. Why are we focusing on a collaborative process in this chapter? Maybe your group is used to doing things haphazardly on an as-absolutely-necessary basis. Why should you take more time (already a precious commodity among most groups) to go through a lengthy process?

• Effective group processes enhance a group's ability to solve problems and make decisions. When working with more than just a couple of people, solving a problem with a set process becomes more manageable.
• It increases the group's efficiency and productivity.
• It increases the group's participation - more people tend to be involved, and, as a result,
• It increases group satisfaction. This means, among other things, that the group is more likely to want to take on other problems. And when they do so, they'll be better placed to solve them.

What is the problem-solving process?

Like any other process, there are many different tasks that need to be done to properly solve problems. And again, like any other process, skipping some of the steps will make the job more difficult in the long run. Here is a brief explanation of each of the steps, to be discussed in more detail in the following sections:

• Running effective meetings - Since your work will be in a group, the first thing you need to understand is how to hold a good meeting. You may have the problem-solving process down pat, but that won't make any difference if nobody shows up at your meeting, or if no one pays attention to what goes on.
• Developing facilitation skills - Strong facilitation skills go hand in hand with running an effective meeting. A good facilitator helps diffuse explosive emotions, makes sure everyone's voice is heard, and steers the group towards the best decisions.
• Developing recorder skills - Again, these skills are part of running an effective meeting. A good recorder works hand in hand with the facilitator, and together, they make sure that not only are everyone's opinions heard, they are also seen, remembered, and followed up on. Having a good recorder is one of the most important parts of setting up an effective meeting.
• Defining and analyzing the problem - This is the core of the problem solving process. Sometimes, the real problem isn't originally apparent.
• Generating and choosing solutions
• Putting your solution into practice - If you have followed the process carefully, you'll be surprised at how easy implementing it actually is!

In Summary:

As we said before, the world is full of problems, and some of them look pretty challenging, to say the least. But the rewards are great. Solutions that are well thought out and carefully implemented can work. How much can you do?

About problems.

___Problems are usually seen as negative.

___Advantages problems may bring:

• Most problems are solvable (or partially solvable, or at least improvable).
• Problems are opportunities to make some good things happen and to create change.
• Problems call upon the best of our abilities, and ask us to go beyond what we thought we could do.

Why is a group problem-solving process important?

___Effective group processes enhance a group's ability to solve problems and make decisions. When working with more than just a couple of people, solving a problem with a set process becomes more manageable.

___It increases the group's efficiency and productivity.

___It increases the group's participation - more people tend to be involved, and, as a result,

___It increases group satisfaction. This means, among other things, that the group is more likely to want to take on other problems. And when they do so, they'll be better placed to solve them.

What is the problem-solving process?

___Run effective meetings.

___Develop facilitation skills.

___Develop recorder skills.

___Define and analyze the problem.

___Generate and choose solutions.

___Put your solution into practice.

Tool #1: Problem analysis sheet

The following page gives you room to analyze the problem or issue you want your group to address. This information can then be used when you go to step 7 in the "how-to's": Set goals and objectives.

Problem Analysis Sheet

What factors put people at risk for (or protect them against) the problem or concern?
Whose behavior (or lack of behavior) caused the problem?
Whose behavior (or lack of behavior) maintains the problem?
For whom is the situation a problem?
What are the negative consequences for those directly affected?
What are the negative consequences for the community?
Who, if anyone, benefits from things being the way they are now?
How do they benefit?
Who should share the responsibility for solving the problem?
What behaviors need to change to consider the problem "solved"?
What conditions need to change to address the issue or problem?
How much change is necessary?
At what level(s) should the problem be addressed?
Will you be able to make changes at the level(s) identified?

Tool #2: Components and Elements Background Table

Use this table to look holistically at the intervention you will develop.

	Enhancing Support	Providing Information and Skills Training
Problem/ Issue to be Addressed
Risk/ Protective Factors
Targets of Change
Agents of Change
Components
Elements
Mode/ Context of Delivery

Tool # 3: Table of Components and Elements

You can fill in this table to look at all of the components and elements that will be done as a part of your intervention. By filling this out, you can see if there are any gaps in your plan that need to be filled in. (For example, if your plan doesn't have any elements related to providing information and skills training, that gap will be very apparent on this table.)

	Providing Information and Skills Training	Enhancing Support and Resources	Modifying Opportunities and Barriers	Monitoring and feedback
Components
Elements

Tool # 4: Determining if interventions done by others are appropriate for your purpose and situation

Use this table to help you determine if a particular intervention you know about is right for your purpose and situation.

What is the intervention?
Is it appropriate for our purpose?
Is it effective?
Is it replaceable?
Is it simple?
Is it practical?
Is it compatible to our situation?

Additional comments:

A PowerPoint presentation summarizing the major points in the section.

• What is critical thinking?

• Why is critical thinking important?

• Who can (and should) learn to think critically?

• How do you help people learn to think critically?

Suppose an elected official makes a speech in which they say, "The government doesn't need to be involved in cleaning up pollution from manufacturing. Business can take care of this more efficiently." What's your reaction?

There are a lot of questions you can be asking here, some of which you may already know the answers to. First, what are the assumptions behind this person's statement? How do they view the job of government, for instance? What's their attitude toward business? Do they believe pollution is a real threat to the environment?

Next, you might want to consider the official's biases. What party does this politician belong to, and what's that party's position on pollution regulation? What state are they from -- one with a lot of industry that contributes to acid rain and other pollution? What's their voting record on environmental issues? Are they receiving contributions from major polluters? Do they live in a place that's seriously affected by pollution? What do they know about the science involved? (What do you know about the science involved?) Does he have any knowledge or expertise in this area at all?

Finally, you might want answers to some questions about the context of the statement. What's the record of private industry over the last 10 years in cleaning up its own pollution without government intervention, for instance? What does pollution look like now, as compared to before the government regulated it? For that matter, when did government regulation start? What effect did it have? Perhaps even more important, who will benefit if these ideas are accepted? Who will lose? What will the result be if things are changed in the direction this politician suggests? Are those results good for the country?

If you ask the kinds of questions suggested here when you see new information, or consider a situation or a problem or an issue, you're using critical thinking. Critical thinking is tremendously important in health, human service, and community work because it allows you to understand the actual issues involved, and to come up with an approach that is likely to address them effectively.

What is critical thinking?

There are many definitions of critical thinking. Some see it as a particular way of handling information. Others look at it as a specific set of skills and abilities. People interested in political and social change see it as challenging and providing alternatives to the generally accepted beliefs and values of the power structure. They're all right to an extent: critical thinking is all of these things, and more.

Critical thinking is the process of examining, analyzing, questioning, and challenging situations, issues, and information of all kinds. We use it when we raise questions about:

• Survey results
• Theories
• Personal comments
• Media stories
• Our own personal relationships
• History
• Scientific research
• Political statements
• And (especially) conventional wisdom, general assumptions, and the pronouncements of authority

Critical thinking is an important tool in solving community problems and in developing interventions or initiatives in health, human services, and community development.

Elements of critical thinking

There are a number of ways to look at the process of critical thinking. Brookfield presents several, with this one being perhaps the simplest.

• Problem/goal identification: What is the real issue here?
• Diagnosis: Given all the information we have, what's the best way to deal with this issue?
• Exploration: How do we do what we decided on, and who will make it happen?
• Action: Do it!
• Reflection: Did it work? If so, how can it work better? If not, what went wrong, and how can we fix it? What have we learned here that might be valuable in the future?

Reflection leads you to the consideration of another problem or goal, and the cycle begins again.

Critical thinking involves being thrown into the questioning mode by an event or idea that conflicts with your understanding of the world and makes you uncomfortable. If you allow yourself to respond to the discomfort -- that's partially an issue of personal development -- you'll try to figure out where it comes from, and to come up with other ways to understand the situation. Ultimately, if you persist, you'll have a new perspective on the event itself, and will have broken through to a more critical understanding.

Goals of critical thinking

• Truth: to separate what is true from what is false, or partially true, or incomplete, or slanted, or based on false premises, or assumed to be true because "everyone says so."
• Context: to consider the context and history of issues, problems, or situations.
• Assumptions: to understand the assumptions and purposes behind information or situations.
• Alternatives: to create ways of approaching problems, issues, and situations that address the real, rather than assumed or imagined, factors that underlie or directly cause them -- even when those factors turn out to be different from what you expected.

Why is critical thinking important?

Without thinking critically, you're only looking at the surface of things. When you come across a politician's statement in the media, do you accept it at face value? Do you accept some people's statements and not others'? The chances are you exercise at least some judgment, based on what you know about the particular person, and whether you generally agree with them or not.

Knowing whether or not you agree with someone is not necessarily the same as critical thinking, however. Your reaction may be based on emotion ("I hate that guy!"), or on the fact that this elected official supports programs that are in your interest, even though they may not be in the best interests of everyone else. What's important about critical thinking is that it helps you to sort out what's accurate and what's not, and to give you a solid, factual base for solving problems or addressing issues.

Specific reasons for the importance of critical thinking:

• It identifies bias. Critical thinking identifies both the bias in what it looks at (its object), and the biases you yourself bring to it. If you can address these honestly, and adjust your thinking accordingly, you'll be able to see the object in light of the way it's slanted, and to understand your own biases in your reaction to it.

• It's oriented toward the problem, issue, or situation that you're addressing. Critical thinking focuses on analyzing and understanding its object. It eliminates, to the extent possible, emotional reactions, except where they become part of an approach or solution.

• It gives you the whole picture. Critical thinking never considers anything in a vacuum. Its object has a history, a source, a context. Thinking critically allows you to bring these into play, thus getting more than just the outline of what you're examining, and making a realistic and effective solution to a problem more likely.
• It brings in other necessary factors. Some of the things that affect the object of critical thought -- previous situations, personal histories, general assumptions about an issue -- may need to be examined themselves. Critical thinking identifies them and questions them as well.

• It considers both the simplicity and complexity of its object. A situation or issue may have a seemingly simple explanation or resolution, but it may rest on a complex combination of factors. Thinking critically unravels the relationships among these, and determines what level of complexity needs to be dealt with in order to reach a desired conclusion.
• It gives you the most nearly accurate view of reality. The whole point of critical thinking is to construct the most objective view available. 100% objectivity may not be possible, but the closer you can get, the better.
• Most important, for all the above reasons, it is most likely to help you get the results you want. The closer you are to dealing with things as they really are, the more likely you are to be able to address a problem or issue with some hope of success.

Who can (and should) learn to think critically?

The answer here is everyone, from children to older adults. Even small children can learn about such things as cause and effect -- a specific event having a specific result -- through a combination of their own experimentation and experience and of being introduced to more complex ideas by others.

Many adults exercise critical thinking as a matter of course. Many more know how, but for various reasons -- fear, perceived self-interest, deeply held prejudices or unexamined beliefs -- choose not to. Still more, perhaps a majority, are capable of learning to think critically, but haven't been taught or exposed to the experiences that would have allowed them to learn on their own.

It is this last group that is both most in need of, and most receptive to, learning to think critically. It often includes people with less formal education and lower incomes who see themselves as having limited influence or agency. Once they grasp the concept of critical thought, it can change their whole view of the world. Often, the experience of being involved in a community initiative or intervention provides the spur for that learning.

How do you help people learn to think critically?

Learning to think critically is more often than not a long process. Many people have to learn to think abstractly -- itself a long process -- before they can really apply the principles of critical thinking. Even those who already have that ability are often slowed, or even stopped, by the developmental and psychological -- and sometimes the actual -- consequences of what they're being asked to do. Often, it takes a crisis of some sort, or a series of negative experiences to motivate people to be willing to think in a different way.

Even then, developing the capacity for critical thinking doesn't necessarily make things better. It can alter family relationships, change attitudes toward work and community issues, and bring discord into a life where none was recognized before. Learning it takes courage.

The point of all this is that, although there's a series of what we believe are effective how-to steps laid out in this section, teaching critical thinking is not magic. The reason we keep using the words "develop" and "process" is that critical thinking, if it takes root, develops over time. Don't be frustrated if many people don't seem to get it immediately: they won't.

Helping others learn to think critically can take place in a classroom -- it's essentially what higher education is all about -- but it's probably even more common in other situations. Community interventions of all kinds provide opportunities for learning, both because participants are usually involved over a period of time, and because they are often experiencing difficulties that make it clear to them that their world view isn't adequate to solve the problems they face. Many are ready to change, and welcome the chance to challenge the way things are and learn new ways of thinking.

By the same token, learning to think critically can be a frightening process. It leads you to question ideas that you may have taken for granted all your life, and to challenge authority figures whom you may have held in awe. It may push you to tackle problems you thought were insoluble. It's the intellectual equivalent of bungee jumping: once you've leaped off the bridge, there's no going back, and you have to trust that the cord will hold you.

As a result, facilitating critical thinking -- whether formally or informally -- requires more than just a knowledge of the process. It demands that you be supportive, encouraging, and honest, and that you act as role model, constantly demonstrating the process as you discuss it.

There are really three aspects of helping people develop critical thinking: how to be a facilitator for the process; how to help people develop the "critical stance," the mindset that leads them to apply critical thinking all the time; and how to help people learn to apply critical thinking to dealing with community problems and issues.

How to be a critical thinking facilitator

Stephen Brookfield has developed a 10-point guideline for facilitators of critical thinking that focuses both on the learner and the facilitator themself.

