Applying Low-cost Community Health Interventions to
Enhance Health in the United States
The United States consists of two Americas, one for the
urbanized and another for rural health care and they are vastly different This
article explores how the application of low-cost health care interventions in
other countries may benefit residents in rural America. Places that lack access
to hospitals, clinics, to mental health services, and of course, women’s health
centers in other countries have similarities to parts of rural America.
Leveraging trained volunteers to educate and assist public
health initiatives in rural areas is widely practiced in Africa.
|
Country |
Focus |
Location |
|
Malawi |
Health
Surveillance Associates focus on preventive, curative, family planning |
Rural/remote |
|
Mozambique |
Community Health Volunteers
and Community Health Extension Workers focus on prevention, family planning |
Rural/nonremote |
|
Kenya |
Community Health Volunteers
and Community Health Extension Workers focus on prevention |
Urban |
Measures of Quality
Capturing quality measures in terms of outcomes and
potential health metrics is uneven for community health centers, because there
is so much variety. Of the entities reviewed for this article, all used the Plan-Do-Act-Cycle
for implementation of health interventions.
Findings
1.
Community and preventive health interventions
are often not funded or underfunded because they don’t provide immediate quantifiable
benefits, like number of hospitalization discharges, clinic visits, etc.
2.
Legal and regulatory barriers to reverse
engineer the health system and develop low-cost high-value health improvements.
Thoughtful legal and regulatory changes should include review of health
interventions that have yielded high value at a low public cost from nations
outside the USA. The health care regulatory climate in the US feeds a siloed
system of invested profit centers, which lack systemic coordination and are often
at odds in targeted health goals.
Social Prescribing-Nonclinical services to improve health
and well-being.
In April 2024, a paper was published in Science Direct,
showing the comparative results of twelve high-income countries, including the
United States, which reviewed the impact of non-clinical community health
referrals and interventions to determine impact on health and well-being.
Methods of social prescribing include a community navigator,
a concept which was widely deployed for the Affordable Care Act enrollments in
the U.S. Referrals for housing, health care enrollment, and nutritional guides
are examples of social determinants of health. There are other community
activities which are low or no-cost which also improve quality of life,
including; community gardens, access to green space through parks and
wildlands, targeted support like twelve-step programs, access to public libraries,
listening to music, and engaging in creative activities, like learning to play
a musical instrument.
Current evidence is weak to show the effectiveness of
community programs in health improvement for people with multiple comorbidities
and social deprivation.
In the United States, the primary organization promoting
social prescribing is Social Prescribing USA. It has sponsored a national
conference and the second one is set for October 2026. It has a 50-state
initiative partnering with Kaiser Health on social prescribing. The link shows
the program map for social prescribing projects across the USA. https://www.socialprescribingusa.com/program-map
Community-based nontraditional health interventions in
the United States
Project Connection out of West Valley City, Utah, connects
people with mental health concerns to supportive community resources to foster
well-being. https://www.projectconnection.co/
Project Enhance in Seattle, Washington has two prongs for
seniors, one for fall reduction and one for enhancing wellness. It does provide
evidence-based analysis of the coaching process, which is rare for community-based
efforts. https://projectenhance.org/
Open Source Wellness
out of Oakland, California promotes 8 to 16 weeks of coaching for wellness
behaviors through community health centers. It coined the term experiential
medicine and is focused on behavioral health to motivate change. One of its’
outreach efforts is partnering through YMCA’s.
Baylor University is partnering with Blue Cross Blue Shield
to assess the impacts of community art programs on health & wellness.
Arts on Prescription, in Winston-Salem, North Carolina has
an arts outreach program with recommendations from geriatricians for seniors
through arts and movement. Wake-Forest University is leading a study on
movement therapy as a method to promote neuro cognitive health. https://improvment.wfu.edu/ https://improvment.wfu.edu/research/active-studies/
Social RX in Atlanta, Georgia works with community-based
organizations to provide mental and social well being for people who may have
barriers to traditional care. The goal of the organization is to combat
loneliness for protective and therapeutic health benefits. Social RX has
partnered with arts organizations in ten states and is working on reaching
fifty states. https://www.socialrx.com/about
Capturing the Results of Well Being Efforts
The University of Florida Center for Arts in Medicine is
conducting epidemiological research on the impact of the arts on health and
well-being. It has amassed hundreds of studies on the epidemiologic impact of
art on well-being measures, such as anxiety reduction, pain abatement, and reduction
in fatigue. The challenge in gaining widespread support for community
organizations linked to health is the research, especially where controls and
randomization have been used, is the failure to show a reduction in anxiety
meaningfully impacts health metrics, such as hypertension, compared to
traditional prescription intervention. Their site lists a randomized control
study of 112 patients in the United Kingdom, which tested reductions in anxiety
from listening to music with or without video, and were not found to be
statistically significant for patients who were undergoing treatment for cancer
or orthopedics.
The scientific proof that social engineering through
informal community organizations positively impacts health outcomes is thin,
but there have been multiple randomized controlled trials (RCTs) that show a
statistically significant (measurable) impact from the art intervention. It is
important to note, this does not mean the result would be considered
significant in the real-world clinical application for participants.
Scientifically measurable does not mean relevant to daily practice applications
for the individual or the clinician.
Summary
We have learned that volunteers are essential to support
community health efforts, especially in rural areas and training for a more
intensive outreach could have a long-term impact payoff for a modest
investment. Additionally, there is evidence to suggest that art, especially
with music, has significant benefits for health and well-being, which means we
should be investing more in these programs and studying the scientific impact
on the mind and body. Of course, this is counter to the Trump Administration’s
approach of taking a wrecking ball to the National Health Institute, the
National Endowment for the Arts, universities, and any organization practicing
scientific research. All to support tax breaks for billionaires and a war in
the middle east. Ironically, as the tax credits for basic health care for the
working-class are expiring, Americans must provide free health care for life
for Trump and Melania. As an homage to Mrs. Trump’s jacket scrawled with “I
really don’t care do you?” Yes mam, I really do care that tens of millions of
Americans are losing their health care, and another million have lost their
jobs.”
And this is the healthpolicymaven signing off encouraging
you not to sign blanket releases when agreeing to medical procedures, so specify
that for which you consent and decline. Having a POLST (Physician Orders for
Life Sustaining Treatment) agreement on file with your primary care provider is
also a good idea. https://polst.org/for-patients/
This column has been in continuous publication since 2007
and no remuneration is received for the opinions of healthcare analyst and
journalist, Roberta E. Winter.
References
Eckhouse, D. R., Hurd, M., Cotter-Schaufele, S.,
Sulo, S., Sokolowski, M., & Barbour, L. (2014). A Randomized Controlled
Trial to Determine the Effects of Music and Relaxation Interventions on
Perceived Anxiety in Hospitalized Patients Receiving Orthopaedic or Cancer
Treatment. 33(6):p 342-351(November/December 2014.).
doi:10.1097/NOR.0000000000000098
Giada Scarpetti, H. S. (2024, April). A comparison
of social prescribing approaches across twelve high-income countries. Health
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He, ". a.-t.-c.-i. (2019, August 16). Costs of
Integrating Close to Community Programs in Five Low-income Countries. British
Medical Journal Global Health, 2019: 4(4 (4) e001390), 5507. Retrieved
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Reimnitz, L. &. (2020, December 2). A randomized
pilot study of music therapy in the form of patient-preferred live music on
fatigue, energy and pain in hospitalized adult oncology patients on a blood
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Rowthorn V, P. A.-D., & 28314501., 8.-1. d.
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