‘It’s All About Empowerment’.
On September 12, more than 400 people listened to a national symposium at the School of Public Health to generate a definition of community health sciences (CHS) and to affirm that it takes center stage in public health.
In addition to three panels with nine panelists, and one discussant to anchor each, the attendees (in person and online) heard two plenary sessions from thought leaders in the field—Nina Wallerstein, director of the Center for Participatory Research at the University of New Mexico, and Robert M. Kaplan, former US Agency for Health Care Research and Quality chief science officer and Nation Institutes of Health (NIH) associate director. The latter asked that we consider a paradigm shift in how health science is done, suggesting that it resemble, or be, community health sciences, not a sole focus on linear biological mechanistic science.
Presenters were diverse in many ways, including junior faculty, a community member, and senior faculty and chairs. The majority of panelists were women, and half of the panelists were people of color. But the diversity and substantive contributions were not limited to panelists and their chosen topics (violence, substance use, HIV, maternal and child health). Audience participants came from as far as Los Angeles, and included associate deans; department chairs; the president-elect of the American Public Health Association; the editor of the American Journal of Public Health; students from area schools; faculty, staff, and alumni; and people from government, industry, and non-governmental organizations. Recent hurricanes kept some from coming from Tampa and Houston, but one panelist presented her work via Skype instead.
So what did they conclude? That CHS is a field and that it has definable features. Furthermore, they concluded that it is essential for improving health, since many facts are discovered with basic sciences that never get implemented or improve health because of a failure to understand how to do so, or they never work because they are not generalizable to a specific community.
The participants agreed that CHS involves the lens of community, is collaborative and engages with communities in partnership, and involves advocacy. It draws on just about any science and method that is relevant to answering health questions of importance to communities—from computational sciences to qualitative methods, and everything in between. It is usually interdisciplinary, and constantly questions findings, particularly when community members raise questions. External validity is critical. CHS pays particular attention to marginalized and stigmatized persons. It also takes account of the fact that single interventions rarely work, and that syndemics (synergistic epidemics) are the norm.
Health outcomes of importance are quality of life and death, though many other outcomes (such as engagement and showing up) are also of importance more broadly. Formative work, repetitive study, and implementation science feature prominently. Trust matters, relationships matter, stories matter, and perhaps most broadly and above all, context—social context in particular—matters.
In sum, the symposium established a preliminary definition of this academic field, one that is essential for improving the health of the public. Next steps will be to refine it, and then to do it, with communities. We thank all of the participants, and look forward to engaging more voices as this nascent field and focus develop.
Richard Saitz is chair and professor of community health sciences.