Only community power can save health care
I began my work on the basis of three observations:
- Health care in high-income countries is increasingly unsustainable
- None of the ‘big ideas’ that I was seeing when working with TEDMED were likely to remedy this
- And the burden of ill-health falls disproportionately on those lower down the socioeconomic ladder, but they tend to have bigger priorities than health
In response, I looked for projects that started from a community’s understanding of its priorities, which may or may not include health. I looked at how those projects fared when they interfaced with the health sector. In general, they fared badly because the sector tends to tell people what they should have rather than listen to what they need.
Through my work, I discerned a set of 12 practice-based principles for how to build a bridge between communities and the health sector. From the perspective of the health sector, they suggested what authentic community engagement might look like.
But from the perspective of communities, they spoke to something more fundamental – their ability to affect their circumstances. In other words, they spoke to whether communities have power.
Elsewhere, community power is increasingly being recognised as the ultimate social determinant of health. As a result, my work has been drawn to the social determinants, even though that was not the frame through which I started.
My perspective, then, is that community power is fundamental to health and key to structural change and health equity. It can ensure that the health sector focuses on what is needed and also positively affect the social circumstances that influence health.
I have come to the importance of community power as a scholar, not an activist. For me, the research examining the connection between community power and health is compromised by ideology. I worry that this will undermine the importance of the topic.
There is much to learn and not enough serious work to learn from. Research into the link between community power and health needs better methods and adequate funding. Ideology and activism have their place but they’re no substitute for good science.
My perspective changes as I learn from my work. This perspective was written in December 2021. My previous perspective can be found here and was written in July 2019.