Through civic agency and by harnessing the power of citizen scientists working with lay citizens, we can tackle the problems of population health.
Health care in the United States is in a bad way by almost any account: our spending is unsustainable and our health indicators are poor when compared to other developed nations (National Research Council and Institute of Medicine, 2013). Debates about the future of health care, including the role of the Affordable Care Act, are fierce and rampant. Moreover, the focus is almost exclusively on provider and payment systems, and the role of citizens is relegated to signing up for mandated health care insurance. The traditional medical model is a hierarchical one, with physicians and policy experts knowing what’s best for patients. More progressive models are collaborative, with providers seeking to partner with patients to help them stay healthy and manage illness well (Mendenhall, Berge, & Doherty, 2014; Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). What is missing, and sorely needed, is a civic science approach to health care transformation, in which concepts and practices of civic agency and the idea of harnessing the joint power of professionals and ordinary people to tackle the wicked problems of population health take center stage.
Through a series of projects, we have developed Citizen Health Care as a way for citizen professionals to engage in the work of health care transformation. The central premise of citizen professional work is that the greatest untapped resource for improving health and social well-being is the knowledge, wisdom, and energy of individuals, families, and communities who face challenging issues in their everyday lives. The ten core principles are as follows:
- See all personal problems as public ones too: the I and the We.
- Look to family and community resources first.
- See families and communities as producers, not just clients or consumers.
- See professionals as partners, not just providers.
- Let community members drive programs rather than programs service communities.
- Make sure every initiative reflects the local culture.
- Grow leaders, then more leaders.
- Make all decisions democratically.
- Go deep before taking action.
- Think big and act practically.
Our projects often involve sustained community action over years. These are usually connected to a community institution that embraces the philosophy. Some other projects are designed as short term “cultural organizing” initiatives aimed to naming a problem, activating new voices, and starting a cultural conversation locally or nationally. Here is a link to one of our on-going projects for illustration: Baby Boomers for Balanced Health Care (www.boomers4balancedcare.org)