Understanding Health, Community, and Community Health
How health, community, and community health are examined, utilized, and defined depend upon the representatives of the community involved. All are key, all are vital, and all are based upon the perspective of key individuals and groups. A politician will obviously differ from a health care provider, a social service agency, and, most definitely, a recipient of various services. Whose perspective is most important? Ultimately, the recipient is paramount, but from a community perspective, every member of the community concerned with its successful and healthful evolution is a recipient of the community organism and must be considered for the community to thrive, grow, and continue to nurture its members, helping them to thrive.
My understanding of health, community, and of community health is complex and biased by what I have seen and what I have experienced in a variety of communities from birth throughout my life. Let’s be honest here. Objectivity is very difficult to achieve, and I didn’t become interested in humanistic psychology to be apathetically objective. I’m here because I want to help people thrive and evolve and to learn from them. Health, to me, is social, emotional, and physical. Health is well-being in a community that allows its members to thrive and contribute personally and socially after being provided rightfully necessary shelter, healthy food (with space to grow it), preventative medicine, and the ability to work. Community is all of that and allowing a space where people feel safe and accepted, safe enough to be themselves, valued enough in the community to suggest and contribute unique solutions to community challenges, no matter the youth or the age of the member. Community health is all of the above.
The Unconquered Minds Service Group
As a researcher and activist, I have been primarily interested in assisting the Black American community in some way for several years through my research within gender and racist language propaganda. Recently, I began participating in the Unconquered Minds Service Group (http://unconqueredminds-sg.com/) based upon a friendship with the group’s leader, Vah Stinson. Based out of Opa-Locka, Florida, the group’s primary focus is the Opa-Locka community, but it should be clear that the group understands that it doesn’t live in a vacuum. As a result of that knowledge and the plight of Black Americans in the United States, historically and currently, there are several other inner cities within the center of Miami, Florida that the group works with. The group’s primary goal is the social health of each individual in the community but their primary focus is upon empowering the communities’ children, which explains their motto, “Build/Organize/Educate, as the group builds character, encourages the forming of positive habits, and helping self to help others within the community one person at a time.
The key focus on the children for Stinson is one that allows him to reflect upon his difficult childhood where his community was overrun by the using and selling of drugs and misguided children being influenced by both. Little has changed since Stinson grew up, and he saw the need to do something more than just lament the plight of the local communities and the fate of the children (V. Stinson, personal communication, September 19, 2016). Utilizing slogans like, “Battered Bruised and Beat Up, or “Broke on All Sides,” helps Stinson relate to community members instead of lecturing them about what they need to do. Current initiatives, “Feed the People” and “Build a child, encourage a child, uplift a child” where the group provides lunches and back-to-school supplies while Stinson and others members provide community building activities such as health checks and motivational speeches designed to empower community members as well as making themselves available during events and throughout the week for children and teens who are struggling personally or socially and need someone to talk with. It’s key for the group to act and make themselves available on a daily basis rather than appearing and reacting to a crisis like most major social assistance non-profits.
While there is no current permanent structure, the group intends to establish a fixed location in the future and begin with an after-school program, Spanish classes, community empowerment activities, and an adult learning center. Group members bring a variety of skills and expertise, though their rolls, and mine, will be flexible while the organization grows. My personal function here is flexible and varies from contributing to the weekly conference calls with positive reinforcement of Stinson’s empowerment talks, analyses of national and local news and contributing to the discussion of the future path of the group and the practical initiatives needed to obtain a permanent community structure. Professionally, my contributory roles are similar, but will necessarily evolve with a building where the community can congregate: A teacher, a mentor, a researcher, an activist implementing initiatives that allow for community health development initiatives that utilize the expertise of the group (who are also community members) as well as members of the community most affected. To help them help themselves to make their community one where children, teens, and adults can thrive without feeling the need to resort to using and dealing drugs to survive is primary, but ultimately my roll will become one where I teach interested community members critical thinking as part of a group of other teacher community teachers whose goal is to build, organize and educate black families and empower them one at a time.
