Community Health Development: A Strategy for Reinventing America's Health Care System One Community at a Time

Michael R. J. Felix; James N. Burdine; Monica L. Wendel; Angie Alaniz

Disclosures

J Prim Prev. 2010;31:9-19. 

In This Article

Abstract and Introduction

Abstract

The purpose of this article is to propose a set of ideas for reinventing America's health care system, one community at a time. Community health development is proposed as a strategy and approach to population health improvement, the ultimate goal of health care reform. The practice of community health development, particularly the partnership approach, provides guidance about how this approach might be employed as a national health care reform strategy. Examples of two communities successfully using the partnership approach illustrate the methods described. Six specific recommendations for policy makers and public administrators in the new administration resulting from our experience with community health development are presented. First, adopt and apply community health development (CHD) as the American approach for facilitating population health improvement and building community capacity. Second, the partnership approach should be promoted as a model for communities to use in implementing CHD. Third, make the community-level the focus for planning, implementing, evaluating, and sustaining a full continuum of health and human services. Fourth, formally recognize the social determinants of health as a key component of a new population/community health status model and as a public policy driver for health care reform, marketplace issues, and population health status improvement at all levels of society. Fifth is a call for a national strategy for the recruitment, training, education, and support of individuals to facilitate this community movement. Sixth, Congress and the Obama Administration adopt and apply CHD as a national strategy and utilize American community-based experiences to bring about a national plan.

Introduction

One of the outcomes of the election of Barack Obama was the re-invigorated debate over various aspects of the U.S. health care system. Dialogue and proposals range from a focus on cost—including reimbursement and quality of care in our fragmented system—to ideas for improving the ability of the population to access services, reducing the health disparities within the U.S. population, and how to pay for and improve system capacity and coverage for the uninsured population in the U.S. Just days before the authors submitted the final version of this paper, the national health care reform was front page news on a daily basis with discussion of a public insurance plan to compete with private insurance, the development of cooperatives similar to the nonprofit Blue Cross organizations of the 1970s, various consumer protection strategies (e.g., elimination of pre-existing condition exclusions and portability of coverage), and expansion of Medicaid and Medicare. At the time of this writing, the mix of these proposed strategies is in flux. Regardless of the mix of approaches in the final legislation, all these strategies require the development of health networks and partnerships to implement them. As a result, the real work to follow will be largely a local endeavor. This article addresses that next phase in the process of "fixing" the health care system in this country.

As its title suggests, the purpose of this article is to propose a set of ideas for reinventing America's health care system. We first provide a philosophical background for community health development as a strategy and approach to population health improvement—the ultimate goal of health care reform. Next, we discuss the practice of community health development, with particular focus on the partnership approach. Examples of two communities successfully using the partnership approach are used to illustrate the methods described. Finally, we conclude with six specific recommendations for consideration by policy makers and public administrators.

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