Community-Based Health Organizations: Advocating for Improved Health / Edition 1 available in Paperback
Community-Based Health Organizations: Advocating for Improved Health / Edition 1
- ISBN-10:
- 0787964867
- ISBN-13:
- 9780787964863
- Pub. Date:
- 01/21/2005
- Publisher:
- Wiley
Community-Based Health Organizations: Advocating for Improved Health / Edition 1
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Overview
Product Details
| ISBN-13: | 9780787964863 |
|---|---|
| Publisher: | Wiley |
| Publication date: | 01/21/2005 |
| Series: | Jossey-Bass Public Health , #12 |
| Pages: | 384 |
| Product dimensions: | 6.05(w) x 8.95(h) x 1.05(d) |
About the Author
Yvonne J. Graham, R.N., M.P.H., Brooklyn's Deputy Borough President, is founder and past president of the Caribbean Women's Health Association, Inc., Brooklyn, New York. She has served on the Public Health Association of New York City's Board of Directors.
Sally Guttmacher, Ph.D., is Director of the MPH program in Community Public Health at New York University and Past President of the Public Health Association of New York City. She is on the Board of the Caribbean Women's Health Association and is the President Elect of the Association of Teachers of Preventive Medicine.
Read an Excerpt
Community-Based Health Organizations
By Marcia Bayne Smith
John Wiley & Sons
ISBN: 0-7879-6486-7Chapter One
Historical and Organizational Frameworks of Community-Based Health Organizations in the United StatesMarcia Bayne Smith
This chapter supplies working definitions of community-based health organizations (CBHOs) and their advocate role and then provides two frameworks, historical and organizational, that facilitate an examination of the role, purpose, and functions of CBHOs. Several concepts are introduced that increase our understanding of the many intangible attributes of health from the community perspective. These concepts-community organizing and the building of social capital, social cohesion, social glue, social bridges, the development of a strong civil society, and the community empowerment that follows -all play vital roles in the quality of life and the quality of health outcomes in any community. At the same time, these concepts point to specific areas of community development and empowerment in which CBHOs play a significant role.
Consequently, the chapter also looks at the historical development of community health, leading up to the emergence and growth of CBHOs. It also looks at the organization and structure of CBHOs and their capacity for empowering communities through development of partnerships that improve health outcomes and other community conditions.
Learning Objectives
Social, economic, political, cultural, legal, and linguistic forces influence the shape and delivery of health services in general and the development of CBHOs in particular in a given community.
The growth or demise of community health services is subject to competing national, regional, and local interests, as well as the historical journey unique to each community.
A receptive political climate, strong social capital, social cohesion, a civil society, and a well-organized advocacy network are essential for community health services to advance.
The development of community health services in the United States has undergone two major stages and is now entering a third.
There is renewed interest in neighborhood-based health centers as effective service delivery models, particularly in urban settings, as a result of immigration and migration, the replacement of manufacturing jobs with service sector jobs, and restructured levels of federal and state support to cities.
The role of government in the development of CBHOs continues to change.
Improvement in community health outcomes requires that CBHOs develop the technological capacity to plan, advocate, deliver, monitor, and evaluate culturally acceptable preventive and primary services.
Working Definitions
It is important, before discussing important concepts, that all participants have a clear idea of precisely what those concepts mean. To that end, I provide here some definitions of the most important terms we will be encountering throughout this book.
Community-Based Health Organizations
Community-based health organizations are formal, legal structures established by, or together with, community residents, in order to advocate for, secure, increase access to, or provide health and health-related social support services to a community. There are two distinguishing characteristics of CBHOs. The first is their unique ability to serve as a bridge between their constituents and mainstream service delivery systems, thus facilitating access to care. The second is their ability to use their knowledge and cultural identity to build reciprocal relationships with a broad range of government health, social service, civic, educational, and religious institutions to foster coordinated, comprehensive, and culturally appropriate services.
The term community-based health organizations is intended to impart the basic philosophical precept of neighborhood-based or locally based entities providing health and social support services to communities or defined populations. CBHOs are presented here not as a category unto themselves but as a subset of community-based organizations (CBOs). The primary focus or mission of CBHOs is to intervene in eliminating the causes of poor health as opposed to focusing solely on the health problems themselves. In this context, they provide health education, outreach, and case management services, and sometimes they do so in conjunction with clinical care.
Community
Community is defined here as a group of people who share a geographical space; have common social bonds of status, concerns, or perspectives about specific issues; and assume, depending on the depth and strength of social capital available in that community, the obligations and responsibilities involved in collectively helping one another (Rubin and Rubin, 2001).
Community-Based
Community-based suggests a cadre of residents who, with the involvement of fellow residents, institutions, and other stakeholders, take on a central role in building and empowering their community and its organizations. The synergy that results from community-based involvement helps garner communitywide involvement and sustain collective efforts in public health actions around concerns identified by residents. Community-based is also indicative of collective activities of residents anchored within their community. For example, a hospital may be located in the community but would not be considered community-based because its support, stakeholders, staff, trustees, and investors may not necessarily come from that community.