Hancock & Minkler’s Community health assessment or healthy community assessment
Though Hancock & Minkler (2012) don’t provide an outline I can utilize within the Unconquered Minds Service Group, the authors ask several important questions that will help to frame a discussion within the group and they provide a critical appraisal of assessment processes that can be referenced when a healthy community program is implemented.
The necessity of assessment is addressed immediately, noting the variety of assessments that are usually employed, depending on the desired results and the motives, including maintaining and justifying the status quo with occasional logistical fine tuning (though I don’t see the benefit of such a limited approach unless it is to tweak an already successful program). Major change assessments differ and obviously involve many more critical community members, including affected and knowledgeable residents, agencies, and some government officials in an effort to measure, assess, collect data, provide training, leadership, and organization, mobilize collective activities, and enable consciousness raising in an effort to research the most efficient means to effect the necessary changes for a healthy community.
But the community has to be clear on what a healthy community is. While community discussion is necessary to assess what the community has and what it does not. Hancock and Duhl (1986) indicate a series of eleven key elements that are necessary (as cited in Hancock & Minkler, p. 158, 2012) for a healthy community. They are all important, but due to space limitations, I am not going to list them all, but the ones that stand out to me as especially important are,
- A clean, safe, high-quality environment (including housing quality)
- An ecosystem that is stable now and sustainable in the long term
- A strong, mutually supportive, and nonexploitative community
- Access to a wide variety of experiences and resources, with the possibility of multiple contacts, interaction, and communication
- A diverse, vital, and innovative city economy
The authors note that health is only one of these key elements. Looking over this list, it’s almost a community’s self-actualization checklist that encompasses much more than Maslow’s original idea of personal safety and evolution. Breaking down this list allows for consideration of its base demographic, geographical, and historical elements, place, time, and person. This opens up a conversation that can reveal environmental factors, economic, political, and social forces as well as age, gender, and ethnic makeup that can affect the overall health of the present population. The results can be eye opening to reveal additional questions beyond just basic health, for example,
- What is the degree of equity (or inequity) in the community?
- What is being done to improve health?
- How rich is the cultural life of the community, its artistic, creative, and innovative elements? (Hancock & Minkler, p. 159, 2012)
Political structures are analyzed just as rigorously to determine if they are adequately serving the citizens they were hired to serve. A proper assessment, according to the authors, includes the municipal council measured against its policy actions regarding the development of healthy public policy, determining if there is a means to assess health impact in the community, the planning commission’s understanding of city design on health, and if neighborhood and resident groups are involved in community change that affects them directly. While this is ideal, I do wonder if each individual community leader would consent to such an assessment if they are not interested in community health and are only interested in personal political advancement. And I wonder what communities can do when faced with such apathy in political leadership. Activism in community improvement must be considered as an alternative in that case. Even neighborhood citizens are queried to determine the extent of their support system to clarify who they go to for advice, where children go for the same, who gets things done, and who the neighborhood leaders are, for example. At this point, Unconquered Minds uses an informal adaptation of this neighborhood assessment based on community leaders and an informal network of participants. Once a formal nonprofit or other legal status is established for Unconquered Minds, it will be much easier to apply for funding to assess the needs of Opa-Locka. In the meantime, informal committees are formed to perform outreach in the community to increase exposure and to actively increase community involvement.
The reasoning for thorough community health assessments is critical and necessary. Without analysis, hard data, critiques, and stories from the affected community, it would be extremely difficult to spark, monitor, and assess change in a way that determines failure or effective success. The impetus for change is a more underlying need and that requires community-wide knowledge of upcoming projects, development of new community skills, and political commitment to community evolution. Reflecting on a few communities I have lived in where nothing of this sort seems to happen, I can see why this is a necessary piece of the puzzle. But what does a community do when the political leadership doesn’t seem concerned with the community it “leads” in the case of Unconquered Minds position within Opa-Locka? Does the group and community move forward on their own, pooling their own resources with other groups and every other necessary component but that political support and commitment?
