Today sees the launch of a new series in Stanford Social Innovation Review called ‘Communities Creating Health‘. It was commissioned by the Creating Health Collaborative and was inspired by a recent meeting on designing evaluations for what communities value.
The meeting focussed on how evaluation designed around disease prevents us from seeing health for what it really is – a means to an end, rather than the end itself. To understand the future of health we have to remember that what people really want is to lead satisfying lives, health being only part of that.
The series builds on the meeting to ask what would happen if the design, implementation, and evaluation of health interventions became something we did with communities rather than to them. It’s likely that we’d have to remember that health is the product of many behaviours, influences, and relationships that lie in the settings of everyday life. In turn, it might make us question why most of our health spending goes to a health care industry narrowly focused on avoiding or treating disease.
For me, at the heart of the issue is the bizarre idea that the health care industry gets to tell people what they should have. While this may have had some legitimacy when the health challenges of the world were solely acute and infectious – two areas where medicine has provided great advances – it’s harder to justify now that the challenge is increasingly lifestyle-related. It’s also absurd to have to listen to an industry that refuses to share its performance, either financially or on the basis of outcomes, and fails to manage its costs, whether by reducing waste or controlling the cost of new technologies.
My co-curators*, Bridget Kelly and Leigh Carroll, and I have worked hard to bring new voices to the debate. You’ll hear from a local barber who went door-to-door to raise the community’s voice, a former rock star obsessed with trying to make fresh food available in low-income neighbourhoods, a social worker experimenting with tools to understand the stories of her community, a local steward asking us to realise that problems are often the source of solutions, and a councilwoman who warns us that analysing data without local context can mean life or death.
We’ve also worked hard to interweave these community-based voices with those of professionals that work to bridge the chasm between what communities want and what the health care sector provides. You’ll hear from professors who’ve developed strategies for engaging disenfranchised communities, design thinkers sharing new tools for developing inclusivity, managers building the teams of tomorrow, directors sharing principles on how to handle the complexity of today’s problems, clinicians trying to design health services like startups, and associates illustrating how all this can strengthen communities.
None of this is possible without money, of course, and so we’ll also hear from two funders: one that worries that the biggest threat to our health is the tendency for power to concentrate in the hands of the few and one that posits that while long-range capital is needed, perhaps the most important thing is for the spenders of the money to be answerable to the local community.
The series builds on the first report of the Collaborative, which shared the principles for creating health as discovered by those at the vanguard of the change. We are meeting again in July and will be joined by new members, all of whom are reaching beyond the limits of health care to explore and start to define the future of health. We will, of course, share our key learnings, just as we did last time.
I’d like to thank Stanford Social Innovation Review, specifically Eric Nee and Jenifer Morgan, and my co-curators, Bridget and Leigh. Eric and Jenifer I’d like to thank for being open to a difficult topic and for making their platform available to the Collaborative. Bridget and Leigh I’d like to thank for their ability to remain focussed on the big picture and their tolerance of my obsession with process and deadlines.
I’ll end with a quote from the final piece in the series, written by Bridget and Leigh. While it may seem odd to give away the ending, it helps to paint a picture of the journey the series will take you on.
There are things those of us working in the health sector can do daily to take community more seriously. We can abandon the comfort of smart-sounding insider lingo, invite feedback on what we do from those whose ideas we can’t safely predict, or have the courage to challenge colleagues to re-evaluate whether a project is truly getting us closer to meaningful ‘well being’. We can be more open and vulnerable in how we write about our work, which many of the authors in this series bravely did. And we can certainly get out and spend more time building relationships in our own neighborhoods. The better we get to know our own people and places, the less reasonable it will seem to leave ‘community’ in the fringes.
I hope you enjoy the series.
* Bridget and Leigh are individually responsible for this work; it does not necessarily represent the views of the Institute of Medicine