1. Affirm learners' self-worth. Critical thinking is an intellectual exercise, but it is also a matter of confidence and courage. Learners need to have the self -esteem to believe that authority figures or established beliefs could be wrong, and to challenge them. Facilitators need to encourage that self-esteem by confirming that learners' opinions matter and are worthy of respect, that they themselves have and deserve a voice.
2. Listen attentively to learners. Repeat back their words and ideas, so they know they've been heard. What they say can reveal hidden conflicts and assumptions that can then be questioned.
3. Show your support for critical thinking efforts. Reward learners for challenging assumptions, even when they're your own.
4. Reflect and mirror learners' ideas and actions. That will help to identify assumptions and biases they may not be aware of.
5. Motivate people to think critically, but help them to understand when it's appropriate to voice critical ideas and when it's not. The wrong word to the boss could get a learner fired, for example. It's important that they understand the possible consequences of talking about their conclusions before they do it.
6. Regularly evaluate progress with learners. Critical thinking involves reflection as well as action, and part of that reflection should be on the process itself.
7. Help learners create networks of support. These can include both other learners and others in the community who are learning to or who already practice and support critical thinking.
8. Be a critical teacher. Model the critical thinking process in everything you do (particularly, if you're a teacher, in the way you teach), encourage learners to challenge your assumptions and ideas, and challenge them yourself.
9. Make people aware of how they learn critical thinking. Discuss learning and thinking styles, intrinsic and extrinsic motivation, learning methods, the role of previous experience, etc. The more conscious you can make people of their preferred ways of learning, the easier it will be for them to understand how they're approaching ideas and situations and to adjust if necessary.
10. Model critical thinking. Approach ideas and situations critically and, to the extent possible, explain your thinking so learners can see the process you've used to arrive at your conclusions.

How to encourage the critical stance

Developing the critical stance -- the generalized ability and disposition to apply critical thinking to whatever you encounter -- is a crucial element in teaching critical thinking. It includes recognizing assumptions -- your own and others' -- applying that recognition to questioning information and situations, and considering their context.

Recognize assumptions. Each of us has a set of assumptions -- ideas or attitudes or "facts" we take for granted -- that underlies our thinking. Only when you're willing to look at these assumptions and realize how they color your conclusions can you examine situations, problems, or issues objectively.

Assumptions are based on a number of factors -- physical, environmental, psychological, and experiential -- that we automatically, and often unconsciously, bring to bear on anything we think about. One of the first steps in encouraging the critical stance is to try to make these factors conscious. Besides direct discussion, role plays, discussions of hypothetical or relatively non-threatening real situations, and self -revelation on the facilitator's part ("Some of my own assumptions are...") can all be ways to help people think about the preconceptions they bring to any situation.

Sources of assumptions are numerous and overlapping, but the most important are:

• Senses. The impact of the senses is so elemental that we sometimes react to it without realizing we're doing so. You may respond to a person based on smells you're barely aware of, for instance.
• Experience. Each of us has a unique set of experiences, and they influence our responses to what we encounter. Ultimately, as critical thinkers, we have to understand both how past experience might limit our thinking in a situation, and how we can use it to see things more clearly.
• Values. Values are deeply held beliefs -- often learned from families, schools, and peers -- about how the world should be. These "givens" may be difficult even to recognize, let alone reject. It further complicates matters that values usually concern the core issues of our lives: personal and sexual relationships, morality, gender and social roles, race, social class, and the organization of society, to name just a few.
• Emotion. Recognizing our emotional reactions is vital to keeping them from influencing our conclusions. Anger at people who perpetrate child maltreatment may get in the way of our understanding the issue clearly, for example. We can't control whether emotions come up, but we can understand how we react to them.
• Self interest. Whether we like it or not, each of us sometimes injects what is best for ourselves into our decisions. We have to be aware when self interest gets in the way of reason, or of looking at the other interests in the situation.
• Culture. The culture we grew up in, the culture we've adopted, the predominant culture in the society -- all have their effects on us, and push us into thinking in particular ways. Understanding how culture acts upon our and others' thinking makes it possible to look at a problem or issue in a different light.
• History. Community history, the history of our organization or initiative, and our own history in dealing with particular problems and issues will all have an impact on the way we think about the current situation.
• Religion. Our own religious backgrounds -- whether we still practice religion or not -- may be more powerful than we realize in influencing our thinking.
• Biases. Very few of us, regardless of what we'd like to believe, are free of racial or ethnic prejudices of some sort, or of political, moral, and other biases that can come into play here.
• Prior knowledge. What we know about a problem or issue, from personal experience, from secondhand accounts, or from theory, shapes our responses to it. We have to be sure, however, that what we "know" is in fact true, and relevant to the issue at hand.
• Conventional wisdom. All of us have a large store of information "everybody knows" that we apply to new situations and problems. Unfortunately, the fact that everybody knows it doesn't make it right. Conventional wisdom is often too conventional: it usually reflects the simplest way of looking at things. We may need to step outside the conventions to look for new solutions.

Examine information for accuracy, assumptions, biases, or specific interests. Helping learners discuss and come up with the kinds of questions that they need to subject information to is probably the best way to facilitate here. Using current examples -- comparing various newspaper and TV news stories, for instance, to see what different aspects are emphasized, or to see how all ignore the same issues -- can also be a powerful way of demonstrating what needs to be asked. Some basic questions are:

• What's the source of the information? Knowing where information originates can tell you a lot about what it's meant to make you believe.
• Does the source generally produce accurate information?
• What are the source's assumptions about the problem or issue? Does the source have a particular interest or belong to a particular group that will allow you to understand what it believes about the issue the information refers to?
• Does the source have biases or purposes that would lead it to slant information in a particular way, or to lie outright? Politicians and political campaigns often "spin" information so that it seems to favor them and their positions. People in the community may do the same, or may "know" things that don't happen to be true.
• Does anyone in particular stand to benefit or lose if the information is accepted or rejected? To whose advantage is it if the information is taken at face value?
• Is the information complete? Are there important pieces missing? Does it tell you everything you need to know? Is it based on enough data to be accurate?

• Is the information logically consistent? Does it make sense? Do arguments actually prove what they pretend to prove? Learning how to sort out logical and powerful arguments from inconsistent or meaningless ones is perhaps the hardest task for learners. Some helpful strategies here might include mock debates, where participants have to devise arguments for the side they disagree with; analysis of TV news programs, particularly those like "Meet the Press," where political figures defend their positions; and after-the-fact discussions of community or personal situations.

• Is the information clear? Do you understand what you're seeing?
• Is the information relevant to the current situation? Information may be accurate, complete, logically consistent, powerful...and useless, because it has nothing to do with what you're trying to deal with.

• Most important, is the information true? Outright lies and made-up "facts" are not uncommon in politics, community work, and other situations. Knowing the source and its interests, understanding the situation, and being sensibly skeptical can help to protect learners from acting on false information.

Consider the context of the information, problem, or issue. Examining context, in most instances, is easier to approach than the other elements of the critical stance. It involves more concrete and "objective" information, and, at least in the case of community issues, it is often information that learners already know.

Facilitating techniques might include brainstorming to identify context elements; discussing how context issues affected real situations that learners are familiar with; and asking small groups of learners to make up their own examples. The real task is making sure that they include as many different factors as possible. Some areas to be examined in considering a community issue, for instance, are:

• The nature of the community. A big city is likely to present different solutions to a problem than a small town, and both differ from a suburb or a rural area. Understanding the resources, challenges, and peculiarities of a community is important to addressing its issues.
• The social situation. A community may be divided among several mutually hostile ethnic or political groups, or among groups that simply have different ideas about how things should be done. There may be class, race, or other issues to deal with.
• Individuals. Individuals can strongly influence the workings of a community, often in ways that aren't immediately apparent. People can spread or squelch rumors, create harmony or dissension, lead others toward constructive solutions or toward disorganization and ineffectiveness.
• Cultures. Cultures -- which can be based on ethnic ties, religion, class, or other factors (think of the jocks, preppies, punks, skaters, and other groups in a high school)-- can create alliances or divisions, and heavily influence how different groups see an issue and its implications.
• Physical environment. A trash-filled, crumbling urban neighborhood can breed despair and fear. Changing the face of that neighborhood may do a great deal to change the situation of people who live there as well, giving them hope and pride of ownership, as well as diminishing violence and crime by increasing light and accessibility. The role of the physical environment is one that has to be examined in any community issue.
• History. It's crucial to examine the history of a problem or issue, as well as efforts to deal with it. The perfect solution you just came up with may have already ended in disaster five years ago. The person you depend on to explain the situation may have been prominent on one side of a huge conflict, and their presence may alienate anyone who was on the other. Bad feelings over real or perceived slights or dishonesty can persist for decades, and if you don't know about them, they can suddenly rise up, seemingly out of nowhere. Not only getting the history, but getting it from a number of different perspectives, is necessary to success in dealing with any problem or issue.

• The interests involved. If there is a conflict, what are the needs and aims of the various factions? Who stands to gain, and who stands to lose? What are the best interests of the community -- or can you determine that at all?

Facilitating problem solving using critical thinking

Actually using critical thinking to solve problems and address issues is, of course, the reason for learning it. Brookfield suggests one problem-solving sequence that can be used in many situations involving community issues. Once people have learned the critical stance, they can apply its principles using this sequence.

Identify the assumptions behind the problem. By asking people to clarify their statements, and by probing for specifics, you can help them look at what is behind their thinking. Some clarifications that you can ask for, accompanied by some of the questions you might ask:

• The current situation. What exactly do you mean when you say things are bad? What things? How are they bad? What would be happening if they were good?
• The problem itself. Can you describe another situation in which the same problem existed? What was happening then? Can you describe a situation in which things were good, and the problem didn't exist? What was happening then? What are the differences here?
• Potential solutions to the problem. If we were able to solve this problem, what would that look like? What would be happening? Who would be involved?
• Actions that would lead to the solution. How would what you're suggesting lead to a solution? What exactly would happen?

Challenge those assumptions. Once you've clarified the assumptions, everyone needs to question them.

• The current situation. Are you sure that everything is bad? Are there good aspects to the situation? What about it specifically do you think is bad? Could that be interpreted in another way? Who might interpret it differently? Why? Are we even looking at the right aspects of the situation? Are we missing something important?
• The problem itself. What exactly is the problem we're talking about? Are you sure that's really the problem? Could the problem be defined in another (this other) way? What's the actual concern here?
• Potential solutions to the problem. What are the actual results we need here? (If we're trying to reduce the adolescent pregnancy rate in the community, for instance, are we aiming to provide a particular number of adolescents with information about birth control? With condoms and other birth control devices? Or are we aiming at an actual reduction in the adolescent pregnancy rate within a particular period...say, two years?)
• Actions that would lead to the solution. Would what you're proposing actually accomplish what you expect it to? Would it really make a difference even if it did?

Imagine alternatives to what you started with. There are a number of ways you can construct different ways to deal with the problem. Two are:

• Brainstorming. Everyone comes up with every alternative they can think of, no matter how silly it seems at the time. After all the ideas have been recorded, the group goes through them, and sorts out what seems worth pursuing. Sometimes the ideas that seem totally silly at first turn out to be the most valuable, which is why it's important to encourage people to blurt out whatever they think of.
• Starting with the ideal endpoint. Determine what everything would look like if the ideal solution were achieved, then work backward from there to understand what you'd have to do to get there.

Critique the alternatives. Develop criteria on which you can judge the alternative solutions you've come up with. Some possibilities:

• Costs
• Benefits
• Effectiveness
• Feasibility
• Consistency with community needs
• Consistency with the values of the group
• Inclusiveness

Once you've selected criteria, another critical thinking exercise is to decide which are most important. In a particular situation, cost might have to be the most important factor. In another, you may be able to weight costs, benefits, and effectiveness together. In others, other criteria may be weighted more heavily.

Finally, apply the criteria to the alternatives you've come up with, and decide which is most likely to achieve the results you want.

Reframe the problem and solution. At this point, learners have come up with a solution. The point of reframing is to look at the problem in the light of all the work they've done. They've perhaps discovered that it was different from what they first thought, or that they needed to view it differently. Reframing solidifies that mindset, and ensures that they approach the problem as they've found it to be in actuality, rather than as they initially saw it.

• The current situation. Start by restating the current situation, as you understand it after critical analysis, in the clearest and most specific terms possible.
• The problem itself. Restate the actual problem as you now understand it.
• Potential solutions to the problem. Explain what changes a solution would bring about, and what things would be like with the problem solved.
• Actions that would lead to the solution. Lay out the alternative you've arrived at.

By and large, people learn critical thinking best when they're approaching real problems that affect their lives in real ways. That's one reason why community interventions and initiatives provide fertile ground for the development of critical thinking.

In Summary

Critical thinking is a vital skill in health, human service, and community work. It is the process of questioning, examining, and analyzing situations, issues, problems, people (in hiring decisions, for instance) and information of all kinds -- survey results, theories, personal comments, media stories, history, scientific research, political statements, etc.-- from every possible angle. This will give you a view that's as nearly objective as possible, making it more likely that you'll be able to interpret information accurately and resolve problems and issues effectively.

Teaching critical thinking, whether formally or informally, requires a supportive and encouraging presence, and a willingness to both model and be the subject of critical analysis. It entails teaching the critical stance -- how to recognize and analyze your own and others' assumptions, question information, and examine the context of any information, situation, problem, or issue. Finally, it requires helping people to apply the critical stance to a problem and learn how to come up with a solution that is effective because it addresses the real issues involved. Once learners can do that, they're well on their way to successfully addressing the concerns of their communities.

What is critical thinking?

___You know that critical thinking is the process of examining, analyzing, questioning, and challenging situations, issues and information of all kinds.

___You know the elements of critical thinking:

• Problem/goal identification
• Diagnosis
• Exploration
• Action
• Reflection
• Repeat the process

___You know the goals of critical thinking:

• Finding the truth
• Considering the context
• Understanding assumptions
• Creating alternative approaches

Why is critical thinking important?

You understand that:

___It identifies bias

___It's oriented toward the problem, issue, or situation that you're addressing

___It brings in other necessary factors

___It considers both the simplicity and the complexity of its object

___It gives you the most nearly accurate view of reality

___It is most likely to get you the results you want

Who can (and should) learn to think critically?

___You know that most people can and should learn to think critically

___You know that the many adults who have the capacity for critical thinking, but who haven't been taught and lack the experiences to learn on their own are both most in need of, and most receptive to, learning critical thinking.

