Community: Problem source and solution beneficiary

For almost a decade, we have fretted over the role that our communities play in the generation of disease, disability, and early mortality. One classic finding: your ZIP code predicts more accurately than does your genes how long you actually will live. Another: negative community health determinants, such as poverty and discrimination, do cause trauma, which does lead to behavioral health disorders, and sometimes, early death.

Rarely do we question the reverse: How might we go about changing our communities so that they produce fewer of these awful effects. Rather, we focus our energy on inoculating person and family from experiencing the resulting ravages. Promotion of personal and family resiliency is a prime example. Fighting back from illness to recovery is another.

Clearly, we must continue or work on resiliency and recovery. But, we also must do much more. We want to foster communities in which members have good health and wellbeing, which are safe and secure, and which are prosperous. This commentary describes two potential strategies for moving toward these goals. The first is through direct action; the second, through indirect action undertaken by organizations that are integral to the community.

1. Direct Action

Direct action to transform our communities in order to make them better has been a key part of the agenda of the American Public Health Association (APHA) for almost a decade. APHA has sought to improve community health determinants so that members can have better health and wellbeing, and greater equity. These efforts also include strategies to incorporate behavioral health interventions into public health programs.

Within the past two to three years, such direct action also has become a focus for the behavioral health field, as we being to incorporate public health strategies into our programs. The joint summit organized by the Carter Center Mental Health Program and the APHA Mental Health Section in the fall of 2017 brought these two perspectives together in a very fruitful manner. Similarly, within the past two years, the American Academy of Social Work and Social Welfare has implemented a Grand Challenges for Social Work and Society initiative that seeks to address four health issues, four wellbeing issues, and four equity issues using direct action.

With direct action, communitywide campaigns and interventions are undertaken to build a healthier, safer, and more prosperous community, typically through public or not-for-profit entities. The focus of the effort could be almost any of the following issues: opioids, depression, high blood pressure, poor wellbeing, lack of health or financial equity, etc. The strategies and tools of public health are critical in these endeavors.

2. Indirect Action 

Indirect action to transform our communities is much newer, and currently is still in the formative stages. In these efforts, companies seek to adopt a culture of health and wellbeing. These efforts are designed to address health, behavioral health, wellbeing, and equity problems that occur for members of the workforce and their families. As initiatives are undertaken, salutary effects can and do occur for the company and for the surrounding community as well.

Companies that have adopted a culture of health and wellbeing experience fewer workplace accidents, less interpersonal conflict, and greater prosperity. Published research has shown that these companies also perform better on the stock exchanges, compared with companies that have not adopted a culture of health and wellbeing.

What currently is required is an explicit effort to bring about needed community improvement through the actions of local corporations and businesses. To do this, strategic models will need to be developed that examine key inputs and outputs for both the company and the community. Whenever possible, interventions that are undertaken should be done using evidence-based practices.

Indirect action represents a very promising approach. Done explicitly, we should be able to reduce community violence, improve community security, enhance overall community health and wellbeing, and increase community prosperity through such efforts.

I am sure that you are wondering whether direct or indirect action is better. My own answer would be that the question is wrong. Clearly, what would be better would be to develop synchrony between simultaneous direct and indirect efforts. More about this in a future commentary.