In my two previous blogs “Starting our Journey to a Healthier, More Prosperous Future in Western Kentucky” and “How to Begin”, I tried to lay out a proposal for building a better future in rural western Kentucky by first creating an improved environment for community health. In this post, I’ll try to explain a bit about what community health is, why it is important and why your personal health and wellness matters to us all.
Community health is actually a bit complicated. It’s difficult even to find a definition that people can agree on that really covers the subject. It’s hard just to define “community”. Often, people speak of a community as a group of people with some defining characteristic, like “the Hispanic community” or “the medical community”. Other times, a community is defined geographically, on any number of scales. A community defined that way could be anything from a group of people living on a street to everyone living in a county, state or any other politically-defined area. From the perspective of the entire biosphere (the Earth and everything that lives on it), the entire human race would be considered a community. One thing all definitions of community have in common is that the members who make up the community share something—whether it is a language, a profession, a location, a social status or whatever. For the purposes of our proposal, however, defining the community is relatively easy. What we share is location. Our community is every single person living in the region of western Kentucky in which our coalition will be operating. I can’t say exactly what that area is going to be, yet, because we haven’t come to a final decision on that. Right now, if you look at our Facebook page (Western Kentucky Community Health Partners), you will see a map that includes Hopkins, Muhlenberg, Webster, Crittenden, Caldwell, Christian, McLean, Union, Henderson, Trigg and Lyon counties, so, for now, everyone who lives in that area is our community. When I first started working on this project, I chose that region because I don’t think Hopkins County, or any other county, for that matter, can prosper as an island in the midst of other rural counties that are still stuck looking for a new way forward. I think if we are to become that “example of what rural communities can be” that I mentioned, we have to work together and rise as a region, not as an isolated community or an isolated county.
Having defined our community, we need to define what we mean by “community health”. I was looking through some of the professional journals that deal with public health and I found an article that had what I think is a pretty good definition: Community health is a multi-sector and multi-disciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities, in a culturally appropriate manner, to optimize the health and quality of life of all persons who live, work, or are otherwise active in a defined community or communities. It isn’t poetry, but it hits all the important ideas. Let’s look at them one at a time.
- It is multi-sector. This means that any effective community health activity has to involve the public, the government, public organizations and private organizations. It can’t be driven from the top down and it can’t be done without involving all of the different sectors of the community.
- It is multi-disciplinary. This means it can’t be just traditional healthcare providers. As I pointed out in the earlier articles, traditional healthcare only accounts for about 20% of what determines health outcomes. The other 80% relies on things like education, housing, transportation, nutrition, economic development, behavioral health, child development, the physical environment and so forth. This is where working collaboratively to identify and address the underlying causes of poor health in a family comes in.
- It is collaborative. We have many wonderful resources available already to our people, but the various organizations work independently, addressing parts of the problem, but seldom being able to address everything. Working independently, we are constantly treating symptoms and consequences. Working together, we can treat the causes and put an end to the cycle.
- It is evidence-based and uses public health science. This is really important, both in respect to achieving the outcomes we want and to attracting resources to support the work. What it means is that we have to do our homework and find out what works and how we can apply it to our situation. We can’t just guess at things that might work. There is always room to try new ideas, but it all has to be based on what evidence says will work.
- It must engage communities. If this is going to work—if we are to be successful in building the future we seek—we have to have buy-in from the people. We have to get people involved and committed to work toward the changes that we need to make and the things we need to do. Without wide-spread support from the people, there is no chance we can make this happen. We can’t tell people what they need. We have to listen to what the people say they need.
- It has to be culturally-appropriate. The rural culture is one big reason I think we can build a new future here. However, we aren’t just that one big culture. Within our region of western Kentucky, there are many different sub=cultures, all of which are valuable. What works well for one group might not work as well for another. The fundamental issues that affect one group may not be significant problems for another group. We have to work with people and preserve our individual cultures, in order for our collective culture—that of rural America—to move forward. We all have to rise together, because if we leave anyone behind, it will act as an anchor on our progress.
- “To optimize health”. That requires us all to look at health differently. Health is not being able to sit up and take nourishment. Health is not defined as not needing to go to the emergency room today. Health means managing your life in such a way as to achieve the best physical and mental condition that is possible for you. If you are 25 and have no chronic medical conditions, what constitutes health for you is probably different than what optimal health means to someone who is 85. But whether one is 25 or 85, it’s a pretty good bet that one’s optimal health could be improved. It’s a certainty it could be improved if the 85 year-old had paid just a little more attention to her health when she was 25 and avoided some of the choices that might have led to the complications she is now dealing with. Health isn’t something you go to the doctor to get back once you lose it. Good health is something that is created and maintained. A big chunk of health is based on choices. When health issues arise, they need to be managed. Acute illnesses (“acute” means sudden-onset and generally short-lived, not severe), like appendicitis, have to be dealt with quickly in a health-care setting. Other illnesses that persist over time (chronic diseases), like diabetes or asthma, also have to be managed, but the management is different from management of acute illness. Type 2 diabetes can be controlled through diet, exercise and, perhaps, medication. If it is properly managed, someone with type 2 diabetes can live a perfectly normal life with no complications. Achieving that level of management may or may not be possible for some patients due to the circumstances of their lives. The point is that health is a way of life that depends on many factors that don’t directly have anything to do with traditional healthcare.
- “Quality of life” is a big consideration. As the old saying goes, “it’s not the years of your life—it’s the life in your years”. One of the terrible statistics about the state of health in rural Kentucky is that people in rural areas of the state live lives that are 4 or more years shorter than average. On top of that, over 20% of people report that they are in poor health. Not only are our lives shorter, we are less healthy before we get around to dying. Physical health is only part of the picture, though. Mental wellness, social inclusion and the physical environment we live and work in play a huge role in quality of life.
All of this applies to the community, just as it applies to individuals in the community. Communities are healthy or unhealthy, just as people are. Kentucky is an unhealthy state, ranking in the bottom five in overall health outcomes. Rural Kentucky is even worse. And that is holding us back. We can build a better future for ourselves and our kids if we can work toward making ourselves and our communities healthier, and by being healthier, we can be more economically prosperous. We can show everyone what is possible in rural America. Remaking a community is not impossible. It can be done and it can be done here. It can be done by us. It can start with you. Take that step that starts a great journey. Smoke one less cigarette. Check in on a neighbor. Read to a kid. Walk a hundred feet further. Serve your family a salad with supper. There are a million little ways to begin. The key is to just start.