Community health development: a strategy for reinventing America's health care system one community at a time.

The purpose of this article is to propose a set of ideas for reinventing America's health care system, one community at a time. Community health development is proposed as a strategy and approach to population health improvement, the ultimate goal of health care reform. The practice of community health development, particularly the partnership approach, provides guidance about how this approach might be employed as a national health care reform strategy. Examples of two communities successfully using the partnership approach illustrate the methods described. Six specific recommendations for policy makers and public administrators in the new administration resulting from our experience with community health development are presented. First, adopt and apply community health development (CHD) as the American approach for facilitating population health improvement and building community capacity. Second, the partnership approach should be promoted as a model for communities to use in implementing CHD. Third, make the community-level the focus for planning, implementing, evaluating, and sustaining a full continuum of health and human services. Fourth, formally recognize the social determinants of health as a key component of a new population/community health status model and as a public policy driver for health care reform, marketplace issues, and population health status improvement at all levels of society. Fifth is a call for a national strategy for the recruitment, training, education, and support of individuals to facilitate this community movement. Sixth, Congress and the Obama Administration adopt and apply CHD as a national strategy and utilize American community-based experiences to bring about a national plan.

The political and policy implications of a rating system of community capacity to improve population health.

This article discusses the political and policy implications of a potential rating system of community capacity for health improvement. Evidence suggests that such a rating system will have little effect in the current health care environment unless it is directly related to the health care dollar. Community change agents and stakeholders, including the growing population of older adults, will perceive a rating system to have value only if the defined purpose meets their interests and needs, and if the rating system results prove useful for decisions that affect the bottom line in working on issues like health improvement and capacity.