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Community Resilience: A Dynamic Model for Public Health Open Access

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In communities across the country, parents and families face the challenge of achieving or maintaining good health in the face of daunting adversity. Adversities include the crippling effects of poverty, limited economic opportunity, chronic violence, racism and discrimination, and other community-based stressors. Adverse community environments such as these only exacerbate adverse childhood experiences (ACEs) that can occur within the context of a household or family. When combined, adverse childhood experiences and adverse community environments – the ‘pair of ACEs’ - result in complex trauma that is felt at the individual, family, and population level.The Community Resilience model and analysis developed in this dissertation will connect wellness to a local context focusing on place-based outcomes and systems-driven community and population outcomes. The model was designed to be used as a Public Health 3.0 strategy for the Chief Health Strategist working across sectors to drive initiatives that address determinants of health. Using this model to assess community resilience, local health departments can convene multiple sectors at the local, state and federal level to manage and deliver assets and resources that contribute to a community’s economic vitality, health and wellbeing. The inequitable distribution of community assets and resources that could provide a foundation for resilience are at the heart of many of the nation’s health disparities.We are not aware of any model that combines community resilience science and the factors that support resilience at multiple levels. Such a model is essential to develop measures and design initiatives aimed at addressing social determinants and adverse childhood experiences in the context of adverse community environments to improve health and wellbeing. This model is designed to help local public health leaders and practitioners apply systems thinking prospectively to public health planning around resilience. Addressing and preventing the growth of further disparities and generational trauma calls for a redesign of our public systems, policies and practices to achieve equity and resilience. Collaborating across sectors, public health strategists can harness data from multiple systems to provide a powerful and insightful understanding of the dynamics at play in producing outcomes associated with population health and equity.Adverse childhood experiences in the context of adverse community environments continuously assault the developing minds of children and negatively impact health across the lifespan. These negative inputs include higher risk for mental health problems, early initiation of drug and substance abuse, school dropout, juvenile delinquency, risky sexual behavior and teen pregnancy. This dissertation will present a model that connects adverse childhood experiences to policy and systems driven inequities. Many of these polices are driven by and reinforce institutional racism. The resulting inequities include lack of access to economic mobility and other supports and buffers such as secure, safe and affordable housing and education that may foster resilience. To begin our analysis of community resilience we focus on housing, public education and criminal justice, and the community and population outcomes that will be most directly influenced by the behaviors of each system and how they interact with one another. These factors are concordant with a body of public health literature that connects social determinants of health, such as employment, housing stability, education and criminality to health, wellbeing, and resilience to equity.

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