A critical exploration of voluntary sector social policy advocacy with marginalized communities using a population health lens and social justice.

Abstract

There appears to be little data on the social policy advocacy work of the voluntary social service sector, also known as community-based organizations (CBOs), in Canada and their role in helping to create healthier communities. Research on this topic is timely in light of the following: shifting expectations of social service CBOs over the past few decades; questions about CBO-government relations; a growing importance of measuring the outcomes/impacts of the social service CBO sector; a need to alter free market ideology and introduce the counterweight of social justice principles to reduce health inequities; a growing interest in holistic policy development; growing awareness that social policies have health implications; and the Canadian welfare state is under transformation. My purpose was twofold: to explore the evolving nature of policy advocacy work undertaken by social service CBOs in Saskatchewan using a population health lens, and to examine the perceived outcomes/impacts of these processes on marginalized groups of people, CBOs, governments and communities using this lens. Using a critical inquiry methodology, qualitative data were collected through a multi-method approach. A case study design was adopted. An examination of the case study context comprised data collected through telephone interviews with 39 voluntary social service agencies from 18 communities throughout Saskatchewan, through government annual reports spanning 60 years and through observations of the political context. The case study included an examination of documents from a policy advocacy coalition, personal interviews with 17 ii individuals involved with the coalition, and observations of the coalition. Follow-up focus groups were conducted with these 17 interviewees. There were a number of findings. There has been growth in the number and diversity of social service CBOs over the past 30 years, government funding cuts and Canada Revenue Agency rules negatively affected CBOs, CBOs perceive policy advocacy is interconnected with other advocacy types, a sense of fear and vulnerability affect some advocacy participants, and of the 39 social service CBOs, 35 said they believed they contribute to people’s health/well-being through their daily work with the social determinants of health (e.g., poverty). A number of different types of advocacy processes were found to exist and some included marginalized people while others did not; CBOs’ choices about including people appeared to depend on a number of conditions (e.g., perception of participation barriers, sense of vulnerability). Interviewees described a variety of perceived outcomes/impacts of advocacy processes (e.g., learning, behaviour change, social connectedness, emotional reactions) in different spheres. The advocacy processes and their impacts were multiple, fluid and not totally predictable. A conceptualization of policy advocacy processes and population health was formulated as were implications and suggested actions for moving toward the creation of healthier communities through enhanced engagement in social policy making.