Creating Health in the 21st Century

This series has explored what it means to create health, sketching a collective path to new systems that can contribute to health in the 21st century. The overarching message is that we in the health sector need to take community—people’s connections to each other and their places, and everything that arises from these connections—more seriously, and that all types of professionals can do this, whether in hospitals or philanthropies or grocery stores.

If we really take community and connectedness seriously, we will be vigilant about the extent to which we strengthen or disrupt it when developing health interventions. We will value the knowledge and assets that all people have to offer from their unique relationships with people and place. And ultimately, we will commit to building the power that communities have to create health themselves, beyond clinical services and public health interventions.

Communities Creating Health

Communities Creating Health, presented in partnership with Creating Health Collaborative, is a series on how the design, implementation, and evaluation of interventions in health can align more closely with what communities value. #creatinghealth FOLLOW THIS SERIES

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Unfortunately, the systems we have created, rather than the solutions we now need, often drive current approaches to improving health. We have garnered from contributors to the series a number of principles to guide us as we develop new ways of doing things, as well as concrete steps toward contributing to a culture that values connections and relationships as much as treatments and health campaigns.

GUIDING PRINCIPLES

1. Acknowledge that our success depends on each other. Creating health will happen among individuals and institutions, so we must set aside ego, trust others, and recognize that our individual knowledge is limited and our progress is collective.

2. Bring more voices to the table. It is vital to understand the dynamics and relationships within a given community. To do that, we must ensure that all who may be affected by and involved in carrying out an intervention have the opportunity to comfortably share their visions and concerns. 

3. Expand what counts as knowledge. The insights that communities share often play second fiddle to what professionals and academics typically deem valuable. Putting them on a more equal footing influences what to implement, how to allocate resources, and conclusions about whether something “worked.” 

4. Embrace emergence, including unpredictability. We must abandon the linear approach favored by traditional health care and embrace the unpredictable nature of community-driven interventions. We must learn and adapt in real time, and remember that unexpected outcomes are one way an intervention can succeed. 

5. Value what people value. All too often we decide what to aim for and evaluate based on what we can easily measure. It is essential to flip this—to identify goals and then figure out ways of measuring progress toward them. 

NEXT STEPS

1. Invest in community organizing. Drawing on community requires hard work that needs supportive infrastructure. The health sector can contribute to building shared infrastructure with other efforts that in many cases have a longer history of community-driven approaches, such as housing and economic development. 

2. Invest in community learning systems. We must develop information-sharing collaboratives and build the capacity of local organizations to use information for decision-making and performance improvement.

3. Experiment. We must try new ways to develop, implement, and assess interventions. People who research, evaluate, and run community health programs can carry this out, but it is possible only with the support of funders willing to embrace a new form of experimentation. 

4. Build the capacity of professionals. Doing something in a new way requires that program managers, community leaders, evaluators, investors, and other professionals understand the reasons for change and have the skills to operate in ways that strengthen community. 

5. Incorporate processes for good teamwork. We must take listening and team-building seriously in every part of the process, including how we design meetings, develop collaborative projects, and engage neighbors.

6. Share and hold each other accountable. We must develop resources and regular meetings to connect implementers, researchers, evaluators, funders, and community leaders so that everyone can share information and tools, and so that accountability becomes the norm.

7. Expand opportunities to document knowledge. Journals and other venues need to commit to curating information from community health initiatives, just as they do for cardiology or pediatrics. This will mean embracing different types of insights from all nooks of society and giving thoughtful consideration to what constitutes evidence.

8. Promote the tangible impact of community. Building on the other steps listed here will make it possible to find new ways to communicate the value of community, and to understand why we need to review policies for their impact on human and community development, much like environmental or health impact assessments.

9. Transform what drives funding decisions. More funders need to commit to doing what emerges as best for local communities, rather than focusing on a narrowly defined disease outcome or what one discipline or advocacy group suggests. 

Finally, there are things those of us working in the health sector can do daily to take community more seriously. We can abandon the comfort of smart-sounding insider lingo, invite feedback on what we do from those whose ideas we can’t safely predict, and have the courage to challenge colleagues to reevaluate whether a project is truly getting us closer to meaningful “well-being.” We can be more open and vulnerable in how we write about our work, which many of the authors in this series bravely did. And we can certainly get out and spend more time building relationships in our own neighborhoods. The better we get to know our own people and places, the less reasonable it will seem to leave “community” in the fringes.

We are grateful to the authors of this series, who stepped forward to document how to take community seriously. We hope their voices will catalyze an expanding cohort of professionals dedicated to embracing the potential of each place to create health in its own way. We thank the authors for their honesty, willingness to articulate personal experiences in a public forum, and commitment to moving this conversation into action. 

Read more stories by Leigh Carroll & Bridget B. Kelly.