For this blog post, I'll introduce some thoughts on how we can build healthy communities—that is, how we exert effort, either individually or together with other members of our community, in initiating, organizing, participating in, or supporting any activity that promotes the health of our community. Your community in this context can range from your family and friends, your immediate neighbors, your larger neighborhood, a collection of neighborhoods including your own, or the entire city or town in which you live!
You may remember from my previous blog post that I reference two conversational spheres when discussing my thoughts on health on this site, with the first sphere, 'health', exploring the social and economic decisions that our society makes that impacts our health and that reflects the value we place on our health and the second sphere, ‘health care’, that includes the mechanisms that exist to address our specific health care concerns, examples of which include health care providers, hospitals, community health clinics, and health technologies and pharmaceuticals. For this conversation, we're mostly talking within the first sphere, looking at the social and economic factors that influence our health.
So—where to start when we're talking about building healthy communities? Well, perhaps at the most basic level, we can talk about social cohesion—or how citizens identify as members within their communities and in relation to others in the same community. Strong social cohesion implies that we don't really feel like strangers within our community; that we're conscious of who's new to it and who's left; that we recognize who may be struggling, whether physically, mentally or spirituality, and who should be celebrated for achieving significant life milestones; that we're confident knowing that our children are safe to play and roam outside; that we care about the design, esthetics and upkeep of our surroundings; and that when there are challenges facing our community, that we feel comfortable and confident speaking with each other about those challenges and can act in unison to solve them.
Now, does this sound like most communities that you know? Perhaps these elements exist in various combinations and perhaps it would be, at various times, difficult to achieve all of these elements all of the time in every community; but what's important is to recognize that strong social cohesion creates the foundation for the kind of civic engagement that produces communities that are able to take action on raising community health standards.
Let's start with the following example: have you ever thought about approaching your neighbors to start a walking or running club? And if you were going to, would you feel comfortable doing so? What would stop you?
Is it because it might be awkward?
Or, is it because you don't feel safe where you live?
If it's the former...well, maybe you can overcome that feeling. You might be surprised by how flexible and pliant your neighbors can be with your suggestion to get active in this way. But if it’s the latter....
….Well, perhaps not every community is best positioned—yet at least—with taking on activities or conversations designed to enhance community health and wellbeing without some early, foundational efforts in creating a 'positive', responsive and safe environment. And I say 'yet' because there are great examples of how once struggling communities were able to transition to strong, vibrant and healthy ones. This process is iterative—that is, it takes time and effort, slowly building on past successes and, more importantly, learning from inevitable failures, while a community makes that transition. In my next blog post, I'll introduce you to some examples. But first, let's explore some characteristics within a community that affects its health.
Poverty, unemployment, crime, access to recreational facilities, the availability of 'good' schools and after school programming, public transportation, parks, playgrounds and trees, other public spaces, like libraries, affordable housing, safe drinking water and clean air, among many other characteristics, all have an influence in determining a community's overall state of health. These characteristics come under the category of the social determinants of health, which, as implied, are the social and economic factors that influence individual and community health outcomes.
These social determinants of health influence one's actual physical, mental and spiritual condition of health—if you've recently lost your job, at first you may go out or eat out less often in a bid to save money, with little impact to your overall health other than, perhaps, some measurable anxiety over finding your next job. If you find yourself unemployed for a longer period of time, you may cut back on your grocery bill, opting to perhaps forgo buying more nutritious and healthier fare, which can typically also be more expensive. You may go out much less, meaning less time spent with your friends in a bid to save money, making you feel more isolated. Your feelings of anxiety may evolve to a state of deep sadness, anxiety or depression, and perhaps in this state you may decide to stay inside more often, perhaps sitting on your couch for hours. And in doing so, you start may start gaining unnecessary weight as you aren't nearly as active and outgoing as you were before...
I can extend this example further, but I'm thinking that you're getting the point. Your social and economic environment plays a direct role on your health. Now, take this example and scale it up beyond the level of an individual and apply it to a community and you may be able to see how a characteristic like this one, in this case, employment opportunities, or specifically the lack thereof, starts influencing the larger community as a whole. Communities that experience sustained high unemployment can sometimes also see a measurable increase in crime, both of which impacts health.
In my next blog post, we'll look at some examples of how individuals and communities have taken upon themselves to improve the state of health in their communities.