What’s your community health priority?
the Northwest Health Foundation, a regional health foundation that I respect and admire greatly, created a website to begin a conversation about health priorities in Oregon. The site, Community Health Priorities is exciting on many levels that could be fodder for other posts. For example, it echos back to my previous post about community voice, advocacy, and engagement that is made possible by new technologies but that is another post.
Today I wanted to focus on one poll question posted to the website that asked: “What’s your community health priority?” The introduction to the poll led with the statement “We know it’s hard, but if you had to choose just one issue to get additional funding, which would it be?” and the possible responses listed included the usual disease of the day suspects like: Improving air quality, More alcohol and drug treatment programs, Prevention of obesity, Adolescent and teen health awareness programs, and Affordable, quality housing.
I answered the poll question and then added a comment to the 14 other comments posted so far. My concern was that the question blurs “health care delivery priorities,” with “community health priorities. The two are very different concepts and need to be understood as distinct. Anyway, here is what I posted as a response to the poll:
I think what is interesting about this list of health priorities is that it is all about deconstructing health into tidy discrete boxes. This process of deconstruction may be good for health care redesign but it should not be confused with community health priorities. Deconstruction means that we can “value” some diseases more or less relative to cost savings on the system or which diseased evokes more fear among the public. Strokes cost the medical system a whole bunch more money (and is scarier) than childhood asthma so if that was the priority choice we should be allocating limited resources to prevent strokes and let vulnerable kids struggle to manage asthma.
Our true community health priorities should be wrapped around the concepts of social capital and connectedness. If we truly had a sense of community and were connected to each other it would radically change the shape and nature of our social fabric. In a connected community our priorities would be about promoting such things as living wages; investing in the commons (eg., public transportation, open spaces and libraries); promoting community gardens and other access to local foods; teaching community members conflict resolution, parenting and primary health prevention. Learning, daycare, food cooperatives would become the norm and not the exception. If we were truly connected as a community, it would not be an option for children to arrive at school hungry or be without health care.
So I would suggest that prioritizing the disease of the day list can be useful but engaging in a deeper conversation about root causes might be even more fruitful.
Okay, some of you might be thinking “semantics shemantics.” But I would argue that semantics matter. If your box is as narrow as to force-choice the disease of the day priority, then I would argue that you box in your imagination about the solutions. As health educators, we talk about root causes but unfortunately, we rarely work at the root cause level and instead get bogged down in discussions about what disease we should be focusing on today.
Kelly House
Mark J Kittleson
Margaret Sullivan
Maria Alexandrova
jodyearly
Shanell L. McGoy
Mainul Mustafa
M. Helen Hogue
Yuba
Okony K. Cham
Kamrun Mustafa
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You state the case for the difference between health care priorities and community health prioritiew well. This is the key reason that the Role Delineation Project arrived at the initial seven areas of responsibility of the health educator, rather than a list of subject matter areas of knowledge about heatlh. Subsequent development of the graduate competnecies and the articulation of the two through the CUP process adhered to the focus on community health versus health knowledge subjects.
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