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Working With Communities: Meeting the health needs of those living in vulnerable communities when primary health care and universal health coverage are not available
  • Mark Dehaven,
  • Nora Gimpel,
  • Heather Kitzman-Carmichael
Mark Dehaven
University of North Carolina Charlotte College of Health and Human Services
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Nora Gimpel
UT Southwestern Medical
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Heather Kitzman-Carmichael
Baylor Scott and White Health
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Peer review status:UNDER REVIEW

13 Jul 2020Submitted to Journal of Evaluation in Clinical Practice
15 Jul 2020Assigned to Editor
15 Jul 2020Submission Checks Completed
18 Jul 2020Reviewer(s) Assigned

Abstract

Background: The health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The historical lack of support in the United States for primary health care, universal health coverage, population health, addressing the social determinants of health, and community empowerment, creates opportunities for community health scientists to develop innovative solutions for addressing community health needs. Methods: We developed a model community health science approach combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. Results: From 2000-2020, we established partnerships with community organizations to reduce the risk of chronic disease in vulnerable minority communities. Our programs have provided structured community health science training for hundreds of physicians and other health care workers in training. Conclusion: As the U.S. begins to seek solutions to chronic health disparities and health inequities, community health science provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest error that U.S. health care systems could make in trying to better address population health and the social determinants of health, would be ignoring the important community initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for reducing health disparities. This has been the greatest lesson we have learned during the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.