Health is the product of many behaviors, influences, and relationships that lie in the settings of everyday life, and yet most of our health spending goes to a health care industry narrowly focused on avoiding or treating disease. Given the rising cost of care, combined with ageing populations with multiple chronic conditions, this narrow focus has created an increasingly expensive and inaccessible health care system that demands sustenance at all costs but is ultimately unsustainable.
We need to take a long, hard look at whether the well-intentioned quest to support health through the lens of disease has detracted from supporting other activities that have the potential to create health in the settings of everyday life.
People do not see their health solely through the lens of disease. Health is a means to other things: caring for family, enjoying friends and hobbies, succeeding at a job, living long enough to see grandchildren grow, or concentrating in a classroom. How, then, do we understand and value the health of a community based not just on exercise rates or prevalence of diabetes, but on its ability to help people attain what matters to them?
Clearly the first step is to understand what communities want—something that is possible only when we prevent top-down strategies for reaching disease-based outcomes from dominating the discussion. In one neighborhood, this might lead to programs to support volunteers who visit the elderly twice a week. In another, it might require that communities install more garbage cans to promote cleaner, safer-feeling streets, as a first step to building walkable, active neighborhoods.
A growing number of people in professions both inside and outside of health care are beginning to ask how we can make this shift. One group of people has evolved into the Creating Health Collaborative, a collective that aims to understand health beyond the lens of health care. Each participant shares their work to surface and embrace broader definitions of and approaches to health, and to share learning, seed debate, receive feedback, and ultimately further their work.
The Collaborative published its first report on the emerging principles for creating health in November 2014, and also contributed to a meeting hosted by the Institute of Medicine (IOM) on designing evaluations for what communities really value. At the meeting, participants discussed how using evaluation methodologies designed for disease-based thinking limits our understanding of value—a discussion that has since broadened to include how we might incorporate a community’s priorities and values into the design, implementation, and evaluation of interventions.
This broader discussion has inspired the forthcoming series, “Communities Creating Health.” It brings together a collection of voices offering a diversity of perspectives on how to create health through community by framing the challenge, making the case for what’s needed, sharing real world examples of approaches, and illustrating the possible benefits.
A community-based, health-creating system will require a broader cohort of people than we traditionally see in health care; parents who cook nutritious meals, people who shovel snow for neighbors with back problems, postal carriers who routinely check in on their clients, and business owners who pay a living wage all need as much support as health care professionals. As the series will make clear, it is time we called upon them to offer insights on how that can happen.
In the weeks to come, a variety of voices will contribute to this discussion, including: a local barber passionate about realizing his neighborhood’s greatest potential, a council member who wants to see data help rather than hinder her community’s progress, innovative researchers in service delivery, and leading practitioners of evaluation science. From these voices emerge eloquent illustrations of what is ultimately incredibly hard work: how to responsibly and effectively approach building new systems with communities; how to listen and be heard; and how to approach a process of change that is by its very nature complex, nonlinear, and highly dependent on the context in which it happens.
We hope that this series will provoke a snowball effect among those working in the health sector, recruiting more and more of them to consider new ways of thinking about how they can create health while also making the changes that communities themselves value most. At the same time, we aim for the series to offer resources, tools, and steps to take on the path from provoked thought to inspired action.