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A Healthy Life

A Healthy Life

Thirteen years ago, when I first came to Phoenix to help set up what was then called St. Luke's Charitable Health Trust, I asked a broad cross section of health care leaders, experts and activists where they thought the organization should focus its efforts to improve the health of Arizonans and their communities.

Most of what I heard reflected views expressed at that time by our Board members. We should address acute and chronic diseases, especially among vulnerable populations; we should improve access to care for children and the elderly; we should consider focusing on areas like behavioral health; we should address issues of inefficiency and ineffectiveness in the medical system; and so on.

Much of this was predictable. After all, St. Luke's Charitable Health Trust came out of the sale of a community hospital system and was deeply imbued in a medical model of care. Many community informants assumed we would continue in that tradition and concentrate on providing health care services to those in need, focus on special issues or populations like reducing health disparities or improving the lives of persons with behavioral disabilities, and so on. And, during our formative years, that's exactly what we did.

But a surprising thing happened along the way. We began to spend more time out in communities themselves, and heard the stories of community health workers, neighborhood activists, church leaders, and others on the front line of community development. They all said basically the same thing: Before you can talk to people about diabetes, mental health or nutrition, you have to ensure that they have the infrastructure in place to provide the basic needs of food, shelter, safety, employment and a decent physical and social environment. Without that, all of your so-called professional "interventionist" models focused on discrete aspects of "health" aren't going to produce much in the way of results.

Gradually, this led us to define Health in a New Key: an emphasis on helping to build resilient communities from the "inside out" by focusing on assets first instead of deficits alone, and relying more on the self-organizing principles, practices and definitions of community residents instead of trying to impose perceived "professional" practices from the outside.

This is starting to bear fruit, but it still engenders Board discussion on what counts as "health," and the specific goals and strategies that ought to be in place to achieve it. For example, a recent report from a Health in a New Key community partner talked about promotoras (community health workers in the Hispanic community) who, when asking residents about their chief health concerns, got an earful about packs of vicious dogs in the area, and how children couldn't very well run around outside and get exercise if it wasn't safe. This led to an organized effort to work with the city to eliminate the problem - an example of community empowerment and a template for the type of adaptive, self-organizing problem-solving activity that characterizes strong communities.

This is all well and good, said more than one of our Board members. But is it really "health?" If so, are we advised to function more like a community development corporation, working on issues like housing, employment and neighborhood safety, and turn away from sponsoring projects like community health fairs, free blood pressure screenings, school health clinics and the like? It's hard enough tracking outcomes in health care proper to specific grants and supported projects. How are we ever going to know whether we're making a difference in something as messy and long term as "community building?" Aren't we abandoning our history, our core purpose?

Good questions, all. While I have my own opinions on them, I have learned from 30 years of experience in working with Boards that it's never a good idea to come easily to belief. The way forward is tested in constant probing and questioning; once a direction is settled on, it is open by necessity to the surprise, discovery and learning that comes from experience. Successful organizations profit from a true diversity of views, and in fact depend on it.

I'm sure the promotoras who went out to talk with young mothers about well-child care and heard instead about wild dogs had to revise their game plan. But leaving the game plan doesn't mean you're abandoning the game. It just means that you're changing the plan.

In the end, a healthy life is a life of genuine choice. If we work together to ensure that all of us, regardless of circumstances, have the conditions in which to exercise meaningful choices, then we will reach our goal of building strong, resilient and healthy communities.

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*The Drift reflects the views of the author, and does not represent the official view of SLHI's Board of Trustees and staff.