Community Health
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Community Health

Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection and improvement of the health status of population groups and communities as opposed to the health of individual patients[]. It is a distinct field of study that may be taught within a separate school of public health or environmental health. The WHO defines community health as:

environmental, social, and economic resources to sustain emotional and physical well being among people in ways that advance their aspirations and satisfy their needs in their unique environment.[1]

Community health, unlike public health, tends to focus more on a defined geographical community. The health characteristics of a community are often examined using geographic information system (GIS) software and public health datasets. Some projects, such as InfoShare or GEOPROJ combine GIS with existing datasets, allowing the general public to examine the characteristics of any given community in participating countries.

Medical interventions that occur in communities can be classified as three categories: primary healthcare, secondary healthcare, and tertiary healthcare. In the United States, community health is rooted within primary healthcare achievements.[2] Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management.

The success of community health programmes relies upon the transfer of information from health professionals to the general public using one-to-one or one to many communication (mass communication). The latest shift is towards health marketing.

Measuring community health

Community health is generally measured by geographical information systems and demographic data. Geographic information systems can be used to define sub-communities when neighborhood location data is not enough.[3] Traditionally community health has been measured using sampling data which was then compared to well-known data sets, like the National Health Interview Survey or National Health and Nutrition Examination Survey.[4] With technological development, information systems could store more data for small scale communities, cities, and towns; as opposed to census data that only generalizes information about small populations based on the overall population. Geographical information systems (GIS) can give more precise information of community resources, even at neighborhood levels.[5] The ease of use of geographic information systems (GIS), advances in multilevel statistics, and spatial analysis methods makes it easier for researchers to procure and generate data related to the built environment.[6]

Social media can also play a big role in health information analytics.[7] Studies have found social media being capable of influencing people to change their unhealthy behaviors and encourage interventions capable of improving health status.[7]  Social media statistics combined with geographical information systems (GIS) may provide researchers with a more complete image of community standards for health and well being.[8][9]

Categories of community health

Primary healthcare and primary prevention

Community based health promotion emphasizes primary prevention and population based perspective.[10]  It is the goal of community health to have individuals in a certain community improve their lifestyle or seek medical attention. Primary healthcare is provided by health professionals, specifically the ones a patient sees first that may refer them to secondary or tertiary care.

Primary prevention refers to the early avoidance and identification of risk factors that may lead to certain diseases and disabilities. Community focused efforts including immunizations, classroom teaching, and awareness campaigns are all good examples of how primary prevention techniques are utilized by communities to change certain health behaviors. Prevention programs, if carefully designed and drafted, can effectively prevent problems that children and adolescents face as they grow up.[11]  This finding also applies to all groups and classes of people. Prevention programs are one of the most effective tools health professionals can use to greatly impact individual, population, and community health.[11]

Secondary healthcare and secondary prevention

Community health can also be improved with improvements in individuals' environments. Community health status is determined by the environmental characteristics, behavioral characteristics, social cohesion in the environment of that community.[12]  Appropriate modifications in the environment can help to prevent unhealthy behaviors and negative health outcomes.

Secondary prevention refers to improvements made in a patient's lifestyle or environment after the onset of disease or disability. This sort of prevention works to make life easier for the patient, since it's too late to prevent them from their current disease or disability. An example of secondary prevention is when those with occupational low back pain are provided with strategies to stop their health status from worsening; the prospects of secondary prevention may even hold more promise than primary prevention in this case.[13]

Tertiary healthcare

In tertiary healthcare, community health can only be affected with professional medical care involving the entire population. Patients need to be referred to specialists and undergo advanced medical treatment. In some countries, there are more sub-specialties of medical professions than there are primary care specialists.[12]  Health inequalities are directly related to social advantage and social resources.[12]

Aspects of care that distinguish conventional health care from people-centred primary care[14]
Conventional ambulatory medical care in clinics or outpatient departments Disease control programmes People-centred primary care
Focus on illness and cure Focus on priority diseases Focus on health needs
Relationship limited to the moment of consultation Relationship limited to programme implementation Enduring personal relationship
Episodic curative care Programme-defined disease control interventions Comprehensive, continuous and personcentred care
Responsibility limited to effective and safe advice to the patient at the moment of consultation Responsibility for disease-control targets among the target population Responsibility for the health of all in the community along the life cycle; responsibility for tackling determinants of ill-health
Users are consumers of the care they purchase Population groups are targets of disease-control interventions People are partners in managing their own health and that of their community

Challenges and difficulties with community health


The complexity of community health and its various problems can make it difficult for researchers to assess and identify solutions. Community-based participatory research (CBPR) is a unique alternative that combines community participation, inquiry, and action.[16] Community-based participatory research (CBPR) helps researchers address community issues with a broader lens and also works with the people in the community to find culturally sensitive, valid, and reliable methods and approaches.[16]

Other issues involve access and cost of medical care. A great majority of the world does not have adequate health insurance.[17] In low-income countries, less than 40% of total health expenditures are paid for by the public/government.[17] Community health, even population health, is not encouraged as health sectors in developing countries are not able to link the national authorities with the local government and community action.[17]

In the United States, the Affordable Care Act (ACA) changed the way community health centers operate and the policies that were in place, greatly influencing community health.[18] The ACA directly affected community health centers by increasing funding, expanding insurance coverage for Medicaid, reforming the Medicaid payment system, appropriating $1.5 billion to increase the workforce and promote training.[18] The impact, importance, and success of the Affordable Care Act is still being studied and will have a large impact on how ensuring health can affect community standards on health and also individual health.

