| Health |
Welcome to the Health section of CPN. Our essays provide several perspectives on how to build community capacities and responsible citizenship in health institutions and behavior, as well as how to put health reform on more solid civic foundations. Case studies are drawn from community health innovations, state reforms based on the Health Decisions model of community dialogue on values, Healthy Communities, participatory innovations in managed care and nursing homes, and education for civic professional roles in health care. To find out more about our plans and how you might contribute, as well as connect to our Health Bulletin Board, click on Health Editorial Team.
Commodity or Public Work? Two Perspectives on Health Care.
by Bruce Jennings and Mark J. Hanson
Health As A Civic Question. A civic approach to health reform offers the opportunity to address the general crisis of politics in this country. Prepared for the American Civic Forum November 28, 1994.
Politicizing Health Care
by John McKnight
Stories & Case Studies
California Health Care Divide Involving the Public in Health Choices. California Health Decisions provides a range of tools to help citizens, providers, the media, and employers meet their health care challenges by identifying their core values, working through key issues, choices, and tradeoffs, and building sustainable solutions. This case study examines how MediCal and non-MediCal Beneficiaries discussed their health values in focus groups in Los Angeles and Orange Counties in November 1993, and the implications for health reform. Case study plus.
Central Medical Center: Redefining the Public Mission of Inner-City Health Institutions. In what was one of the last remaining African-American hospitals in the country, this St. Louis acute care facility became a site for public problem solving in partnership with other community groups beginning in 1991. Some 30 organizations and programs came into the hospital, from GED classes and women's groups to a joint chaplaincy-police department project on violence. Volunteers, nurses, physicians, and parents participated in the Saturday School program. This "citizen politics" approach also involved local artists and ministers in initiatives on art and healing. Story.
Citizen Politics Reinvents Alabama County Extension's Approach to Health. In Calhoun County, Alabama, County Extension health agents no longer "fix" community problems. Instead, they serve as catalysts, empowering ordinary citizens to develop solutions to the problems they experience. The citizen politics model has been used to address health issues from arthritis to diabetes and has altered Extension's whole approach to health work. Story.
Georgians Speak Out on Health Care: What They Want and What They are Willing To Do. Georgia Health Decisions, an independent, nonprofit, and nonpartisan group sponsored 257 community forums in civic clubs, churches, public housing projects, schools, hospitals and living rooms across the state in 1991-93. In this process citizens had a chance to discuss their underlying values in health reform, and to clarify how these would guide difficult choices and tradeoffs. Focus groups and citizen panels were also used to permit specific demographic clusters to articulate their concerns and to search for value consensus with other segments of the diverse Georgia population. Includes: case study plus. Case study plus.
Community Meetings Shape Oregon Health Plan. Confronted with the challenge of health reform, Oregon Health Decisions, a nonpartisan grassroots group, convened hundreds of community meetings throughout the 1980s to develop consensus on the basic values that citizens felt should shape reform. These were used to educate lawmakers, who then developed a reform process that included such meetings as an essential part of public deliberation on reforming Medicaid and extending coverage to the uninsured . The highly popular Oregon Plan resulted from these initiatives. Story and case study plus.
Healthy Boston Builds Strong Communities. Healthy Boston is a bold and innovative initiative that focuses on making things happen in communities in an inclusive and collaborative manner. The vision for Healthy Boston was to use a 6 million dollar fund to help self-identified communities within the city establish coalitions, define their own needs, use their own resources better, and be in a stronger position to negotiate with the city government and other outside agencies regarding resources and services. Case study plus.
Hospice Austin Develops Community Model to Expand Minority Access. Confronted with low minority participation in the hospice program, the HCFA organized "Town Meetings" around the country to develop new strategies. The Austin program decided to "raise their own nurses" with minority scholarships that required 600 hours each year of hospice service while in school, and a full-time commitment for two years upon graduation. Nurses invest $100,000 of Hospice dollars in the local NAACP credit union. Local ministers have collaborated to raise minority volunteers in hospice from virtually none to 26 percent of all volunteers. And programs have now become more responsive to the cultural differences and strengths for care within distinct minority communities. Story.
Lazarus Project Empowers Residents and Staff in Nursing Home. The Lazarus Project is a four-year old effort to address the feelings of powerlessness and dependency among the frail elderly in the Augustana Home in Minneapolis, Minnesota. Residents and staff have engaged each other not just as professionals and clients, but as citizens capable of confronting difficult issues, such as residents' needs to speak openly about death and dying, and staff's sense of overwhelming responsibility. A
" model has begun a process of change in staff and resident practices, as well as governance patterns. Case study plus.
Orphan Project Develops Community and Legal Support Systems for Parents and Foster Parents of Children Affected By AIDS. The Orphan Project, founded in New York City in 1991, has developed a collaborative model with agencies, hospitals, social service and volunteer groups to provide community and family supports, as well as policy changes, to meet the needs of the entire spectrum of children affected by AIDSfrom dying infants to healthy adolescents. Grassroots groups, such as Mothers of Children with AIDS (MOCA), and large medical institutions, such as Montefiori Medical Center, have worked to develop forms of service and a standby guardian law that empower mothers with AIDS and foster parents in providing care and removing bureaucratic impediments. Story and case study plus.
Teen Pregnancy Addressed in Public Forums. Lee County Extension Agents in Alabama have used the citizen politics model to bring a wide array of citizensincluding teenagerstogether to address the causes of teen pregnancy, with a focus on possible solutions. Story.