Promoting Community Health
by: Greg Vigdor, WHF President & CEO
Here we are at the start of the 8th annual Governor’s Health Bowl. Since 2004 – this signature event of the Healthiest State Campaign has generated more than 25 million miles of health. It is truly an incredible accomplishment!
Much of the focus during the Health Bowl is on things that tend to promote personal responsibility such as physical activity, eating better, getting more sleep and so on. And while promoting personal responsibility is critical to our vision of making Washington the Healthiest State in the Nation, it is important to recognize that collective action is an equally critical piece to the health puzzle. You can see it in the laws relating to our health passed by Congress or the state legislature, which can have a powerful effect our health. Another example might be what some employers may do in terms of practices like health benefits, sick time, or creating an environment that some workers find overly stressful. Or even what our local public health departments might do to protect the public's health – from restaurant inspections to handling a contagious disease outbreak.
But this affect on our health extends far beyond these “personal” and "collective" sectors. More importantly, so may the solutions to what really ails us.
Working together might have gotten a bad rap in some quarters – largely because some believe this can only happen under the spell of the government. It actually is a commonplace reality of our lives and can be a real boon to our health. Many of us belong to clubs, social groups, places of worship, extended networks of people who share the same interests, and all sorts of other formal and informal gatherings. We do relate regularly to other people, and should. And, the real phenomena of the last decade is not that we do this less, but that we now do much of it through texting, messaging, social media and the internet. Working through how best to relate to others in this new way may hold the key to discovering how to really improve health across our communities.
Examining a health question like this goes far beyond the usual framing of our health problem, which tends to get pigeonholed into ‘not enough access to insurance or health care services’. And this is why "Promoting Community Health" is such an important action area for our Campaign. While health coverage is an important issue and one that we are working to improve (through our Personal Health Advocate Service at 855-WA-Health/855-924-3258), maximizing personal and group relationships may hold more potential for really improving our actual health. And, while there may be great division on "health insurance for all", or at least the means for doing so there may be far greater agreement that we can and should promote our community's health by working together.
The good news is that there is a movement across the nation to Promote Community Health, and it is one that should have a broad basis of support from liberals, conservatives and independents. It is called the Healthy Communities movement and dates back to the early 1990s. Coinciding with our birth as an organization, we have been a big part of building and nurturing this both in Washington state and also across the Nation.
At a basic level, Healthy Communities tries to promote health at the local level by growing leadership; thus building relationships and practices that can provide enduring action to the major health issues we face as people and communities. The movement has been governed not by top down requirements but by the articulation of some broad patterns that speak to the values and behaviors that will create real, cooperative action. The Healthy Communities has a prescription for health known as the "Seven Patterns of a Healthy Community.”
A really important part of this movement is that Healthy Communities is not something to be imposed from above, but something to be home grown; a true grassroots effort. For example, government may frequently be involved in Healthy Communities projects, but usually would not be the sole driving force in the project’s development.
Healthy Communities is a movement that has meandered across the social landscape in a very uncoordinated way over the past 20 years. No one has been in control of the movement, yet it continues to flow forward. A couple of years ago, some of us who were involved in the genesis of the movement came together and agreed that it was still progressing with numerous projects all across the Nation that fit neatly under its definitional tent. Our own Healthiest State Campaign is an excellent example of a grassroots, statewide endeavor that is clearly not defined nor directed by government.
We pledged to try to take some steps to catalyze the movement so that it can further contribute to the health of the Nation. Many new projects have come on line and the future for Healthy Communities remains promising.
Despite the successes, the Healthy Communities movement is also under assault; to a large extent through friendly fire. One example of this is the government embracing the movement and, in turn, making Healthy Communities its work. The government is able to do this in a pronounced way through the hundreds of millions of dollars in new financial resources that come from health reform legislation. It’s not always a great fit though as the government tends to control and dictate projects rather than softly leading them. I am not an opponent of government, but recognize that "partnering" and "softly leading" are not its strengths.
Also shooting some bullets is the commercial world of health care, which is now at least embracing the term. It is hard not to hear ads on television or radio where health insurers or providers are extolling their intent to contribute to a healthy community. Many of these companies don't have much of an idea of what a healthy community really means and these ads seem more like a campaign designed to market products and services than to fuel the growth of the Healthy Communities movement. Nice that they believe in the term, but it seems like for many of them it is intended to suggest that their interests are altruistic rather than financial.
Foundations are also getting into the act by using their money for Healthy Communities projects. Many of the wealthier organizations are fueled by dollars from not-for-profit health care entities converting to for profit status. Legally – they were required to put millions of dollars into Foundations to gain this new status. That's not a problem. But many of them also draw their staff and strategic direction from the medical care or public health worlds, and frequently they just carry forward the limited view of Healthy Communities from this experience. Projects rather than people. Drummed up incremental action measures for short-term grants and reports, rather than long-term commitments to relationships and patterns of leadership at the community level.
Meanwhile, many of the local, poorly funded, and most resource challenged Healthy Communities folks struggle to move forward, even if their work is where the potential for real change resides. We understand because we count ourselves among them. Can we survive the attention from government and multi-million dollar health care system players who want to own the space but not necessarily the full vision and patterns of Healthy Communities? Time will tell.
My guess is that to be an enduring movement, Healthy Communities must pass through many phases. Some will be more dangerous than others. And the ability to weather these storms is the challenge of any successful movement. So don't lose hope. If some government, insurers, hospitals, and foundations don't really believe in the true tenets and aims of the Healthy Communities movement, then their attention will soon fade to other things or labels – even if they control most of the economic and other resources to support the work. And if those of us who really believe in the movement and approach can stay the course, even while we might be starved for attention or resources, the potential of the movement to truly transform the health of the Nation can and will be realized.
My advice is to just keep at it, for as long as you can. That is our mantra and intent. Even as we have had to constrict what we are doing due to funding shortfalls, we remain steadfast to making a difference and keeping our unique brand of health improvement alive in the state of Washington. So should you.