Working towards health equity necessitates centering people’s lived experiences and recognizing them as agents of change in shaping the conditions that impact their well-being. Across health and its social determinants like housing, employment, and neighborhood safety, communities understand the barriers they face and often lead the way in developing solutions rooted in cultural practices, lived experience, and informal networks. Yet too often, health policies and programs are developed from the top down, without meaningful incorporation of community members’ expertise. Valuing community experience as essential knowledge is key to building more equitable systems. 

The Spectrum of Community-Centered Practice  

As community power grows along each part of this spectrum, deeper trust and greater accountability are built, both within communities and between institutions and those they aim to serve. While community-led approaches represent a powerful vision, many institutions are still on the path to being ready to operate this way—a process that takes time, intentional investment, and sustained effort to shift organizational culture, decision-making norms, and relationships with community partners. In practice, organizations are at different points on the continuum due to their history, capacity, and experience with power-sharing. What matters most is a commitment to adapting approaches in ways that are increasingly community-led and equity-centered. This work is not about replacing one kind of expertise with another, but rather honoring the full range of knowledge that people bring, including lived, cultural, professional, and academic experience. Effective systems elevate the leadership of those closest to the challenges at hand and are designed around structures where people with diverse forms of expertise lead together and shape decisions collaboratively.  

Community Engagement

At one end of the spectrum, community engagement can be a powerful tool for shifting outcomes and building trust. Soliciting community input can uncover health disparities and ensure programs and solutions are more tailored and inclusive. Many communities—especially Black, Indigenous, and other people of color—have experienced long histories of harm from health systems. Engagement helps rebuild trust by showing up, listening with humility, and making changes based on their input. However, when done poorly, it risks reinforcing inequities and undermining future collaboration.  

At Dalberg, we believe community engagement must go beyond platitudes. Through our work with both grassroots organizations and large-scale initiatives, we’ve learned that meaningful engagement requires intention, adaptability, and humility. As part of the $600M statewide California Jobs First initiative, we supported the Kern Coalition in designing and facilitating in-person convenings as part of a process that engaged over 800 residents across Kern County. The experience highlighted the importance of building accessibility into engagement design—through real-time translation and community-based outreach that enabled participation from underrepresented groups. With The Bread Project, a nonprofit focused on workforce development for individuals facing barriers to employment, we conducted focus groups with training participants to understand their experience in the program and assess the program’s impact. These conversations reinforced the value of culturally responsive, respectful formats that are grounded in participants’ lived experiences.  

This work has been complex and at times difficult. We didn’t always get everything right, and we’re still learning. But through these efforts, we have begun to see what meaningful engagement can look like when it’s intentional, reciprocal, and grounded in trust—and these lessons have shaped a set of practices that we continue to apply and refine in our work: 

• Design engagement to be accessible, culturally responsive, and adaptive: True engagement is responsive, not scripted. Use formats that accommodate a range of experiences—such as accessible language, live translation, and flexible meeting times—and stay attuned during convenings to adjust pacing or facilitation in real time. 

• Ensure reciprocity in engagement: Treat participation as a two-way exchange by sharing findings, demonstrating how input shaped decisions, avoiding extractive practices, and providing fair compensation for people’s time and expertise. 

• Watch for biases when inviting participants: Consciously select representative participants by working with a variety of organizations to avoid echo chambers and understand who isn’t in the room and why. 

• Acknowledge and navigate power dynamics: Be transparent about institutional power dynamics and design to mitigate them, while also addressing power imbalances within communities by elevating less-heard voices, not just the most vocal. 

• Partner with trusted community-based organizations (CBOs) as enabling infrastructure:  CBOs provide not only trusted relationships but also the logistical and financial infrastructure to support meaningful, sustained, and compensated engagement with communities. Investing in CBOs with flexible funding helps build long-term capacity for inclusive outreach, organizing, and power-sharing. 

As organizations deepen their community engagement practice, they begin building the trust, relationships, and organizational habits that enable more formal power-sharing. This can lay the groundwork for community governance by fostering readiness, identifying internal and community champions, and establishing mechanisms for shared decision-making. 

