Family Wellness Warriors

This article discusses the development and implementation of a culturally relevant resiliency model to address the physical, mental, emotional, and spiritual wellness needs of adults who have experienced harm. Common diseases in adulthood have been linked to abuse in childhood. To end abuse and improve health in Alaska, Alaska Native people are forming partnerships with health care organizations, government agencies, social service providers, and faith communities to disseminate Family Wellness Warriors Initiative strategies. Nearly 3000 people have participated in Family Wellness Warriors Initiative trainings. Through this healing work, families and communities are working together to change health disparities and restore hope.     

Contextual influences on reproductive wellness in northern India

OBJECTIVES: There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. METHODS: Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. RESULTS: The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. CONCLUSIONS: Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.     

The place of health in the health of place: the case of the Hokianga special medical area

Contemporary models of health have broadened the concept so that health includes, but is not exclusively, biomedical wellness. One concern arising from this widened perspective is the degree to which health service provision promotes healthier, more convivial communities. This paper examines the contribution of health services to the experience of place in the Hokianga, an isolated and predominantly Maori area of New Zealand. While other public services are being increasingly privatised, charged to users and restructured to central nodes of provision, health care in the Hokianga remains free and delivered within a network of community clinics. It is argued that the taking of health care into communities both enhances the wellness of the population and positively enhances the experience of place for local residents.     

Wellness in the healing ministry

Wellness has gained a foothold in most healthcare delivery systems because of its focus: Keeping people well is the ultimate goal of a healthcare system. Three generations of wellness models have evolved over the past 16 years. First-generation wellness efforts focus on reducing health risks. Hospitals have developed programs and services to improve customers' and employees' health status. And corporations are lowering health risks by offering employees worksite fitness centers, cholesterol and other screenings, and smoking-cessation programs. Second-generation wellness efforts link wellness to benefits. Hospitals and corporations have implemented health incentive programs, structured to reward people for maintaining low ranges in their controllable health risk factors. Third-generation wellness efforts show that connectedness can improve health. Such efforts emphasize the importance of spiritual and emotional well-being as an inextricable part of physical health and healing. Today prayer and support groups, guided imagery, and prayerful meditation are becoming more mainstream. Such wellness approaches encourage persons to think and care for themselves more holistically.     

A Comparison of Self-reported Physical Health and Health Conditions of American Indian/Alaskan Natives to Other College Students

American Indian/Alaska Natives comprise a small portion of the general college student population, but often have the poorest health and wellness, as well as the highest dropout rates compared to any other race or ethnicity. Despite the well-documented issues this group faces in higher education, they are often ignored in studies due to their status as the minority within the minority, comprising only 0.8 % of all college students in the US. This study examines the differences in college students’ overall ratings of health across racial and ethnic groups, focusing specifically on the health and wellness of AI/AN students compared to their counterparts. This paper also investigates the physical health issues students experienced in the past 12 months and the health issues’ impact on their academic achievement. Results showed that AI/AN students reported the lowest overall health ratings and the most health issues in the past year.     

Building structures of environmental repossession to reclaim land,self-determination and Indigenous wellness

In Canada, Indigenous health inequalities are sustained by colonial structures that create social disadvantage and limit Indigenous self-determination to Land. Drawing on the concept of environmental repossession, this study explores how Indigenous communities are building local structures to reclaim their territories and renew the values, responsibilities and knowledges tied to these places for wellness. Specifically, this study examines the meanings of the everyday work of the Department of Sustainable Development in Biigtigong Nishnaabeg and shares lessons for other communities seeking to foster self-determination over Land, identity and wellness. Qualitative analysis of interviews with current and former department staff members support an advanced understanding of how repossession strategies are sustained by Indigenous communities to foster place-based goals and address structural barriers to wellness.     

