Community Health

Community Health as a Conceptual Framework

As a conceptual framework, community health offers a view of health as the product of individual and extra-individual factors. This framework moves beyond a traditional focus on person-level factors and reframes both causes of disease and sources of health as interactions between individuals and their social and physical environments. Community health as a perspective is a relatively new concept. The time since 1980 has been cited as seeing enormous growth in the awareness of the need to attend to environmental causes of health. Rather than focusing only on modifying individual behavior, a community health perspective prescribes both behavior- and environmental-based strategies. The rise of this perspective has been credited to the acknowledgment that most public health problems are too complex to be understood simply as a product of individual behavior.

Possibly because of its interdisciplinary nature and lack of one core disciplinary home, the concept of community health is still in its formative stage. In discussing community health as a conceptual framework, researchers have referred to two similar, more established frameworks, including the socioecological model and empowerment theory. Both of these perspectives are based on the assumption that individual and environmental factors come together to influence health and illness, and both offer a set of principles guiding the approach to understanding health and disease, preventing disease, and promoting health.

The socioecological model specifies the following three assumptions: (1) environmental settings have multiple physical, social, and cultural dimensions that affect a variety of individual physical, emotional, mental, and social health outcomes; (2) individual characteristics such as genetics, psychological characteristics, and behavior affect health and, moreover, interact with the environment to affect individual outcomes; and (3) the variety of diverse settings within an individual's life interact to affect health. Community health has ecological roots and similarly views individuals as being nested within a series of embedded systems that are interrelated and interdependent. These systems range from social dynamics to physical organizations and can include families, neighborhood groups, schools, places of worship, government policies, and both explicit and unspoken prejudices. A community health perspective acknowledges the dynamic interaction between the systems in which individuals exist and acknowledges the [Page 197]importance of both systems being able to effectively meet the needs of individuals, and individuals effectively accessing systems of support. A community health perspective sees the effective functioning of these systems as vital to the health of individuals.

Empowerment theory views health as the product of an individual's social, economic, and environmental condition. Using an approach slightly different from the socioecological model, empowerment theory has at its core the need for authentic involvement of community members throughout the process of understanding the contributors to health and disease, and ultimately promoting health. Empowerment theory states that different groups in a society hold different levels of power and that this power affects the control that individuals have over their own health. Under this framework, community health stems directly from the ability of individuals to be involved in decision making in their communities. Empowerment advocates for the creation of more comprehensive networks of support and views healthy relationships between a community and other effective organizations as critical—organizations such as criminal justice systems, school systems, and healthcare providers. Participation is essential to this process as community members are vital to building and maintaining relationships across healthy settings.

...