Community Co-Governance  

It is important to value lived experience as a core qualification for leadership. As one roundtable participant put it: “What if we thought of lived experience in the same way we think about degrees or licenses?”[1] Shared governance models offers a way to formalize that expertise by ensuring that people with lived experience, who are often underrepresented in decision-making structures, hold formal authority rather than being engaged solely as advisors or informants. But introducing community governance roles without clear, representative, and well-supported structures can lead to symbolic participation that replicates the very inequities it aims to address. Co-governance must be designed to share power meaningfully, not just offer a seat at the table. The most effective models enable people with lived and learned experience to exercise joint decision-making power, grounded in mutual respect and a shared commitment to equity. 

Implementing community co-governance can be challenging in practice, and we have learned important lessons about what it takes to design inclusive and effective structures. In Richmond, California, we worked with the City to develop a governance model for the Rapid Response Fund that reflected community priorities. The final design included two complementary governance bodies—one of institutional stakeholders and one of community members with lived expertise. This experience taught us how difficult—and necessary—it is to balance inclusivity with operational clarity. In Imperial and San Diego Counties, we supported the Southern Border Coalition as it revised its Regional Plan and established multiple levels of community-led decision-making. This work helped us understand the importance of aligning governance bodies around a clear purpose, while ensuring that all members are equipped to contribute meaningfully.  

These and other experiences continue to shape how we think about co-governance: as a design challenge that demands shared purpose, honest reflection, and a commitment to equity. We have developed a set of practices based on what we’ve learned so far: 

• Design co-governance structures with function in mind: Clarify what decisions community members will shape, define responsibilities, and choose a governance model—such as combined or dual boards—based on the purpose and context.  

• Account for power differences: When there is a significant distance between institutional and community leadership, it is even more important to design participatory processes that enable meaningful and equitable engagement from all participants. 

• Offer training and build shared norms: Community leaders may bring different forms of experience than those typically found in nonprofit governance. Provide orientation and capacity-building that clarifies expectations, fosters mutual respect, and supports co-leadership across lived and professional expertise. 

• Practice accountability and reflection: Regularly assess whether the governance body is meeting its purpose, elevating all voices, and actively addressing power dynamics. 

Community governance equips organizations to take steps toward a community-first approach by strengthening power-sharing, institutional accountability, and inclusive leadership. Making this shift means aligning structures with community-defined priorities, investing in long-term partnerships, and creating space for community members to lead on vision and resource direction. 

Community Leadership

At the far end of the community-centered spectrum is a fully community-led approach—where communities don’t just contribute to decisions or share governance responsibilities, but fully set the agenda. These approaches are led by people with lived experience and are grounded in the realities, priorities, and aspirations of the community itself. Rather than starting with institutional mandates or predefined goals, community-first models ask: What does the community want to solve? How does it want to solve it? Then, community members drive where resources go, acting as decision makers throughout. For example, Dalberg’s partners at One Neighborhood Builders (ONE|NB), a nonprofit community developer in Rhode Island, led the development of the Central Providence Roadmap—a collective impact plan created by residents, community organizations, and civic leaders to advance health and economic equity in the neighborhood. The Roadmap is a collective impact plan developed by residents, community organizations, and civic leaders to realize a vision of greater health and economic equality together.  

Community-led models can yield deep ownership and accountability, particularly in settings where historical marginalization has eroded trust in systems. They also ensure that the definition of success is shaped by those most impacted by the problems organizations are working to address. While these approaches can be challenging to implement, the difficulty often lies in institutional habits, funding norms, and decision-making structures that are not yet designed to support community-led vision and control. Sustaining and scaling these models requires internal culture shifts, trust-based partnerships, and long-term investment in the capacity of communities to lead. Community-led is not a static endpoint, but an ongoing practice of realigning systems and resources around community-defined priorities and power. 

Putting the Spectrum into Practice

As organizations move toward more community-centered models, it’s important to acknowledge the real tensions inherent in this work—like balancing speed with inclusion, or adapting institutional processes to support genuine power-sharing. These are not reasons to delay action, but signals that intentional design and reflection are needed. Navigating these tensions with care—and in partnership with communities—can build the foundation for more just, effective, and enduring change. 

Embracing that complexity is part of the work. The spectrum of community-centered practice offers a clear call to action for those advancing health equity: to locate where they are today, and consider what it would take to move one step closer to shared power? Whether that means testing new governance models or deepening co-creation practices, each shift can build trust and deliver more lasting impact. We are working toward a future where centering community voice is not exceptional—it is foundational. 

[1] Participant at roundtable facilitated by Dalberg and FUTURES Without Violence on community power.