King's College's Graduate Program in Health Care Administration helps to achieve community wellness: a case study

Graduate programs in health care administration can become catalysts in the community wellness initiatives that the Institute of Medicine and the Centers for Disease Control and Prevention have identified as being critical to the improvement of public health among the U.S population. This paper examines the results of such a program at King's College, Wilkes-Barre, Pennsylvania, which developed community wellness programs through the establishment of a center for health promotion, assisted in the establishment of a city health department, developed a peer leader tobacco education program for elementary school students, and produced a 30-minute video on adolescent high-risk behavior. The program's goal is to facilitate coalition building among health agencies and to produce graduates equipped with administrative skills and a thorough knowledge of the value of well-developed community wellness programs. Healthy communities will require the emergence of leaders who can gather information about high-risk health behaviors and work with communities to implement solutions. Health care administration programs have a tremendous opportunity to become catalysts in the development and implementation of educational programs that may improve a community's overall health and reduce health care costs.     

A vision for a healthier America: what the states can do

States face a growing chronic disease burden that threatens to overwhelm their fiscal resources and health care systems. Consequences of inaction--for individuals, states, and our country--are incalculable. To maintain global economic competitiveness, reduce burgeoning health care costs, and ensure that our children have healthy futures, disease prevention/health promotion must become a core value in state government. Although personal responsibility is crucial to attaining wellness, governors can play an essential role in reorienting states' actions toward prevention of ill health. Governors can motivate a shift in U.S. culture toward wellness through three primary avenues: communities, worksites, and schools.     

Program management and policy issues in information outreach: lessons from Tribal Connections

With the advent of the Internet, American Indian/Alaska Native (AI/AN) communities in the Pacific Northwest have new opportunities to access high quality and relevant health information. The Pacific Northwest Regional Medical Library (PNRML), regional headquarters of the National Network of Libraries of Medicine, a program sponsored by the National Library of Medicine, sought to facilitate that access and worked with a selected group of sixteen tribes and native village consortia. The steps were: (1) work with AI/AN communities to arrive at mutually-agreeable health information connectivity objectives and long-term solutions, (2) provide funding to AI/AN communities to ensure Internet connectivity and the presence of Internet workstations for health workers and for the public, and (3) train in effective health information seeking. Community-based approaches helped the PNRML adjust policies and practice for improved information outreach to AI/AN communities in the region. The project participants, collaborating with our staff, successfully carried out many of the community goals and, at the same time, we gained insight about the variables that were barriers or facilitators of success. While we are coming at outreach from a library perspective, the policy and method lessons we learned could apply to a broad variety of outreach endeavors.     

Perspectives on American Indian health

American Indians and Alaska Natives continue to experience significant disparities in health status compared with the US general population and now are facing the new challenges of rising rates of chronic diseases. The Indian health system continues to try to meet the federal trust responsibility to provide health care for American Indians and Alaska Natives despite significant shortfalls in funding, resources, and staff. New approaches to these Indian health challenges, including a greater focus on public health, community-based interventions, and tribal management of health programs, provide hope that the health of Indian communities will improve in the near future.     

Inupiat youth suicide and culture loss: Changing community conversations for prevention

Inupiat living in Northwest Alaska have one of the highest youth suicide rates in the world. Other circumpolar peoples share this disturbing distinction. This demographic and ethnic health disparity has spurred research that investigates acculturation stress as a cause of Inuit youth suicide. Despite this body of knowledge, few studies describe how local people connect suicide to culture loss, even though this understanding is crucial for developing effective prevention and intervention strategies. This article describes how Inupiat understand and talk about youth suicide and suicide prevention within public settings. I have used participatory action research (PAR) to illuminate the meanings and processes that surround youth suicide. In meetings focused on suicide prevention, local people clearly link self-destruction with historical oppression, loss of the Inupiaq culture and current manifestations of these realities in alcoholism, abuse and neglect. This narrative typically focuses on young people and the Inupiaq community's current failure to lead them to a bright future. The article describes these understandings and offers suggestions to expand them in order to create new possibilities for community-based prevention and the promotion of wellness in circumpolar communities.     

