Strengths v. Deficit Approaches to Community Health

When conducting research on promoting positive outcomes at the community-level, there are generally two approaches: deficit-based and strengths-based. I alluded to this at the beginning of the Historical Trauma: Part 1 post last week. Deficit-based research examines the existing issues within a community and attempts to overcome them. Strengths-based research identifies and promotes the strengths within the community. These are not necessarily conflicting beliefs, as they each have an appropriate time and place and can work together to simultaneously prevent community-level concerns (strengths-based) and overcome existing concerns (deficit-based). However, most researchers tend to primarily operate from one of these perspectives in an effort to focus on one strategy and create a cohesive narrative. While these principles can be applied to any number of fields (health, linguistics, education, etc.), for the rest of this post, I will focus on community health research as that is a primary goal of the Nipwaayoni Acquisition and Assessment Team (NAAT).

Tribal youth watching an adult mix food in a bowl.
Tribal youth participating in 2019 Myaamia Food Workshop lead by Potawatomi Chief Loretta Barrett Oden.
Photo by Karen Baldwin.

Deficit-Based Perspective

Research within Indian Country is currently and historically rooted in a deficit-based perspective. This perspective focuses on the problems of an individual or community and attempts to identify specific solutions for that problem.[1] For example, when we go to the doctor’s office and have a broken leg, we get a cast. The implication here is that something is wrong and there is a specific solution that the individual or community needs in order to overcome that problem. This is particularly helpful for acute and straightforward problems like a broken leg. However, when applied to more abstract and complex community-level concerns (like community health), this tends to not work as well.

Deficit models create a cycle of negative experiences, behaviors, and possibly even further leads to the deficits themselves (see figure below). Within this cycle, once the deficit and needs of the community are identified, specific prescribed interventions are created to address that particular problem. Because the problems that communities experience tend to be complex in nature and many factors contribute to those problems, these interventions do not holistically address the problem and can even lead to negative experiences and behaviors by individuals or the community. For example, when we talk about health within a community, we have to consider differential access to health-based resources (access to healthy food sources, doctors, insurance, etc.). Because individuals within a community all differ on their access to these resources, there is no one-size-fits-all approach that will work for all people in that community and definitely not across communities. This furthers the cycle and keeps it going for a long time.[2]

Diagram of the deficit-based approach
Visual adapted from W. McCaskey, The Strengths Approach (Victoria: St. Luke’s Innovative Resources, 2008), as cited in Wayne Hammond and Rob Zimmerman, “A Strengths-Based Perspective,” A Report for Resiliency Initiatives, 1-18.

This deficit cycle and general reliance on a deficit-based perspective can lead to several issues within communities.

Issue #1: Help Comes Too Late

One of the primary issues with deficit-based interventions is that they are offered too late. The programs that result from deficit-based research wait until a problem has already developed, often when the problems have become deep-rooted or more severe than they otherwise would have been with earlier intervention and/or prevention. Waiting to offer support to overcome some sort of well-developed problem means that the individual has likely tapped into all the personal resources they know to use on their own and they now need someone else to help them. 

Issue #2: Fosters Dependency

Deficit-based interventions lead to a dependency on outside support for healing rather than allowing for self-sustaining programs over time. When an individual or community feels it is out of options, they turn to external resources for support. If that type of support is then perceived as being something they are not capable of on their own, they require those outside resources for extended periods of time and may become reliant upon that.

Issue #3: Not Sustainable

We have also noticed that a majority of funding (i.e., grants) for promoting health within Indigenous communities are available for projects that operate from this deficit-based perspective. Unfortunately, these have been shown to not be successful over time and tribal communities are not necessarily benefitting from the resulting interventions. Because of this bias in funding, the evidence provided to policy makers who make decisions about Indigenous communities promotes decisions out of this deficit model. Then, the only way we are able to tackle health inequalities is rooted in a model that (a) doesn’t work, (b) fosters dependency on external support, and (c) keeps native people focused on these perceived deficits. 

Issue #4: Emotional Fatigue

Finally, on a community-level, the perpetual focus on the problems of the community can be adopted as part of their own narrative. The community sees themselves through the lens of being in “poor health” and defined by their shortcomings. As a result, the rest of the world perceives this as truth (after all, they view themselves this way!) and this narrative becomes ubiquitous. Once that happens, it is incredibly difficult to be motivated to make positive changes. Additionally, the main tactic for motivating the community to overcome the issues is fear. While fear is initially a powerful motivator, when sustained for long periods of time it tends to lead to other issues including a sense of powerlessness, giving up on the problem, and possibly even mental health concerns. 