How to help others learn to think critically

___You know that learning critical thinking is an irreversible, often frightening process that requires support.

___You understand how to be a facilitator of critical thinking:

• Affirm learners' self-worth
• Listen attentively to learners
• Show your support for critical thinking efforts
• Reflect and mirror learners' ideas and actions
• Motivate people to think critically, but help them to understand when it's appropriate to voice critical ideas and when it's not.
• Regularly evaluate progress with learners
• Be a critical teacher
• Make people aware of how they learn critical thinking
• Model critical thinking

___You know how to encourage the critical stance (i.e. applying critical thinking to whatever you encounter):

• Help learners recognize and examine their own assumptions
• Examine information for accuracy, assumptions, biases, or specific interests
• Consider the context of what you're looking at

___You know how to facilitate problem solving using critical thinking

• Identify the assumptions behind the problem
• Challenge those assumptions
• Imagine alternatives to what you started with
• Critique those alternatives
• Reframe the problem and solution

Tool #1: Two Conceptions of Cognitive Development

There are a number of ways to look at cognitive development, i.e. the development of thinking. Perhaps the most familiar is the conception of Jean Piaget, a Swiss philosopher, who looked at the development of his own children to try to understand the development of the intellect in general. From his sample of three, he saw a pattern of development that had, in its simplest terms, three stages:

• Preoperational: Piaget used the word "operations" to refer to the logical structures of thinking. At the preoperational stage, logical structures really aren't much of a factor except in the most fundamental ways. The light comes on when you flip the switch simply because it does. There's very little, if any, understanding of cause and effect, or of the consequences of any but the simplest actions.

A defining moment in my own life came when I was three. I was coasting down an incline on my tricycle, and realized that I was about to hit some bushes. I turned right...down a flight of stairs I knew full well was there. It just hadn't occurred to me that my action would have a consequence in the future, even the future that was only two or three seconds ahead.

• Concrete operations: At this stage, people can understand what they can take in through the evidence of their senses (things that are "concrete" enough to touch or see). Thus, addition and subtraction are easy -- you can manipulate objects to see how they work -- but algebra, which involves "unknowns" is harder. You can't see the unknowns, so they're a great deal more difficult to understand.

A professor of cognitive psychology used to tell his classes this story: "When the channel changer knob fell off my TV set, the channel had to be changed with a pair of pliers. Without the numbers on the channel changer, I could never find the stations. One day when I was struggling with the thing, my eight-year-old daughter asked what was wrong. I said,'I can't find Channel Four.' My daughter went over and picked up the knob, pointed to the number, and said'There's Channel Four.' That's concrete operations."

• Formal operations: At this highest stage (which has a number of more narrowly defined substages within it), people are capable of abstract thought. This is often defined as the ability to think about thinking. It includes bringing ideas or events that aren't present or obvious to bear on a particular issue; being able to project consequences into the future; predicting what others might do, even if it's very different from what you might do; envisioning several possible outcomes from the same action; etc.

A couple of older-children examples of formal operations:

A sixth-grade class in the '50's was told that English newspapers were seldom longer than eight pages, and were printed on thin paper. The teacher asked why this was the case. Two of the children understood immediately that the answer had to do with a fact they had learned the week before: that England had cut down most of its forests. They realized that its relatively few trees were much too valuable to be used for making paper.

A nine-year-old was asked to explain why Earth was a sphere. After a few seconds of thought, he was able to explain that, since gravity pulls equally in all directions, the shape that would be formed by gravity pulling space debris and dust together from a central point would be a sphere. Every point on a ball, if it's perfectly spherical, is exactly the same distance from the center.

Since he observed, for many years, only his own children, Piaget assumed that their development was typical. He therefore assigned preoperational thinking to very early childhood; concrete operations to the elementary school years, about ages 6 to 11 or 12; and the start of formal operations to puberty or early adolescence.

As it happens, there are great variations in development, depending to a large extent upon an individual's experiences and stimulation, and probably upon brain development as well. A large number -- perhaps a majority -- of adults still function at concrete operations in at least some areas.

And that's another issue: even people who spend much of their cognitive lives at the highest levels of thought -- theoretical physicists, for instance -- probably don't use formal operations all the time. Certain issues, such as dealing with their parents, may present emotional barriers to thinking in critical or logical ways. In reality, few of us are able to turn the full force of our intellect on everything we encounter.

Piaget saw cognitive development as a process of increasing differentiation (understanding how things, people, events, ideas, etc. differ from one another) and increasing integration (understanding the connections among all those different things, people, etc.) The mechanism of that process is set off by a person coming into contact with something that doesn't match his view of reality.

Someone in this situation has two options: he can ignore the new phenomenon, and simply continue seeing the world as he always has; or he can try to make sense of the world in a different way in light of the new reality he has seen. It may take many encounters with reality to start a change in perception, especially if cognitive development means leaving behind some basic belief. Some people simply are unable ever to see anything that doesn't agree with their preconceptions.

Although textbooks tend to present this material as if changes happened abruptly, in fact change is going on all the time. People's thinking may get more sophisticated in some areas, but not others, which brings us to another theory of cognitive development.

Howard Gardner sees Piaget as looking at only one part of cognitive functioning. Gardner finds eight aspects of intelligence, rather than just one:

• Logical-mathematical (what he believes Piaget was examining)
• Verbal (speaking and writing ability, learning languages, etc.)
• Interpersonal (relations with others)
• Intrapersonal (understanding of self)
• Spatial (ability to see, understand, and use spatial relationships, including talent for painting and the other visual arts)
• Kinesthetic (physical and athletic ability)
• Music
• Environmental (Being able to recognize patterns in one's environment)

According to Gardner, each of these aspects is separate from the others. Different aspects develop at different rates in different people, so that some who are far advanced in, for instance, music at an early age, may still have very little interpersonal capacity. This is one way of explaining those theoretical physicists we mentioned earlier: some of their intelligence's are highly developed, while others are not.

For the most part, at least in the past century, schools and the society at large have valued the logical/mathematical and verbal abilities, while paying little attention to the others. If Gardner is right, his theory has major implications for education, as he himself has written. We should be stimulating children in all areas, so that they can become adults who are competent in every aspect of intelligence.

A PowerPoint presentation summarizing the major points in the section.

• The nature of problems

• Clarifying the problem

• Deciding to solve the problem

• Analyzing the problem

We've all had our share of problems - more than enough, if you come right down to it. So it's easy to think that this section, on defining and analyzing the problem, is unnecessary. "I know what the problem is," you think. "I just don't know what to do about it."

Not so fast! A poorly defined problem - or a problem whose nuances you don't completely understand - is much more difficult to solve than a problem you have clearly defined and analyzed. The way a problem is worded and understood has a huge impact on the number, quality, and type of proposed solutions.

In this section, we'll begin with the basics, focusing primarily on four things. First, we'll consider the nature of problems in general, and then, more specifically, on clarifying and defining the problem you are working on. Then, we'll talk about whether or not you really want to solve the problem, or whether you are better off leaving it alone. Finally, we'll talk about how to do an in-depth analysis of the problem.

The nature of problems

So, what is a problem? It can be a lot of things. We know in our gut when there is a problem, whether or not we can easily put it into words. Maybe you feel uncomfortable in a given place, but you're not sure why. A problem might be just the feeling that something is wrong and should be corrected. You might feel some sense of distress, or of injustice.

Stated most simply, a problem is the difference between what is, and what might or should be. "No child should go to bed hungry, but one-quarter of all children do in this country," is a clear, potent problem statement. Another example might be, "Communication in our office is not very clear." In this instance, the explanation of "what might or should be" is simply alluded to.

As these problems illustrate, some problems are more serious than others; the problem of child hunger is a much more severe problem than the fact that the new youth center has no exercise equipment, although both are problems that can and should be addressed. Generally, problems that affect groups of people - children, adolescent mothers, people with mental health conditions, people experiencing poverty - can at least be addressed and in many cases lessened using the process outlined in this Chapter.

Although your organization may have chosen to tackle a seemingly insurmountable problem, the process you will use to solve it is not complex. It does, however, take time, both to formulate and to fully analyze the problem. Most people underestimate the work they need to do here and the time they'll need to spend. But this is the legwork, the foundation on which you'll lay effective solutions. This isn't the time to take shortcuts.

Three basic concepts make up the core of this chapter: clarifying, deciding, and analyzing. Let's look at each in turn.

Clarifying the problem

If you are having a problem-solving meeting, then you already understand that something isn't quite right - or maybe it's bigger than that; you understand that something is very, very wrong. This is your beginning, and of course, it makes most sense to...

• Start with what you know. When group members walk through the door at the beginning of the meeting, what do they think about the situation? There are a variety of different ways to garner this information. People can be asked in advance to write down what they know about the problem. Or the facilitator can lead a brainstorming session to try to bring out the greatest number of ideas. Remember that a good facilitator will draw out everyone's opinions, not only those of the more vocal participants.
• Decide what information is missing. Information is the key to effective decision making. If you are fighting child hunger, do you know which children are hungry? When are they hungry - all the time, or especially at the end of the month, when the money has run out? If that's the case, your problem statement might be, "Children in our community are often hungry at the end of the month because their parents' paychecks are used up too early."

Compare this problem statement on child hunger to the one given in "The nature of problems" above. How might solutions for the two problems be different?

• Gather information on the problem. You might collect any of several types of information available. Most commonly, what you hear or read will fall into one of the following categories:
  • Facts (15% of the children in our community don't get enough to eat.)
  • Inference (A significant percentage of children in our community are probably malnourished/significantly underweight.)
  • Speculation (Many of the hungry children probably live in neighborhoods with more limited economic resources in town.)
  • Opinion (I think the reason children go hungry is because their parents spend all of their money on cigarettes.)

When you are gathering information, you will probably hear all four types of information, and all can be important. Speculation and opinion can be especially important in gauging public opinion. If public opinion on your issue is based on faulty assumptions, part of your solution strategy will probably include some sort of informational campaign.

For example, perhaps your coalition is campaigning against the death penalty, and you find that most people incorrectly believe that the death penalty deters violent crime. As part of your campaign, therefore, you will probably want to make it clear to the public that it simply isn't true.

Where and how do you find this information? It depends on what you want to know. You can review surveys, interviews, the library and the internet.

• Define the problem. With the information in front of you, you're ready to write down a "problem statement" - a comprehensive definition of the problem. Before you do, remember two general principles:
  • Define the problem in terms of needs, and not solutions. If you define the problem in terms of possible solutions, you're closing the door to other, possibly more effective solutions. "Violent crime in our neighborhood is unacceptably high," offers space for many more possible solutions than, "We need more police patrols," or, "More community members should have guns to protect themselves."
  • Define the problem as one everyone shares; avoid assigning blame for the problem. This is particularly important if different people (or groups) with a history of bad relations need to be working together to solve the problem. Teachers may be frustrated with high truancy rates, but blaming students uniquely for problems at school is sure to alienate students from helping to solve the problem.

You can define the problem in several ways; The facilitator can write a problem statement on the board, and everyone can give feedback on it, until the statement has developed into something everyone is pleased with, or you can accept someone else's definition of the problem, or use it as a starting point, modifying it to fit your needs.

After you have defined the problem, ask if everyone understands the terminology being used. Define the key terms of your problem statement, even if you think everyone understands them.

The Hispanic Health Coalition, has come up with the problem statement "Adolescent pregnancy is a problem in our community." That seems pretty clear, doesn't it? But let's examine the word "community" for a moment. You may have one person who defines community as "the city you live in," a second who defines it as, "this neighborhood" and a third who considers "our community" to mean Hispanics.

Deciding to solve the problem

At this point, you have already spent a fair amount of time on the problem at hand, and naturally, you want to see it taken care of. Before you go any further, however, it's important to look critically at the problem and decide if you really want to focus your efforts on it. You might decide that right now isn't the best time to try to fix it. Maybe your coalition has been weakened by bad press, and chance of success right now is slim. Or perhaps solving the problem right now would force you to neglect another important agency goal. Or perhaps this problem would be more appropriately handled by another existing agency or organization.

You and your group need to make a conscious choice that you really do want to attack the problem. Many different factors should be a part of your decision. These include:

Importance. In judging the importance of the issue, keep in mind the feasibility. Even if you have decided that the problem really is important, and worth solving, will you be able to solve it, or at least significantly improve the situation? The bottom line: Decide if the good you can do will be worth the effort it takes. Are you the best people to solve the problem? Is someone else better suited to the task?

Negative impacts. If you do succeed in bringing about the solution you are working on, what are the possible consequences? If you succeed in having safety measures implemented at a local factory, how much will it cost? Where will the factory get that money? Will they cut salaries, or lay off some of their workers?

Even if there are some unwanted results, you may well decide that the benefits outweigh the negatives. As when you're taking medication, you'll put up with the side effects to cure the disease. But be sure you go into the process with your eyes open to the real costs of solving the problem at hand.

Choosing among problems

You might have many obstacles you'd like to see removed. In fact, it's probably a pretty rare community group that doesn't have a laundry list of problems they would like to resolve, given enough time and resources. So how do you decide which to start with?

A simple suggestion might be to list all of the problems you are facing, and whether or not they meet the criteria listed above (importance, feasibility, et cetera). It's hard to assign numerical values for something like this, because for each situation, one of the criteria may strongly outweigh the others. However, just having all of the information in front of the group can help the actual decision making a much easier task.

Analyzing the problem

Now that the group has defined the problem and agreed that they want to work towards a solution, it's time to thoroughly analyze the problem. You started to do this when you gathered information to define the problem, but now, it's time to pay more attention to details and make sure everyone fully understands the problem.

Answer all of the question words.

The facilitator can take group members through a process of understanding every aspect of the problem by answering the "question words" - what, why, who, when, and how much. This process might include the following types of questions:

What is the problem? You already have your problem statement, so this part is more or less done. But it's important to review your work at this point.

Why does the problem exist? There should be agreement among meeting participants as to why the problem exists to begin with. If there isn't, consider trying one of the following techniques.

• The "but why" technique. This simple exercise can be done easily with a large group, or even on your own. Write the problem statement, and ask participants, "Why does this problem exist?" Write down the answer given, and ask, "But why does (the answer) occur?"

• "Force field analysis." The "but why" technique asks you to dig deep to find the cause of the problem. With force field analysis, you will be looking more broadly at the issue and the forces surrounding it.
  • Start with the definition you penned above.
  • Draw a line down the center of the paper. Or, if you are working with a large group of people who cannot easily see what you are writing, use two pieces.
  • On the top of one sheet/side, write "Restraining Forces."
  • On the other sheet/side, write, "Driving Forces."
  • Under "Restraining Forces," list all of the reasons you can think of that keep the situation the same; why the status quo is the way it is. As with all brainstorming sessions, this should be a "free for all;" no idea is too "far out" to be suggested and written down.
  • In the same manner, under "Driving Forces," list all of the forces that are pushing the situation to change.
  • When all of the ideas have been written down, group members can edit them as they see fit and compile a list of the important factors that are causing the situation.

