In July 1997, the Hawai’i District Health Office (HDHO) in partnership with the University of Hawai’i at Hilo Department of Baccalaureate Nursing, the Hawai’i County Office of Aging, the Hilo Community School for Adults and the Hawai’i Alliance for Community Health sponsored a workshop “Action Planning for Community-Based Initiatives.” A basic concept emerging from the meeting was the belief that it is important to change the environment in which individuals engage in “unhealthy” behaviors in order to maximize efforts to reduce the prevalence of those behaviors within the population. It encourages citizen participation and the development of a community’s capacity to address local health problems. In the workshop, participants identified barriers to creating and maintaining community partnerships/coalitions. Existing concerns of child abuse and neglect, promoting health for older adults, adolescent pregnancy, substance abuse, risk for chronic disease, and youth violence were topics used as examples for training purposes. These topics were consistent with priority health concerns for the 6 island communities as well as being reflected in Healthy Hawai’i 2000 objectives.
A community initiative focusing on building the capacity of community members on the Big Island of Hawai’i was created following the workshop. Four principal program objectives were identified in this project. They include:

  • Community partnership development in each of the 6 districts on the Big Island;
  • Providing initial staffing to coordinate and facilitate coalition development;
  • Providing training for the initial staff and for key community leaders in core competencies for doing the work (e.g., planning, facilitation, grant writing);
  • And documenting community change and the successes of the local community partnerships.

This Prezi presents the development of a grassroots movement to address the above issues, the capacity built as part of the initiative, findings from a participatory evaluation, and future directions.

Where I live now, the past is still present for so many people. I know people here that can point to the house of the family that owned their family members as slaves. I have a close friend who is very light skinned African American, and people seem oblivious to her rich family experience (which is their loss). Her African American heritage is part of why she is so awesome, but others are quick to deny that part of her background because she is so successful. I’ve had to learn that it is much more important to walk with humility, and let others teach me about their cultural heritage. Once we assume their experience, we are no longer friends or have a harder time becoming friends. When we listen to them, we find that we have many more experiences in common than not, and we have a much richer friendship too. We all inherited this world, but we don’t have to perpetuate the problems. We can work to stop it, even if it is a little at a time.

We are working with folks in Greensboro to improve access to health care among the low (and no) income, and the chronically under served. The divide is huge and problematic. We will change the system, but it will take a while. I seem to have to learn every day that it is as much about becoming friends as it is about changing systemic and institutionalized bias. People are so used to being excluded that it will take a while for them to learn to use the services that are becoming available. The Affordable Care Act was a nice first step, but we have a LOT of work to do to change a few centuries of exclusion and all the behavior associated with it. The trust that comes with friendship is the only way it will move forward.

One potential way forward is to create a new partnership with the Faith Community (often not present at the table for community change initiatives), health service providers and Universities to facilitate new systems changes (new and/or modified programs, policies and practices) that will have a positive impact on a larger segment of the community. These may be as small as changing the location of bus stops to allow for easier access in under served communities, or as large as creating free health clinics at Churches. This builds on the extraordinary trust present within the Faith Communities, and allows for greater access to health services. Universities can play a role through their academic training mission (creating new programs and jobs), as well as with new measurement systems that would allow for ongoing improvement in health outcomes based on the hundreds of innovations that are anticipated.

For more information about how to facilitate lasting improvement in the community, see the Community Tool Box, especially Chapter 1, which contains much more about community collaboration, systems improvement, community action planning, and evaluation of these kind of open systems initiatives.

There are a lot of people working to improve the lives of our children, families and communities. Most of those efforts are aimed at immediate needs. Things that are necessary, and make us feel good about contributing to positive things in the lives of others. This work is important, but it falls short of providing lasting solutions. Treatment approaches are necessary, but not sufficient for solving problems. I often use headaches as an example. People use aspirin, NSAID pain relievers, and other things to relieve the pain. However, headaches are not caused by the absence of aspirin, or NSAIDs, or anything else done to relieve the pain.

Finding the root cause of the headache may be possible, and will make the need for pain relievers unnecessary. What if we could do the same thing with communities?

This presentation summarizes pieces of the puzzle related to building healthier communities, focusing on primary prevention, and generally creating environments that result in people being happier, healthier, and more successful. Click on the following link to view the entire presentation…