The idea of working with communities to achieve sustained, substantive progress on any social issue is well-supported. One of my inspirations for continuing to work in health is the prominence given to community-based approaches. Here in the US, my organization, the city of Newark’s Department of Child and Family Well-Being, is reviewing the Public Health Accreditation Board standards to become accredited as a public health department, and I am heartened to see the significance of community needs and community solutions interwoven within the measures, codified within the mandatory prerequisites of a community health assessment and a community health improvement plan (CHIP). The latter is particularly notable and perhaps even radical—a strategic plan not for a department, but for an entire community, developed in concert with stakeholders who understand the landscape of health resources and community assets as well as the needs of their families, clients, and constituents. A CHIP is not a single community-based program, but a foundation for systemic, ongoing community-based programming.
CHIPs are saturated in community—community assessments inform them, the community representatives convened by the health department create them, community interventions result from them—but what does this mean? Yes, I can state unequivocally that I believe community-level involvement is one key solution to pervasive health challenges, and it follows that building community strengthens our health if health is physical, mental, and social well-being, but the idea of “community” remains vague, subject to oversimplification, diffuse claims, even manipulation and exclusion. We are alternatively told that community buy-in, community ownership, community engagement, or community participation is a prerequisite to meaningful success, but what is a community, and how do we describe and define our communities in ways that are productive, inclusive, respectful, and accurate? If we cannot adequately identify what the community/communities representatives are to reflect and where efforts should be integrated, how can we fully leverage the synergistic benefits of working with a community? If we use community as a catch-all term, what will our generalizations overlook, and will we recognize why a program is less effective than it could be?
The community for the CHIP is defined by the geographic boundaries served by the particular health agency, often the political boundary of a city or county. Newark, for example, has nearly 280,000 people among its five wards. For the community assessment my co-fellow and I are updating for one of the local Head Start programs, the community spans the four cities and two counties in which they have sites. The Community Toolbox, an expansive online resource for any community-centered work, focuses on geography, as it frames its model for cities and communities: “By community, we mean a group of people who share a common place, experience, or interest. We often use this term for people who live in the same area: the same neighborhood, the same city or town, and even the same state or country.”
What limitations are being placed on health solutions by geographic foci, and what health effects are being missed? Recognizing the importance of the environment—green spaces, complete streets for walking and biking in addition to driving, clean air—in influencing our health is key to moving beyond a biomedical model of healthcare premised on an individual’s genome and the personal behaviors that have affected his/her body, but can we understand a community by its physical space, and does shared physical space make a community? I live in a Lusophone community, but I do not speak Portuguese, and I have simply to walk down my block to realize the ways in which I am limited in my interactions with my “community.” A woman asked me for directions yesterday, and though I feel more and more confident in knowing the landscape of my neighborhood, we could not communicate effectively even by gestures.
This Community Toolbox model also recognizes that other connections between people exist based on shared identities and/or shared experiences: racial, ethnic, religious, the presence of a disability, etc. Communities are therefore difficult to parse for surveys, programs, or any efforts in understanding, serving and capturing progress within “the community,” as many identities are wrought by individual and historical forces and can defy geographic containment as well as exist simultaneously with other identities that seem contradictory or unconnected. Identity is one of the most fraught concepts of humanity, a deeply personal yet civic construction, sometimes fluid and other times damningly static, and potentially wielded for empowerment or exclusion by individuals or groups in moments of middle-school mean-girling or years-long campaigns with ethnic connotations. Likewise, equating culture and community could obscure cross-cultural connections that do exist within communities. I do fear that discussing “different communities” can be a shorthand way of approaching cultural, racial, religious, ethnic, or socio-economic differences, much as the “urban” descriptor has been appropriated as code speak for “black,” but how do we capture a community without a full anthropological study?
Interdisciplinary ties with anthropologists and sociologists may be crucial to creating change that is systemic and embedded throughout the spaces in which individuals live their lives. Such work may help us understand and replicate current successes—change often starts with self-defined communities, civic and religious groups bound by fellowship, where community is a feeling. As I conduct statistical analyses, how many identifying variables should I use to capture differences and define communities as subgroups of my sample; when does such parsing obscure authentic, genuine feelings of connectedness among folks that could be harnessed for change? Health itself is dastardly multifaceted on an individual level, so discerning patterns as a group level is perhaps more complicated.
For now, I want to define analyses by specific characteristics before resorting to the presumption of community. I would prefer using community in a broad sense, as in the Newark community served by the DCFWB, and seek precision when discussing the diversity of this community. Perhaps such an approach will foster an even greater appreciation for the city in which I now live, and as health work in the community and with the community builds, more communities may be revealed. As we plan and implement community-based initiatives, I hope we can consider the breadth and depth of community involvement, celebrate a sense of belonging wherever found, and cultivate a deeper appreciation for the communities we serve.