Academic resources

See also


  1. ^ "A discussion document on the concept and principles of health promotion". Health Promotion. 1 (1): 73-6. May 1986. PMID 10286854. 
  2. ^ Goodman RA, Bunnell R, Posner SF (October 2014). "What is "community health"? Examining the meaning of an evolving field in public health". Preventive Medicine. 67 Suppl 1: S58-61. doi:10.1016/j.ypmed.2014.07.028. PMID 25069043. 
  3. ^ Community-oriented health services : practices across disciplines. Mpofu, Elias,. New York, NY. ISBN 9780826198181. OCLC 897378689. 
  4. ^ "Chapter 36. Introduction to Evaluation | Community Tool Box". Retrieved . 
  5. ^ Pearce J, Witten K, Bartie P (May 2006). "Neighbourhoods and health: a GIS approach to measuring community resource accessibility". Journal of Epidemiology and Community Health. 60 (5): 389-95. doi:10.1136/jech.2005.043281. PMID 16614327. 
  6. ^ Thornton LE, Pearce JR, Kavanagh AM (July 2011). "Using Geographic Information Systems (GIS) to assess the role of the built environment in influencing obesity: a glossary". The International Journal of Behavioral Nutrition and Physical Activity. 8: 71. doi:10.1186/1479-5868-8-71. PMID 21722367. 
  7. ^ a b Korda H, Itani Z (January 2013). "Harnessing social media for health promotion and behavior change". Health Promotion Practice. 14 (1): 15-23. doi:10.1177/1524839911405850. PMID 21558472. 
  8. ^ Stefanidis A, Crooks A, Radzikowski J (2013-04-01). "Harvesting ambient geospatial information from social media feeds". GeoJournal. 78 (2): 319-338. doi:10.1007/s10708-011-9438-2. ISSN 0343-2521. 
  9. ^ Ghosh DD, Guha R (2013). "What are we 'tweeting' about obesity? Mapping tweets with Topic Modeling and Geographic Information System". Cartography and Geographic Information Science. 40 (2): 90-102. doi:10.1080/15230406.2013.776210. PMC 4128420 Freely accessible. PMID 25126022. 
  10. ^ Merzel C, D'Afflitti J (April 2003). "Reconsidering community-based health promotion: promise, performance, and potential". American Journal of Public Health. 93 (4): 557-74. doi:10.2105/AJPH.93.4.557. PMC 1447790 Freely accessible. PMID 12660197. 
  11. ^ a b Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane E, Davino K (2003). "What works in prevention. Principles of effective prevention programs". The American Psychologist. 58 (6-7): 449-56. doi:10.1037/0003-066x.58.6-7.449. PMID 12971191. 
  12. ^ a b c Barbara S (1998). Primary care : balancing health needs, services, and technology (Rev. ed ed.). New York: Oxford University Press. ISBN 9780195125436. OCLC 38216563. 
  13. ^ Frank JW, Brooker AS, DeMaio SE, Kerr MS, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP (December 1996). "Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins". Spine. 21 (24): 2918-29. PMID 9112717. 
  14. ^ "Chapter 3: Primary care: putting people first". Retrieved . 
  15. ^ Weiner, B. J.; Alexander, J. A. (1998). "The challenges of governing public-private community health partnerships". Health Care Management Review. 23 (2): 39-55. ISSN 0361-6274. PMID 9595309. 
  16. ^ a b Minkler, Meredith (2005-06-01). "Community-based research partnerships: Challenges and opportunities". Journal of Urban Health. 82 (2): ii3-ii12. doi:10.1093/jurban/jti034. ISSN 1099-3460. 
  17. ^ a b c World health statistics. 2016, Monitoring health for the SDGs, Sustainable Development Goals. World Health Organization,. Geneva, Switzerland. ISBN 9241565268. OCLC 968482612. 
  18. ^ a b J., Rosenbaum, Sara; Peter, Shin,; Emily, Jones,; Jennifer, Tolbert, (2010). "Community Health Centers: Opportunities and Challenges of Health Reform". Health Sciences Research Commons. 
  • John Sanbourne Bockoven. Moral Treatment in American Psychiatry, New York: Springer Publishing Co., 1963

External links

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