Clearly, these two exercises are meant for different times. The "but why" technique is most effective when the facilitator (or the group as a whole) decides that the problem hasn't been looked at deeply enough and that the group's understanding is somewhat superficial. The force field analysis, on the other hand, can be used when people are worried that important elements of the problem haven't been noticed -- that you're not looking at the whole picture.

Who is causing the problem, and who is affected by it? A simple brainstorming session is an excellent way to determine this.

When did the problem first occur, or when did it become significant? Is this a new problem or an old one? Knowing this can give you added understanding of why the problem is occurring now. Also, the longer a problem has existed, the more entrenched it has become, and the more difficult it will be to solve. People often get used to things the way they are and resist change, even when it's a change for the better.

How much, or to what extent, is this problem occurring? How many people are affected by the problem? How significant is it? Here, you should revisit the questions on importance you looked at when you were defining the problem. This serves as a brief refresher and gives you a complete analysis from which you can work.

If time permits, you might want to summarize your analysis on a single sheet of paper for participants before moving on to generating solutions, the next step in the process. That way, members will have something to refer back to during later stages in the work.

Also, after you have finished this analysis, the facilitator should ask for agreement from the group. Have people's perceptions of the problem changed significantly? At this point, check back and make sure that everyone still wants to work together to solve the problem.

In Summary

The first step in any effective problem-solving process may be the most important. Take your time to develop a critical definition, and let this definition, and the analysis that follows, guide you through the process. You're now ready to go on to generating and choosing solutions, which are the next steps in the problem-solving process, and the focus of the following section.

You understand the nature of problems:

___They may be defined as the difference between what is and what might or should be.

___They may occur within or outside of the group.

___They occur at different levels of severity.

You have clarified the problem:

___You have started with what you know.

___You have decided what is missing.

___You have gathered information on the problem.

___You have defined the problem.

You have decided to solve the problem:

___It is important.

___It is feasible.

___You are the best people to solve the problem.

___You have weighed the negative impacts.

___You have chosen among possible problems.

You have analyzed the problem:

___You know what the problem is.

___You know why the problem exists.

___You know who is causing the problem.

___You know when the problem first occurred or became significant.

___You know how much, or to what extent, the problem is occurring.

Choosing which problem to solve

A small, rural substance use prevention group is trying to decide where to focus their youth related efforts. In the following chart, the group compared two problems to see which one is more important to the group.

	Problem 1: Many underage teens smoke cigarettes or chew tobacco	Problem 2: Many teenagers use illegal drugs (marijuana, cocaine, et cetera)
How frequently does the problem occur?	Very Frequently	Frequently
How many people are affected?	Most area high school students have smoked at least once; a significant percentage smoke regularly	In our rural community, few illicit drugs are available; this is a fairly small number
For what amount of time are they affected?	Regular smokers, often for life	Often life-long consequences
How severe is the effect?	Relatively severe	Can be tremendously severe
How important do group members perceive the problem to be?	Very Important	Less Important
How important is the problem perceived to be by others?	Less important; smoking and chewing are widely accepted here	Very Important
How likely is it that we can solve/significantly improve the problem?	Very Likely	Possible, but difficult
Are there any negative impacts?	None	None

Which problem will the coalition choose? That remains to be seen; this chart won't give a magic answer. But by using this or a similar device, it's easy to see all of the different aspects of the problem, and the group is now better equipped to make an informed choice.

Tool 1: Deciding on a problem statement

This exercise is adapted from an exercise on developing vision statements created by Lori Alvarado, DCCCA Center, Lawrence, KS. This activity works best in groups with less that 40 people.

• Ask everyone present at the meeting to write down his/her definition of the problem.
• Ask people to pair off and share their problem statements with each other. Together, the pair can create a new problem statement, incorporating ideas from both.
• Ask pairs to join together in groups of four, and again merge the statements into one.
• Continue joining the groups in larger and larger groups until everyone is together again, and you have one agreed upon statement.

Tool 2: Choosing which problem to solve

The following table can be used or adapted to help you decide which problem you want to try to solve if you have several on your plate at the same time. By answering each question, you can get a clearer idea of all of the aspects of solving a problem, and should be able to choose more easily and effectively. For a completed example of this chart, see the Examples section above.

	Problem 1	Problem 2
How frequently does the problem occur?
How many people are affected?
For what amount of time are they affected?
How severe is the effect?
How important do group members perceive the problem to be?
How important is the problem perceived to be by others?
How likely is it that we can solve/significantly improve the problem?
Are there any negative impacts?

A PowerPoint presentation summarizing the major points in the section.

What are "root causes?"

Root causes are the basic reasons behind the problem or issue you are seeing in the community. Trying to figure out why the problem has developed is an essential part of the "problem solving process" in order to guarantee the right responses and also to help community members "own" the problems.

What is the "but why?" technique?

The "But why?" technique is one method used to identify underlying causes of a community issue. These underlying factors are called "root causes."

The "But why?" technique examines a problem by asking questions to find out what caused it. Each time an answer is given, a follow-up "But why?" is asked.

For example, if you say that too many people in communities with limited economic resources have problems with alcohol use disorder, you should ask yourself "but why?" Once you come up with an answer to that question, probe the answer with another "but why?" question, until you reach the root of the problem, the root cause.

Why should you identify root causes?

Identifying genuine solutions to a problem means knowing what the real causes of the problem are. Taking action without identifying what factors contribute to the problem can result in misdirected efforts, and that wastes time and resources. However, by thoroughly studying the cause of the problem, you can build ownership, that is, by experiencing the problem you will understand it better, and be motivated to deal with it.

The "But why?" technique can be used to discover basic or "root" causes either in individuals or broader social systems:

• It can be used to find which individual factors could provide targets of change for your cause, such as levels of knowledge, awareness, attitudes, and behavior.
  • Do people need more knowledge about nutrition?
  • Do children need to learn refusal skills to avoid smoking?
  • Do adolescents need to learn how to use contraceptives?
• It can explore social causes. For example, it could help us determine why a certain neighborhood seems to have a higher rate of a specific problem. These social causes divide into three main sub-groups:
  • Cultural factors, such as customs, beliefs, and values;
  • Economic factors, such as money, land, and resources;
  • Political factors, such as decision-making power.
• It can uncover multiple solutions for a certain problem and allow the user to see alternatives that they might not have seen before. It increases the chances of choosing the right solution, because many aspects of the problem are explored during the "But why?" exercise.

When should you identify root causes?

• Whenever you are faced with addressing a challenging community problem. Of course, the "But why?" technique is not always your best bet and should not be used 100% of the time. It's extremely efficient to find a variety of solutions and is a quick and inexpensive technique that can be done by anyone, at any time, anywhere. For some issues, however, you should use more sophisticated methods, such as surveys, interviews and data collecting.
• When there is support for a "solution" that does not seem to get at the real causes of the problem. For example, if there is hunger in community, let's distribute free turkey at Thanksgiving.
• When there is ignorance or denial of why a community problem exists.

How does the "but why" technique work?

Technique Guide

Here's how it works. A group examines a community problem by asking what caused it. Each time someone gives an answer, the "asker" continues to probe, mostly by asking "But why?" or "How could that have been prevented." Example:

Too many (too few) people are ________.

Q: But why?
A. Because...

Q: But why?
A. Because...

Q: Could that have been prevented?
A. Yes

Q: How?

Q: But why?
A. Because...

Q. But why?
A. Because...

Q But why?
(and so forth)

• First, invite people who are both affected by the problem and are in a position to contribute to the solution to brainstorm possible causes. The more representative the working group is, the more likely it is for the root causes to be uncovered.
• The working group should then examine a community problem, such as substance use or violence, by asking what caused it. Each time someone gives an answer, the group asks, "But why?" Here's an example:

A child has an infected foot.

Q: But why?
A. She stepped on broken glass while walking.

Q: Could that have been prevented?
A. Yes.

Q: How?
A. She could have been wearing shoes.

Q: But why doesn't the child have shoes?
A. Because the family can't afford shoes.

Q. But why?
A. The father or mother has no job.

Q. But why?
(and so forth)

In this example, the "But why?" analysis leads to at least two very different conclusions. The criterion for choice between them is to look into the environment of each one. Many solutions may apply to your problem, so it's up to you to find the one that fits it better. The "But why?" analysis by itself doesn't lead automatically to the best solution. It just points out many paths you may take.

___You understand what root causes are

___You understand what the "but why?" technique is

___You understand why you should identify root causes

___You know when you should identify root causes

___You understand how the "but why?" technique works

___You know how to decide among the options you're left with from the "but why?" technique

___You know how to apply the "but why?" technique

"But why?" in Latin America

David Werner, a community health organizer in Latin America, used the "But why?" technique to get to the more fundamental, underlying causes of widespread ill health of villagers in Western Mexico:

"...(At first) I did not look far beyond the immediate causes of ill health. As I saw it, worms and diarrhea were caused by poor hygiene and contaminated water. Malnutrition was mainly caused by scarcity of food in a remote, mountainous area where drought, floods and violent winds made farming difficult and harvest uncertain.

Little by little, I became aware that many of their losses -- of children, or of land or of hope -- not only have immediate physical causes, but also underlying social causes. There is a photograph of a very thin little boy in the arms of his malnourished mother. The boy eventually died of hunger. The family was -- and still is -- very poor. Each year the father had to borrow maize from one of the big landholders in the area. For every liter of maize borrowed at planting time, he had to pay back three liters at harvest time. With these high interest rates, the family went into further debt. No matter how hard the father worked, each year more of his harvest went to pay what he owed to the landholder." - D. Werner, Helping Health Workers Learn, Front-7

 

The "But why?" method is not explicit in this story, but by asking "But why?" questions, Werner could help people analyze their problems, and prevent waste of tactics and resources. Using the "But why?" technique, he could see beyond the most obvious causes for the problems he was trying to eliminate. For instance, he learned that malnutrition may have more causes than simply lack of food.

Tool 1: Discussion Guide for Identifying Root Causes

A note to all readers/participants: This exercise is designed to help practice identifying underlying factors that are behind a community problem. We are calling these underlying factors "root causes." To identify "root causes," we will be using a technique called "But Why?"

Goal: To analyze a community problem by trying to determine its most fundamental reason, or "root causes."

Task 1: Select one member of your group to act as the "asker." This Person will be the one asking the "But why?" questions.

Task 2: Chose a issue to examine, a specific problem. Once the specific problem is identified and described, your "asker" will guide you in identifying what your group considers to be the "root causes" of that problem. The identification of root causes should be made by answering the "But why?" questions.

Task 3: After you have identified some key root causes for your priority problem, discuss what approaches might be undertaken to remove or counteract those root causes.

Possible Approach: _____________________________________________________

Possible Approach: _____________________________________________________

Possible Approach: _____________________________________________________

At this point, you should look at all possible approaches and select the one that fits your problem better, the one that is the best solution.

A PowerPoint presentation summarizing the major points in the section.

 

"Our children have dramatically different life chances depending on where they were born. In Japan or Sweden they can expect to live more than 80 years; in Brazil, 72 years; India, 63 years; and in one of several African countries, fewer than 50 years. And within countries, the differences in life chances are dramatic and are seen worldwide. The poorest of the poor have high levels of illness and premature mortality. But poor health is not confined to those worst off. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.

It does not have to be this way and it is not right that it should be like this. Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity. Putting right these inequities – the huge and remediable differences in health between and within countries – is a matter of social justice.
Reducing health inequities is...an ethical imperative. Social injustice is killing people on a grand scale." -excerpt from the 2008 World Health Organization Commission on Social Determinants of Health Final Report Executive Summary (PDF)

What are social determinants of health and development?

“Social determinants” refer to broader social factors, such as income inequality or social exclusion, that lead to or influence health and development outcomes. In Section 4 of this chapter, for instance, a development worker in Mexico tells of realizing that one of the major causes of malnutrition in the area where he was working was not that there simply wasn’t enough food. Sharecropping farmers were able to grow enough to feed their families, but had to borrow seed from the landowner to plant their crops. The terms of the loan were that, for every liter of maize borrowed at planting time, three liters had to be repaid from the harvest. With this high interest rate, farmers experiencing economic hardship went deeper and deeper into debt, and had to use more of their crop each year to pay the landowner. Without power, group solidarity, and influence, the farmers were unable to create conditions that assured the health and well-being of their families.

There is a great deal of research on the social determinants of health. Most of it points to three overarching factors:

• Income inequality. Once a country has reached the point of development where most deaths come not from infectious diseases (tuberculosis, dysentery, cholera, malaria, flu, pneumonia, etc.), but from chronic diseases (heart disease, diabetes, cancer), the economic and social equality within the society is a greater determinant of death rates and average lifespan than the country’s position with regard to others. The United States, for instance, lags behind Japan, Sweden, Canada, and many other less affluent countries in the life expectancy of its community members. The difference seems to be the size of the gap between the most and least affluent segments of the society.
• Social connectedness. Many studies indicate that “belonging” – whether to a large extended family, a network of friends, a social or volunteer organization, or a faith community – is related to longer life and better health, as well as to community participation.
• Sense of personal or collective efficacy. This refers to people’s sense of control over their lives. People with a higher sense or stronger history of efficacy tend to live longer, maintain better health, and participate more vigorously in civic life.

Many of the social determinants listed below are specific forms of or contributors to these three categories. At a community level, it may be difficult to influence income inequality directly, but a non-governmental or community-based organization may be able to approach it through addressing a particular issue. A small organization may be able to have more effect on social connectedness and the sense of efficacy, since collective action can influence both social ties and the experience of changing communities and systems.

The World Health Organization, in its publication The Solid Facts, recognizes the need to break these factors down into more manageable pieces. It lists ten factors that affect health and life expectancy, and advocates addressing each within a comprehensive program of social protection that addresses all of them within a society. These ten factors are:

• The social gradient (extent of equity or the difference in wealth and opportunity between those with the most and those with the least)
• Stress
• Early life experience
• Social exclusion (the opposite of social connectedness)
• Work
• Unemployment
• Social support
• Addiction
• Food
• Transport

The factors listed below are, in most cases, more specific than the three broader determinants discussed above. In addressing social determinants, however, keep in mind these broader factors, and gear programs and policies toward influencing them at whatever level you can, given the resources and scope of your organization.