Community Influence
How does the community influence health and health behaviors within it? From a sociological perspective, humans do not live in a disorganized fashion. Although we make individual and personal decisions all the time, we can do so only in the context of the family, community, city, country, and larger world in which we live. Sociology has taught us that our social world guides our behavior and life choices in much the same way that the seasons influence our clothing and activities (Macionis, 2005). Another answer, from an urban planning point of view, says, quite simply, that your health is influenced by where you live. It would appear, then, that regardless of the perspective, one's environment or community becomes critically important in terms of its ability to influence health behaviors, activities, and ultimately health outcomes.
Knowledge of how community influences health helps us in various ways. For one thing, it helps us think critically about various "truths." Many of the "truths" that abound about health are not necessarily factual. For example, a popular belief during the 1970s and 1980s was the notion that we are each individually and solely responsible for our own health. Because that idea was accepted by policymakers, it not only drove health policy but also made it easier to blame victims of certain illnesses and praise healthier people for their willpower or superior health behaviors (Byrd and Clayton, 1993). When we understand the influence of community on health, we are better able to think about our beliefs critically and to determine to what extent community or individual behaviors contribute to health outcomes and why.
Knowledge of how community influences health helps us determine how to work effectively within communities to address health concerns. Developing a deeper understanding of how community influences health can shed light on the various factors contributing to the disproportionate incidence of illness and disease among certain racial, ethnic, and socioeconomic groups and explain differences in the availability of funding and providers from one community to the next. As we understand more about the significant influence of community on health, we gain greater clarity in assessing health conditions in a given community. Often this newfound clarity leads to active involvement in development and pursuit of goals that will improve the health of a community.
Knowing how community influences health also helps us value the cultural diversity of every community. The rich diversity of the United States is the result of four centuries of immigration from around the world. There have always been ethnic enclaves of recent newcomers and distinct neighborhoods inhabited by descendants of previous immigrants. The residential pattern of ethnic enclaves helps community members maintain their cultural practices while functioning within the larger social milieu. As the size of an immigrant group grows, it eventually comes to include individuals identified as natural healers in whom the group places its trust regarding matters of health. In such communities, Western "biomedicine" is not necessarily the first course of action but frequently the treatment of last resort. One of the many lessons to be learned from cultural diversity is that group values and experiences influence health behaviors that affect health outcomes.
Health
In the preamble to its constitution, the World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely as the absence of disease or infirmity." This broad definition suggests that the well-being of any group of people cannot be viewed in isolation from its history and current conditions. However, the unwillingness to broaden the definition beyond a focus on disease and infirmity, and the repercussions for human health, is rooted in a dramatic shift in the way people viewed the world during the Age of Enlightenment, in the sixteenth and seventeenth centuries. That view, based on a method of "scientific" reasoning that is mechanistic and linear, is often referred to as Cartesian thinking or Cartesian reductionism (Cottingham, 1998; Payer, 1988). The Cartesian paradigm has exerted undue influence on shaping views in every sphere of life for some four hundred years. It is credited with development of the Western biomedical model that reduced health to mechanical functioning and established strict divisions between mind and body (Capra, 1982).
An important outgrowth of Cartesian reductionism is the contemporary biomedical model, which is essentially concerned with only four things: the diagnosis, the disease, the patient, and the treatment (Foss and Rothenberg, 1987), in that order. The biomedical model is ill-suited to addressing current community health needs in an advanced industrialized society like the United States, for two reasons. One has to do with new knowledge about the etiology of disease, which stresses that in addition to the early biological programming, chronic health risks result over the life course from adverse environments, childhood and adolescent illnesses, nutritional practices, levels of physical activity, and many other influences (Brunner, 2000). The other has to do with the fact that over the course of the past hundred years, infectious epidemics and pandemics have become less prevalent, replaced by chronic illnesses and new epidemics that are more closely associated with behaviors governed by social norms, habits, beliefs, and shared characteristics and perspectives.
As a result, despite the phenomenal scientific advancements and accomplishments in medicine in recent decades, the biomedical model has proved inadequate to address health-related behaviors and their health outcomes. The poor fit of this model with current health problems is particularly noticeable in non-Western and nonmainstream communities in the United States (Bayne Smith, 1996b). In fact, the biomedical definition of health as the absence of disease tended to ignore group history and in so doing did not address the idea of community health. As a result, it is only in the past twenty to thirty years that medicine in the United States has become concerned with the disparity in health between groups or communities or with the differences in population and community characteristics that can either contribute to or detract from improving health outcomes. As efforts are made to define health in more comprehensive terms, it is expected that the health of communities will be addressed.
Organization
An organization is an entity built by members of a community to gather and focus information, pressure government and private agencies, conduct protests, contribute to the empowerment of its members, or create new forms of ownership (Rubin and Rubin, 2001). Organizations bring resources and capacity to educate, empower, and mobilize a community and foster the development of CBHOs as organized, structured responses to health concerns.
