April 6-12 is National Public Health Week. In honor of Thursday's theme of "Building Broader Communities" and the week's overall theme of Healthiest Nation 2030, we present this article, adapted from Chapter 9 of Community-Oriented Health Services, by Elias Mpofu, Phd, Ded, CRC.
The global gap between the “haves and the have-nots,” and the contrasting issues of undernutrition among the poor and overnutrition among the wealthy, have been recognized for more than a decade (World Health Organization [WHO], 2002). Health and health needs differ markedly between high- and low-resource settings and while most health risks cluster around the poor or most disadvantaged, no risk occurs in isolation and each may have one or more causes.
Health care systems have the potential to reduce health risks and achieve “good” outcomes and efficiency when their four core functions (financing, resource generation, service delivery, and stewardship) are organized and carried out in a systematic manner. Although health care spending varies widely across the world, merely allocating more funds/resources to health care by a country does not mean the health care system will be more effective or efficient.
In low-resource settings (which may include settings where there are limited financial assets; buildings; infrastructure; residents/people living in the community; and actions that individuals, groups, or communities may take to address adverse conditions or situations), people may be more likely to experience poorer health and suffer an unequal burden of illness, premature death, and disability than those in more advantaged areas or communities. Those living in low-resource settings may also be more likely to face scarcity of medicines and public medical care, or less likely to access care, placing them in a situation of not only requiring more care and services but also, not having opportunity or resources to access available care and services.
Reducing inequities in health and health care requires the efforts of entire communities to create community partnerships, for identifying health needs, and also for problem solving and taking action. In the last 20 years, community-oriented approaches have underpinned many health services provided in low-resource settings. Community-oriented health services (COHS) are those that support participatory health and well-being. In line with the WHO’s International Classification of Functioning, Disability, and Health (ICF), participation is an important health quality process and outcome. Participation is (and has been) most commonly considered from an individual’s perspective regarding involvement in his or her health management or health promotion.
In considering participation from a community perspective, we need to consider more broadly individuals’ participation and involvement in formal and informal networks and/or community-oriented services or programs (which may or may not be related to a specific health condition). We must explore the concept of “participation” in community health, encompassing the concepts of community participation and community capacity, and spanning a range of disciplines and resource-challenged communities and/or settings. Specifically, it describes the nature of a low-resource setting, as well as the concepts of community participation and community capacity for health and provision of health service as they apply in low-resource settings. Finally, consideration is given to contextual differences in the health of communities and development of interventions to reduce health inequities, support community participation in health, and promote capacity building in communities in low-resource settings.