The social determinants of a particular community health or development issue may be unique to a particular community or group, or may be part of the larger society. People from different immigrant cultures, different social classes, or with different levels of education might experience the same issue very differently because of different social factors.

There are three major ways in which social determinants may affect specific populations. These can also be viewed as levers – points of intervention – that can be used to address those social determinants and lessen their effects.

1.  Differences in exposure. Certain population groups, because of economics, geography, or other factors, may be more likely than others to encounter particular health risks. People in poverty, for example, are likely to be exposed to higher levels of stress, economic uncertainty, and unhealthy conditions than their wealthier people in their country.

A specific example: in low- and middle-income countries, rural villages experiencing poverty may get all their water – for drinking, washing, waste disposal, and other uses – from a single, above-ground source, such as a lake or stream. In that case, the villagers are far more apt to be exposed to water-borne diseases and pollutants than wealthier neighbors who can afford to buy bottled water or drill a well.

2.  Differences in vulnerability. Because of their poverty, their exposure to stress and uncertainty, or other factors, those same population groups might find themselves more vulnerable than others to health problems. The inability to pay for regular health care or medical treatment increases the possibility of chronic illness. In the example of the village above, poor nutrition, as a result of poverty, could increase villagers’ vulnerability to water-borne disease, as would the inability to organize to finance a village well.

3.  Differences in consequences. Differences in wealth, social standing, connectedness, and other factors can lead to very different outcomes where health issues are concerned. For a middle- or upper-class family in many countries, a minor health problem – missing a few days of work, paying a modest sum for treatment – might be just an annoyance. For a family experiencing poverty, it might be the difference between a roof over their heads and homelessness, or between children attending school and dropping out to go to work. Discrimination, high stress levels, employment conditions, and other factors can result in disparities in health and health care among different groups.

There are a number of social factors to address to improve conditions for health and development. Some of the more common factors to be addressed are:

Economic factors.

The unemployment rate, for example, has a great influence on such issues as domestic violence, substance use, depression, or physical illness. Economic inequality affects people’s stress levels, exposure to violence and toxins, educational prospects, access to services, high-risk behavior, and mortality rates.

Social inclusion.

Social connectedness and the cohesion of the community have been shown to have a direct relationship to good health and lower mortality rates. These factors can also encourage civic participation in changing conditions that affect group goals.

Education.

More education means not only better jobs and more affluence, but also a greater sense of control over one’s life. People with more education have more choices in health, housing, careers, and other areas that affect the quality of their lives.

Racial or ethnic bias.

Social exclusion can be the result of prejudice, which results in different access to health care, education, or other services.

Social norms of acceptance of particular behaviors or practices.

Smoking, or even harmful alcohol use, may be an accepted part of the culture of a community. In that case, many more people will adopt it than in a community where it is frowned upon.

Cultural factors.

There are many elements of culture that might have a bearing on social inclusion, efficacy, and income inequality.

• Gender roles in different cultures may lead to differences in opportunities for men and women, and to disparities in nutrition, health, education, and life opportunities for their children as well.
• Food preferences in different cultures may have profound health effects. For centuries, for instance, the Japanese ate a diet consisting largely of rice, vegetables, and fish, and, at least partly as a result, experienced fewer heart health problems than the meat-and-potato eaters in the United States.

In many cases, people only one generation removed from rural poverty – as typified by many Eastern European immigrants to the U.S. in the early 20th century – may eat more fat because being able to eat fatty foods, such as meat, symbolizes wealth in peasant cultures. Many turn-of-the-20th-century immigrants to the U. S. – the grandparents of contemporary Americans – thought fat children were healthy children, because fat children clearly get enough to eat, as opposed to going hungry. Starvation was a real danger in the time and place of their childhoods.

• Religion can have profound effects on both health and development issues.
• Attitudes toward mainstream culture can influence everything from medical care to whether or not high school students can attend dances. This, in turn, affects the type and amount of health care received, the sense of connectedness within a community, and many other factors.
• Language barriers can cut people off from health care and other services, make it difficult for them to find and keep decent jobs, and affect their children’s education.

The influence of mass media.

The media, particularly television, can send powerful messages about community health and development. In the 1950s in the U.S., smoking was portrayed in movies, magazines, and TV as glamorous and sophisticated. Now, there are no TV ads for cigarettes, virtually no one in the movies smokes, and anti-smoking messages are everywhere. These conditions both reflect and are partially responsible for the fact that fewer than 25% of adults in the U.S. now smoke.

The media can help or hinder other efforts to improve health (through programming that shows people exercising as a matter of course, for instance, or that shows the same people eating fatty fast food or drinking too much). They can also, similarly, encourage or discourage tolerance for others, push a political agenda, or condone or condemn such behavior as solving disputes with violence and engaging in sex without adequate protection against pregnancy or STIs.

Politics.

It is probably fair to say that all community issues are political to some degree. If a factory is poisoning town wells with its effluent, for example, local officials are faced with the choice of not dealing with the actual cause of the problem (the dumping of waste) and endangering community members’ health, or addressing the dumping and endangering community members’ jobs. Politicians with larger constituencies, using poll data, may pander to what they perceive as people’s selfishness and prejudice, passing legislation or instituting policies that discriminate against one group or another, or fly in the face of the public interest. Even honest differences of political opinion – over whether the government should be responsible for providing social services or not, for instance – can have enormous consequences in the community.

Living conditions.

Run-down or inadequate housing, dangerous streets, noise, and blighted neighborhoods all have their effects on those who experience them every day, as do manicured landscapes and calm environments. The stress of living in a difficult situation carries over into many other areas of life.

Geography.

Location may have a great deal to do with whether people receive services or not. In low- and middle-income countries, children from isolated villages in the mountains or on the seacoast may have no opportunity for school or medical care, for instance. In the U.S., as mentioned earlier, access to medical care and other services may depend on the availability of transportation. In urban areas, that access may have a lot to do with the neighborhood in which the services are located: another gang’s turf or a neighborhood perceived as hostile may be as effective in denying services as if they didn’t exist at all.

Why address social determinants of health and development?

 

Reasons for addressing the social determinants of an issue include:

If you want to solve or prevent a problem for the long term, you have to deal with its root causes.

If you address the root causes, you’re more likely to successfully address the issue for the short term as well. To cure a disease, you have to treat more than the symptoms – but you usually have to treat the symptoms, too. Dealing with social determinants will not only resolve the issue over the long term, but will make alleviating the current effects of the issue possible also.

To eliminate cholera, one of the most important steps is to provide people with clean drinking water. During the London cholera epidemic of 1854, John Snow, a physician, mapped the houses where the disease struck. He learned that many of the stricken were drawing water from a pump that tapped a filthy part of the Thames River, because conventional wisdom said it was better than the piped water also available to them – which actually came from a cleaner area. He was able to close the pump and substitute piped for pumped water, almost immediately ending the outbreak. Snow’s insights about the social determinants of cholera, along with the later work of others, eventually helped to eliminate the disease as a threat in most of the developed world. But they also served to stop the 1854 epidemic.

Who should address social determinants of community health and development?

The Community Tool Box advocates for participatory approaches to planning and, in this case, for a participatory approach to analysis and intervention as well. The presence of members of the groups affected by the issue will ensure that everyone knows its full context and history, as well as what various segments of the community might be willing and unwilling to do about it. Those who should be involved include:

• Those directly affected by, or experiencing increased risk for, a particular health condition or community development issue.
• Policy makers, legislators, officials, or others who can affect the issue.
• Human services staff, administrators, and others (such as police officers, teachers, and coalition members) who are responsible for dealing with the issue at hand.
• Respected local figures, including advocates, clergy, and others in the community to whom people turn for support.
• Members of groups that may be asked to change or sacrifice or take action in order to address the issue. Employers, landlords and other property owners, health and human service workers, police, and teachers all might fall into this category.

When should you address social determinants of community health and development?

You should always look at the social factors that play a role in community issues, but there are some times when analysis of those factors is particularly important.

• When it’s clear that simply focusing on the issue isn’t enough. As cities have found again and again, all the enforcement in the world won’t really stop youth violence. There has to be a change in the culture that creates that violence.

In the late 1960s, Philadelphia was a city of gangs. One night in 1969 in North Philadelphia, there were five shootings in a one-square-block area. The neighborhood was crawling with police who were apparently powerless to stop the string of attempted revenge killings (“attempted” only because only three of the shootings were fatal). What eventually succeeded, a couple of years later, was a peacemaking effort that involved the gang leaders and that addressed the social issues that lay behind the existence of gangs and violence in the neighborhood: the isolation and alienation of black youth from the society at large, the lack of jobs, and the irrelevance of school to young people whose main concern was getting home alive. Gang members formed entrepreneurial businesses – making films, developing clothing lines – and school became relevant because education was necessary to run a business successfully. Community violence lessened as truces were signed and hope for a reasonable life grew.

• When you’re advocating for legislation, policy change, or funding to address a community issue. The legislation, policy, or funding – and therefore your advocacy – should address the underlying causes of the problem you’re trying to solve, as well as its symptoms. Otherwise, you’ll be dealing with the symptoms forever.
• When you’re trying to demonstrate that fundamental change is needed. Change is difficult for everyone. Trying to get a whole community to change its attitudes and/or behavior is even more difficult. Being able to explain clearly how the changes are related to positive results can make things easier.
• When you’re looking for long-term solutions to long-term problems. Long-term solutions are impossible without taking into account the root causes of the problems you want to solve. Analyzing the social determinants of those problems makes it possible to address them, and come to real, permanent solutions.
• When your focus is on community wellness and prevention. Whether you’re trying to guard against a disease or debilitating condition, or trying to create a healthy community, you have to look at the issue as a whole in order to be successful. You can’t lower your blood pressure, for instance, without adjusting your diet, exercise, stress levels, and daily activities, all of which may be governed, to some extent, by social as well as personal factors. By the same token, you can’t alter racial tensions in a community without somehow addressing all the history that led to those tensions, the preconceptions and misconceptions on both sides, personal experiences, the attitudes of community officials and police, the racial prejudice endemic in the society, etc.

How do you address social determinants of community health and development?

Now that you’re convinced that addressing the social factors that cause or influence community health and development issues is important, how do you go about doing so? There are really two parts to addressing social determinants. The first is identifying how various social factors affect the issue you’re concerned with, and the second is developing and implementing an action plan based on an understanding of how, and from what angle, to approach them successfully in order to change the way the issue plays out in the community and, ultimately, resolve the problem.

Identifying social determinants

The issue you’re dealing with may be obvious, but it’s likely that all of its social determinants are not. There may be local customs that seem so obvious to the folks you’re working with that they don’t consider them worth mentioning, even though they may control a great deal of the community’s functioning. If they’re unique to that community or region, and you’re not a native, you’ll have to learn about them if you have any hope of changing conditions. In other cases, social factors may have to be traced through several layers of the society before you reach the point where they originate and can be influenced. The way to find out about these and other social determinants is to do a community assessment.

Assess the community to find the social determinants of your issue. The purpose of community assessment is largely to assess the community for needs and assets, but the strategies it proposes are equally useful in searching for social determinants of health and development.

• Start by talking to people:
• Community leaders
• Members of the group most affected by the issue
• Government officials
• Staff and volunteers of non-governmental health and community development organizations (NGO’s)
• Community activists and organizers
• Anyone who has a stake in the issue you are trying to address

If there are conflicting factions or “sides” involved in the issue, it’s important to hear from all of them. Even if you’re clear about who’s in the right, or about what needs to happen in order for the issue to be resolved, understanding all points of view can tell you a great deal about the social factors that underlie the situation in the community.

You can hear what people have to say in various ways:

• Individual interviews
• Group interviews
• Focus groups
• Community meetings
• Informal conversations
• Listening and observation at gatherings held for other purposes
• Learning as much as you can about community history. Social determinants of health and development often run deep and go back generations.

The Battle of Montaperti was fought between the Italian cities of Florence and Siena, then independent republics, in 1260. In the 21st century, a sports contest between the two, whether on the high school or professional level, often spurs a cry of “Remember Montaperti” by the Sienese – the victors 750 years ago.

Apply critical thinking principles to analyze the results of the assessment. Very briefly, these include:

• Make sure your information is accurate.
• Consider the reliability of your sources.
• Examine and challenge your own and others’ assumptions and biases.
• Identify the interests being served or ignored.
• Ask the right questions. This could also be considered a principle of critical thinking, and dovetails with the “But why?” technique. Some of the questions you might want to ask are:
• Whom does the issue affect?
• What do those affected have in common? Class? Race or ethnicity? Gender? Physical characteristics? Geographical origin or location? Behavior or personal practices? Lifestyle? Education? Employment? Personal history? Culture? Interests? Other characteristics?
• What is the history of the issue in the community? When did it become an issue? What else was happening at the time, both in the community and in the society at large?
• Who stands to gain, and who stands to lose – socially, economically, or politically – if nothing changes?
• Who stands to gain, and who stands to lose if changes are made? Is there a win-win option, where everyone benefits?
• Who has the power to create change in this situation? What are reasons they may or may not do so?
• Where is the issue centered, geographically and socially?
• Are there economic aspects to the issue? What would it cost to change the situation or to leave it as it is, and who would bear the cost in either case?

The “But why?” technique is actually quite simple. Once you have the answer to an initial question, you follow up the answer with “But why?” The answer to that question gets another “But why?” until you get as far as you can go. At that point, you have an answer that identifies the root of the problem, and therefore implies a solution.

Addressing social determinants

As we’ve discussed, most social determinants come down to:

• Economic inequality
• Social connectedness
• A sense of efficacy

The lower people’s economic levels, the less connected they are to others – through family, social groups and organizations, faith communities, etc.; the less convinced they are of their ability to control their situations and their lives, the greater the likelihood that they’ll experience more health problems than those in the society who fare better in those categories.

