by Jacqline Wolf Tice
C.E.A. Winslow, the 20th-century “founder” of the modern public health movement, famously described public health as, “the science and the art of preventing disease, prolonging life, and promoting physical health and mental health and efficiency through organized community efforts.” His seminal description is included in textbooks worldwide and lays the foundation for all Community Health initiatives and programming. Winslow specifically describes these efforts as “science and art,” implying the need for both empirical and subtle methods of inquiry that encompass the biological, psychological, and social components of the human experience. In Community Health, socioeconomic factors, such as income level, education, job status, housing situation, and transportation availability, are equally as important in addressing health as knowing one’s medical history. Through understanding and addressing these factors, underlying causes for conditions can be addressed. For example, if I do not have steady employment, and receive SNAP benefits (Supplemental Nutrition Assistance Program), I may limit my fresh food intake in favor of high-calorie, less nutritious, insulin-boosting products that have a longer shelf life. If I am unable to visit my physician due to a lack of easy transportation, or I live in a “food desert” with low access to fresh food, my risk of developing diabetes increases.
Community Health assesses the built environment (schools, work environments, housing), ambient environment (air, water, soil, climate), and the many human/social/community structures and norms in order to evaluate the broader mechanisms that might assist entire populations in working towards better health and wellbeing. There are many models for implementing population-based initiatives; the Ecological Model is one which is common and easily understood. From a micro-perspective, the individual sits within the relational, organizational, community, and public policy contexts of society, as all of them contribute to overall health. This model provides a structure for Community Health to monitor individual behaviors like exercise and dietary choices; to compare individual choices among friends; to evaluate if there is access to good schools and a coordinated system of healthcare delivery that ensures your medications won’t produce negative effects; and to evaluate the effects of zoning laws that govern open spaces in communities. When certain conditions – such as diabetes, drug addiction, and low-birth-weight babies—begin to “cluster” (become prevalent) in specific areas, or in certain populations, the structure of the Ecological Model provides a mechanism by which we can answer the question, “Why?”
In 2015, St. Luke’s Community Health Department conducted a Community Health Needs Assessment by asking around 3,000 participants a series of questions related to the various categories describe in the Ecological Model. While the formal report will be released later in 2016, their data will describe the present condition of population health and inform appropriate programming. A previous CHNA indicated high rates of obesity and high blood pressure, especially in low-income vulnerable populations. This is a marker of health disparities. As a result, the Bethlehem Partnership—a collaborative of over 200 area providers, including the school district, community organizations, local businesses, and social service agencies—worked together to develop performance indicators for a report card with partners collecting and analyzing data. One solution implemented is the Adopt a School model, a comprehensive strategy with goals focused on improving health outcomes by making programs accessible to uninsured or under-insured children through the use of Mobile Vans. These Vans provide medical, dental, vision, and mental health assessments and programs, various physical activity and nutrition education initiatives, and literacy programs and youth mentoring programs. Food security was another area of concern in the Lehigh Valley. In response, the Kellyn Foundation provides programs such as school gardens and a Mobile Market to bring fresh food from local farmers into food insecure neighborhoods in Easton, Bethlehem and the Slate Belt.
The Health Bureaus in Bethlehem and Allentown have, among their many initiatives, active monitoring programs for HIV/AIDS, communicable diseases, maternal and child health, and tobacco cessation services.
“Prevention” and “Partnerships” are the two most important words in Community Health. As Winslow urges, the ability to prevent disease, prolong life, and promote mental and physical health requires a comprehensive understanding of all contributing factors, as well as a network of capable organizations to enable solutions. The Lehigh Valley has work to do in areas of equity and access to services, but there are strong, committed actions in motion right now that will continue to improve health outcomes across the Valley.
by Jacqline Wolf Tice
Jacqline Wolf Tice is a Certified Health Education Specialist and is in the Master’s Degree program in Environmental Policy Design program at Lehigh University.
(Essays express the ideas of the individual authors and do not necessarily represent the views of the Alliance.)