Okihiro May, Sehgal Vija, Wilkinson Tiana, Voloch Kelli-Ann, Enos Rachelle, O'Brien Joyce
Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MO).
Hawaii J Med Public Health. 2014 Dec;73(12 Suppl 3):34-9.
Native Hawaiians and other residents living in economically disadvantaged communities suffer disproportionately from many health conditions, especially chronic diseases. Reversing this trend requires a comprehensive approach encompassing more than just improvement in healthcare delivery. Indeed, societal changes at multiple levels must occur, including environmental, systems, and policy change, in order to bring about sustainable improvements in community health and wellness. A key strategy to accomplish these upstream changes is an increase in the capacity of community-based organizations to provide leadership in health advocacy, support community health promotion, prioritize resource allocation, and participate in community health research. In disadvantaged communities where health disparities are the most severe, community health centers (CHC) are well positioned to take a pivotal role in these efforts. This report is a case study to describe processes taking place at Hawai'i's largest CHC to build organizational capacity and bring about upstream changes that improve community health and wellness. Ongoing processes at the CHC include (1) Institutional: commitment to address health disparities, expand the CHC research infrastructure, and develop a comprehensive worksite wellness program (2) Collaborative: development of a network of community partners committed to the common goal of improving the health and wellness of community residents, and (3) Systems and Policy: activities to strengthen the CHC's and community's ability to influence systems changes and policies that reduce health disparities. Preliminary results are encouraging although the processes and timelines involved require a long-term commitment in order to affect tangible results that can be measured.
夏威夷原住民和其他生活在经济弱势社区的居民在许多健康状况方面，尤其是慢性病方面，承受着不成比例的负担。扭转这一趋势需要一种全面的方法，而不仅仅是改善医疗服务。事实上，必须在多个层面发生社会变革，包括环境、系统和政策变革，以便在社区健康和福祉方面实现可持续的改善。实现这些上游变革的一个关键战略是提高社区组织的能力，使其能够在健康倡导方面发挥领导作用、支持社区健康促进、优先分配资源并参与社区健康研究。在健康差距最为严重的弱势社区，社区健康中心（CHC）在这些努力中处于关键地位。本报告是一个案例研究，描述了夏威夷最大的社区健康中心为建设组织能力并带来改善社区健康和福祉的上游变革而正在进行的过程。该社区健康中心正在进行的过程包括：（1）机构层面：致力于解决健康差距、扩大社区健康中心的研究基础设施并制定全面的工作场所健康计划；（2）合作层面：建立一个社区合作伙伴网络，致力于实现改善社区居民健康和福祉的共同目标；（3）系统和政策层面：开展活动，加强社区健康中心和社区影响系统变革及减少健康差距政策的能力。尽管所涉及的过程和时间表需要长期投入才能产生可衡量的切实成果，但初步结果令人鼓舞。
