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. 2026 Feb 21.
doi: 10.1111/1468-0009.70068. Online ahead of print.

How Health Departments Can Use Inside-Outside Strategies to Build Partnerships With Community Power-Building Organizations to Achieve Structural Change

Anthony B Iton  1   2 , Pritpal S Tamber  3 , Gina Massuda Barnett  4 , Rachel Rubin  5 , Adam Kader  6 , Christina R Welter  7   8 , Elizabeth Fisher  8 , Jennifer Ybarra  9 , Pamela Agustin-Anguiano  10 , Greg Bonett  11 , Jeanne Ayers  12 , Meredith Minkler  1
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How Health Departments Can Use Inside-Outside Strategies to Build Partnerships With Community Power-Building Organizations to Achieve Structural Change

Anthony B Iton et al. Milbank Q. .

Abstract

Policy Points Changing structures, such as laws, policies, regulations, practices, and norms, in pursuit of health and racial equity is hard for any organization to do alone, including health departments. Health departments can advance health and racial equity by partnering with movements for fairer and more just social arrangements that often emanate from civil society through the work of community power-building organizations. This requires health departments to adopt an inside-outside strategy, which consists of practices needed internally to effectively participate in movements and practices needed externally to become allied in them.

Context: Disparities in health often arise due to unfair or unjust social arrangements making them inequities. These social arrangements are codified through structures-laws, policies, regulations, practices, and norms. Changing structures is generally considered the work of professional entities, such as health departments. However, inequities persist, which suggests new, more focused approaches are needed.

Methods: Health departments are not alone in pursuing fairer and more just social arrangements. There are also movements for social justice, which emanate from community power-building organizations (CPBOs). CPBOs benefit from being in relationship with organizations that know how to change structures, such as health departments.

Findings: For health departments to be in relationship with CBPOs and movements requires them to adopt an inside-outside strategy. Inside refers to the work needed to be done internally to effectively participate in movements. Outside refers to the work needed to be done externally to become allied in them. We describe two such strategies, one from California and one from Illinois.

Conclusions: Our examples illustrate how public health's careful participation in movements can advance health equity. Health departments need to think of themselves as part of an ecosystem of organizations pursuing fairer and more just social arrangements.

Keywords: community benefits; earned sick leave; health equity; minimum wage; public health; social movements.

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