Community initiatives to promote health and wellbeing

The approach of Fall often signals renewed energy in our local communities—those places we call home and to which most of us feel strong allegiance and commitment. At this time of year, many local communities conduct a United Way campaign, families gather on local soccer and football fields, neighborhood schools and community centers are full of life, and we truly see our own communities in action.

Our local communities can and should do other very important things as well. Here, I would like to focus on the roles that communities must play in altering the calculus through which the negative social and physical determinants of health cause disease and disability in community members.

In earlier commentaries, I have described the negative effects of two determinants,  poverty and income differential, but I have not outlined fundamental community interventions to address these problems.

To review a little: The social and physical determinants principally affect health and wellbeing through their role in causing trauma. More intense and more prolonged trauma is related to worse health and wellbeing. Thus, we need community and personal interventions that address these determinants and reduce or eliminate trauma.

In earlier commentaries, I have described person-level disease prevention and person-level health promotion interventions. They need to be effective, and we need sustainable ways of paying for them. As they are developed, such evidence-based services need to become covered Essential Health Benefits under the Affordable Care Act.

In order for communities to undertake necessary disease prevention and health promotion actions, they, like individual community members, need to become health literate and active. Previously, I have described community and personal health literacy and health activation.

Here are three key examples of community initiatives designed to reduce or eliminate determinants that cause trauma:

• Adverse childhood events (see here, for example)
• Poverty and near poverty (see here, for example)
• Social exclusion and isolation (see here, for example)

Yet, although essential, these interventions are only part of the picture. Each is designed to reduce deficits. We also need community interventions to enhance positive features of health and wellbeing.

Here are three key examples of community initiatives designed to promote positive health:

• Wellbeing (see here, for example)
• Wellness (see here, for example)
• Social engagement (see here, for example)

An equally important issue is how we can pay for these community interventions in a sustainable way. Secretary of Health and Human Services Sylvia Burwell’s recent value purchasing initiative on performance adjusted case and capitation rate systems can be helpful in this regard. Imagine that the expectation is developed for a specific, small percent of a capitation rate to be withheld for community interventions. Thus, our health insurance would not only be for personal care, but for community care as well.

It has become almost axiomatic that the financial picture of our current disease care enterprise will continue to deteriorate without a very well planned approach to disease prevention and health promotion. The very high and growing cost of disease care, coupled with the rapid aging of the U.S. population, makes this a virtual certainty. The question is how we can exit this vicious downward spiral. Community prevention and promotion initiatives can play a major role in reversing this trend.

More than 35 years ago, we proposed a Health Promotion Organization that would address personal health and wellbeing. Although such organizations are just as important today, we did miss a very big part of the picture at that time. We also should have proposed a Community Health Promotion Organization.