Health comes from community

Recently I had the privilege of travelling to Vancouver, British Columbia to attend the inaugural BC Forum of the Canadian Coalition for Global Health Research. We had a wonderful host in the Department of Global Health of Simon Fraser University (and especially from Drs. Craig Jones & Vic Neufield). It was a challenging and pivotal conference for me.

That is not what I want to share now. The conference started with an amazing keynote address, and then moved into a discussion of “Indigenous Health Research” which was an innocuous title that was hiding a discussion that really made me think about many of my assumptions about health care, the role of research, and how we “help” patients/communities in a new way.

Behind that title was a discussion of the interim First Nations Health Authority in British Columbia. However, it was more than the development of a health system to support a native people that struck me.

What struck me were the ways in it was developed, and the fact that there was a recognition of health as being an essential element of community. From the traditions and social structures that kept pre-contact peoples healthy, to the post-contact health problems that affected the diverse people of the First Nations of British Columbia, there was a basic recognition that the health of a community and the health of individual persons are inextricability linked. From that, I realized that the only solutions for healthy people are rooted in a respect for community and culture that comes through communication and a shared vision for health and community. That in a way, health IS community. Health is not something that gets shipped in on a truck, flown in on a plane, dispensed from a pharmacy, or provided from a clinic. Health is the attitude of the community towards food, water, children, families, work, and exercise … whether that is valued (or not). The mechanics of health care are just that, the tools that enable a community that desires to be healthy to make that happen.

Which lead me to an even bigger, more disruptive thought?  What if the real point of health care was to truly support the community it serves?  To do more than just trundle along as some behemoth that sucks up resources and dispenses “health.”  That we should be learning from the patient and from the community what they need to be healthy, not constantly prescribing solutions and interventions. That instead of always having to be the “smartest” person in the room, we embrace the wisdom of being the most caring person in the room, coming to the person who needs us … not demanding they come to us. To me, this is the real promise of Global Health: Teaching us that health comes from community, not something that is given or provided.

The real promise of Global Health is not that “rich” nations can “provide” health care to the “poor” nations. The real promise of Global Health is that we can learn from building patient & community centered health systems how to provide better health care for all of us, regardless of where we live.

Michael Moore is a medical student who blogs at The Lancet Student

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  • buzzkillersmith

    This is of course a bit of an over-simplification.  The health status of a person does depend on the person’s environment, a fact that is the whole basis for the science of public health.  It also depends on the person’s genetics and on mostly random factors like whether or not the person gets hit by a truck.  Health is clearly multi-factorial and if any pundit says “health depends on this,” it’s time to stop listening. 
    Where does medicine come in?  Mainly when health fails or is at very high risk of failing (eg. in diabetics). We’re fairly decent at dealing with some of these failures but very lousy at structuring the environment to maintain health. No surprise there–keeping people healthy is not our job. It has always been thus, and is likely to be thus in the future. 
    Don’t listen to politicians and pundits who state that everyone will be healthy if we just organize the medical system this way or that way.  Nonsense.  Don’t listen to fools who decry our “healthcare system” as a sick care system.  A robust sick care system has to exist because everyone gets sick eventually. When you’re well, stay away from the doctor. 

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    There is definitely a public factor in the health of individuals.  Just the other day in a discussion with a colleague I found out that the access to good care in Michigan is very good when compared to other states.  The communities in West Michigan as well as the state government has made sure that there are programs available through private nonprofits as well as through local health departments.  

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