Strengths-Based Perspective 

A strengths-based perspective, on the other hand, focuses on what assets an individual or community has and seeks to maximize them in order to promote health.[3] It assumes that all individuals have existing strengths and the capacity to solve their own problems. It does not ignore the very real and sometimes very large problems that exist within people’s lives, but assumes that there are many resources that the individual has to be able to overcome any of the obstacles that they may face. 

In the strengths-based cycle, the identification of strengths enables the individual or community to have the ability to discover new strengths on an ongoing basis (see figure below). This leads to a sense of empowerment and ability to make meaningful changes on their own. It tends to foster a positive self-identity and resilient thought processes that help individuals to prevent future concerns and to independently problem-solve when facing some sort of struggle.[4]

Diagram of the strengths-based approach
Visual adapted from W. McCaskey, The Strengths Approach (Victoria: St. Luke’s Innovative Resources, 2008), as cited in Wayne Hammond and Rob Zimmerman, “A Strengths-Based Perspective,” A Report for Resiliency Initiatives, 1-18.

Benefit #1: Externalizes the Problem

Strengths-based perspectives do not view the individual or community as the source of the problem, but rather suggest that the individual or community is being impacted by a problem. This externalization of the problem removes the blame, responsibility, and shaming that tends to only hold people back from being able to express their resiliency. It allows us to examine all the cultural, sociopolitical, systemic, structural, and economic factors that have an impact on community health and appreciate the true complexity of the problem.[5]

Benefit #2: Empowerment

Because this approach focuses on the strengths of a community rather than weaknesses, it gives communities more confidence in the face of challenges. Communities feel empowered to begin with the knowledge systems that have enabled them to be resilient throughout time and build from there. Digging deeper into these inner strengths allows individuals and communities to also see other strengths that they didn’t previously view as strengths.[6]

Benefit #3: Capacity Building

Within a strengths-based approach, there is a lot of room for growth. Building the skills, tools, and thought processes that help communities to be successful in their journeys of living well is a lifelong process that is never achieved. With this growth mindset, communities can continue to innovate, improve, and build their own structures of support over time.[7]

Influence in NAAT work

From the inception of NAAT in 2012, we have always taken a strengths-based approach to our assessment work. Practically, this means that rather than collecting data on rates of diabetes, substance abuse, domestic violence, and other problems that may exist within our community, we focus on the many strengths that we do have and identify how those strengths impact the community. In our eyes, these strengths include (but are not limited to) our language education and cultural programming, long-standing knowledge and value systems, the people within the community itself, and tribal leadership. By focusing our efforts on promoting these many strengths, we have seen continual growth within the community. Literal growth with ever-increasing enrollment numbers, but also growth in identity formation, sense of community and connectedness, academic attainment, engagement, knowledge, and much more.

Myaamia citizens watching a man sifting corn.
Myaamia citizens learning how to make hominy at a workshop in 2021.
Photo by Karen Baldwin.

In conclusion, health-based research for Native communities is a complex topic that is best served using a strengths-based approach. By examining the many assets, strengths, and resiliencies of tribal communities, we are able to empower them on their journeys toward living well. For Myaamiaki, specifically, this approach has assisted us in the continual growth of our language and cultural programming over time, ultimately resulting in positive outcomes for our community.

If you would like to read more about NAAT, please see the following publications/web pages.

Introducing the Nipwaayoni Acquisition and Assessment Team (NAAT)

NAAT on the Myaamia Center Website


Bibliography

[1] The University of Memphis Engaged Scholar, “Comparison Between Asset and Deficit Based Approaches,” The University of Memphis Engaged Scholar, The University of Memphis, Accessed August 2nd, 2021, https://www.memphis.edu/ess/module4/page3.php.

[2] Hammond, Wayne, and Rob Zimmerman. “A strengths-based perspective.” A report for resiliency initiatives (2012): 1-18.

[3] ibid.

[4] ibid.

[5] ibid.

[6] Hammond, Wayne. “Principles of strength-based practice.” Resiliency initiatives 12, no. 2 (2010): 1-7.

[7] ibid.

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