Thinking that ‘Community Health’ like any other phenomenon may mean many things to different people, the opinions of experts on the CH-CoP were requested on what ‘community health’ really means to each one of them.
Though started by Tarry Asoka on 12 February 2018, the conversations are still open, and so far, 17 responses of which 11 in French and 6 in English have been generated (see the graphic below). Other than having clarity on what community health denotes, an additional aim is to differentiate this term from related ideas such as Primary Health Care and Public Health, and whether community health can be measured. What follows is a synthesis of the views of the experts.
Defining Community Health, many experts think necessary to start defining related concept like Community. So they defined community as:
“A group of people who might have different characteristics but share geographical location, settings, goals or social interest. Examples of communities include people living in the same town, village, and members of a church, mosque or members of a sports association.”
Considering other concepts related to community health, experts stated that it was a field of action in public health, a key issue of Primary Health Care, a central strategy for preventive medicine, a core strategy in health promotion, a strong indicator of the place occupied by communities in political decisions and development, a way to universal health coverage. We can outline some statement as: “PHC is a veritable strategy for improving Community Health”, “Community health is a field of action in public health”, “Community health is, ‘an effort to improve health and reduce health inequities”.
- Community health as a production of actors in society
Experts drew attention to the centrality of actions taken by “individuals, households, families and communities’ agency for the improvement of their health/wellbeing”. They stated it in two parts: autonomous health actions developed by these actors (e.g. villagers’ decision to keep their well clean) and those actions taken by them when it is encouraged by an external player (e.g. a program, a health facility). One can retain that community health is the product of social interactions between different actors in order to promote, protect and preserve health within a given community. The ‘wide array’ of community actors includes among others, individuals, households, extended families, communities, civil society actors (grassroots organizations, churches, NGO etc.), firms, and governments all levels. Some statements can be given as illustration:“Community health starts from the (empirical) recognition that good health (and wellbeing more in general) is (also) the outcome of behaviors/actions by a wide array of actors (and not just the health facilities and staff with a clinical training)“Community health is a basic health consideration driven from the affected people in the communities in order for them to prepare physically, mentally, psychologically, environmentally and all other important factors considered which will mitigate their exposure to health problems.”
- Community health builds on community participation
Related to the first perspective of community health as a social production, is the role of community actors who play a dual function of “delivering some specific actions (e.g. when adults recommend children to wash their hands before eating)” and “supporting those actions mainly delivered by others which relies for their effectiveness, efficiency, fairness or sustainability on community actors (e.g. health facilities need community actors to find patients lost in follow-up)”.Experts have, thus, indicated that community health builds on community participation. The effective community participation is conscious, voluntary, systematic and driven by the goal of health improvement and well-being of people. This also required effective appropriation and empowerment of communities.
- Community health as a process with different stages
For many experts, community health is defined through its implementation. Thus, it implies different stages which can be resumed as follow: (i) reflexions on needs and priorities or community diagnostic, (ii) execution, (iii) management and evaluation of activities. Some principles are stated to guide this process. Therefore, it is about “not doing for people”, but “doing with people”.
- Community is a field of tensions and an issue for community’s perceptions
Understanding community health also imply to take into account some tensions. As stated by an expert: “First, it requires both a vision (it is about transforming the society) and contextualised empirical validation (versus idealism/ideology). Second, it bumps into the normative, political and empirical challenge of defining what communities are (especially in individualistic societies) and what their legitimate area of influence (versus individual choice for instance) is. Third, it is today a dynamic area of intervention in global health, with all the issues related to power at local, national and global level (cf among others, the risk of instrumentalization mentioned above).”
The lines of tensions that underlie community health let see some significative couple: ideology/empirism, individual/community, local, national/global.
Community’s perception of ‘community health’ is also a point of interest in community health. The example come from Gambia during a PRA processes. Simple concepts that come to the mind of the ordinary woman and man in the rural area when one speaks of community health might include ‘protecting and improving our well-being’, “us-community” versus “them-external”. The perception of community health also shed light on some tensions that may exist and on which one should bear attention. So the views on community health from a community’s perspective are not intended to confuse but help us in unpacking the concepts in the scientific definition of the term.
Within the CH-COP, this is not going to be the end of the discussions as regards what community health really means, rather it helps us to facilitate the conversations that will ensue.
Thanks to all experts for their richful contributions!
Let’s contribute in our CH-CoP platform!