Working With Communities: Meeting the health needs of those living in
vulnerable communities when primary health care and universal health
coverage are not available
Abstract
Background: The health care delivery model in the United States does not
work; it perpetuates unequal access to care, favors treatment over
prevention, and contributes to persistent health disparities and lack of
insurance. The historical lack of support in the United States for
primary health care, universal health coverage, population health,
addressing the social determinants of health, and community empowerment,
creates opportunities for community health scientists to develop
innovative solutions for addressing community health needs. Methods: We
developed a model community health science approach combining
community-oriented primary care (COPC), community-based participatory
research (CBPR), asset-based community development, and service learning
principles. The approach defines health as a social outcome, resulting
from a combination of clinical science, collective responsibility, and
informed social action. Results: From 2000-2020, we established
partnerships with community organizations to reduce the risk of chronic
disease in vulnerable minority communities. Our programs have provided
structured community health science training for hundreds of physicians
and other health care workers in training. Conclusion: As the U.S.
begins to seek solutions to chronic health disparities and health
inequities, community health science provides useful lessons in how to
engage communities to address the deficits of the current system.
Perhaps the greatest error that U.S. health care systems could make in
trying to better address population health and the social determinants
of health, would be ignoring the important community initiatives already
underway in most local communities. Building partnerships based on local
resources and ongoing social determinants of health initiatives is the
key for medicine to meaningfully engage communities for reducing health
disparities. This has been the greatest lesson we have learned during
the past two decades, has provided the foundation for our community
health science approach, and accounts for whatever success we have
achieved.