How a Community-Academic Partnership Serves as a Force for Change in Health Care and Health Professions Education

Brief communication HOW A COMMUNITY-ACADEMIC PARTNERSHIP SERVES AS A FORCE FOR CHANGE IN HEALTH CARE AND HEALTH PROFESSIONS EDUCATION As academic health centers become increasingly aware of their leadership role in improving the health of the public, many are considering community-oriented primary care (COPC) as a possible framework for their health care programs.1"3 A COPC approach directs health care initiatives to a defined community by identifying health care needs within that community and responding to those needs through interventions and the evaluation of health outcomes. One such academically based program, the Center for Healthy Communities in Dayton, Ohio, has taken COPC a step further by forming a health service partnership with the community it serves. In this partnership, academicians and community members work together to actively promote the health of the community by encouraging individuals to take an active role in their health and by educating health professions students in new ways. Established in 1991 as Partners for Community Health Development, the partnership was formally organized as the Center for Healthy Communities in 1994. The center, which includes the Dayton community and the health professions schools of Wright State University and Sinclair Community College , was initially developed by the leadership of the health professions schools, including the deans and associate deans of both schools as well as the provost and president of Wright State University. Community leaders were identified early in the program planning process through discussion and networking. The hallmark of the center is its model for change in health care delivery, which departs from the present illness-care-focused system to one that emphasizes community-oriented primary health care and wellness (Figure 1). The change agents in this new system are members of the community and academe, and the proposed outcomes are enhanced education on the part of both health professionals and patients, and better health care service delivery. The strength of the model rests on the ability of participants to effect long-term change at several levels—community, health care provision, health professions education, and health policy. Since its inception, the center has captured the attention of the governor and state and federal legislators. It is viewed as an innovator in health care partnerships through community participation. The center has a diversified Journal of Health Care for the Poor and Undersetved · Vol. 8,No. 1 · 1997 6 A Community-Academic Partnership FIGUREl CENTER FOR HEALTHY COMMUNITIES MODEL FOR CHANGE funding portfolio with funds from both external and institutional sources (federal, state, foundation, private, and university). About the community Dayton, Ohio, is a midsized city (population of 182,044) with some of the problems experienced by larger cities. Like many other industrial cities, Dayton has seen its job base erode. Approximately 22 percent of Dayton's families live below the poverty level. According to the 1990 census, the per capita income in 1990 was $9,956, with significant portions of Dayton's children and elderly living below poverty levels. Despite its problems, Dayton is also a city of strengths. The city serves as a "barometer" for the nation because Dayton's Maurana et al. opinions mirror national trends. For example, Dayton's reactions to President Clinton's economic plan were sought by the New York Times, Los Angeles Times, British Broadcasting Corporation, U.S. News and World Report, and Time. Thus, Dayton, as America's "average" city, provides an excellent site for the development of innovative health care delivery and education programs that can serve as models for similar cities. The Center for Healthy Communities focuses on two communities within Dayton that reflect the most need. One community is primarily African American located in West Dayton; the other is primarily white Appalachian located in East Dayton. A portion of these communities has been designated as a federal health manpower shortage area with a lack of primary care physicians. Goals and activities The power in the center's goals lies in the fact that a broad base of community and academic members developed the ideas, are committed to them, and are now implementing them (Table 1). The center emphasizes the philosophy of "doing with" rather than "doing for" or "doing to." Total Quality Management techniques...