Pathways to Healthy Communities

The following comes from a presentation on, “Developing a Systems Thinking Perspective of a National Deliberation Project on Healthcare Costs” as part of the “How Can We Reduce Costs and Still Get the Care We Need?” Kumu project which was featured in the last blog post, “Using Deliberation and Systems Thinking to Address Healthcare Costs”. They are the three concluding statements arrived at after the completion of a systematic inquiry into the NIFI forum on healthcare costs.

1. We should not approach issues of Healthcare Costs in terms of "Cost Savings". Instead, we should approach it in terms of "Reinvesting and getting a Better Return”.
2. We should endeavor to bring Healthcare concerns, both health, and costs, closer to community-based approaches. The positive aspect of such an approach is that there are already numerous efforts going on. These need to be prioritized to a far greater degree. (and made to have a Collective Impact)
3. Community-based efforts should focus first on health then find cost-efficient means of implementing programs, not the other way around. 

The salient point for this post is, “The positive aspect of such an approach is that there are already numerous efforts going on. These need to be prioritized to a far greater degree.” This means moving our attention away from the deliberative process of deciding issues of healthcare costs to creating and implementing programs in a community based on those decisions.

This then would be a part of a process of creating what will be called Healthy Communities (wiki-tag). Below are several new websites recently added to the New Community Paradigms Wiki, all of which have some focus on health and community.

Healthy Communities involves building Healthy Cities (wiki-page) as well as focusing on Community Design (wiki-page), Geographic Based (wiki-page) community change agencies, and rethinking our Streets (wiki-page).

Healthy Cities approaches working toward community health from a variety of different perspectives and levels. Some are more functional and could be applied in a variety of settings, like a toolbox. This particular Community Tool Box | Table of Contents is a service of the Work Group for Community Health and Development at the University of Kansas.

“The Community Tool Box is a free, online resource for those working to build healthier communities and bring about social change. Our mission is to promote community health and development by connecting people, ideas, and resources.”
Others like the Gallup-Healthways Well-Being Index provide important health data.

“The Gallup-Healthways Well-Being Index® is the first-ever daily assessment of U.S. residents' health and well-being. By interviewing at least 1,000 U.S. adults every day, the Well-Being Index provides real-time measurement and insights needed to improve health, increase productivity, and lower healthcare costs. Public and private sector leaders use data on life evaluation, physical health, emotional health, healthy behavior, work environment, and basic access to develop and prioritize strategies to help their communities thrive and grow. Journalists, academics, and medical experts benefit from this unprecedented resource of health statistics and behavioral economic data to inform their research and reporting.”

Another similar site is Rankings | County Health Rankings & Roadmaps, sponsored by the Robert Wood Johnson Foundation, which "allows you to Look up your county’s Rankings, learn about their methods, and download the data you need."

An example at a local city level of a community focusing on health is Davidson Design for Life.

“Davidson Design for Life (DD4L) is an initiative of the Town of Davidson to foster healthy community design through the use of health impact assessments (HIA), public participation, and collaborative efforts in Davidson, the Charlotte-Mecklenburg region, and North Carolina.”
Even though a small community of 11,750 people (2013) with Davidson College nearby with 1,920 students, the site provides information on Health Impact Assessment: What is it?, for the surrounding region and information on HIA in the US.

At a state level for Minnesotans is Alliance for Healthy Homes and Communities.

“All Minnesotans should have the opportunity to make choices that allow them to live a long, healthy life, regardless of their income, education, or ethnic background. Everyone wants good health to be productive at work and to succeed in school and to have affordable medical and housing costs. To make this opportunity a choice for all Minnesotans, we all have to do our part in creating and maintaining healthy homes and communities. Every person and every organization have a role to play, small or large.”
Closer to home is LA2050 - Shaping the future of Los Angeles, which involves though a major city with a population of over 3.8 million and a focus that expands beyond healthcare concerns to other areas, so it has been placed under Geographic Based community change agencies.

“LA2050 is a community-owned mechanism to create a shared vision of success for Los Angeles in 2050 and to track progress toward that vision.”
At a state level is The California Endowment which is also involved in the Creating Health Collaborative and in the related Stanford Social Innovation Review presentation on “Organizing Communities to Create Health”.

"The California Endowment was established in 1996 as a result of Blue Cross of California's creation of its for-profit subsidiary, WellPoint Health Networks. Since then, we've invested in health broadly, from strengthening the safety net for families struggling with poverty to diversifying the health care workforce. The lessons learned from early investments were the genesis for Health Happens Here and the 10-year, $1 billion Building Healthy Communities plan, in which residents in 14 places are working to transform their neighborhoods."

The sites cited above involve data and organizations. There is also a need to consider at a more foundational physical level in the promotion of health through design, which is what the Center for Active Design does.

“The Center for Active Design is a nonprofit resource for design professionals, policymakers, real estate developers and community advocates, committed to promoting and expanding the Active Design Guidelines published by New York City in 2010. We maintain a multi-disciplinary perspective in the translation of health research into design solutions that amplify the role of architecture and urban planning in improving public health and well-being.”

"Rethinking the Automobile", a project created to raise awareness around the negative impact of the automobile on our world by livable streets advocate Mark Gorton no longer seems to exist. The presentation, associated with the site, still exists on Vimeo. 

Elsewhere, from a more creating health perspective, is the StreetFilms video Carmaggeddon Averted as Broadway Comes to Life, in which "Mark Gorton takes us on a tour of Broadway's car-free squares and boulevard-style blocks, where conditions have improved dramatically for pedestrians, cyclists, and, yes, delivery truck drivers," putting forward the counterintuitive truth that taking away space for cars improves traffic and makes the city safer and more enjoyable for everyone on foot, based on established theories like traffic shrinkage and Braess's paradox that help to explain why this happens.

These are not the only websites in the NCP wiki related to health or healthcare, in fact, most can be related, at least indirectly. They are the most recent and have not been featured previously.

Laying out a few possible pathways to creating Healthy Communities does not lay out the entire required journey. Moving from the primarily deliberative process to actual implementation of programs still, means overcoming any fundamental differences in perspectives or mindsets within the community (which will exist even if everyone is familiar and adept at systems thinking) and crossing the Knowing-Doing Gap by Jeffrey Pfeffer and Robert I Sutton as discussed in previous posts. There is still lots more work to do but this does make it all the more possible.