Peer-led community wellness: Dare to act now!
Together with the noisiness of the Greatest Recession, governmental deficits, and National Health Reform, a quiet and little-noticed revolution is taking place in our notions about the role of one’s community in health and well-being. Here, I hope to chronicle these important developments and to draw out some of their key implications. These inaudible steps can be expected to have very loud and transformative consequences.
For longer than a century, sociologists have examined the role that one’s community plays in child development, self-concept, sociality, social networks, marriage, sense of well-being, criminal behavior, and even health. As an example of the latter, Emile Durkheim studied the key role of anomie—the absence of community—in the genesis of suicide. Now, after an equally long period in which we have almost completely divorced clinical care from the community, we are rediscovering some of these important linkages.
Let me contrast two very different types of communities. For illustrative purposes, I will overdraw the differences.
Community 1 is resourceful in what it offers both financially and interpersonally to its members. People who live there know that they and their family are supported by others in the community, and that the community provides personal, social, economic, and cultural opportunities for them. They have a positive sense of well-being and good quality of life. Health of community members is at least good, and lifespan is at least moderately long.
Community 2, by contrast, is impoverished in what it is able to offer its members. People who live there are likely to feel isolated from others, and to perceive that the community offers little if any opportunities for them. Rather, the environment is more likely to be perceived as threatening. Families with children are likely to be very concerned about their children’s future. In this environment, one is not likely to have a good sense of well-being, and is not likely to perceive that the quality of life is very good. Healthy of community members is usually poor, and lifespan is relatively short.
This contrast has motivated modern work by Michael Marmot and David Satcher. They have examined the role that social and physical determinants of health play in promoting positive health status and well-being. Related work is being done by the CDC on health-related quality of life and well-being. Similarly, the national Healthy People 2020 project has supported the inclusion of indicators that reflect health promotion and disease prevention, and the Robert Wood Johnson Foundation, in conjunction with CDC, has developed a set of county health indicators. Underlying all of this work is the usually-unstated assumption that one’s community plays a very large role in one’s health and well-being.
What are some of the major implications for us?
More than three decades ago, I and several colleagues developed the concept of a community-based health promotion organization. For the entire intervening period, the concept has remained dormant. My fervent hope is that we may now actually be on the cusp of an era in which we have the tools and the will to make it real.