By Cameron Shuler
Over the past several years, conflict analysis and resolution approaches have continued to transcend disciplinary boundaries, ranging from criminal justice and environmental sciences to, more recently, public health. While completing my master’s degree at S-CAR, I was offered the opportunity to work at the National Association of Community Health Centers (NACHC). Through this opportunity, my understanding and application of conflict analysis theories and approaches has been both challenged and sharpened.
Founded in 1971, NACHC serves as the preeminent national health care advocacy organization for America’s medically-underserved and uninsured. The mission of NACHC is “to promote efficient, high quality, comprehensive health care that is accessible, culturally and linguistically competent, community directed, and patient centered for all.”[1]
Over the course of the tumultuous history of health care in the United States, numerous initiatives have sought to increase access to and improve the quality of comprehensive patient care. Despite the relative success of these initiatives, individuals and communities continue to face barriers in seeking affordable and accessible treatment, particularly in low-income communities.
One of the most well renowned initiatives aimed at addressing public health inequality was developed during the early 1960s during President Lyndon B. Johnson’s War on Poverty. Through the work of health care pioneers and the support of the federal Office of Economic Opportunity, the Community Health Centers Program became a reality. Since 1965, community health centers (CHCs) have continued to grow and evolve to meet the complex and changing needs of medically-underserved communities nationwide.
Similar to grassroots, community-driven approaches to peacebuilding, the community health center model is designed to empower local communities while providing direct health care services. Acknowledging the unique needs of each community, CHCs are governed by a consumer-majority board to ensure needs are locally-driven and the voices of community members are heard and met. In addition, care provided by CHCs is designed with an emphasis on the specific needs of each patient while addressing those challenges that inhibit low-income, medically-underserved populations from obtaining both affordable access and quality care.
Recent research around social determinants of health (SDOH) underscores how social context, environment, and demographics shape and affect life outcomes for vulnerable populations. The Centers for Disease Control and Prevention (CDC) defines SDOH as the “conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.”[2]
Through the lens of conflict analysis and resolution, these factors and conditions serve as examples of structural violence. First developed by Johan Galtung, the term structural violence is used to describe “the consequence of social conditions.”[3] Structural violence demonstrates how practices that are embedded into the political and socio-economic fabric of society shape individual life outcomes. Throughout the United States, medically-underserved populations continue to face challenges ranging from low immunization rates and undiagnosed hypertension to pediatric obesity. However, CHCs are uniquely positioned to not only meet the needs of the medically-underserved, but also to understand the root causes underlying health inequities. By improving accessibility to affordable care while also understanding the cultural context of the communities they serve, CHCs are able to anticipate, prevent, and more effectively treat conditions and diseases.
One of the primary ways in which CHCs seek to improve access while also providing holistic patient-centered care is through enabling services. Enabling services are defined as “non-clinical services that aim to increase access to health care and improve health outcomes.”[4] Enabling services account for how social, economic, and environmental factors impact the health and health behaviors of medically-underserved populations. Specific examples of enabling services include case management, transportation, language interpretation and translation services, and health education. By integrating services that increase access to care while also providing care that is culturally competent, medically-underserved communities are strengthened and empowered.
The community health center model provides a rich and important example of how conflict analysis and resolution approaches can be utilized beyond the traditional boundaries of the field. By expanding the horizons of our understanding and challenging our conventional knowledge of conflict analysis and resolution, theories and approaches can be tested with greater rigor and lead to continued growth. The uniquely interdisciplinary field of conflict analysis and resolution provides a myriad of opportunities for cross-disciplinary partnerships and collaboration, which in turn leads to new knowledge and increased innovation in how we design and implement future conflict analysis and resolution strategies.
Sources
[1] “Mission,” National Association of Community Health Centers, http://www.nachc.org/about-nachc/mission/.
[2] “Social Determinants of Health: Know What Affects Health,” Centers for Disease Control and Prevention, January 28, 2018, https://www.cdc.gov/socialdeterminants/.
[3] “What is Structural Violence?” Structural Violence, http://www.structuralviolence.org/structural-violence/.
[4] “Enabling Services at Community Health Centers – A Critical Component in Building Sustainable Health Care Homes,” September 2010. http://www.aapcho.org/wp/wp-content/uploads/2010/09/AAPCHO-ES_at_CHCs_Building_Sustainable_Health_Care_Homes-Sep2010.pdf.