Does the “community” really have voice? – Deb Dole

The business of health care has effectively muffled, if not silenced the voice of communities. The real needs of communities are often overlooked as health care dollars, programs and initiatives are rolled out in an effort to "fix" what is believed to be broken. The result is a labeling of individuals and communities as "non-compliant" or "resistant" when the pre-determined initiatives do not have the desired effect. I was perusing http://www.Grants.gov/ to see what the latest topics in maternal/child health were being funded. All of the buzz words such as "health disparities", "infant mortality", and "teen pregnancy" were prominently displayed in many titles. After reading further, a majority of funding opportunities were directed at implementation of programs previously "proven effective". Where is the voice of the community in determining what their own needs are or what programs might be useful? Issues of power and control continue to rule the day.

Action research and community-based participatory research hold the promise of changing the dynamics of the discussion…redistributing the power. The midwife in me tends to want to mother those around me. While well-intentioned, sometimes this is not the most helpful approach. Let me help you often turns into let me do it for you. Engaging communities, not just health professionals who work in communities in the discussion is critical to turning up the volume of community voice. Teaming those who have access and voice (academic community, medical professionals) with those who have been muffled or silenced can fundamentally change the ways in which public policy directed at the health of communities can be shaped to actually benefit those communities. Change from the inside out…lasting and meaningful…How do we start?

Maybe we start by listening.