The chronic care model developed by Ed Wagner and colleagues is the definitive description of how to deliver high quality care for people with chronic disease. The component that has tended to be most under developed has been that related to the engagement of the resources of the wider community.
Healthcare tends to ask the question, “what’s the problem?,” community development has a different mindset – it asks, “what are the assets we can use and build on?”
The resources of the community are free or at least very cheap and no one is exploited or made to do something they would rather not. Cultural sensitivity is important in many communities particularly in ensuring treatments are accepted and followed, and community engagement strategies greatly improve this. Building sustainable communities to support patients have huge additional spin offs and can also support strategies for recruiting and training local workers, economic development and other social programs.
The Nuka healthcare system in Alaska provides a clear example of this approach. It recognizes that disease and its treatment as social, psychological and cultural components as well as the traditional bio-medical issues. The patient is treated as a customer and as an owner of their healthcare and their healthcare system and it infuses the healthcare system with the specific culture of this region.
Any healthcare system can start down this path by first searching for the assets that exist in the community they work with and secondly by developing their healthcare services to work with and realize the value of those assets.
This can only take place if the healthcare organization and its professional staff cede some power to those communities and the individuals in them.
Our research into patients groups backs this up with a recognition that there is a clear gap in health systems understanding of community assets.