Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available
Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available
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DOI：
10.1111/jep.13495
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发表时间：
2020-10-13
影响因子：
2.4
通讯作者：
Kitzman, Heather
中科院分区：
文献类型：
--
作者：
DeHaven, Mark J.;Gimpel, Nora A.;Kitzman, Heather
基本原理，目的和目标美国的医疗保健提供模式不起作用;它使获得医疗服务的不平等现象永久化，有利于治疗而不是预防，并导致持续的健康差距和缺乏保险。绝大多数患有可预防疾病和健康差距的人，以及没有保险的风险最大的人，是生活在高风险和脆弱社区的低收入少数民族（美洲原住民，西班牙裔和非洲裔美国人）。美国历史上缺乏对全民医疗保健（UHC）和初级卫生保健（PHC）的支持，强调全民医疗保健，人口健康和健康的社会决定因素，需要社区卫生科学家开发创新的本地解决方案，以解决未满足的社区卫生需求。方法我们开发了一个模型社区健康科学的方法来改善脆弱社区的健康状况，通过结合社区为导向的初级保健（COPC），社区为基础的参与性研究（CBPR），基于资产的社区发展，和服务学习的原则。在过去的二十年里，我们的团队与社区居民，当地领导人和许多不同类型的组织合作，以满足弱势患者的健康需求。该方法将健康定义为临床科学、集体责任和知情的社会行动相结合的社会成果。结果从2000年到2020年，我们建立了一个联邦资助的研究计划，通过与社区组织和其他利益相关者合作，测试干预措施，以改善弱势社区的健康结果。该伙伴关系的目标是减少慢性病风险和多种疾病，具体做法是促进改变生活方式，增加健康行为和健康知识，改善就医和病人自我管理，以及解决健康和人口健康的社会决定因素。我们的方案还在高风险社区为数百名受训医生提供了结构化的社区卫生科学培训。我们的社区卫生科学方法表明，只有直接与受影响社区合作，共同开发各种因果因素的医疗保健解决方案，才能解决影响健康的因素。随着美国开始考虑扩大符合PHC和UHC原则的医疗保健选择，我们的社区卫生科学经验为如何让社区参与解决当前系统的缺陷提供了有用的经验教训。也许美国卫生保健系统更好地解决人口健康和健康的社会决定因素的最大资产是大多数地方社区已经开展的重要健康相关举措。在当地资源和卫生举措的持续社会决定因素的基础上建立伙伴关系，是医学有意义地让社区参与改善卫生成果和减少卫生差距的关键。这是我们在过去二十年中学到的最重要的一课，为我们的社区卫生科学方法提供了基础，也是我们取得成功的原因。
Rationale, aims, and objectives The health care delivery model in the United States does not work; it perpetuates unequal access to care, favours treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are low-income minorities (Native Americans, Hispanics, and African-Americans) who live in high risk and vulnerable communities. The historical lack of support in the United States for Universal Health Care (UHC) and Primary Health Care (PHC)-with their emphasis on health care for all, population health, and social determinants of health-requires community health scientists to develop innovative local solutions for addressing unmet community health needs. Methods We developed a model community health science approach for improving health in fragile communities, by combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. During the past two decades, our team has collaborated with community residents, local leaders, and many different types of organizations, to address the health needs of vulnerable patients. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. Results From 2000 to 2020, we established a federally funded research programme for testing interventions to improve health outcomes in vulnerable communities, by working in partnership with community organizations and other stakeholders. The partnership goals were reducing chronic disease risk and multimorbidity, by stimulating lifestyle changes, increasing healthy behaviours and health knowledge, improving care seeking and patient self-management, and addressing the social determinants of health and population health. Our programmes have also provided structured community health science training in high-risk communities for hundreds of doctors in training. Conclusion Our community health science approach demonstrates that the factors contributing to health can only be addressed by working directly with and in affected communities to co-develop health care solutions across the broad range of causal factors. As the United States begins to consider expanding health care options consistent with PHC and UHC principles, our community health science experience provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest assets US health care systems have for better addressing population health and the social determinants of health are the important health-related initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for improving health outcomes and reducing health disparities. This has been the greatest lesson we have learned the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.