Community health

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Community health is a branch of public health which focuses on people and their role as
determinants of their own and other people's health in contrast to environmental health, which
focuses on the physical environment and its impact on people's health.

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:

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.[1]

Medical interventions that occur in communities can be classified as three categories: primary care,
secondary care, and tertiary care. 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.[2] 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 .

Contents

1 Measuring community health

2 Categories of community health

2.1 Primary healthcare and primary prevention

2.2 Secondary healthcare and secondary prevention

2.2.1 Chronic disease self management programs

2.3 Tertiary healthcare

3 Challenges and difficulties with community health

4 Community health in the Global South

5 Academic resources

6 See also

7 References

8 Further reading

9 External links

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.[3] 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.[4] 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.[5] 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.[6]

Social media can also play a big role in health information analytics.[7] Studies have found social
media being capable of influencing people to change their unhealthy behaviors and encourage
interventions capable of improving health status.[7] 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.[8][9]

Categories of community health

Primary healthcare and primary prevention

Community based health promotion emphasizes primary prevention and population based
perspective (traditional prevention).[10] 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.[11] 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 significantly impact individual,
population, and community health.[11]

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.[12] 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.[13]

Chronic disease self management programs

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Chronic diseases has been a growing phenomena within recent decades, affecting nearly 50% of
adults within the US in 2012.[14] 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.[15] 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.[16] 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.[17][18]

Furthermore, better self-monitoring skills can help patients effectively and efficiently make better
use of healthcare professionals' time, which can result in better care.[19] 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.[18]

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 utilizations 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.[20] 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.[21] 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.[15]

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.[15] 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.[16]

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.[22] 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:[19]

underrepresentation 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.[12] Health inequalities are directly related to social advantage and
social resources.[12]

Aspects of care that distinguish conventional health care from people-centred primary care[23]

Conventional ambulatory medical care in clinics or outpatient departments Disease control

programmes People-centred 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 programme

implementationEnduring personal relationship

Episodic curative care Programme-defined disease control interventions Comprehensive,

continuous and personcentred 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

See also: Cultural competence in healthcare

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.[24] 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.[24]

Other issues involve access and cost of medical care. A great majority of the world does not have
adequate health insurance.[25] In low-income countries, less than 40% of total health expenditures
are paid for by the public/government.[25] 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.[25]

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.[26] 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.[26] 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.

Ethnic disparities in health statuses among different communities is also a cause of concern.
Community coalition-driven interventions may bring benefits to this segment of society.[27]

Community health in the Global South

Access to community health in the Global South is influenced by geographic accessibility (physical
distance from the service delivery point to the user), availability (proper type of care, service
provider, and materials), financial accessibility (willingness and ability of users to purchase services),
and acceptability (responsiveness of providers to social and cultural norms of users and their
communities).[28] While the epidemiological transition is shifting disease burden from
communicable to non communicable conditions in developing countries, this transition is still in an
early stage in parts of the Global South such as South Asia, the Middle East, and Sub-Saharan Africa.
[29] Two phenomena in developing countries have created a "medical poverty trap" for underserved
communities in the Global South — the introduction of user fees for public healthcare services and
the growth of out-of-pocket expenses for private services.[30] The private healthcare sector is being
increasingly utilized by low and middle income communities in the Global South for conditions such
as malaria, tuberculosis, and sexually transmitted infections.[31] Private care is characterized by
more flexible access, shorter waiting times, and greater choice. Private providers that serve low-
income communities are often unqualified and untrained. Some policymakers recommend that
governments in developing countries harness private providers to remove state responsibility from
service provision.[31]

Community development is frequently used as a public health intervention to empower

communities to obtain self-reliance and control over the factors that affect their health.[32]
Community health workers are able to draw on their firsthand experience, or local knowledge, to
complement the information that scientists and policy makers use when designing health
interventions.[33] Interventions with community health workers have been shown to improve
access to primary healthcare and quality of care in developing countries through reduced
malnutrition rates, improved maternal and child health and prevention and management of
HIV/AIDS.[34] Community health workers have also been shown to promote chronic disease
management by improving the clinical outcomes of patients with diabetes, hypertension, and
cardiovascular diseases.[34]

Slum-dwellers in the Global South face threats of infectious disease, non-communicable conditions,
and injuries due to violence and road traffic accidents.[35] Participatory, multi-objective slum
upgrading in the urban sphere significantly improves social determinants that shape health
outcomes such as safe housing, food access, political and gender rights, education, and employment
status. Efforts have been made to involve the urban poor in project and policy design and
implementation. Through slum upgrading, states recognize and acknowledge the rights of the urban
poor and the need to deliver basic services. Upgrading can vary from small-scale sector-specific
projects (i.e. water taps, paved roads) to comprehensive housing and infrastructure projects (i.e.
piped water, sewers). Other projects combine environmental interactions with social programs and
political empowerment. Recently, slum upgrading projects have been incremental to prevent the
displacement of residents during improvements and attentive to emerging concerns regarding
climate change adaptation. By legitimizing slum-dwellers and their right to remain, slum upgrading is
an alternative to slum removal and a process that in itself may address the structural determinants
of population health.[35]