Building organizations presents a difficult challenge for communities where civil society is weak, recollection of historic experiences is an obstacle, or resources, skills, and capacity are lacking. As a result, some communities must first focus on providing their constituents with social support services to assist them in breaking down barriers that stand in the way of their quest for a community organization to provide health services.
Health Advocate
A health advocate seeks to influence decisions about health policy and the allocation of health resources in order to improve community health outcomes. As health advocates, CBHOs employ organized strategies and actions while holding themselves accountable to the communities on whose behalf they advocate.
Health advocates strive to improve health outcomes for their community by gaining a voice and a place at the table of relevant institutions and agencies where decisions affecting community health are made. The strength of CBHO advocacy efforts lies in the fact that access issues are felt most acutely at the local level. Therefore, CBHOs are in a unique position to articulate social issues that affect health as well as local approaches to health improvement. In this context, their goal is to change the relationships of power between centers of decision making and the people and communities affected by those decisions.
Since the terrorist attacks of September 11, 2001, perceptions of health and the impact of political, social, and economic events on the health of a given community have changed. As a result, along with new concerns about air pollution and air quality and the availability, supply, and quality of vaccines against smallpox, anthrax, and various other biological and chemical agents, there are also new concerns about "community health." In that regard, the very presence of nuclear power plants in our communities seems now more than ever to pose an increased health threat. In this environment of heightened awareness of terrorism, one of the equally pressing health needs that has surfaced is for ongoing mental health services at a time when resources for mental health services in several states and communities have either been reduced or evaporated entirely. Though sometimes considered not as tangible as physical health, the mental health and other nonphysical characteristics of communities carry important ramifications for the health of a community.
Community Health
Before we can define community health, we must recognize that in the United States, some communities are subject to greater environmental health risks and deficits, such as low social capital and weak civil society, as a result of distinct population characteristics. The residents of these communities are not only assigned a lower rank in the U.S. social hierarchy but are also at greater distance politically and economically from all those above them. In addition, residents of these communities tend not to form advocacy organizations, nor are they part of social networks that can facilitate access to services and resources relative to their health care needs (Murray, Frenk, and Gakidou, 2001). It is in these communities that CBHOs are well positioned to organize residents and focus their efforts. The emphasis must be on the building of social capital and social cohesion and on community development and empowerment resulting from an engaged civil society. The desired end product is empowered communities that develop the organizational capacity to advocate for improved health outcomes.
Community Building, Social Capital, Social Cohesion, and Civil Society
The term community building broadly describes the work of organizing a community and creating linkages at various levels. The concept of building social capital is more complex. Social capital is not the same as economic capital. Economic capital is most often measured individually, whereas social capital is a collective assessment of specific kinds of resources within a community, group, or society. Thus capital in a community context refers to the supply of less discernible resources: trust, duty, reciprocity, responsibility, obligation, and control. In the absence of these intangible forms of social capital, communities, groups, and sometimes whole societies become disorganized and destabilized.
(Continues...)
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Table of Contents
Tables, Figures, and Exhibits.Foreword (Mary E. Northridge).
Preface.
Acknowledgments.
Part One: The Context of Community-Based Health Organizations (CBHOs).
1. Historical and Organizational Frameworks of Community-Based Health Organizations in the United States (Marcia Bayne Smith).
2. CBHOs: Improving Health Through Community Development (Marcia Bayne Smith)
Part Two: Community-Based Health Organizations: Essential Functions and Ongoing Challenges.
3. CBHOs: A Research Report (Marcia Bayne Smith, Sally Guttmacher).
4. Case Study: The Health Keepers Model of Service Delivery (Yvonne J. Graham).
Part Three: The CBHO Environment and Models for the Future 201
5. The Political and Economic Management of CBHOs (Marcia Bayne Smith).
6. Planning for Sustainability (Yvonne J. Graham).
7. The Future of CBHOs: Improving Health Outcomes for Everyone (Marcia Bayne Smith, Yvonne J. Graham).
The Authors.
Name Index.
Subject Index.
What People are Saying About This
"This is the first comprehensive account of a major new force in health care—the voices of people and communities themselves, working to shape the system to meet their needs. It is essential reading for everyone—students, providers, and planners—who will need these new partners in the effort to improve the health of our most vulnerable populations." —H. Jack Geiger, M.D., Logan Professor Emeritus of Community Medicine, City University of New York Medical School
"A lively and scholarly account of the successes and obstacles that community health organizations face." —Nicholas Freudenberg, Distinguished Professor of Public Health, Hunter College, City University of New York
"A comprehensive, scholarly, and passionate book that analyzes the health of communities and describes effective organizing models for change." —Karen Benker, M.D., M.P.H., assistant clinical professor, Department of Preventive Medicine, State University of New York Downstate Medical Center