And as we’ve also discussed, particular individuals or populations are most likely to be disproportionately affected by health problems because of:

• Differences between them and others in the society in the level of their exposure to those problems.
• Differences in their vulnerability to those problems.
• Differences in the consequences to them of those problems.

These characteristics feed each other in a cycle of poverty and limited influence or agency. An effective intervention has to break that cycle by understanding the social determinants behind it and changing them and the conditions that they cause in a truly profound way.

You can develop interventions that can reduce people’s exposure to, their vulnerability to, and their consequences from health problems, and that can also encourage gains in economic equality, social connectedness, and efficacy. By doing so, you can help people not only improve their health and that of their children, but move up the ladder of economic and social status, thus cementing their gains, and securing them for the next generation.

This may seem like an impossible task. How can you change a society? It’s hard for governments and even harder for most NGOs and community-based organizations, given the limits on their resources. Major social change often takes not a single type of intervention, but an all-out assault on a number of social factors over a long period of time. Unless you’re a high government official, or have access to unlimited funds, you’re probably not planning anything that broad . . . and you don’t have to.

Rather than trying to concentrate on the huge issues, you can intervene in the environmental and policy conditions that reflect social determinants and that can more easily affect differences in exposure, vulnerability, and consequences. In the process of addressing these types of issues, the folks you’re concerned with can learn much of what they need to change their position in society.

Environmental here refers not just to the natural environment, but to the total environment of the people in question. That includes the built environment – buildings, roads, power sources, farms, etc. – as well as the social environment – culture, social rules and norms, government, business, education, economics, etc.. The term “environment” here encompasses all the natural and human physical, social, economic, and political structures that surround people’s lives.

Environmental and policy conditions include:

• Knowledge and skills. Individual and group knowledge and experience affect the availability of resources for supporting health and well-being. A villager who understands how to advocate with the government for clean drinking water, for instance, can greatly enhance the health prospects of their community.

Helping people gain knowledge and skills can be an intervention in itself, or be part of a broader intervention that nonetheless provides participants with tools to safeguard or improve their health and their lives. Some community development programs, for example, include literacy classes as part of the support they provide. With literacy, participants gain skills that allow them to continue and expand the community development activities they’ve begun, or to get jobs that will better serve them and their families. Literacy also gives people who’ve historically had limited power a means to power over their lives by helping them understand the forces working on them (not to mention the terms of contracts and other papers to which they’re asked to agree), and take action on their own behalf.

Providing knowledge of specific health issues and practices can have a dramatic effect on the health of a community. Safer sexual practices, for instance, can cut down on the incidence of HIV infection, and information about the treatment of infant diarrhea can drastically reduce infant mortality.

In both these examples, addressing a specific issue serves to address efficacy, and, in the case of literacy training, economic inequality as well. Depending on how programs are structured, most can also address social connectedness, either by bringing a community or population group together to work on an issue, or by creating a community among those involved (in literacy classes, for example.)

• Support within and between groups. Emotional support from family and friends, such as for the stress of difficult work or family situations, helps us cope with situations that cannot be easily changed. Links with other groups, such as faith communities or non-governmental organizations (NGOs), can provide access to goods and services. Just as important, joining with other groups to work for increased resources and better health conditions can permanently improve the quality of community life.

Again, an intervention to connect people or groups with others may stand alone, or may be integrated into a larger concept. A government agency might encourage groups to combine across ethnic or geographic lines in order to receive funding or training for health and community development projects. In a situation where the government is perceived as withholding support, a group of villages without access to health care, for instance, might come together to petition the government for a centrally located health clinic that would be easily reachable for all of them. Groups like this represent the most fundamental kind of community organizing, which brings groups and communities together to advocate for their interests and to take control of what happens to them.

• Barriers to, access to, and opportunities for resources and services. Some social groups, such as women or people from underrepresented ethnic groups, face discrimination and other barriers in gaining access to education, jobs, and basic services. The quality and availability of even basic education and health services are unfairly distributed among social groups.

In cases where education, jobs, services, and other necessities are unequally distributed, the appropriate action may be to organize the community, as above, to demand equal treatment; to use the court system to try to gain access and opportunity; or to attempt to address the issue locally, using available community assets and the initiative of local people. If the initiative comes from the government, it might create programs that remove or address barriers to opportunities and services, such as discrimination, unaffordable expense, geographic isolation, lack of transportation, limited literacy, and lack of job skills.

• Consequences of Actions. Research has long shown that people are more apt to take or continue action if it rewards them with goods, peer approval, pleasure, status, satisfaction, or the desired results than if it punishes them with high costs, disapproval, misery, loss of status, dissatisfaction, or frustration. If gaining access to health care or to healthy goods or practices is difficult, slow, and tedious, and often ends in failure, it won’t be long before people stop trying.

A possible remedy here is, as above, to improve access and break down barriers to access to goods and services, thus making the attempt to obtain them less frustrating and more likely to be repeated. Strategies might include providing transportation to and from existing services or distribution points, locating new services closer to where they’re needed, or lessening bureaucratic requirements. If the intervention involves action by participants, actions should be planned in small steps, so that people can easily experience success, at least at the beginning. A series of small successes is more likely to develop a sense of efficacy and keep people moving ahead than a grand failure.

• Exposure to or protection from hazards. Contact with environmental hazards – polluted water, toxic substances or dangerous practices in the workplace, endemic diseases such as malaria, widespread violence – increase risk for disease or injury. By the same token, actions taken to reduce or eliminate those hazards – drilling a new well, instituting protective workplace safety procedures, disease eradication campaigns, negotiating a peace treaty – work to make disease or injury less probable.

An intervention to decrease or prevent exposure to hazards can take any one of several forms. A self-help program to dig a well or use filters to obtain clean water, channel sewage, grow food without pesticides or chemical fertilizers, eliminate VOCs (volatile organic compounds, often-toxic chemicals – used in glues, dyes, paint, and solvents – that vaporize at room temperature and can affect the health of many people) in a building, or clean up a neighborhood can not only improve health conditions, but increase participants’ sense of efficacy as well.

A different approach might involve advocacy for government assistance or services – drilling a well, installing a sewer system, establishing a health clinic, instituting public transportation, etc. – or to pass or prevent laws that affect exposure to health risks. These actions would speak to both social connectedness (community organizing brings communities or groups together to apply pressure and advocate effectively) and participants’ sense of efficacy.

A third possibility that also addresses both social connectedness and efficacy might involve an initiative to change the behavior of – or prosecute – a corporation or other party responsible for pollution, unsafe workplace practices, illegal dumping, shoddy and dangerous construction, selling harmful products, or other potential hazards.

• Policies. Policies that affect community health and development may be formal or informal, and may be those of governmental or non-governmental bodies (e.g., corporations, institutions, foundations, professional associations). They may relate to the provision of goods and services (e.g., clean water, adequate food, health care, education, housing) or to regulations and their enforcement (e.g., environmental and drug laws, welfare rules, trade regulations, non-discrimination laws in employment and education.) Public policies often mirror a community’s or society’s norms (the unspoken rules of “how things should be”), and, as a result, are often a direct reflection of social determinants.

Changing or instituting policy is generally a matter of advocacy. It’s important because policies can, and do, affect all three of the differences – in exposure, vulnerability, and consequences – that create less healthy conditions for populations experiencing increased risk.

An initiative aimed at policy change can start at any level. It may begin with government, with the realization by legislators, other elected or appointed officials, or an agency that some sizeable group of community members is in danger of, or already suffering from, disparities in health. It may begin with an NGO or grassroots organization that works with (or is composed of) that group. Or it may begin with the people themselves, who have simply come to the end of their patience with their situation.

Policy change is often difficult, but, in the long run, it can be the most effective means of improving health and development outcomes, because it can lead to real social change. The ideal intervention would be one that either originates with, or involves those who will benefit from the change in question, since that gives them control over what happens to them.

Several principles, assumptions, and values help guide collaborative action to create conditions that promote health and development. These include:

• Priority issues and strategies for collaborative action are best determined by people most affected by the concern. This can enhance community efficacy and empowerment, and is also most likely to address the issues most important to those involved.
• Since health and development outcomes are caused by multiple and interrelated factors at multiple levels, single interventions are likely to be insufficient. This suggests the importance of comprehensive interventions that address environmental and policy conditions at all levels.

Multi-pronged, multi-faceted interventions are the ideal, and are, in general, necessary to create real and permanent social change. The reality for small organizations, however, is that such interventions may not be possible, because of limited resources and geographic and/or political isolation. There are at least two ways to deal with this reality: One is to form a coalition, pulling in other organizations – including national and international NGOs and even the government where possible – to mount a collaborative effort on many fronts. The second is to develop a long-range strategic plan that takes as its base the saying of the Chinese philosopher Lao Tzu, “The longest journey begins with a single step.” That involves starting with a single issue in order to tackle something manageable and achieve a success that will energize and empower those affected. Then you can go on to the next issue and the next, always maintaining and consolidating gains as you go. In this way, you can end up with an effort that addresses the full range of social determinants, without exceeding your capacity at the beginning. It may take a while, but your chances of creating real change are better if you take it step by step, as long as you don’t lose sight of the goal.

• Collaborative efforts must bring about change in multiple sectors and systems. (This requires leadership to engage groups with different interests, such as those in business or education, to share resources and responsibilities in common purpose.

Again, depending on your resources, even a coalition or other collaborative body might have to take this one step at a time.

• The aim of support organizations is to build capacity so that local people can take action over time and across issues.

Capacity-building involves helping local people gain the skills and knowledge – and establish or strengthen the community organizations and institutions – necessary to allow them to take action and control their own fate. That may entail direct training, using resources like the Community Tool Box, and a certain amount of “on-the-job training”. There’s no substitute for experience in health and community development, although having some background before you’re thrown into it is certainly helpful.

At some point – earlier is usually better than later, and from the beginning is often best – local people have to be directly involved in planning and carrying out strategies for improving their situation. Taking on responsibility and leadership positions builds both a sense of efficacy and connectedness in the local population, and also puts their future where it belongs – in their own hands.

• Health and development efforts should involve collaborative partners as catalysts for change. (Partners must convene conversations that lead to addressing the issue, broker relationships, and develop resources for those doing the work of changing communities and systems.)

Partners can be NGOs or community health or development organizations, government agencies, corporations, academic institutions, faith communities – any party that is generally respected, has some clout, and can function as an honest broker.

As is perhaps obvious from the discussion directly above, an important goal of addressing social determinants is strengthening the ability of the community to sustain the changes that an intervention brings about. If a population is malnourished, giving them food is only a temporary solution: helping them to develop self-sufficient and sustainable farming practices, or training them for necessary and available work, on the other hand, can be permanent ones.

Another important goal is to take on tasks that can actually be accomplished. A local entrepreneur, owner of a large and flourishing tire business, a real estate development firm, and several other successful ventures, was asked how he got to the position he was in. His answer was simple: “Crawl, walk, run.” He started small, with something he knew he could handle. When he succeeded at that, he used it as a base to take on something a bit more challenging, consolidated his gains again when he succeeded at that, and just kept going.

Social change often works the same way. Success breeds success, and you’re far more likely to be successful if you attempt something that’s challenging but doable. Once you accomplish it, you have a foundation from which to address the next issue, or the next level of issues. Communities never lack the most important resource – people, and their intelligence and determination – but they may lack the material resources that allow them to attempt overall social change – change that entails addressing several social factors and levels of power – all at once. They can do it, however, if they take it one step at a time.

The last bit of how-to in this section will be familiar to regular Tool Box users. You have to keep taking that one step at a time again and again and again for as far into the future as you want your community to exist. Addressing social determinants of health and development isn’t a one-time thing. People have to maintain their gains and their healthy practices, and teach the next generation what they’ve learned about creating a healthy community, so that it will continue to be one.

In Summary

“Social determinants” of health and development issues are the social factors that determine or influence the issues. Most fall into the three categories of economic inequality, social connectedness, and sense of efficacy. By understanding and addressing these social factors, you can increase your chances of resolving issues over the long term by getting at their root causes.

It makes sense to use a participatory approach to analyze and address social determinants of health and development issues. By including those who know the history and context of the issue, and by subjecting it to analysis from many minds and perspectives, you’re more likely to arrive at a thorough understanding of it. This kind of analysis is especially effective when it’s clear that simply putting a Band-Aid on the symptoms of the issue isn’t enough, and that you have to employ a long-term strategy in order to address it effectively. Such a strategy may incorporate advocacy for a change in law or policy and leadership training, as well as community-based actions.

A community assessment will help you understand what the social determinants are in a particular case. By asking the right questions to determine community reality – Who is affected and how? What are the patterns in who is affected, who is opposed to action, what are the interests at stake? What are the costs of action and inaction, and who will pay them? – and talking to those affected and others who may already know what the social determinants are in the situation, you can create a complete picture of the issue.

Using that picture, you can address the social factors in order to reduce the population’s exposure to, vulnerability to, and consequences from the issue at hand. The best approach is usually through environmental and policy conditions, rather than through attempting to change social factors – which can be far-reaching and ingrained in the culture of the society – all at once. Work toward incremental, sustainable change, help local people learn the skills to take over and continue the effort themselves, and make sure the effort continues indefinitely, and you’ll ultimately be successful in developing a healthy community.

What are social determinants of community health and development?

___Social determinants of community health and development issues are the social factors that determine and influence the issues.

___The three overarching factors are:

• Economic inequality
• Social connectedness
• Sense of efficacy

___The ways they most often play out are in:

• Differences in exposure
• Differences in vulnerability
• Differences in consequences for different populations

___More specific social determinants can include:

• Racial and ethnic bias
• Cultural differences
• Media influences
• Politics
• Living conditions
• Geography

Why address social determinants of community health and development?

___If you want to solve or prevent a problem for the long term, you have to deal with its root causes.

___If you address the root causes, you’re more likely to successfully address the issue for the short term as well.

___The social factors involved may have more resonance for those affected than the issue itself.

___It may be easier to approach an issue through its underlying social factors than to deal with it directly.

___Addressing the social determinants of community issues is crucial to understanding them fully, so that your strategy and tactics for dealing with them correspond to reality.

___Addressing social determinants presents a tremendous opportunity for learning and community leadership development.

Who should address social determinants of community health and development?

