The Difference Between Community Health, Community-Based Health

June 16, 2020 - As value-based care and outcomes-based reimbursement increasingly become a reality in healthcare, medical professionals have leaned on key strategies to prevent acute healthcare episodes and boost the health of a population. Central to those efforts have been population health principles like community health and community-based health.

But amid the myriad challenges stakeholders face in executing those strategies comes one existential hurdle: healthcare has a terminology problem.

Community health and community-based health sound like they could be different words for the same thing. And the consequences of that confusion, while they may seem like trivial semantics, bear actual weight. Community health and community-based health are different things, and therefore demand clarification.

Compounding and overlapping meanings for community health and community-based health can leave stakeholders “forming contradictory or incompatible assumptions about community and can undermine our ability to evaluate the contribution of community collaborations to achievement of public health objectives,” Kathleen M. MacQueen, PhD, MPH, of the National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), wrote in a seminal 2001 exploration of the meaning of “community.”

MacQueen and research partners suggested that by leaving the different definitions of community, community health, and community-based health obscure, it is difficult to measure and effectiveness of interventions. That could have lasting consequences.

READ MORE: How Mobile Health Clinics Drive Care to Vulnerable Patients

“These and other constraints on the shared understanding of the meaning and scope of community health may hamper the growth and effectiveness of this field,” wrote Richard A. Goodman, Rebecca Bunnell, and Samuel F. Posner in a separate 2014 article seeking to define community  health.

Below, PatientEngagementHIT outlines community health versus community-based health, where these two concepts align, and what makes them distinct.

Population health links community health, community-based health

In order to fully understand the difference between community health and community-based health, one must first examine what ties the two concepts together. Population health, which has been pushed to the forefront as part of healthcare’s shift to value-based care, has brought to light many of the concepts embedded in both community health and community-based health.

Per the CDC, population health is “an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally. This approach utilizes non-traditional partnerships among different sectors of the community – public health, industry, academia, health care, local government entities, etc. – to achieve positive health outcomes.”

Population health is distinct from public health and other person- and patient-facing healthcare concepts because of its outcomes-driven approach. Population health addresses a group of individuals who share certain attributes, introduces a health intervention, and assesses how that intervention impacted health outcomes.

For example, a population health management strategy may target individuals with diabetes at a certain primary care clinic. Providers may track key health indicators, like blood glucose levels, and introduce a population-level intervention aimed at lowering those metrics. The population health strategy will track those metrics, inform shifts in strategy, and ultimately work towards an end goal, usually of cutting healthcare costs.

But population health doesn’t have to mean a group of patients with the same disease. The population could be individuals living in a given geographic region, working in a certain office or for a specific employer, or facing a specific set of social circumstances.

Community health and community-based health all share in those same goals. Individuals involved in community and community-based health aim to improve the health of a given population, boost health metrics, and ultimately lower costs.

What make them distinct from population health — and from each other — is not the what, but the how. Healthcare organizations spearheading population health management programs integrate community health and community-based health as a part of that programming.

Community health hinges on social services, coordination

Community health is one strategy within a larger population health management effort. Per the definition refined by Goodman et al, community health is a broad-ranging public and population health strategy aimed at improving the health of a group of people.

“Community health is a multi-sector and multi-disciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities, in a culturally appropriate manner, to optimize the health and quality of life of all persons who live, work, or are otherwise active in a defined community or communities,” Goodman and colleagues wrote.

Hinging on health equity and the social determinants of health, healthcare professionals and community stakeholders can design community health programs that address key social needs that ultimately affect a person’s health.

“Working at the community level promotes healthy living, helps prevent chronic diseases and brings the greatest health benefits to the greatest number of people in need,” the CDC says on its website. “It also helps to reduce health gaps caused by differences in race and ethnicity, location, social status, income, and other factors that can affect health.”

A community health strategy may include supporting local food pantries and food banks, for example. Food security is a key social determinant of health. Limited access to food, or access to only less nutritious food, can lead to certain chronic illness such as diabetes. It can also exacerbate chronic illnesses that individuals may have already developed, like a heart disease patient being unable to adhere to a certain diet.

Support for local food banks to offer more nutritious foods, referring individuals who may be food insecure to food banks, and providing healthy food subsidies are all community health strategies that address this key social determinant of health.

Importantly, community health leverages social services and input from public stakeholders. For example, many community health initiatives have been informed by community health needs assessments (CHNAs).

These assessments, while ultimately carried out by hospitals, look at the social needs of a given geographic population that may affect their health. Community partners help hospitals administer these surveys and provide feedback about how to target the needs outlined in the CHNA.

To that end, stakeholders involved in community health may include, but are not limited to:

• Healthcare organizations
• Government
• Social workers
• Public policymakers
• Social services
• Community activists and stakeholders

Community health is distinct because it does not involve a medical or pharmaceutical therapy. It is not the administering of a certain drug or the widespread receipt of a healing procedure, nor does it always address patient education. Instead, it leverages the material and immaterial resources within a community to boost health.

Community-based health delivers healthcare outside the clinic

Whereas community health hinges on non-medical interventions to improve population health, community-based health is defined by the delivery of medical care and education.

What makes community-based health distinct, however, is the community setting. This can take many shapes.

A mobile health clinic that parks itself outside of a trusted community center, for example, qualifies as community-based health. A blood drive or health fair at a local church also qualifies as community-based health.

These approaches do not necessarily address the downstream determinants of health, like food or housing, but rather explicit health care and education. Community-based health is important to population health strategies because it addresses some of the key barriers many high-risk patients face:

• Healthcare access is often cost-prohibitive for patients
• Public health messaging may not be accessible for all patients
• Physical healthcare facilities may not be accessible for patients, especially those without transportation access or who live in geographically remote areas
• Trust in traditional healthcare institutions is often left wanting, especially among ethnic minority and traditionally oppressed populations

Like community health, community-based health hinges on the input and expertise of community members. Using the example from above, a healthcare organization may have partnered with the community church because it wanted to deliver an important educational message to a high-risk population that often visits that church.

This population may include individuals who do not trust the healthcare organization or do not visit the healthcare organization. By delivering that educational message in a trusted environment by a trusted community leader — in this case, the faith leader — patients may be more receptive to the information.

Similar principles emerge for the mobile health clinic example. Mobile health clinics usually park in community centers, helping to connect to care individuals who may live far away from the brick-and-mortar facility or who do not have transportation. Putting that clinic outside the community center also signals that this is a trusted place to receive care.

These community-based settings are usually low- or no-cost and are host to medical providers who can deliver care in multiple languages besides English.

As healthcare continues to embrace value-based reimbursement models, it will be important to understand how community health and community-based health work together and on their own to improve population health.

By addressing the downstream, social determinants of health and creating avenues for traditionally marginalized and underserved populations to access care, these two strategies work to improve health. Specifically, community and community-based health can prevent disease, manage illness, and, ideally, improve outcomes.

In doing so, healthcare organizations can continue their work to improve patient health at a lower cost.