It takes a community.

Abstract

From the Editor-In-Chief Health AffairsVol. 33, No. 11: Collaborating For Community Health It Takes A CommunityAlan R. WeilPUBLISHED:November 2014Free Accesshttps://doi.org/10.1377/hlthaff.2014.1092AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHealth disparitiesHealth outcomesPopulation healthPayment modelsSocial determinants of healthChildren's healthIt is now well understood that population health arises more from social determinants than it does from clinical care. As payment models for health care services gradually incorporate rewards for better health outcomes, health care providers are coming to understand the importance of social context. Around the country we observe health plans, hospitals, and physician practices building stronger relationships with social support systems that can meet critical patient needs that directly affect health.While laudable, these efforts are not designed to alter fundamental community characteristics that determine health. Addressing social determinants of health and disparities that arise from them requires deploying the entirety of community assets. The health care system cannot—nor should it be expected to—tackle these problems alone. Community development has its own history, with an emphasis on creating jobs and affordable housing. Viewing community development as an opportunity to improve health is a more recent phenomenon. This month’s issue of Health Affairs examines new possibilities created by alignment of the fields of health and community development. Manuel Pastor and Rachel Morello-Frosch review recent changes in the community development field that have set the stage for the new focus on improving health. They “stress that efforts to promote an urban health agenda must directly engage and empower disadvantaged groups to advance broader systems change.”Ian Galloway describes how social impact bonds, or “pay-for-success,” can be used to work around the limitations of the fee-for-service payment model that dominates health care. Galloway explains how this approach, which provides a financial return to investors based on improvements in health outcomes attributable to a targeted intervention, can provide a much-needed source of funding for these types of investments.MeasurementThe drive toward measurement is not unique to the health care field. Assuring that community development promotes health requires valid and reliable metrics that capture the relationship between community attributes and population health. Three papers in this issue (by Matthew Trowbridge et al., Joseph Schuchter and Douglas Jutte, and Bethany Rogerson et al.) address alignment between health and development goals. While noting barriers to alignment, together these papers offer a path forward to harness growing interest among the real estate and community development fields to attend to the health needs of people affected by their work.DisparitiesInherent in the community development enterprise is the need to address disparities. Dolores Acevedo-Garcia and colleagues present the Child Opportunity Index and demonstrate that white non-Hispanic and Asian or Pacific Islander children are disproportionately represented in the highest-opportunity neighborhoods while black non-Hispanic and Hispanic children of any race are disproportionately represented in the lowest-opportunity neighborhoods. Dima Qato and colleagues show that pharmacy access varies by the racial and ethnic composition of Chicago neighborhoods.Andrew Beck and colleagues bring together the issues of disparities and measurement. They combine data on housing code violations with data on children’s hospitalization for asthma to map the need for targeted interventions to improve health.CollaborationWhat does it take to harness community resources to overcome poor health outcomes? In a word: collaboration. Just as health does not arise from a single factor, healthy communities emerge from concerted efforts that stretch across public and private sectors and break down barriers between the long-standing silos of different government agencies and programs. Papers by Jason Corburn et al., Rajiv Bhatia, Shana Sandberg et al., and Emilio Carrillo et al. provide examples from California, Minnesota, and New York of the kind of collaboration that holds the promise for achieving results.AcknowledgementHealth Affairs thanks the Kresge Foundation, the Robert Wood Johnson Foundation, and the Annie E. Casey Foundation for their generous support of this issue, and Steven Woolf for help planning the issue. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 3 History Published online 1 November 2014 Information Project HOPE—The People-to-People Health Foundation, Inc. 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