This post was first published by Collaborative Consulting – see here.
We’re pleased to announce a new partnership with Bridging Health & Community (BH&C), an organization committed to overcoming the disconnect between the health sector and local communities.
Here at Collaborative Consulting, we’re passionate about bringing the health and social sectors closer together, fostering meaningful cross-sector partnerships that drive healthcare innovation and improve health outcomes. The team at BH&C is equally passionate about bringing the health sector and local communities closer, and about the power of communities to shape their own health.
Together, we’re excited about the potential to design and implement effective cross-sector partnerships, help more people live healthier lives, and build a better system of health where providers partner not only with each other but also with the communities they serve. I (Lori Peterson) discuss our new partnership and more with BH&C co-founder and CEO, Pritpal S. Tamber.
Lori: Hi, Pritpal. The concept of community ‘agency’ is central to your work. Can you help our readers understand what this means and why it matters?
Pritpal: Agency is the ability to make purposeful choices. Leading epidemiologists have been clear for almost three decades that having the ability to make purposeful choices is fundamental to people’s health, as well as their general ability to thrive.
Focusing on risk factors, whether they’re about personal choices (like smoking, diet and exercise) or about social circumstances (like access to education and economic security) explain less than half of why people are healthy or sick. The rest seems to come down to whether people have agency.
Lori: This is such an important idea. As you know, we often help our clients partner across the medical-social divide. We certainly see strong results from these cross-sector partnerships, and we also share your view that the industry needs to move beyond partner-to-partner collaboration and involve the community itself. So, from your perspective, why should health organizations partner with the communities they serve?
Pritpal: Little of what we’re doing right now is positively impacting health. People are enduring more and more lifestyle-related chronic conditions. Rates of obesity, diabetes – you name it – are rising, despite the health system spending billions trying to change people’s health-related behavior. We need new ideas that will resonate with the people we’re trying to serve.
Beyond that, though, health organizations have to go back to the science. The industry has focused mainly on ‘behavior change’ to mitigate the risks associated with personal choice, and the ‘social determinants of health’ to mitigate the risks of the social environment. Both matter, of course, but it’s also important to embrace the role of agency.
The wider policy context is changing too. As remuneration shifts from activities to outcomes, health organizations will need to think harder about whether and how they genuinely engage communities. Personally, I don’t think the way ‘value-based healthcare’ has been operationalized is courageous enough, but it’s a step in the right direction and has the potential to nudge people into new conversations.
Lori: It’s clear health organizations can go further. So, how can seeing health from the perspective of communities help them have greater impact?
Pritpal: Healthcare needs to be reconfigured, rebooted. And there’s no better way than starting with the people you’re intending to serve.
Things have changed since healthcare was first designed. We’ve seen a drop in acute causes of death – infections and trauma – and a rise in lifestyle-related chronic conditions – diabetes, high blood pressure, cancers, to name just a few. If we remove aggressive cancers from that list, most of these chronic conditions are managed on a day-to-day basis in parallel with the other trials and tribulations of life. So, health – at least the version described in bio-medicine – becomes part of a series of choices. And, quite frankly, if the wider palette of choices includes economic survival or safety in your neighborhood, bio-medical health may not seem so urgent.
At the same time, bio-medicine is always evolving. When I was at medical school, we studied diabetes. These days, the kids coming out of medical school have learnt about metabolic syndrome, diabetes’ pre-cursor. Through advances in bio-medicine, we’re able to diagnose not only more but more sooner. But that just creates an endless list of things that clinicians tell people to watch out for, change their behavior for, take medicines for. It’s relentless, and for some, it just becomes noise.
We also have to admit that healthcare has gotten more expensive. There’s an assumption out there that the rising cost of care is related to an aging population but it’s not true. Healthcare is getting more expensive because healthcare can choose to be more expensive.
Cost inflation, coupled with the ability to do more, has created the perfect growth model for the industry. But it’s one based on supply, not demand. And this disconnect is all the more apparent given the shift to lifestyle-related chronic conditions and the palette of choices in day-to-day life.
Lori: In other words, seeing health from the perspective of communities can help health organizations better meet the needs of the people and communities they’re meant to serve. That sounds obvious, so why aren’t they already doing this?
Pritpal: Because reconfiguring systems is extraordinarily hard. At best, established systems change incrementally. But what’s needed is transformational change. That said, change is possible if an organization is open to having its underlying assumptions and beliefs challenged. I’d highlight three.
The first is to embrace the importance of agency to health. There is a lot of evidence to support this.
Second, we need to move beyond the assumption of linear cause-and-effect. People want to know that if they do X, they’ll get Y. But operating in complex social environments does not guarantee this. X may lead to Z or Q, or perhaps Y – but whatever it leads to the pathway is not linear.
And third, we need to accept that the way we fund health is through the lens of sickness – its treatment and prevention. When we say a community is healthier, we’re really saying they’re demanding fewer services related to sickness – ER attendances, visits to the clinic, interventions. There is no business model for health.
Bringing all of that together, if you successfully foster the agency of a community, they may lobby for better working conditions or better housing or a better school. All that matters to health, but it’s hard to render that into an ROI within healthcare’s current business model. We need to embrace new ways of calculating value that are more societal and less industry-specific.
Lori: Right. So, how can we overcome obstacles like these?
Pritpal: At BH&C, we have identified 12 Principles to foster the agency of the community. Any health organization can look at the principles and start asking themselves how they can change their way of working to make fostering the agency of the community an intentional byproduct of their work. It’s possible to do that in care delivery, in prevention related to behavior-related risk factors, and in trying to counter the social determinants of health. We’ve also created an implementation tool (PDF) to help organizations think through how they might change how they’re working to align more deeply with the principles.
Lori: I’m glad you mentioned implementation. As you know, I believe ideas are not enough; change only happens with action. How do you see Collaborative Consulting helping BH&C translate its ideas about agency into action?
Pritpal: We want to help organizations in health change their way of working, and, in parallel, learn what worked, what didn’t, and what were the best ways to overcome obstacles. It’d be hard for us to do that if we’re engaged in the day-to-day of the work – we need to be able to zoom out to see the patterns across different projects – so we hope that Collaborative Consulting can help organizations put BH&C’s 12 Principles into practice while we focus on the learning.
Lori: Well, we’re certainly looking forward to collaborating with you, and are excited about the 12 Principles for our health and social sector clients. Thanks for joining me in this conversation, Pritpal.
Pritpal: My pleasure. Let’s get to work.