Abstract
Population health strategies tend to focus on individuals’ behaviors, genes, or health care access, yet it is well established that socioecological conditions are fundamental to health and strongly influenced by policy. In the US, health and other policies continue to be shaped by the country’s unique legacy of racial and economic segregation. Policy reform must be at the center of population health. This requires communities to have power. We present theoretical and empirical research linking community power and health, and we share an example of our work in which communities organized to hold policy makers accountable for advancing health equity in the distribution of parks. We call this a democratic approach to health improvement and discuss how population health, whether part of public health, philanthropy, or health care, needs to focus on community power and include funding for power-building organizations. We conclude that achieving health equity requires enhancing the quality of democracy.