Community-driven policy goals: Health system improvement through culture change

This study engaged members of a rural community in the design of strategies for sustainable health system improvement. An ongoing community-based participatory research approach was used by a regional healthcare access coalition and a state health policy center to engage a consumer work group, which met regularly for over a year. The study began by presenting the consumer group with local data on health, background on the drivers of community health, and examples of successful improvement models. Consumers reflected on this data and offered their insight, then further information was provided regarding the social determinants of health, using the World Health Organization's framework. The group selected three determinants as their focus for further work: access to healthcare, stress, and healthy living. Local experimentation was recommended to identify promising interventions that might improve social determinants of health in their community. Mini-grant photovoice projects focused on increasing access to healthy food, decreasing stress among workers and empowering the homeless. Reflections on the projects revealed themes of empowerment and systems thinking insight. Culture change was identified as the ultimate goal of health system improvement to manage chronic disease and improve access to well care. This consumer group saw the social determinants of health as part of their local health system. Opportunities to engage in learning and short-term project development revealed the need for policies that support both cultural and environmental change to improve healthy consumer choices. Consumer recommendations have been integrated into ongoing community health improvement planning.