Engaging All Stakeholders in the Culture of Community Health

September 26, 2017 - Creating a community health program — a county farm to table project or subsidized housing system — is not something healthcare organizations and their partners are required to do. And yet as healthcare begins to extend beyond the four walls of the doctor’s office, the culture of community health is becoming more pervasive.

These projects all come down to a strong sense of community pride, according to Robert Wood Johnson Foundations Managing Director Abbey Cofsky who oversees programs for community health and equity.

“People are committed to creating a community that is thriving and a community that creates opportunity, a community that people can take pride in for themselves, for their family, and for their neighbors,” Cofsky told PatientEngagementHIT.com.

In a recent review of over 200 communities engaging in the culture of health, RWJF awarded eight exemplars that are supporting health outside of medical care. These communities from states across the country are focused on safe and affordable housing, food security, crime and public safety, and career development for all individuals.

Although each of these communities targeted different social determinants of health in their improvement initiatives, Cofsky stated civic mindedness and camaraderie was at the heart of each of their projects. Residents wanted to leave their cities, towns, and counties better than they found them.

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“This is where these people grew up,” Cofsky noted. “They want it to be a place that offers opportunities for their children, for their grandchildren.”

Also at the heart of the community projects is the healthcare industry.

“There is a natural leadership role that hospitals and healthcare providers are positioned to play in many communities,” Cofsky asserted.

“Hospitals are very much tied to the fate of their community,” she added. “They are major businesses, employers, and entities that own real estate in the community. Hospitals are really invested also in the health and wellbeing of the community for the sake of their employees and their patients and their potential patients.”

In fact, Cofsky would contend that this leadership role is one of the major contributors to community health’s rise in prominence.

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Although many healthcare organizations face changes in payment structures that bring the social determinants of health to the forefront, Cofsky also argued that hospitals are being compelled to step up to the plate as community leaders.

“Hospitals feel a real sense of civic leadership in their community,” she noted. “Hospitals are seeing themselves as an economic intervention for their community and their region and are increasingly recognizing the role they can play there.”

Across all awardees, communities have lived up to the example set by their local hospitals, making decisions to improve the health of their neighbors and families over corporate or personal gain.

In Allen County, Kansas, one of RWJF’s prize winners, residents voted to raise taxes to build a new community hospital.

In Garrett County Maryland, residents saw the benefits of a public health center over a new county jail. In a community-wide vote, residents showed that supporting public health would eventually reduce the need for more jail space.

But those good intentions don’t mean communities are without their own challenges to face. On a macro scale, many of the top-performing communities see the same set of hurdles that make it difficult to work together.

“They are dealing with issues of racism, dealing with inequality, and with corruption,” Cofsky said.

It requires strong leadership to overcome these challenges, Cofsky added. Hospitals can often play this role by organizing community health conversation events, engaging necessary stakeholders, and using objective data to identify the areas where the community needs to band together.

“In many of these prize communities there is leadership,” Cofsky explained. “This leadership is willing to bring people together to have difficult conversations and to bring data and information to those conversations to make informed judgments and decisions.”

In Allen County, community leaders gather stakeholders to have tough conversations around race and inequality. Although the conversations are difficult and require strong leadership to moderate, they have resulted in more actionable decisions that improve health for all residents.

Many communities also face challenges that are unique to the individual city or county. Prioritizing community needs and issues alongside resources presents a major hurdle for most communities. Here hospitals must lead the charge and orient communities in a data-driven direction, Cofsky said.

Community health needs assessments are effective in helping to both identify areas that need improvement and areas where the community is rich in resources and expertise. Where priorities align, communities should develop interventions.

Hospitals and communities also falter when they cannot distinguish between a genuine and perceived scarcity of resources. A community may lack the funds necessary to build a new public health building but can become creative about alternative strategies to deliver public health messaging.

“Communities confront the problem of wanting to do more than there are available resources, or at least apparent resources for,” Cofsky said. “All of our prizewinners are figuring out how to make resources go far by thinking through how to leverage the assets that exist within the community.”

“How do communities make the most of what they have to really leverage every opportunity?” she added. “How can they be creative in pulling in partners, maybe unlikely partners to help them think about you know documenting change or evaluations?”

In another exemplary rural town, Algoma, Wisconsin, community leaders are seeing the potential for the youth to contribute to community health. Rural areas typically suffer from a dearth of healthcare resources, often struggling to make ends meet for traditional healthcare needs.

In Algoma, leaders helped engage children in civic health, imparting leadership skills and a sense of community to kids.

Youth have been at the helm of CPR trainings in local businesses and have created community gardens with adults with disabilities. These programs have helped support better health in the community, while imparting to both children and adults the skills to be better leaders and more civic-minded.

“We see a lot of youth engagement,” Cofsky said of all the prize winners. “It just speaks to a sense of inclusion, a sense of really creating opportunities for the next generation. When you see a whole community coming together to work together, it changes the way people think about where they live and what’s possible.”

Ultimately, building a culture of health within a community is going to require engaging all relevant stakeholders.

Moving past the hospital and community organization partnerships, healthcare organizations must tap into their patients and other residents to build excitement for improving community health. Leveraging the civic-mindedness of residents will help drive the energy necessary for a stronger culture of health, Cofsky said.

“There’s a role for everybody,” Cofsky concluded. “It takes the community to come together and to put a value on health and wellbeing.”