HealthConnect Fellows: Engaging authentically in systems change

Dec 7, 2022
healthconnect fellow presentation
Keshia Fields speaks to a student group with Andrea Dencklau and Rick Kozin.

Policies and systems shape our environments and influence the choices we make. Mid-Iowa Health Foundation has invested in people leading system-change efforts through the HealthConnect Fellowship so that central Iowans have the conditions to support good health and well-being.

Rick Kozin, Lead Mentor with the Fellowship, kicked off a conversation with college students at Iowa Campus Compact’s Civic Action Academy. Kozin was joined by Fellows Keshia Fields, Diversity, Inclusion, and Organizational Development Specialist with Polk County, and Andrea Dencklau, Research and Systems Innovation Director with Iowa ACEs 360, who shared their perspectives and experiences on how to engage in system-change work.

Here are some of the insights they offered during the hour-long conversation:

1. Be aware of the role you play as you engage in efforts.  

Using the Black Lives Matter movement as an example, Fields described differing levels of engagement.  Fields shared how participating is putting a post on social media. Involvement could be asking to receive the newsletter and joining an activity. Engagement is asking the questions: “What can I do in my community that will help this movement? Who do I align with?” She described engagement as continuous involvement in a deeper way.

Dencklau offered that if you are not directly impacted by the issue, such as being a White person getting involved in the Black Lives Matter movement, engagement entails building relationships and understanding your role. Rather than speaking at an event, your role may be to support, such as donating money or bringing supplies. She said, “We always have to think about, ‘Is it about me? Or is it about greater justice?’”

Dencklau’s journey to system-change work began with her first job out of college, teaching parenting skills and supporting women at a homeless shelter. In this role, she heard about the challenges women were experiencing and how they didn’t have the freedom to make choices they needed to make for themselves.

“That was my first real look at child welfare and how unjust of a system it was,” she said, “and how important it was for me to step out of whatever I thought was going to be helpful and to be helpful in the way that they needed me to be, which was systems change.”

2. Engage in decision-making at the local level.

While decisions are made at all levels of government, Fields shared that there’s a unique opportunity to influence policies and systems at a local level. Her own journey to create change within government began by applying for a job on a whim with the Johnson County Public Health Department. The position led her to realize “how much local government affects the people who live here,” she said. As an African American woman, she especially brings a perspective decisionmakers are not used to hearing.

“My voice can be heard here, because you haven't heard my voice before in these spaces,” she said.

Now in her position at Polk County, she is aware of her identity and how many others who are marginalized are not included in conversations. At the tables she sits at, she asks: “Who else are we missing?” She asks herself: “Who can I bring with me?” Her HealthConnect Fellowship is about supporting individuals who are marginalized in moving into leadership roles within County government, so they have more power to shape decisions.

3. Change must come from those most impacted.

Changing systems means having proximity – Who is most impacted by the policies and practices created within systems? In the child welfare system, for example, Black and Brown families are disproportionately harmed by a system that was designed to separate families. “My role in systems change work is to really think about: Who are we asking? Who are we partnering with to create better policies and practices?” Dencklau said. “Otherwise, we’re doing the same things over and over again and it’s unjust.”

Dencklau also views her work as helping better prepare organizations to have those most impacted involved in decision-making, which includes her own self-refection. “How do I help in whatever power capacity I might have to open those spaces up and challenge bias when I see it, disrupt the systems as much as I can by asking really challenging questions of my peers and my colleagues, but most importantly, myself,” she said. “What biases do I have? There’s no way I’ve learned everything.”

Kozin added: “When we want to try to identify what people care about, their hopes and dreams, their fears, and deepest concerns, we really have two choices: We can guess, or we can ask. And for reasons that still bewilder me, we guess a lot. And we guess wrong a lot. To compound that, we blame folks because they're not acting consistently with our guess.”

4. Thoughtfully hold decisionmakers accountable.

Because of the Fellowship, Fields is more aware of the people connected to decisionmakers who can influence their thinking and how decisionmakers receive information. Sometimes it’s planting seeds with those in their networks, so they hear the same message from different people in different settings until it sinks in.

Dencklau reminded participants that people making decisions are human and flawed, but often desire to do better. Building relationships is important to be able to push.

“One of the most important things when you challenge a system leader is offering them some kind of hope and possibility that it can be different,” she said, “because a lot of times, they're also harmed by the systems within which they're working. We have to offer some sort of possibility that we don't have to keep doing this, we can do something different.”

5. Progress is measured in small wins.

Often as advocates, we aim for the big changes we want to see happen. But with limited time and resources, these wins can be nearly impossible to achieve and not sustainable. “Small wins really matter,” said Fields. “Those small changes are like ripple effects.”

Kozin added that there is no way of knowing how close you are to making change until you engage in a conversation with a decisionmaker. Most of the time, they aren’t acting as you’d like for three reasons: They aren’t aware there’s a problem, they are aware there is a problem but they don’t know what to do about it, or they know there is a problem and what they need to do and they aren’t willing to do it. Knowing where a decisionmaker is on their readiness to create change can help you know what to do next to leverage your power.

6. Stay focused on your why.  

Staying motivated to create systems change can be difficult when the work is challenging and takes time. Dencklau said she stays motivated by recognizing when to take things personally and when feedback or a reaction is a reflection on what the other person is experiencing. Sustaining the work also requires staying focused on why you do it and finding people you can talk to who understand what you’re trying to do.

For Kozin, the motivation to engage in system change is anger from seeing the same problems and injustices continue to occur.

Fields stays motivated by acknowledging the negative when it’s helpful to her, but otherwise ignoring it.

“If I'm constantly focused on that negativity, then anything's going to ruin me,” she said. “I think about the positives. I think about those small wins. I think about people who may have not come to me before that are starting to come to me. And I'm like, ‘Okay, change is happening.’”

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