| 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.
Civic
Perspectives
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 "public
community" 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 AIDS—from 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 citizens—including teenagers—together
to address the causes of teen pregnancy, with a focus on possible
solutions. Story.
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