Thinking Holistically: A Community-Based Approach to Health Care
Many people claim inspiration from Dr. Paul Farmer, the founder of the global health NGO Partners In Health (PIH), myself included. I just had the pleasure of reading Tracy Kidder’s Mountains Beyond Mountains, which examines the life and philosophy of Dr. Paul Farmer’s work on infectious diseases. The book explores the relationship between poverty and health care, with a particular focus on Haiti, one of the most medically underserved countries in the world. Despite the immense challenges faced in the regions where PIH operates, Dr. Paul Farmer’s dedication to a community-based approach to public health has refocused public concern around local health care. The widely acclaimed health care model implemented in Haiti centered on conducting a community health census to identify local problems and needs.
Years later, the idea of conducting a community health census made its way into American politics. In 2010, the Patient Protection and Affordable Care Act (PPACA) was passed by the United States Congress and signed into law by President Obama. Among the changes that came with the PPACA was a requirement for nonprofit health care systems to adopt a whole new perspective through a Community Health Needs Assessment (CHNA).
The CHNA directs nonprofit hospitals to produce a report on the health needs of its surrounding communities, as well as a health implementation plan once every three years.
What may be the most interesting aspect of the CHNA is its ability to identify specific barriers patients face when it comes to accessing health care, and how the hospital attempts to address those barriers. In order for a hospital to adequately address the health needs of its patients, it must first understand the social and economic issues the community faces. After all, we are a product of our environment. Communities with high levels of obesity, lack of nutritional food, drug or alcohol use, violence related to gangs, and other themes can all be accounted for within the CHNAs. Each community is unique.
Some hospitals have been dedicated to this type of outreach long before the PPACA required nonprofit hospitals to understand the greater health needs of their communities. Boston Medical Center (BMC) is the largest safety net hospital in New England which provides a significant level of care to low-income, uninsured, and vulnerable populations. In 2001, BMC launched the Preventative Food Pantry, a response to the increasing number of patients that reported having a difficult time affording nutritional food for their families. Later that same year, BMC launched the Demonstration Kitchen to educate patients on how to cook healthy meals at home. The Domini Social Bond Fund currently invests in a bond issued by the Boston Medical Center.
Community-based approaches have the potential to change the face of health care. Just like BMC, hospitals can be in the business of not only treating the sick or injured, but can also assist in preventing disease in the first place. Increased transparency and the disclosure of community health obstacles is key to holistically improving the health of the greater community and the health of our loved ones.