___Those affected by the issues (the targets of change).

___Those who can have an effect on the issues (the agents of change).

___Staff members from organizations that work directly with the target population and/or the issue.

___Respected community leaders and citizens.

___Those who will be asked to change, sacrifice, or take action in order to address the issue.

___Anyone else who has a stake in the issue.

When should you address social determinants of community health and development?

___When it’s clear that simply focusing on the issue isn’t enough.

___When you’re advocating for changes in laws, policies, or funding.

___When you’re seeking fundamental change.

___When you’re seeking a long-term solution to a long-term problem.

___When your focus is on community wellness and prevention.

How do you identify social determinants of community health and development?

___You assess the community.

___You ask people who know.

___You apply critical thinking principles to the issue.

___You ask the right questions.

How do you address social determinants of health and community development?

___You work to address larger social factors through environmental and policy conditions, including:

• Knowledge and skills
• Support within and between groups
• Modification of access to, barriers to, and opportunities for resources and services
• Consequences of actions
• Exposure to or protection from hazards
• Policy change

___You’re guided by these basic principles:

• People most affected should choose the issues and plan strategies for the work.
• True change in social determinants demands comprehensive interventions that address multiple and interrelated factors at multiple levels.
• Collaborative efforts should aim at bringing about change in multiple sectors and systems.
• Support organizations should build capacity in the community to control its own fate.
• Health and development efforts should involve collaborative partners as catalysts for change.
• Strategies should be self-sufficient and sustainable over the long term.
• Efforts should be aimed at goals that can be accomplished by the people in question with the resources at hand.
• Successes should be consolidated and maintained, so that new and greater challenges can be taken on.
• Efforts should continue indefinitely.

Example #1: Meet the Wonder Women of Indonesia

Rovina is one of hundreds of "wonder women" in Kopernik’s Wonder Women initiative that has empowered women to become clean energy micro-social-entrepreneurs, connecting life-changing solar lights, clean cookstoves, and water filters with last mile communities in some of Indonesia's poorest provinces.

More than 80 million people live without any electricity in Indonesia, and many more live with unreliable access to electricity.

Almost 100 million people rely on smoky, fuel-hungry three-stone fires for cooking.

And clean drinking water is often a costly luxury.

There is great demand for affordable, clean energy technologies, especially in the poorest provinces of eastern Indonesia, but geography and demography make energy access a huge challenge.

This is where Kopernik's Wonder Women Eastern Indonesia initiative comes in.

Equipping women with the skills and resources to become clean energy micro-social entrepreneurs is a viable, sustainable way of connecting these technologies with the people who need them the most.

Read more

 

 

Example #2: Community Health And Literacy Center: A Health, Literacy & Recreation Hub

The Community Health and Literacy Center, formed out of a collaboration between the Children’s Hospital of Philadelphia (CHOP) and the City as unexpected partners, worked together to bring a neglected neighborhood both improved access to health care and health, promoting recreation and literacy opportunities.

The center, which opened in the spring of 2016, is a first-of-its-kind hospital-city partnership. The project includes a CHOP pediatric clinic; a full-service community health center run by the city’s department of public health; a branch of the Free Library of Philadelphia; and a modern recreation center with a playground and green space, run by the city’s Department of Parks and Recreation. It offers welcoming outdoor space for the neighborhood and an indoor community meeting space. The location has excellent public transit access, with a subway stop on site. CHOP and the city are working to integrate services and programming as a way to have more of an impact on improving population health.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #3: Vita Health & Wellness District: Health at the Center of a Neighborhood Transformation

The Vita Health & Wellness District project was established through a partnership between the Stamford housing authority and Stamford hospital to revitalize an impoverished inner city area, in Stamford Connecticut, into a mixed-income community with expanded neighborhood services centered around a sustainable urban farm. Addressing the social determinants of health provide a framework for managing the neighborhood transformation in ways that would support and strengthen the existing community.

The Vita project is a great example of how a hospital can fulfill the Affordable Care Act’s mandate to engage its community by partnering to address the social determinants of health. The project also demonstrates how a forward-thinking community development organization can effectively partner with the health sector to pursue comprehensive community revitalization that could not have been achieved otherwise. These are still early days in what promises to be a fruitful and long-lasting partnership.

Read more about the Vita Health & Wellness District project on the Building Healthy Places Network blog.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #4: Rolling Hills Apartments: Weaving Together Opportunities for Healthier Lives for a Diverse Immigrant Community

Twin Cities LISC, a local community development financial institution, has partnered with local organizations and city agencies to create quality affordable housing with improved healthcare access, including constructing a Federally Qualified Health Center. LISC also employed community health advocates to weave together the isolated health-related efforts in the neighborhood of focus into a cohesive health agenda. More specifically, they connect and help support existing efforts, identify and help address gaps, and facilitate the conversations and activities that sustain collaboration.

Learn how social determinants of health are being addressed to build healthier lives for immigrants in St. Paul, Minnesota in this Community Close-Up from the Building Healthy Places Network.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #5: Revitalizing People and Place with a Healthy Food Hub Origin

Following the devastation of Hurricane Katrina in New Orleans, the founders of what became Broad Community Connections (BCC) began to attend community meetings, and investigate with their fellow community members how to rebuild a city in disarray. These discussions highlighted many of the problems that many central New Orleans resident had faced even before the storm, including but not limited to economic disadvantage, community disinvestment, health disparities, and lack of access to many needed goods and services. BCC was designed to revitalize Broad Street, a commercial thoroughfare running through the heart of the city and to connect several of the central city neighborhoods.

Founded in 2008, BCC set its sights on improving health and improving economic vitality in the area. Ultimately, the ReFresh project provided a high-quality grocery store to a low-income food desert and created a multi-faceted hub to improve healthy food access and local food systems, foster community connectivity, support youth development, and anchor economic development.

Read more about the ReFresh project in New Orleans on the Building Healthy Places Network blog.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #6: Under One Roof: Health Care and Social Services in the Same Place

The Chicanos Por La Causa (CPLC) is the largest community development corporation based in Arizona. CPLC is committed to building stronger, healthier communities as a lead advocate, coalition builder, and direct service provider. CPLC helps more than 200,000 people through programs in four areas–housing, economic development, education, and health and human services. CPLC recognizes that the needs of the families it serves are complex as a family rarely approaches the CDC with only one need. As a result, CPLC sought to establish cross-sector partnerships that would more effectively and holistically meet the needs of families.

Read more about CPLC on Rooflines - The Shelterforce Blog, from the National Housing Institute.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #7: Boston Children’s Hospital Community Asthma Initiative

The Community Asthma Initiative (CAI), an initiative of Boston Children’s Hospital, began addressing health disparities in Boston neighborhoods impacted by asthma in 2005. CAI provides an enhanced model of care, which includes asthma education and home visits for families with children ages 2–18 living in the Greater Boston area that were previously treated in the Emergency Department (ED) or hospitalized as a result of asthma. CAI works with partners and coalitions to address asthma health disparities by implementing changes in policies at the local and state levels. As of June 2014 there were reductions in the number of children with ED visits, hospitalizations, missed school days, and missed work days for parents.

Read more about the Community Asthma Initiative from the National Forum on Hospitals, Health Systems & Population Health.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #8: It’s Not Just About the Buildings: How Community Development Organizations are Promoting Residents’ Mental Health

Around the country, housing and community development groups are increasingly stepping up to partner with residents to improve community well-being by proactively strengthening residents’ emotional and mental health. Read more.

Example #9: Pilot Project Directs Healthcare Resources to Rural Missouri

A pilot project has been announced that plans to improve health outcomes in rural Missouri communities. It’s a collaborative effort between the Missouri Department of Social Services and the MO HealthNet Division.

The Transformation of Rural Community Health (ToRCH) project focuses on addressing social care challenges that impact residents’ ability to maintain their health and manage chronic conditions.

“(It’s) a groundbreaking initiative that empowers and encourages rural communities to collaborate to address healthcare-related social needs among their Medicaid population, with a focus on driving better health outcomes,” said Robert Knodell, Missouri Department of Social Services Director.

One key focus of the project is to tackle social determinants of health that influence overall wellbeing – safe housing, transportation, access to healthy foods, and physical activity opportunities. The U.S. Department of Health and Human Services explained that these needs influence the conditions where people are born, grow, learn, work, play, worship, and age.

“For too long, our payment systems have failed to reward hospitals for efforts to address some of the root causes of poor health,” said Kirk Mathews, MHD Chief Transformation Officer, “The ToRCH program allows hospitals to receive payment for proactively addressing issues that contribute to poor health outcomes. Under this model, hospitals are empowered to truly be in the ‘healthcare’ business in addition to the ‘sick care’ business.”

Six rural hospitals were selected last June as part of the pilot project, in Salem, Clinton, Sedalia, Rolla, Bolivar, and Richmond. The funding allows them to act as community hubs.

Click here to read the full article at the MissouriNet website.

A PowerPoint presentation summarizing the major points in the section.

• Before you start

• Generating solutions

• Evaluating solutions

• Making a decision

 

 

It would be nice, when faced with a problem, to be able to immediately have the perfect solution pop into your head, recognize it as such, and be ready to go. Unfortunately, it's not always quite that easy. Even with a group of intelligent and dedicated people, it's not always easy to think of any solution to the problems facing the coalition, much less one that is effective and feasible. Just like anything else, it takes work -- some hard thinking, evaluating, and decision-making on the part of all members.

And that's what we'll focus on in this section. In the next few pages, we'll discuss setting the stage for an idea-generating session, as well as different methods you can use to come up with the most ideas possible. Then, when you have more ideas than you know what to do with, we'll talk about how to evaluate your solutions. Finally, we'll talk about the process of decision-making, and, in particular, how to gather a consensus.

Before you start

Previously, we talked about the importance of having a comfortable, well-lighted room to meet in. When holding a session to generate solutions to a problem, it is even more important that people are relaxed and at ease both mentally and physically. Why? Two reasons are particularly important:

• To promote creativity. Helping people think in different ways is always a challenging task. You are asking people to be creative and to use a part of their brain that they may not be accustomed to activating. Being creative can be difficult for many of us. Soft lighting, comfortable chairs, and even relaxing music can help innovative ideas flow.
• To promote open discussion. Most people are comfortable talking about facts or about other people's opinions. Sharing your own ideas, however, especially ideas that you haven't had time to think through, or that you think might be unacceptable to the group, can be much more daunting. No one wants to be laughed at or thought of as stupid because of the ideas that they have suggested. So, it's important that people have a fair amount of confidence, both in themselves and in the group, before you begin the process.

There are two key ingredients in making people comfortable: putting people at ease mentally and looking after their physical comfort.

To put people at ease mentally, they need to be comfortable talking with the group. If you began the process by defining and analyzing the problem, as we discussed in Section 5, group members should already have reached a certain level of comfort with each other, and the facilitator might decide that more team-building is unnecessary. This is especially true if group members have known each other and worked together for a while.

On the other hand, if some or all group members don't know each other well and seem to be a bit uncomfortable, you might want to take a few minutes to try a team-building exercise. It doesn't need to be complex, or even serious. In fact, something a bit nonsensical, such as asking everyone in the group to describe the most disgusting thing they ever ate, or to reveal what they would prefer to be reincarnated as, might be just the thing to loosen tension and help people feel more at ease with one another.

Paying attention to physical comfort of members is just as important. If your chair is too hard, or you're shivering in your sweater, or sunlight is glaring in your eyes, it's hard to focus on anything else. And when they are uncomfortable, most people become less open to new ideas.

Envision the place where you are most at ease and where you think most clearly. Where is it? Your living room? The beach? The library? What is it about that place that makes it so welcoming? What parts of that place can be transferred to your meeting area?

You probably won't be able to have your meeting in the place you find most comfortable. (Sometimes, though, you might! Why not hold a meeting at the beach?) And, of course, the same places won't be equally comfortable for all people. A meeting in the boss's office might be fine for them, but less comfortable for members of their staff.

What you can do, however, is try to introduce aspects of the place you're most comfortable into your meeting site. You could by providing music, or chocolate chip cookies, or posters on the wall. You're limited only by the imagination and preferences of members of the group.

And even if you can't do much, you'll probably find that there are some basic comforts everyone will find important, and you will want to take care of them before the meeting. Some possibilities include:

• Soft lighting
• Comfortable chairs
• Access to restrooms
• Making sure the temperature is comfortable for everyone
• Taking breaks when the meeting gets too long
• Refreshments (at an absolute minimum, you'll want to be sure there is water available)
• Making sure the building is accessible

Generating solutions

When the group is comfortable, you will be ready to work together to think up some possible solutions. Listed below are just a few of the many different ways to do so. Your group can try the one that members prefer; all should yield some good solutions.

• Simply go around the room and ask everyone to suggest ideas. No tricks, no gimmicks, but it works.
• Send a piece of paper around the room. People can write down their ideas, which can later be discussed without anyone knowing who suggested which idea.
• Idea writing. Idea writing is especially helpful to people who like to write. It also helps many people generate and comment on ideas in a short amount of time. Large groups should be divided into small groups of five or six. Each person writes a possible solution to the problem on their own pad of paper. Then each person puts their pad on a table in the middle of the group. Next, everyone takes someone else's pad and comments on the idea. People keep doing this until everyone in the group has commented on everyone else's idea. During or after the meeting, all the ideas are discussed or summarized in a report.
• Brainstorming. Brainstorming is a tried-and-true way to come up with ideas in a group. The method is simple: The problem is stated, and the recorder stands in front of a room with some newsprint or a blackboard. People in the group say whatever ideas pop into their minds. The recorder writes down all of the comments made.

Helpful hints to keep in mind when brainstorming include:

• Watch out for assumptions; every unnecessary assumption reduces the number of potential solutions. If your group is looking for entertainment for an upcoming celebration, for example, don't assume that there isn't talent within the group. You might have an outstanding singer who is just too shy to bring their talents up unasked.
• Simply giving instructions that people can or should be creative in the brainstorming session may help raise the number and quality of solutions created.
• No idea is too outlandish. The meeting recorder writes all the ideas down. Why? An idea that seems ridiculous on first hearing might turn out to be possible and even desirable. It may also be modified by other members of the group, and end up being the perfect solution to the problem.

