Moving Toward Holistic, Community-Centered Health
Many leaders said the U.S. needs a more well-rounded view of health that’s defined by well-being rather than illness.
“American healthcare could learn from Native Americans about how to address the whole person,” a health leader said. “We’re not addressing the whole person, we’re often just addressing the body part. That approach to healing is pathetic.”
A wellness- and prevention-oriented approach would help shift the health system toward addressing the underlying causes of health disparities, as a leader highlighted.
“I noticed our doctors would spend up to 45 minutes with a patient. When a patient goes in for a cold or fever, that’s not the only reason they’re going in,” the leader said. “They are talking to the doctor about how their child does not have a wheelchair and because of this they can’t go to school; they’re sharing that the neighborhood they living in, it’s not safe for them to walk on the street outside; they’re talking about the experience of being a survivor of torture from war overseas. A very, very heavy lift for a doctor.”
This same leader described how this clinic is now building relationships between patients and case workers focused on understanding everyday needs. “Now we provide housing, legal, job development support, in addition to clinical care,” the leader said.
Payment systems and structures create barriers to providing more holistic care, some leaders said. “There are a lot of other ways to approach health,” the leader said. “We know for sure that Indigenous people all have ways of healing. We may be able to go get a massage or adjust our back at the chiropractor and our insurance will pay for it. But why doesn’t our insurance pay for sweat [lodges]?”
A community-based organizational leader added: “The Community Health Worker movement has the potential to create real, positive impact in BIPOC communities, but in some or many states the funds allocated to bill for these services are primarily being utilized by health plans. It’s an example of resources that could be used to close racialized health disparities being placed in the wrong places because instead of the system changing to adapt to what having a community health worker means, we have asked the community health workers to adapt to the system.”
Community relationships are crucial to health, one leader said: “Health is dictated by your community. The more community connectedness you experience, the better your health. Medicine’s current orientation is treatment, but we need to focus on prevention. Having more connection to ‘near peers’ like doulas or promotoras inside of healthcare to provide social support and safety will result in de-medicalizing the system.”
A recurring theme for health leaders was the importance of community leadership in the design of health systems, including the importance of supporting trusted cultural and faith-based practices.
“Community-based work exists on a continuum. The large majority of current work aims to bring medical treatment to the people—by placing clinical services in churches or community centers,” said scholar Dr. Miraj U. Desai. “However, less work is undertaken that begins first with what these communities are already doing to address the well-being of their constituents, including their novel or ancestral practices, some of which have existed for hundreds if not thousands of years. Mindfulness, for instance, has existed for thousands of years in Asian tradition, but is almost never given such credit in the current mindfulness revolution in this country, instead being exposed to cultural erasure. And in our community-partnered work with an African American church around mental health/depression, we often discuss how the church has provided more well-being and anti-racism support than a mental health organization could possibly provide on their own.”
These are the views of health leaders who participated in an 8-month project to analyze structural racism across the U.S. health system and provide recommendations for the collective leadership required to dismantle it.