Community health
is a major field of study within the medical and clinical sciences
which focuses on the maintenance, protection, and improvement of the
health status of population groups and communities. It is a distinct
field of study that may be taught within a separate school of [public
health] or [environmental health]. The WHO defines community health as:
Medical interventions that occur in communities can be classified as three categories: primary healthcare, secondary healthcare, and tertiary healthcare. Each category focuses on a different level and approach towards the community or population group. In the United States, community health is rooted within primary healthcare achievements. Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management.
The success of community health programmes relies upon the transfer of information from health professionals to the general public using one-to-one or one to many communication (mass communication). The latest shift is towards health marketing.
...environmental, social, and economic resources to sustain emotional and physical well being among people in ways that advance their aspirations and satisfy their needs in their unique environment.Community health tends to focus on a defined geographical community. The health characteristics of a community are often examined using geographic information system (GIS) software and public health datasets. Some projects, such as InfoShare or GEOPROJ combine GIS with existing datasets, allowing the general public to examine the characteristics of any given community in participating countries.
Medical interventions that occur in communities can be classified as three categories: primary healthcare, secondary healthcare, and tertiary healthcare. Each category focuses on a different level and approach towards the community or population group. In the United States, community health is rooted within primary healthcare achievements. Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management.
The success of community health programmes relies upon the transfer of information from health professionals to the general public using one-to-one or one to many communication (mass communication). The latest shift is towards health marketing.
Measuring community health
Community health is generally measured by geographical information systems and demographic data. Geographic information systems can be used to define sub-communities when neighborhood location data is not enough. Traditionally community health has been measured using sampling data which was then compared to well-known data sets, like the National Health Interview Survey or National Health and Nutrition Examination Survey. With technological development, information systems could store more data for small scale communities, cities, and towns; as opposed to census
data that only generalizes information about small populations based on
the overall population. Geographical information systems (GIS) can give
more precise information of community resources, even at neighborhood
levels. The ease of use of geographic information systems (GIS), advances in multilevel statistics, and spatial analysis methods makes it easier for researchers to procure and generate data related to the built environment.
Social media can also play a big role in health information analytics.
Studies have found social media being capable of influencing people to
change their unhealthy behaviors and encourage interventions capable of
improving health status.
Social media statistics combined with geographical information systems
(GIS) may provide researchers with a more complete image of community
standards for health and well being.
Categories of community health
Primary healthcare and primary prevention
Community based health promotion emphasizes primary prevention and population based perspective(traditional prevention).
It is the goal of community health to have individuals in a certain
community improve their lifestyle or seek medical attention. Primary healthcare is provided by health professionals, specifically the ones a patient sees first that may refer them to secondary or tertiary care.
Primary prevention refers to the early avoidance and
identification of risk factors that may lead to certain diseases and
disabilities. Community focused efforts including immunizations,
classroom teaching, and awareness campaigns are all good examples of how
primary prevention techniques are utilized by communities to change
certain health behaviors. Prevention programs, if carefully designed and
drafted, can effectively prevent problems that children and adolescents
face as they grow up.
This finding also applies to all groups and classes of people.
Prevention programs are one of the most effective tools health
professionals can use to greatly impact individual, population, and
community health.
Secondary healthcare and secondary prevention
Community
health can also be improved with improvements in individuals'
environments. Community health status is determined by the environmental
characteristics, behavioral characteristics, social cohesion in the environment of that community. Appropriate modifications in the environment can help to prevent unhealthy behaviors and negative health outcomes.
Secondary prevention
refers to improvements made in a patient's lifestyle or environment
after the onset of disease or disability. This sort of prevention works
to make life easier for the patient, since it's too late to prevent them
from their current disease or disability. An example of secondary
prevention is when those with occupational low back pain are provided
with strategies to stop their health status from worsening; the
prospects of secondary prevention may even hold more promise than
primary prevention in this case.
Chronic disease self management programs
Chronic diseases has been a growing phenomena within recent decades, affecting nearly 50% of adults within the US in 2012. Such diseases include asthma, arthritis, diabetes, and hypertension.
While they are not directly life-threatening, they place a significant
burden on daily lives, affecting quality of life for the individual,
their families, and the communities they live in, both socially and
financially. Chronic diseases are responsible for an estimated 70% of
healthcare expenditures within the US, spending nearly $650 billion per
year.
With steadily growing numbers, many community healthcare
providers have developed self-management programs to assist patients in
properly managing their own behavior as well as making adequate
decisions about their lifestyle.
Separate from clinical patient care, these programs are facilitated to
further educate patients about their health conditions as a means to
adopt health-promoting behaviors into their own lifestyle. Characteristics of these programs include:
- grouping patients with similar chronic diseases to discuss disease-related tasks and behaviors to improve overall health
- improving patient responsibility through daily disease-monitoring
- inexpensive and widely-known
Chronic Disease self-management programs are structured to help
improve overall patient health and quality of life as well as utilize
less healthcare resources, such as physician visits and emergency care.
Furthermore, better self-monitoring skills can help patients
effectively and efficiently make better use of healthcare professionals'
time, which can result in better care.
Many self-management programs either are conducted through a health
professional or a peer diagnosed with a certain chronic disease trained
by health professionals to conduct the program. No significant
differences have been reported comparing the effectiveness of both
peer-led versus professional led self-management programs.
The
distribution of rural CDSME program participantsvaried across the US.
Analysis across rurality indicated that approximately 22.1% (using
county-level rurality) to24.4% (using ZCTA/ZIP Code-level rurality) of
CDSME programparticipants resided in rural areas.
