There has long been an established scientific link between social determinant risk factors (SDRF) operating in low-income community and the despairingly poor health, education and social outcomes being experienced by families and children residing in these communities. Continued research established that families and children residing in the lower third of the community’s income profile experienced the worst outcomes in the community. This trend led to the deduction that the inequitable distribution of wealth is underlying cause of this inequitable distribution of SDRF in low income communities.
In 1964, during the civil rights era, efforts to improve access to primary care services for residents of low-income, underserved communities were initiated. Primary care services were to be delivered from a community clinic infrastructure located within the community – through a community oriented primary care (COPC) service system. This COPC service system is an adaptation of a system of health care delivery used in South Africa, by Sidney and Emily Kark, a husband and wife team of white physicians, to deliver care in black underserved communities, during the time of Apartheid.
In 1996 following decades of failed, individualistic, monetary investment by philanthropy and other non-governmental organizations to address the outstanding inequity in health and wellbeing outcomes , the William K Kellogg Foundation (WKKF) and the Robert Wood Johnson Foundation (RWJF) joined forces to design and construct a nine-year, Turning Point (TP) collaborative initiative to address the problem. The foundations provided over $27 million funding for its implementation - making it to date, the largest singly non-governmental funding effort at addressing this problem. The idea behind the foundations collaborative effort was to achieve success through simultaneously promoting community capacity building within low-income communities, nationally and enhancing the capacity of existing public health service systems to better address the impact of social determinant risk factors (SDRF) operating within the communities.
In 2010, a decade after completion of the WKKF and the RWJF 1996 collaborative initiative, the problem of inequitable distribution of poor health and well-being outcomes in low-income communities remained unchanged. Our public health service systems were unable to address the issues associated with SDRF that serves to drive these outcomes. Against a background of knowledge on the challenges to the success of the failed WKKF - RWJF 1996 TP collaborative initiative and years of its successful implementation in the field of public health practice, Fusion Health Solution initiated a self-funded, 10-year community-based implementation initiative within of a rural Native American Indian Reservation. The concept behind the design and construct was to create a hybrid that fused the success of the 1964 COPC effort with the success achieved from the successful implementation efforts of the foundations’ 1996 community capacity building effort in the field. In this hybrid unit the district’s managerial office was the community entity through which our TP community capacity building effort would operate. Our district unit entity was tasked with developing a methodology for promoting and protecting the health as well as the well-being of the district’s children – now and for generations to come.
A 2020, review of the documented outputs, outcomes and successes achieved by our 2010 project allowed us to identify the methodology for achieving improved health and well-being outcomes in low-income, resource strapped, underserved communities. The answer was a community well-being promotion care (CWPC) practice system administered through the infrastructure of an established community institution. While COPC serves to address primary care service needs, CWPC address community identified health and wellbeing needs.
The accumulated experiences from over a decade of wellbeing care promotion work in the field of public health practice has served to establish the founding principles for the practice of the wellbeing promotion work we pursue in the future. The three FHS core principles of success are:
- An understanding and appreciation of the fact that while institutions can deliver excellent services, only people can deliver efficient and effective care.
- While the institution will deliver the services, the care content that goes into well-being care must originate from community led strategic planning efforts.
- Vulnerable populations if given equal opportunity to access all available resources, with guidance, can define and charter their own course and pathway to achieving their perceived success.