Preventing as a Community

This week I am attending a meeting in Oakland, California focused on community prevention (and some grant opportunities for community prevention programs that are mandated in the new health care law). The aim of the meeting is not simply to acknowledge that community focused prevention programs and initiatives can work (which most of us know to be the case), but how we in health define “community”; what prevention means; and how our cultures (American) can move towards creating healthier communities rather than just focusing on specific diseases?

These are all interesting and dynamic questions which need to be explored in full, and the focus of the meeting will be what structural and social changes can be made. However, simply making “structural” changes – adding sidewalks, taxing tobacco, or making neighborhoods safer – will not necessarily engage communities. Community prevention has to come from within. Not just communities having the will or desire to make their communities healthier (in their eyes or ours), but they have to embody prevention. Healthier lives and “communities” are a lived experience. There are day-to-day realities that penetrate deeper than whether or not you have access to fresh produce or quality, affordable health care services.

Evidence-based methods and tactics are what get funding for communities to implement prevention programs. Hopefully this gathering will acknowledge that the internal experience is evidence and should be part of any comprehensive community prevention campaign.

As an interesting counter to this meeting, beginning next week I will be spending several weeks on Mfangano Island, Kenya. The Organic Health Response (OHR) is attempting to revolutionize disease prevention by fostering community from within – as an organization which has taken a truly diverse group of volunteers and has them supporting community members on Mfangano, rather than make changes for them. OHR has a sustainable ethos (which started with an organic farm), has harnessed IT, and thrives off of and builds social solidarity, not external structural changes. With one of the highest concentrated rates of HIV infection in Africa (and the World) – over 30% of adults are HIV + – the Lake Victoria region must make community prevention work. AIDS is a cornerstone of OHR, but holistic, community drive, community prevention is the aim.

Two very different perspectives on making communities healthier – a world apart? Or maybe not. It could be wishful thinking on my part to imagine that there is tangible give and take between the two, but I think not.

*Image is author’s own: Protests (which later turned violent) in Oakland, CA. Unsafe neighborhoods – violent environments – are unhealthy communities.

Stay tuned for notes from the island upon my return from Kenya!