Population Health Blog

Population Health Blog

Why It Matters

Creating resilient communities

By Dennis Archambault

At a time when society is undergoing a difficult transition, one in which the future of the Afforable Care Act — specifically expanded Medicaid, as well as the support of community health centers and graduate medical education teaching health centers is in doubt, it is helpful to consider the value of resilience.

Richard Heinburg, in his essay, “A Hard-Nosed Optimism,” refers to the “optimism of the will” in discussing the notion of community resilience.

Referring to the 20th century writer, Antonio Gramsci’s concept, “pessimism of the spirit; optimism of the will,” during challenging times, people need to be aware of the realty retain sufficient optimism to endure.

“Persistence of the best of what we humans are and have achieved will require us to build resilient, enduring communities—ones with high internal levels of mutual trust, and that are capable of adapting quickly to changing conditions and responding effectively to a range of threats. Such communities arise and sustain themselves only by nurturing and prizing certain qualities of character on the part of their members.
“The people who are most likely to be of use in such communities are those who exhibit old-fashioned virtues, including honesty, bravery, self-control, cheerfulness, humility, and generosity. The ability to amuse and entertain oneself and others will be a welcome bonus; likewise the ability to speak convincingly, and the willingness both to endure discomfort and to find satisfaction in small things. I think qualities like these may start to get at what Gramsci meant by ‘optimism of the will.’”

The Community Health Resilience Initiative http://oha.inl.gov:7777/pls/apex/f?p=101:HOME states, “Regardless of the event, a community’s ability to successfully return to a “new normal” is based on its resilience, or its capacity to withstand, respond positively to, adapt, and recover expeditiously from a crisis or adversity.” There is no signal definition accepted for community resilience. Variations include:

• “The ability to prepare for and adapt to changing conditions and withstand and recover rapidly from disruptions, including deliberate attacks, accidents, or natural occurring threats and incidents.”

• “The ongoing and developing capacity of the community to account for its vulnerabilities and develop capabilities that aid that community in (1) preventing, withstanding, and mitigating the stress of a health incident; (2) recovering in a way that restores the community to a state of self-sufficiency and at least the same level of health and social functioning after a health incident; and (3) using knowledge from a past response to strengthen the community’s ability to withstand the next health incident.”

• “Community resilience is the ability of a community to use its assets to strengthen public health and healthcare systems and to improve the community’s physical, behavioral, and social health to withstand, adapt to, and recover from adversity.”

Regardless of the definition used, the concept deserves consideration in population health, especially within impoverished communities.

Dennis Archambault is vice president of Public Affairs for Authority Health.

‘Corner stores’: Oases in the food desert?

By Dennis Archambault
At a recent meeting of the Detroit Food Policy Council’s Grocery Store Engagement Committee, it occurred that many of the small markets that comprise the network of 1,200 – not known for offering fresh, nutritious food – may be areas of opportunity. The committee is undergoing a strategic planning process which will likely include some form of persuading them to augment their product line to better serve the health needs of our community. Organizations in other cities, such as the Philadelphia Food Trust (http://thefoodtrust.org/), are working on similar strategies.

In Detroit, Authority Health is in the second year of a State of Michigan grant to promote fresh fruits and vegetables in Southwest Detroit markets – “Mi Plato, Mi Vida”. An announcement of a new initiative is coming later this spring. It makes sense to take an assets view of the challenge rather than a deficit view. If the buildings are there, and people are using them to buy their food, it makes sense to try to persuade the owners that improving their store environment and product offerings will lead to sales and everyone wins.

Dennis Archambault is vice president of Public Affairs for Authority Health.

Primary care physicians and providers play an essential role in health equity

By Dennis Archambault
The recent report by the National Academies of Sciences, Engineering, and Medicine, “Communities in Action: Pathways to Health Equity,” offers promise in efforts to promote health equity. Authority Health has long held that one of those pathways is through the primary care relationship between physician or provider and patient. Medical residents in our teaching health center program are oriented to population health through a University of Michigan certification program, with the expectation that they will incorporate this knowledge into their primary care practice.
The Canadian Medical Association has been a progressive voice in this area. Four years ago, it adopted a policy statement that has direct implications for practitioners: “Health equity is created when individuals have the opportunity to achieve their full health potential. Health equity is undermined when social and economic conditions, the social determinants of health, prevent or constrain people from taking actions or making decisions that would promote health. While the majority of these determinants fall outside of the traditional health sector, the implications for health services in Canada are enormous. Most major diseases including heart disease and mental illness follow a social gradient with those in lowest socio-economic groups having the greatest burden of illness.”
In a 2008 report, the World Health Organization has challenged all providers: “Those in the health sector bear witness to, and must deal with, the effect ts of the social determinants of health on people… The health care system and those working within it have an important and often under-utilized role in reducing health inequalities through action on the social determinants of health.
Finally, recently Cecil Wilson, M.D., president of the World Medical Association, said in a blog post, “The primary responsibility for addressing the social determinants of health is that of government and society. But physicians, by virtue of their role in the health care system – taking care of patients and possessing an intimate understanding of health care – must play a role in addressing this problem.”
We hope that social determinants become included in standard health histories, and ongoing counseling with routine wellness visits. That, coupled with navigation assistance can help physicians direct their patients to resources that will mitigate the social barriers to achieving optimum health.

Dennis Archambault is vice president, Public Affairs, for Authority Health.