• Nobody should comment on how good or bad the ideas are; there should be no discussion about them at this time. Keep producing all kinds of ideas until everyone runs out of steam.
• Ideas can be "piggy-backed" or combined as people see connections during the process.
• The facilitator should keep the energy high and constantly ask for more and different ideas. This may even be done in the manner of an auctioneer, with constant chatter and a fast-paced discussion.
• If the group gets off the subject, the facilitator or recorder should gently remind them of why they are there.
• Discussion, analysis, and idea selection come later.

Variations on brainstorming:

• A period of individual brainstorming can precede the group activity. Each person generates their own ideas privately and later shares them with the group.
• If idea generating is done on a day after you defined and analyzed the problem, group members can be asked to generate solutions as "homework" between the two sessions.

Evaluating solutions

Hopefully, your work up to this point has produced many potential solutions. Now, it's time to decide which idea is best. There are many possible ways to do this. One approach includes doing the following three things for each idea:

•  Judge each idea independently. List on separate pieces of paper:
  • What you like about the idea
  • What you don't like about the idea
  • What the side effects might be
• Ask the following questions:
  • Is it practical?
  • Is it effective?
  • Is it cost effective?
  • Will it be easy to put into practice? There's a lot involved in this question. Related questions might include: Can it be done by group members, or will you need outside help? How much time will it take? Will anyone need to learn new skills?
  • Will it be accepted by everyone involved? That is, by group members, those who will be affected, and those doing (and paying for) the work? How about the community as a whole?
  • Is it consistent with other things done by the group?

Looking at the above questions, it's easy to see that the answers will often be fairly subjective. Spending $1000 on a project may not be much if you are working on a $300,000 grant, but may be quite a bit more for less well-funded groups. But going through the above questions should give you a pretty good idea of what will work for you.

• Modify the solution you are looking at if suggestions have come up that can improve it.

After looking carefully at each idea, and weighing the pros and cons of each, you're now ready to make your decision.

Making a decision

When it comes to how to make a decision, you can:

• Have someone decide, and then announce the decision to the group
• Gather input from individuals, and then have one person decide
• Gather input from the group, and then have one person decide
• Vote
• Try to build consensus among everyone at the meeting

All of these are feasible alternatives that may be chosen at different times. For the group problem-solving process, however, we strongly recommend the last option. Choosing by consensus - discussing and debating the possibilities until everyone comes to an agreement - is often the strongest of these ideas, because everyone is part of the solution. Members are much more likely to fully support a decision that they had a hand in creating.

That's not to say that it's always easy to build consensus. Sometimes, it might be; when the group has looked carefully at all of the options available to them, one might jump out as clearly being superior to the others. But, when the solution is not so evident, it can be quite a challenge to form an agreement, especially if people in your group have strong opinions one way or another.

The following tips are often helpful to keep in mind during the discussion:

• Avoid arguing blindly for your own opinions. It's easy to get so caught up in what you believe that you don't really hear what others are saying. Be sure to listen as carefully as you speak.
• Don't change your mind just to reach an agreement. If you aren't happy with a solution now, it's not likely it will please you much more when you are doing the work several months down the line.
• It's easy to think of this as an "all or none" situation: someone must win, and someone has to lose. That's not necessarily the case. If the group is locked between two different possibilities, see if a third will be more palatable for everyone involved.
• If people are becoming frustrated, or you are making no progress, then take a break. Have some coffee, work on something else for a few minutes, or adjourn for the day. Sometimes, just a short breather can give people a new perspective.

What if you can't reach an agreement?

If a thorough discussion doesn't seem to result in a decision on which everyone agrees, you have a couple of options. (Hint: The group can decide before you debate solutions what you will do if you can't agree on any of the proposals.)

• You can try one of the other decision-making possibilities mentioned above (nominate one person to make the final decision, vote, etc.).
• You can try what authors David Quinlivan-Hall and Peter Renner call the "nominal group technique." To do this, ask each participant to assign a number to every solution, with one being their favorite solution, two being their second favorite, and so on. The numbers are all added up, and the solution with the lowest value is the one chosen.
• In some cases, you might choose not to decide, or to defer the decision until the next meeting. Some ideas and opinions may change if people are allowed some time to mull them over.

Whatever you as a group decide to do, the facilitator should ask for feedback after the decision has been made. Questions might include, "Do you have any problems you would like to air?"; "Do you have any suggestions that might make this better?"; and, "Are you completely satisfied with the solution we have chosen?"

In Summary

Generating and choosing solutions within a group are two pretty tough tasks. You are asking people to think creatively, put aside their inhibitions, and come up with new ideas; then, you go a step further and ask them to use all of their political skills and negotiate a decision.

The good news is that when you've made it this far, you're almost home. In the next section of this chapter, Putting Your Solution into Practice, we'll talk about implementing all of your hard work. But, if you have been following the process, now is definitely the time to celebrate what you've already accomplished. You've come a long way!

___You understand that it's important to make people comfortable to stimulate creativity and to promote open discussion of ideas.

___You understand that you can make people comfortable both through team-building activities and by providing physical comfort.

You understand the different methods used to generate solutions:

___Simply go around the room and suggest ideas

___Send a piece of paper around the room

___Idea writing

___Brainstorming

You know how to evaluate solutions:

___You have judged each idea independently.

___You have determined whether each idea is practical, effective, cost-effective, easily put into practice, accepted by everyone involved, and consistent with other things done by the group.

___You have modified the solution where necessary.

You understand the different ways to make a decision:

___You can have one person decide, and announce the decision to the group.

___You can gather input from individuals, and then have one person decide.

___You can gather input from the group, and then decide.

___You can vote.

___You can try to build consensus among everyone at the meeting.

You know what to do if the discussion doesn't result in an agreement accepted by everyone:

___You can try one of the other decision-making possibilities listed above.

___You can try the nominal group technique.

___You can choose not to decide.

A PowerPoint presentation summarizing the major points in the section.

• Why should you plan your action?

• How do you plan your action?

• How do you implement your solution?

• Evaluating what's happened

• What can go wrong, and what to do about it

Many of us have seen this happen: we've been involved in a meeting where a problem is brought up, discussed, argued about, and finally, sometimes painfully, resolved. A solution is proposed, everyone agrees that it is acceptable - and then it gets lost down the road of forgetfulness or apathy, or wherever it is that good ideas often end up.

In previous sections in this chapter, we have looked carefully at each part of the problem-solving process. Now, in this last section of the chapter, it's time to pull all of this together and complete the work you may have started some time ago. In this section, we'll discuss how to take your solution from the "great idea" stage through planning the details, implementing what you have done, and figuring out if the process was effective. We'll conclude with some possible solutions to glitches that might come up while you are working.

Why should you plan your action?

So why is it so important to plan the details of your solution? Simply put, careful planning allows you to more effectively solve the problem with which you are grappling by giving you the framework on which the solution will hang.

• Planning lets you be sure you have taken care of all of the details. After all of the work you have done, it can be a hassle, to say the very least, if a crucial detail has been forgotten --if nobody picked up a key to the dance hall you rented as part of a fundraiser, or you forget to pack dress shoes for your meeting in the Capitol with the governor.
• Planning helps you save time, energy, and resources in the long run. We can't say it too many times -- planning pays.

Some solutions don't require a lot of planning; you decide, then you act, and then you're done. That's more likely for an individual facing a problem, however, than it is for a group. An individual might decide, for example, that they need to improve their relationship with their supervisor, so they schedule an appointment to talk about their professional relationship. At the meeting, the two might discuss their individual views of how the relationship could improve, and agree to meet weekly to discuss the state of their project. In such a case, a written action plan would hardly be necessary.

With a group, however, the same problem is likely to be more complex. Consider the following situation:

Instead of two individuals, 20 people in an office are having problems working together. So they decide to do two things. They will hold a retreat to talk about their differences (there is too much for too many people to say, and too many hard feelings, to be covered during the meeting), and they will schedule a weekly meeting to keep communication clear and complete. Great, but where will the retreat take place? Who will lead it? Where will they get the money to pay for it?

Although the basic problem, communication, is the same, the greater number of people involved makes a written action plan much more of a necessity.

How do you plan your action?

So how do you go about planning your solution? The good news is that you've already had a lot of practice. By this point, even if your group started out as strangers, you've had time to get to know each other, become comfortable, and get familiar with the process in general. This level of comfort is going to help a lot to make the process proceed smoothly.

Planning your action simply involves asking the right questions, and writing down the answers in a logical form that everyone will read and understand.

First, however, you will want to brainstorm with the group to determine everything that needs to be done. Break down your solution into individual, doable parts, or "action steps."

When you have your own complete list of individual action steps in front of you, put every one of them through the same series of questions. Decide:

• How much, or to what extent, will the action occur? For example, if you are going to hang posters to advertise a program, how many will you need to be effective?
• Who will do the work? Will it be done by people at the meeting, or will you need to recruit others? How will that occur?
• When will the step take place? How soon? A deadline for action can help participants focus and will almost certainly mobilize them more effectively than an "open-ended " due date.
• What resources (money, time, et cetera) do you need? Where will you get them?
• What will you do if something goes wrong? What's the backup plan?
• Which step needs to happen first? Is there an order in which these actions should occur? Should things happen simultaneously? As soon as possible?

It's a good idea to write all of this down on a chart that can later be shared with the group.

If the problem you are working on is particularly large or complex, the group might decide to go through a longer action planning process, similar to what you might do to write a coalition's strategic plan.

How do you implement your solution?

Now, with your action steps in front of you, it's time to start the grunt work of implementing your plan! These are the last steps to take before you go to work:

• Make sure, as you have been doing throughout the problem-solving process, that everyone is clear and in agreement about what's been decided. The facilitator might go down the chart you have written and say, "Steve and Kate, you're going to design some possible logos and show them to us at the next meeting, right?" Ask people for verbal agreement to make sure you are all in agreement about the next steps.

At this point, the facilitator should say what they plan to do as well. Their follow up plan might be to send notes out to various group members reminding them when it is time for them to do the task they agreed to do.

• The facilitator should ask for questions. Did anything come up that anyone's not clear about? Are there any new issues? Any areas of confusion?
• Does everyone know how to contact other members if they need assistance or have questions about their assignments? Leaders in the group might want to make their phone numbers available, if they are not already.
• Set another meeting date. This is an essential part of follow through. The next meeting can serve as an update, if the problem is not entirely taken care of. It can also serve as a time for celebration -- look at all of the work you've done already!

Evaluating what's happened

When you finish a meeting, sweep away the crumbs, and go home, an experienced facilitator will usually have some sense of how the meeting went. Was it a good meeting? Were people fully involved? Certainly, one way to measure this is by what has been accomplished. Did you define the problem? Come up with a workable solution?

It's also important, however, to understand how meeting participants feel when they leave the meeting. Were they happy with the process? Did they have a chance to explain their ideas? If members leave a meeting disgruntled, it's highly likely that they won't be coming back to future meetings, and they may not follow up on agreed upon tasks.

The facilitator can reduce the likelihood of this by asking group members to fill out a written evaluation before they leave. It doesn't have to be long, or complex; a few simply questions might do the trick. It also helps if the response sheets are anonymous; people are more likely to give their true opinions of what has happened, particularly if that opinion is negative or critical. The facilitator can follow up on the critique with a letter mailed out to all participants.

Of course, there's another kind of evaluation to be done: you can evaluate how well your solution is working to solve the problem. Depending on the problem, this may or may not be necessary. For example, if you are working on office communication, a few weeks of meetings should tell you whether or not communication has improved without any scientific study. If you are working on solving a larger problem, however, such as adolescent pregnancy, you will probably want to determine if your group's actions are truly effective. (For example, has the adolescent pregnancy rate has decreased in your community?).

What can go wrong, and what to do about it

Into every life, some rain must fall -- and for community organizers, the deluge often happens on the day of the community picnic.

Even if the facilitator has led an enthusiastic, dedicated group flawlessly through the problem-solving process, glitches still occur when it comes to putting the plans into practice. Here are some of the most common ones, and what you can do if they occur.

In Summary

Solving problems is one of the most challenging aspects of working effectively with a group. It's also one of the most rewarding. Operating together, groups can overcome obstacles individuals have found insurmountable. As Margaret Mead reminded us, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has."

You understand why you should plan your action:

___To provide the framework on which your solution will hang.

___To be sure you have taken care of all the details.

___To save time, energy, and resources.

You have planned your action:

___You have broken down your solution into individual action steps.

___You have decided to what extent each action step will occur.

___You have decided who will do the work.

___You have decided when each action step will take place.

___You have decided what resources you will need and where you will get them.

___You have decided what you will do if something goes wrong.

___You know which steps need to happen first.

You have implemented your solution:

___You have made sure everyone is clear and in agreement about the process.

___The facilitator has asked for new questions.

___Everyone knows how to contact each other.

___You have set another meeting date.

You have evaluated what happened:

___You have evaluated the success of the meeting.

___You have evaluated the success of the solution.

You know what to do if something goes wrong:

___You know what to do if the wrong person volunteers for the job.

___You know what to do if no one volunteers for the job.

___You know what to do if enthusiasm fails.

___You know what to do if the solution is taking too much time.

___You know what to do if the solution arouses community opposition.

___You know what to do if a seemingly new and better opportunity arises.

___You know what to do if the solution doesn't seem to be working.

Tool #1: Action planning sheet

Use the following table to list each of your action steps in the first row, and answer the following questions for each.

	Action Step 1	Action Step 2:	Action Step 3:
How much, or to what extent, will this action occur?
Who will do it?
When will it take place?
What resources do we need? Where will we get them?
What is the backup plan?
In what order will these steps occur? Does it matter?

Tool #2: Feedback form

At the end of the meeting, the facilitator and recorder can pass out the following sheets to be filled in anonymously by meeting participants.

Participant Feedback Form

Date of meeting:

Overall, how useful did you find the meeting?

What did you like best about the meeting?

What did you like least about the meeting?

Was the proper amount of time spent on each subject?

If not, which subjects took too long?

Which weren't given enough time?

What should be different about future meetings?

Additional comments:

We appreciate your help and feedback at and about today's meeting. The facilitator will address concerns brought up on these feedback sheets and send a letter to all participants in the next two weeks.

A PowerPoint presentation summarizing the major points in the section.