Below is the introduction to the new version of our application tool, which can be found here.
I began my work on the observation that clinical science and practice fail to appreciate how people and communities define their health.
This failure stems from its inability to appreciate health as more than ‘the absence of disease’. It has fueled medicalisation, health care inflation, and the rise of non-communicable, chronic conditions – all of which have contributed to making health care unsustainable.
Through my writing and research, I have explored what it takes for the health sector in high-income countries to better understand low-income communities. I have gleaned 12 practice-based principles for how to build a bridge between the health sector and communities.
My work has coincided with a growing recognition that a community’s social context matters more to its health than the availability and quality of health care. In response to these ‘social determinants of health’, the health sector is exploring working with community-based organizations to meet individual’s ‘social needs’. This work is often called clinical-community partnering, social prescribing, or community health.
While addressing individual’s social needs is important, the work also has the potential for the health sector to acknowledge how removed it has become from people’s real lives. In this context, the 12 principles offer a strategic framework for how clinical community partnering or social prescribing might be configured to go beyond the immediate challenge of meeting individual’s social needs to reconnecting the health sector and communities.
Learning Through Doing
I gleaned the 12 principles from the struggles of almost 100 community-oriented practitioners. The principles began life as a set of recurring themes for why community-oriented work often fails. I flipped these themes into 12 things that prospective community-oriented practitioners should consider to minimize their risk of failure.
In parallel to learning from practitioners, I have sought to learn what the principles collectively represent. In 2016, I understood that they represented an inclusive and participatory process, one that had the potential to foster the ‘agency’ of individuals and communities. I understood that agency is core to having a sense of control, which, in turn, is core to health.
In 2018, in response to the growing interest in the ‘social determinants of health’ and understanding communities’ needs, I understood that the principles collectively represented what authentic community engagement might look like.
While both remain true, I have realized that describing two sides of the same coin is not the same as describing the coin per se. The 12 principles represent a strategic framework for resetting relationship between the health sector and communities.
The 12 Principles
- Include in a community’s collective effort those who live there, those who work there, and those who deliver or support services provided there
- Spend time understanding differences in context, goals and power
- Appreciate the arc of local history as part of the story of a place
- Elicit, value and respond to what matters to community residents
- Facilitate and support the sharing of power, including building the capacity to use it and acknowledging existing imbalances
- Operate at five levels at the same time: individual, family, community, institutional and policy
- Accept that this is long-term, iterative work
- Embrace uncertainty, tension and missteps as sources of success
- Measure what matters, including the process and experience of the work
- Build a vehicle buffered from the constraints of existing systems and able to respond to what happens, as it happens
- Build a team capable of working in a collaborative, iterative way, including being able to navigate the tensions inherent in this work
- Pursue sustainability creatively; it’s as much about narrative, process and relationships as it is about resources
This tool has been created to help you understand, embrace and apply the lessons from over 100 community-oriented practitioners. It exists to minimize your risk of failure while creating the opportunity to develop deeper relationships with the communities you serve.
It is not easy work but I have seen it to be both essential and possible.
As well as an updated title, subtitle and design, the new version includes an update to principle six to include ‘family’.