Community Involvement In Health

An evidence-based analysis of the opportunities and challenges of moving towards more person-centred health systems.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.

A wide-ranging analysis of community involvement in health development (CIH) as a concept, a strategy, and an ongoing experiment in the search for ways to improve health care for the majority of the world's population. Noting that discussions of health-sector reform have given CIH greater prominence, the book aims to provide a resource of ideas and practical methods for all health professionals interested in applying a participatory approach to development work. The book has seven chapters. The first traces the historical evolution of the concept of CIH and discusses its place within the broader areas of development theory and practice. The next three chapters provide detailed case studies of recent experiences with CIH in Bolivia, Nepal, and Senegal. Chapter five, on health development structures, draws on data from nine countries included in a study, which explored the potential of civil society organizations to promote and facilitate CIH. Results of the study confirm the considerable potential of health development structures to bring together both different sectors and different levels of government. Chapter six discusses the need to develop an appropriate methodology of participatory development. Lessons from the case studies are used to identify a set of operational principles for community action for health. The final chapter draws a number of important conclusions concerning ways in which the concept of CIH can move closer to practical reality. Many past failures are attributed to the unrealistic expectation that participatory efforts would make it possible to achieve more with less money.