There is a trend to bring health care back into our communities, which is a very good thing. Many health care professionals, researchers, and people on the street are finding that health care works best when it is locally rooted, with services that are easily accessible in or near our communities. The trend has been shaped by many factors, including:
- Aging of the Americas, and the world;
- Feedback from consumers about what makes health care services work;
- Cost effectiveness of services close to home;
- Better quality outcomes for many types of care;
- Benefits of building upon community networks.
The federal Healthy People 2020 outlines the benefits of community-based models in reaching people, and engaging them more actively in managing their health and health care. The focus on creating partnerships between health organizations, public health departments and communities is both innovative in design, and built upon centuries old health practices from traditional and minority communities. The health professionals bring certain types of expertise to the table. Community leaders, members, and grassroots organizations bring different types of, equally important expertise to the table.
Over the past decade or so, health researchers, epidemiologists, and other health experts have increasingly realized that many health outcomes are shaped by social and demographic forces. These Social Determinants of Health include income, education, race or ethnicity, and other factors. This means that chronic diseases disproportionately hit the poor, minorities, and those with less than average education. This means that, when health professionals work in partnership with communities, the real needs become better understood, and healthcare agencies can meet people where they live, and respond in more holistic ways that help people to manage their health more effectively.
One of the national leaders in reaching people where they live is the Robert Wood Johnson Foundation. This funder, RWJ, has published county “County Health Ratings and Roadmaps” for many years, and they have created funding strategies that focus on “Place Matters,” with a focus on community.
Key Elements of Successful Community Based Health Models
There are a number of different models for engaging communities in shaping the way health care is delivered, and health and wellness are supported. Many of these models are overlapping, in that they share many similar core principles and strategies.
Asset Based Community Development (ABCD), developed by John McKnight and John Kretzmann focuses on engaging communities to identify their community’s strengths (or assets), and to mobilize those in order to bring the community’s capacity to the table, and continue to build community capacity. There is another important reason for engaging a community in analyzing and leveraging its assets, which is that doing this creates a better fit between community needs and priorities and how health services are prioritized and delivered.
Cultural Diversity underlies effective models, emphasizing the real engagement of the diverse community in all aspects of the community and its work. In health care, this includes full engagement in planning and feedback, representation on boards, committees and staff. Healthcare providers that represent the communities they serve, and have staff, volunteers and board members from those communities have better communication with the community; deeper understanding of community needs and effective ways to work with people; and the community’s respect and trust.
Systems Approaches are critical to effective models for health and health care. The World Health Organization coined the term “Social Determinants of Health,” which refers to those elements of our individual, family, and community lives that affect health. These include income and poverty, education, employment, race and ethnicity, sex, gender identity, age, and household composition. How and where we live affect our health. As many funders are now saying, “place matters.”
Community Engagement is another element critical to the success of health initiatives and models of care. When the community leaders and key organizations are at the table in meaningful and ongoing ways, this helps to provide a strong base for success. If large percentages of people in the community are involved from time to time in ways that fit the community’s own culture, in events, discussions, or Town Halls for planning and feedback, then they feel a level of ownership and commitment that translates into using and supporting services. When there are times that health providers need community support on big issues, those that are engaged will often come out in support of the agency’s policy, plan, funding need, or special initiative.
Interagency Cooperation is key to effective community health, as there are almost always multiple organizations in any community that have an impact on individual, family, and community health. These include health care providers, but also schools, faith communities, and many other types of organizations. Most of the effective models have lead agencies that work together as a core group, that also involve and work cooperatively with many other organizations. When these organizations play well together, the community benefits.
Targeted Focus on people who are at greatest risk is also paramount. This includes people who happen to be marginalized or facing significant difficulties. The Social Determinants are always helpful for identifying those who face greatest health disparities and are often at most risk. These include the poor, racial and ethnic minorities, LGBT populations, the young, and the old.
More information about types of models can be found in another article: “Models for Effective Community Based Healthcare.”