What is a “healthy community?”
When you ask people what makes a healthy community, the answer is almost always much broader than “medical care,” “hospitals,” “doctors,” or “access to good health insurance.” The people in a healthy community are safe and feel safe, are well informed, feel that they have the power to make choices, have lasting bonds with one another, have strong families, and a sense of meaning in their lives. Linda Bergthold, a principal of the human resource and benefits consulting firm William M. Mercer, says that “health is only in a very minor way about medical care.” The evidence is there in any hospital: half the cases that come in the door are rooted in behavior, another 30 percent in the safety of the environment. Though the diseases and traumas happen to individual bodies, their roots are social.
Similarly, Tom Chapman, who has just left his post as CEO of Greater Southeast in Washington, D.C., to take over George Washington University Medical Center, calls for “a pure and thorough recognition that it is not healthcare delivery that fundamentally drives health. Other major determinants — such as good housing, jobs, a strong economic base, good nutrition, responsible behavior, genetic makeup, and education — dwarf healthcare. One of our frustrations as providers is that the harder we work to provide health, the further we get behind, because we have no influence over these other determinants. It doesn’t work to use `healthy community’ in a narrow parochial sense. If everybody gets immunized, then kids get blown away in gang warfare, that’s not a healthy community.”
We found wide agreement with this — and with the idea that at a deep and practical level, the health of a community depends on its inter-connectedness. Bergthold’s healthy commmunity would be “dense with empowering organizations at the local level, a community that has identified its own priorities and set out to build them.” For “anti-economist” Hazel Henderson, “this means shifting our value system away from compulsive individualism toward re-balancing the needs of communities.” In the same vein, Tom Chapman said that the people of a healthy community would have a “collective understanding of their interdependency.” Health futurist Clem Bezold calls a healthy community “one in which the community has a shared vision, and is able to make that a significant part not only of public policy, but of healthcare and commerce.”
Sean Sullivan, executive vice president of the National Business Coalition, points out that things like housing, education, crime, or the community’s vision of itself “are not things that usually show up in conversations of healthcare reformers about ways of reducing healthcare costs — or that managed competition will have much impact on.”
Some consider the economy the most fundamental aspect of community building. Drew Altman, president of the Kaiser Family Foundation, says, “A good job and a strong family is the best health and human services program. You’ve got a shot at educating the upper middle class about their diet, for instance, but you don’t have a chance with people who are just surviving.”
But others look through a different lens. Clem Bezold, for instance, says, “For me, development — creating new jobs and attracting more industry — is not necessarily a viable direction to go. I see a steady increase in the ratio of people who desire to work, relative to opportunities. In other words, we’ll see a steady rise in unemployment. So the task becomes: how do you create communities that do more with less, that can live in more sustainable ways in face of adverse economic development?”
But whether the economy is primary, as Altman would have it, or is inseparable from deeper questions of the nature of strength in a community, as Bezold and Henderson would say, the exercise of bringing people together to build a stronger community, done correctly, tends to work on all aspects of the problem at once. Health futurist Leland Kaiser calls building healthy communities “a resource generation strategy” that “makes sense because a society depends for its well being on a full utilization of all its resources, especially people.”
In the broadest sense, the things we can do to help the individuals in a community live healthier lives — safer lives in stronger families with less stress, better nutrition, more information, and greater wisdom — are the same things we can do to help make a community more democratic, wealthier, more interconnected, better educated, and even happier. You can’t build healthy individuals in a sick community. If you want to fight disease, you have to build healthy communities.
Implication You can’t truly effect the health of the people you serve until you get beyond the walls of your institution, and even of healthcare itself.
Action Re-frame your mission from “curing disease” to “creating health,” and then one step further, to “building a healthy community.”
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