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Current attention to health status and other health related topics are shifting to include the community as a part of this conversation.   Evidence for this shift is found in professional literature as well as on social media sites such as Facebook and Twitter. Community is no longer regarded as just a place where health happens; it is now becoming a base for inclusion of health related conversations. These community-based conversations are taking place around the world, thanks in part to social media.

Why the shift?

Within the United States the governmental level is one location at which this conversational shift is taking place.   The Affordable Care Act (ACA) (Section 2701) includes a community focus within the health quality component. This portion of the law seeks to address quality improvement of health care services through new initiatives such as measuring adult quality of care experiences. These quality measures seek input from health consumers on their experiences with the care provider and setting and how the care provided relates to improving an individual’s health status. Results from this data are included when considering changes in the healthcare payment systems. Presently such services are covered by fee for service. This could change to a pay for performance fee.

Who is thinking about this shift?

ReThink is an example of one of several organizations rethinking health focus through community-based conversations.    These conversations seek to expand membership to health related groups and individuals who will share in the development of a larger picture for health, both at the individual and community levels. Past health planning has been undertaken in small pieces with limited recognition that the small pieces are not working together. One of the participant voices excluded from these conversations are community members who can now speak from within their own community settings.

Strategies reflecting the shift

Strategies that increase the conversations and learning from the community are set forth through the work of Kretzmann and McKnight (1993), “Building Communities from within.” The authors differentiate between two different approaches that point toward building communities. One community developmental system brings its programs into a community based on previous community needs assessment data and its subsequent analysis. This process is in line with the Center for Disease Control ( who defines community health as “the study and improvement of the health characteristics of a biological community.” (

Kretzmann and McKNight suggest a second approach. This plan looks at starting within the community to discover its individual, association and institutional assets, skills and capacities. These assets help identify the development of new relationships for the purpose of building the capacity of the community.

A.R. Goodman (2014) reflects on the question many of us are still asking, “What is community health?” ( Because there appears to be a lack of shared understanding of the science and practice of “community health,” additional thought, reflection and investigation is needed to begin the discovery of this answer.

A new group, Flip the seeks to identify and develop, through open experimentation, “a transformation of the health care experience with actionable ideas for change.” This group is seeking ideas, feedback and developing allies for this focus shift within a clinical setting.

A call to action

This call to action and change at the community level and involving the community is also utilized by Paul Farmer, M. D. (www.Partners in He seeks to involve the community from the beginning in all aspects of health planning through to evaluation. He recognizes the capacity of community as a starting point but then works to build in other capacity building experiences that allow the community to grow, as it understands itself. An example of his work took place in Haiti during the HIV crisis. There he was able to include many local residents in both planning and completing health care functions that were found missing from the traditional clinic setting approach to the disease. Now Dr. Famer is speaking out along with the Open Society Foundation to address eboli. Granted this is a virus born disease but until community members understand transference factors that are included in the daily lives of each community resident, this epidemic will not easily come under control.

Dr. Farmer also recognizes that better food; living conditions and education play a part in any community-based conversation around health.

In the midst of this acknowledged shift how do you see yourself beginning to address community based issues be those issues of health, education, transportation, economic wellbeing. In addition to increasing the conversation about this shift in focus there is an aware of a call to action on the part of everyone to help build a better, larger community.

Let’s talk

Because this is a timely and ongoing conversation, I would appreciate hearing from you @eankelly08(dot) about:

Your thoughts on the topic;

If you liked this page;

Your insights and experiences on how to keep this conversation going.


 Affordable Care Act (2010). “Improving the quality and efficiency of health care.” Section 2701, Title III.

Farmer, P. (2013). To repair the world. Berkeley Ca. University of California Press.

Goodman, A. R. (2014) “What is community health?”

Kretzmann, J. & McKnight, J. (1993). Building communities from within: A path toward finding and mobilizing a community’s assets. Evanston Il. Institute of Policy Research