What is a Community?
Although community is a part of our daily experiences, the idea of community is elusive and can mean many things, particularly in a health care context (Bent, 2003). Attitudes about the role of community in health care and health policy differ when compared with attitudes about the role of community in other areas. For example, health care entrepreneurs view health care communities as a market where they are likely to find a concentration of persons to buy health care goods or services; however, public health professionals must be concerned about entire populations in a given area regardless of people’s ability to buy, knowing that where economic market potential is lower, health risks and needs may actually be higher (Geronimus, 2000). Although the concept of community has broad appeal, in a politically charged environment, claims of community often become moral claims that may serve to divide people more than bring them together (Monroe, 1997). For example, differing neighborhoods within cities or towns may have competing interests for zoning regulations that affect traffic flow in and out of the community, local job opportunities, and health risks associated with production waste. This effect has serious consequences for questions of public health and the policies that support or define public health, such as policies that mandate reporting of or vaccination against communicable diseases or policies that exclude certain health care treatments from government health insurance programs.
Milio (2002) has noted that the basis for health lies in physical communities, where we find homes, schools, recreation and entertainment centers, faith centers, businesses, and governmental and voluntary organizations. These assets, along with means of communication and transportation, form a community’s infrastructure (Box 91-1). The quality, availability, and accessibility of the infrastructure make a difference in health prospects of the people who live in those communities.
Communities must share both spirit and a sense of place in order to build, achieve, and sustain health and well-being. Through attachment to place, communities share attachment to social responsibility for creating healthy surroundings. This attachment does not exist among detached groups that may share other interests (Milio, 1996). The importance of the physical and socio-economic environments in determining the health and needs of communities and individuals is well-recognized. As noted by the Institute of Medicine, “the health risk conferred by place is above and beyond the risk that individuals carry with them” (IOM, 2003, p. 68), and there is international interest in understanding the relationships among communities of place and health of the population (Diez Roux, 2001; Durie & Wyatt, 2007). Commitments to community-level responsibility for healthy populations pose challenges to most of our current and emerging health policies, which overwhelmingly target health care service delivery and health insurance. Can you think about what kinds of actions or policies within your community may be affecting health or quality of life? How would you work within a multidisciplinary context to promote health at the community level in these areas?