Another key question the authors ask is who defines community health and through whose eyes, whether the political structure, a citizen or the community in question. It’s important to take the definition of the World Health Organization’s definition that encompasses the health of the whole person, physical, mental, and social. To assess that requires individuals in the community and significant cooperation from a majority of citizens and the organizations, groups, and formal and informal networks that make up its assets and capabilities of community building. This is powerful and allows positive change to occur in ways that normally don’t happen in communities burdened with the bureaucracy of hierarchical authority. With, preferably, an evolutionarily flexible political structure in tune with the community, a healthy community constantly remakes itself into one of mutual support that develops to a maximum potential that improves physical and social environments and expands community resources. And this only touches the surface of a quality assessment for a healthy community. Throughout the text the authors reference several community health quality check lists and necessary elements and cite a few case studies as examples (Hancock & Minkler, pp. 158-160, 2012). Sadly, Opa-Locka and most communities that I have visited do not possess which is why I see constructive and evolutionary action so necessary.
Obviously, more involvement with each community is eventually required and that is measured by the depth of the need for community health and evolutionary change. While initial information gathering, according to the authors, includes objective demographic information like death, divorce, and unemployment rates that takes account of underemployment rates measured against race, class, and child welfare, it doesn’t tell the whole story. Additionally, minimal contact observation methods, like the “windshield tour” (Hancock & Minkler, p. 164, 2012) that will be necessary to conduct with Unconquered Minds in the future to assess Opa-Locka’s healthy community needs and to determine the condition of houses and cars, as well the degree of activity and social interaction between residents and children. Finally, as part of the preliminary assessment, there are interactive contact methods that allow the groups to critically assess their community and their place within it. Some include asking key groups a series of assessment questions, a nominal group process where everyone contributes critical assessments and creative solutions while encouraging conflicting opinions, and then there are focus groups, where they address key questions about their feelings and their community. There are other methods that will be addressed in succeeding chapters that I am eager to explore since each of these select group interactions would necessarily have to include all varied groups in the community, depending upon its size, unless an adequate and representative cross-section of citizens were selected.
There are also several other measures that can be employed, quantitatively and qualitatively that include measures that are face valid and make sense to people, measure key health determinants, measure things people in the community actually care about, and ultimately carry social and political power enough to be accomplished. Employing key group conversations and other qualitative methods that probe the expectations and needs of the community, quantitative methods can and will be useful, but without the communities’ input, I don’t really see questionnaires as yielding anything of value in the same way that political polls gather opinions at a very superficial depth. Nothing substantial will get accomplished in this way. It is this interaction with the community that makes them a part of the change process rather than one that reacts to the changes of government every two years that allows the community to take an active role in the community that isn’t present in most cities I have lived in. This is the case with the citizens of Opa-Locka, Florida and the surrounding inner cities of Miami Dade. But every method listed here and in the text, while it must take the problems into account, it cannot ignore the assets of the community in terms of already present resources in infrastructure as well as community and personal assets. Because I am interested in intentional communities of the small to medium sized I can see this as clearly as pooling the resources in a neighborhood, but for a larger entity, for neighbors that rarely communicate outside of their immediate purview, interaction and assessment must be stimulated. One of the last methods the authors mention is a multimethod assessment, which; given the wide variety of communities and sizes, is a practical recommendation. And for those not properly trained in participatory action research or asset-based community development, the authors recommend the easily accessible Mobilization for Action through Planning and Partnerships (MAPP) that can be at http://www.naccho.org/resources/toolbox. I plan to explore this resource and suggest it within the committees of Unconquered Minds.
While this chapter isn’t everything that is needed for a healthy community assessment, it is my first exposure to some of the necessary elements in some three years. That previous exposure was my introduction, but for me it was life affirming and, based on my professor’s encouragement, I have pursued that interest to Saybrook University. Given my involvement in the Unconquered Minds Service Group and my desire to actively work with them to begin the evolution of Opa-Locka, Florida, I can envision preliminary assessments and gradual changes taking place that we can use to assess and engage surrounding communities.
Hancock, T. & Minkler, M. (2012). Community health assessment or healthy community assessment: Whose community? Whose health? Whose assessment? In M. Minkler (Ed.), Community organizing and community building for health (3rd ed., pp. 153-170). Brunswick, NJ: Rutgers University Press.
Stinson, V. (n.d.). Unconquered Minds Service Group. Retrieved September 26, 2016, from http://unconqueredminds-sg.com/