There
has been a lot of debate regarding the effectiveness of these programs
and how well they influence patient behavior and understanding their own
health conditions. Some studies argue that self-management programs are
effective in improving patient quality of life and decreasing
healthcare expenditures and hospital visits. A 2001 study assessed
health statuses through healthcare resource utilization and
self-management outcomes after 1 and 2 years to determine the
effectiveness of chronic disease self-management programs. After
analyzing 800 patients diagnosed with various types of chronic
conditions, including heart disease, stroke, and arthritis, the study
found that after the 2 years, there was a significant improvement in
health status and fewer emergency department
and physician visits (also significant after 1 year). They concluded
that these low-cost self-management programs allowed for less healthcare
utilization as well as an improvement in overall patient health. Another study in 2003 by the National Institute for Health Research
analyzed a 7-week chronic disease self-management program in its
cost-effectiveness and health efficacy within a population over 18 years
of age experiencing one or more chronic diseases. They observed similar
patterns, such as an improvement in health status, reduced number of
visits to the emergency department and to physicians, shorter hospital
visits. They also noticed that after measuring unit costs for both
hospital stays ($1000) and emergency department visits ($100), the study
found the overall savings after the self-management program resulted in
nearly $489 per person.
Lastly, a meta-analysis study in 2005 analyzed multiple chronic disease
self-management programs focusing specifically on hypertension,
osteoarthritis, and diabetes mellitus, comparing and contrasting
different intervention groups. They concluded that self-management
programs for both diabetes and hypertension produced clinically
significant benefits to overall health.
On the other hand, there are a few studies measuring little
significance of the effectiveness of chronic disease self-management
programs. In the previous 2005 study in Australia, there was no clinical
significance in the health benefits of osteoarthritis self-management
programs and cost-effectiveness of all of these programs.
Furthermore, in a 2004 literature review analyzing the variability of
chronic disease self-management education programs by disease and their
overlapping similarities, researchers found "small to moderate effects
for selected chronic diseases," recommending further research being
conducted.
Some programs are looking to integrate self-management programs
into the traditional healthcare system, specifically primary care, as a
way to incorporate behavioral improvements and decrease the increased
patient visits with chronic diseases.
However, they have argued that severe limitations hinder these programs
from acting its full potential. Possible limitations of chronic disease
self-management education programs include the following:
- under representation of minority cultures within programs
- lack of medical/health professional (particularly primary care) involvement in self-management programs
- low profile of programs within community
- lack of adequate funding from federal/state government
- low participation of patients with chronic diseases in program
- uncertainty of effectiveness/reliability of programs
Tertiary healthcare
In tertiary healthcare,
community health can only be affected with professional medical care
involving the entire population. Patients need to be referred to
specialists and undergo advanced medical treatment. In some countries,
there are more sub-specialties of medical professions than there are
primary care specialists. Health inequalities are directly related to social advantage and social resources.
| Conventional ambulatory medical care in clinics or outpatient departments | Disease control programs | People-centered primary care |
|---|---|---|
| Focus on illness and cure | Focus on priority diseases | Focus on health needs |
| Relationship limited to the moment of consultation | Relationship limited to program implementation | Enduring personal relationship |
| Episodic curative care | Program-defined disease control interventions | Comprehensive, continuous and person-centered care |
| Responsibility limited to effective and safe advice to the patient at the moment of consultation | Responsibility for disease-control targets among the target population | Responsibility for the health of all in the community along the life cycle; responsibility for tackling determinants of ill-health |
| Users are consumers of the care they purchase | Population groups are targets of disease-control interventions | People are partners in managing their own health and that of their community |
Challenges and difficulties with community health
Summary of Governance Issues, Strategies, and New/Lingering Problems
The complexity of community health and its various problems can make
it difficult for researchers to assess and identify solutions. Community-based participatory research (CBPR) is a unique alternative that combines community participation, inquiry, and action.
Community-based participatory research (CBPR) helps researchers address
community issues with a broader lens and also works with the people in
the community to find culturally sensitive, valid, and reliable methods
and approaches.
Other issues involve access and cost of medical care. A great majority of the world does not have adequate health insurance. In low-income countries, less than 40% of total health expenditures are paid for by the public/government. Community health, even population health,
is not encouraged as health sectors in developing countries are not
able to link the national authorities with the local government and
community action.
In the United States, the Affordable Care Act
(ACA) changed the way community health centers operate and the policies
that were in place, greatly influencing community health.
The ACA directly affected community health centers by increasing
funding, expanding insurance coverage for Medicaid, reforming the
Medicaid payment system, appropriating $1.5 billion to increase the
workforce and promote training.
The impact, importance, and success of the Affordable Care Act is still
being studied and will have a large impact on how ensuring health can
affect community standards on health and also individual health.
Academic resources
- Journal of Urban Health, Springer. ISSN 1468-2869 (electronic) ISSN 1099-3460 (paper).
- International Quarterly of Community Health Education, Sage Publications. ISSN 1541-3519 (electronic), ISSN 0272-684X (paper).
- Global Public Health, Informa Healthcare. ISSN 1744-1692 (paper).
- Journal of Community Health, Springer. ISSN 1573-3610.
- Family and Community Health, Lippincott Williams & Wilkins. ISSN 0160-6379 (electronic).
- Health Promotion Practice, Sage Publications. ISSN 1552-6372 (electronic) ISSN 1524-8399 (paper).
- Journal of Health Services Research and Policy, Sage Publications. ISSN 1758-1060 (electronic) ISSN 1355-8196 (paper).
- BMC Health Sciences Research, Biomed Central. ISSN 1472-6963 (electronic).
- Health Services Research, Wiley-Blackwell. ISSN 1475-6773 (electronic).
- Health Communication and Literacy: An Annotated Bibliography, Centre for Literacy of Quebec. ISBN 0968103456.
