Since 2013 we have looked at why health care is failing communities in difficult social circumstances, such as poverty and exclusion.
By spending time with almost 100 practitioners, we’ve come to appreciate that working with these communities requires starting from their priorities, only one of which is health. We have gleaned 12 over-arching principles for how to do this. Together, they describe an inclusive, participatory and responsive process.
Along the way, we have learned that the process has the potential to foster the ‘agency’ of communities – their ability to make purposeful choices. This ability is core to having a sense of control, which is fundamental to health. In fact, risk factors – whether personal, environmental or social – cannot fully explain why people are healthy or sick. The missing link is whether people have a sense of control.
We help health care change its way of working to be more inclusive, participatory and responsive.
Not only can this new way of working foster the agency of communities, it also enables health care to reconsider its role with the communities it serves. Health care must move beyond deploying technical solutions for acute illnesses and trauma. It must learn to support people and communities to define and shape their own health.
But change is always hard. And the change health care must go through is perhaps the hardest – to share power. If it is to share power, health care needs to examine its current and historic role in perpetuating the daily realities of the communities they're part of.
The 12 Principles
The detailed rationale for the principles was included our 2017 report, Fostering Agency to Improve Health. The principles are:
- Include in a community’s collective effort those who live there, those who work there, and those who deliver or support services provided there
- Spend time understanding differences in context, goals and power
- Appreciate the arc of local history as part of the story of a place
- Elicit, value and respond to what matters to community residents
- Facilitate and support the sharing of power, including building the capacity to use it and acknowledging existing imbalances
- Operate at four levels at the same time: individual, community, institutional and policy
- Accept that this is long-term, iterative work
- Embrace uncertainty, tension and missteps as sources of success
- Measure what matters, including the process and experience of the work
- Build a vehicle buffered from the constraints of existing systems and able to respond to what happens, as it happens
- Build a team capable of working in a collaborative, iterative way, including being able to navigate the tensions inherent in this work
- Pursue sustainability creatively; it’s as much about narrative, process and relationships as it is about resources