I'm on a community health list serve that focuses on improving health world-wide. This is something I got today from Jose Miguel and Luz Stella (2 people I have never met, but who work with a group called MAP international)...it's a little long, so skim it if you want :) It is most relevant for the improvement of health overseas, but I thought it was interesting for us here in the US as well in the middle of some major health reform. I don't want to get into a political blog here, but I like what he says, and think of most of it can apply here. Health in a wide definition of the word has to come from people's own motivation. Disease can be treated by doctors, but overall good health must be something people decide to pursue on their own and that I as a physician can never achieve for someone without their own help.
Over some delicious Thai food last night Aaron was grilling me on various questions about experiences with educated patients vs uneducated, compliance issues etc in relation to a paper he is writing. After attempting to answer his questions with my limited 5 months of doctoring experiences, I was telling him that I had spoken with one of my attendings about possibly getting involved in some school violence research she is doing and Aaron asked what school violence had to do with health. To me it has everything to do with health. I think the writing below helps sum up why we as pediatricians think everything has to do with health -- violence in schools, nutrition, disease prevention, self esteem, sleeping habits, grades, parenting habits, disciplining and so much more. Health is not just a narrow topic that deals only with disease but undermines how you can experience life.
"We are more and more convinced that health cannot be purchased, donated,
provided or "delivered". Health is a social process given by the capacity
for full self-actualization as individuals, families and integrated
communities (according to the will of God) in the various bio-psycho-social
aspects, in a self-sustaining manner without jeopardizing the conditions
which would allow successive generations to experience this fullness.
Comprehensive Health is a social process which enables individuals and
societies to gain control over health determinants and adapt dynamically to
their environment, engaging in the transformation of all those factors which
prevent the entire society from living in harmony and justice (with each
other, with God, and with the various physical, biological and psychosocial
ecosystems), without experiencing progressive conflict (or disease) and
without the presence of high risk of damaging their state of health if this
lifestyle and these ecological conditions are maintained. This is a new
paradigm no focused on "health services delivering" but on facilitating self
empowering process in communities to gain control over those health
determinants. CHWs play a key role making this a reality. Health is a
journey manifested in a dynamic process of self-empowered families &
communities gaining control over an integrated web of health determinants
that enables them for the construction of meaningful and sustainable
families and society.
This new paradigm of understanding health and development requires new ways
of approaching the way in which people see their own problems, fears, dreams
and desires, and how they can assume full responsibility in the direction of
their own history. Diagnosis and planning processes cannot continue to be
made from an outsider's perspective. True development and true health is a
matter of people, and not only health services or the measuring of
statistical data about biological, economical, or production phenomena.
History has shown that significant sustainable community development happens
only when local community people have developed the capability and
responsibility to invest themselves and the resources in the effort of
building their own well being. Communities have not been built from the top
down or from the outside in. Communities are the fruit of their own
intertwined processes and the ability they develop to care for themselves
and to proactively dialogue and interact with other communities or cultures
(but keeping the power to maintain their own identity and control of their
own history). Each society throughout history constructs a set of concepts,
beliefs and unstated assumptions about life, their society and the universe
that constitute a particular worldview for that specific group. People's
worldview is one of the most critical lenses through which they view
reality. It is the frame of reference for their thoughts and actions and
for the assumptions about how the world is and ought to be organized. God
knows very well each cultures and context and God can rise in each setting
committed people to make Jn 10:10 a reality in their families and
communities. Our responsibility is not to go to solve problems, but to go to
facilitate local people to assume responsibility on God's mission for their
land and contexts. CHWs that have tasted God's love and commitment for life
become very effective facilitators in the transformation of communities
worldviews, a critical element for behaviors modification.
The traditional goal of "Health for All" needs a new approach of "All for
Health" in which the "priesthood of the believers" can be embodied
constructing healthy environments, healthy behaviors and healthy policies
that allow nurturing and sustainable conditions for the coming generations.
CHWs are the facilitators of local movement to achieve this.
Self-empowerment allows self-agency and co-agency processes of local
communities assuming responsibility for their own health, wellbeing and
history. When impoverished communities discover "we are the people we have
been waiting for", new children, new families, new local organizations, and
new communities will rise."
Hope you stuck through it all...some good stuff in there :)
