Abstract
Background: In recent years, public health and social care systems have faced pressures due to socio-demographic changes and sustainability issues. Integrating social and health services is critical to ensuring equitable, continuous, and high-quality assistance, adopting a holistic approach to individuals' health and well-being. The framework of Population Health Management (PHM) has gained traction for its focus on improving the quality and sustainability of public health systems, reducing health inequalities, and enhancing social and health outcomes. A key initial step in PHM involves identifying the target population, with the concept of "community" being a focal point in primary care and population health since the Alma Ata Declaration. However, conceptualizing "community" remains complex, influenced by the specific goals and structures of health organizations. [1, 2, 3, 4]
Approach: This study aims to analyze the concept of ‘community’ by exploring perspectives from key stakeholder groups involved in district management, particularly middle managers. Grounded in MacQueen's definition [5], the research seeks to understand how participants identify and define "community." A web-based brief poll was conducted during meetings and seminars, posing both open-ended and closed-ended questions regarding participants' perceptions of community.
Results: Results indicated that 35% of respondents defined community as "a group of people linked by social ties, relationships, or family connections," while 20% viewed it as "a group of people who recognize their role in supporting each other and the collective well-being." Participants noted that if they had responded from a professional perspective, they would have defined community in geographical terms. The discussion emphasized the necessity of a broad definition of community, allowing for various organizational approaches to community engagement. Open responses revealed associations of "community" with geographical locations, specific populations, shared values, and mutual support, reflecting its multifaceted nature and the diverse perspectives on collective engagement. The need for multisectoral approaches is highlighted to address social determinants that influence health outcomes.
Implications: The findings underscore the need for a unified definition of ‘community’ to effectively implement PHM strategies and associated organizational reforms. The distinction made by managers between ‘population’ and ‘community’ illustrates a broader understanding of these terms, with ‘community’ viewed as an active participant in shaping health initiatives. Achieving a shared understanding of community is essential for the successful application of PHM strategies, facilitating proactive health interventions and fostering effective multisectoral collaboration.
References
1.World Health Organization. Primary health care policy paper series. Population health management in primary health care: A proactive approach to improve health and well-being. Copenhagen: WHO Regional Office for Europe; 2023.
2.World Health Organization. Declaration of Alma-Ata. WHO Regional Office for Europe; 1978.
3.Mannarini T, Fedi A. Multiple senses of community: the experience and meaning of community. J Community Psychol. 2009;37:211-27.
4.Kassler WJ, Tomoyasu N, Conway PH. Beyond a Traditional Payer—CMS’s Role in Improving Population Health. N Engl J Med. 2015;372(2):109-11.
5.MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss RP, Scotti R, et al. What Is Community? An Evidence-Based Definition for Participatory Public Health. Am J Public Health. 2001;91(12):1929-38.