Multi-stakeholder perspectives on perceived wellness of Special Olympics athletes

BackgroundResearch to date with children and youth with intellectual and developmental disabilities (IDD) has previously focused upon specific aspects of health (e.g., physical activity, nutrition). A broader focus on ‘wellness’ takes a positive approach to health by addressing how individuals can lead meaningful lives by focusing on their unique strengths and resources across multiple wellness dimensions, rather than focusing on deficits.ObjectiveThis study, conducted in partnership with Special Olympics (SO), aimed to understand the state of perceived wellness and wellness-promoting behaviours of children and youth with IDD from multi-stakeholder perspectives (i.e., SO athletes, caregivers, and coaches).MethodsA cross-sectional Likert survey methodology was employed to generate data on the perceptions of multiple stakeholders on different wellness dimensions identified through a literature review and consultations with SO stakeholders.ResultsAthletes, caregivers and coaches generally agreed rather than disagreed with wellness statements, with the exception of coaches' responses regarding healthy nutrition. Athletes agreed more than caregivers and coaches that they engaged in some wellness promoting behaviours (i.e., calming oneself down, participating in their communities). Athletes and coaches were more likely to agree than caregivers about athletes’ positive outlook.ConclusionAthletes’ perceptions of their own wellness are unique from those of caregivers and coaches. Focusing on wellness can broaden understandings of how to support young people with IDD by drawing on their strengths and resources to foster optimal health and a sense of wellness in ways that are meaningful and relevant to them.     

A far greater sense of community: The impact of volunteer behaviour on the wellness of rural older Australians

This paper builds on place-based research investigating the transformative potential of volunteering for service-deprived, ageing rural communities. Here, we critically explore the relationship between communities of place, voluntarism and wellness for rural older Australians. We draw on data from a large qualitative multi-site study, and utilise Ryan et al.’s (2005) systemic model of community attachment. Findings support the dual perspective of strong community sentiments through social embeddedness in rural communities; and personal interests, associated with rational choice theory, through healthy ageing practices. Both aspects have demonstrated positive impact on wellness, but also risks to wellness associated with over-expectations of volunteers.     

Peer Reviewed: Evolving Definitions of Mental Illness and Wellness

Understanding of the definitions of wellness and illness has changed from the mid-20th century to modern times, moving from a diagnosis-focused to a person-focused definition of mental illnesses, and from an "absence of disease" model to one that stresses positive psychological function for mental health. Currently, wellness refers to the degree to which one feels positive and enthusiastic about oneself and life, whereas illness refers to the presence of disease. These definitions apply to physical as well as mental illness and wellness. In this article, we build on the essential concepts of wellness and illness, discuss how these definitions have changed over time, and discuss their importance in the context of health reform and health care reform. Health reform refers to efforts focused on health, such as health promotion and the development of positive well-being. Health care reform refers to efforts focused on illness, such as treatment of disease and related rehabilitation efforts.     

Healthy doctors, healthy communities

Promoting health and eliminating disease are goals of Healthy People 2010, a national initiative for all communities. Physician-directed interventions that advance these principles are most effective when directed by clinicians who regularly participate in such healthy behaviors themselves. This pilot study describes an 8-week intervention, "Well-being for You and Your Patients," for first-year medical students to experience health behavior change. In the 2-hour sessions, students set goals for changing health behavior in 6 dimensions of wellness; report their progress; and enjoy a 30-minute change-of-pace wellness activity. The authors recommend adapting the course for medical student alumni to facilitate health behavior change with small groups of adults, school-age children, teens, and elders in churches, schools, community health centers, and other community-based organizations. Through continuing medical education and Grand Rounds, residents and physicians in practice could also be trained to implement specific behavioral change strategies.     

Environmental risk, health and justice: the protagonism of affected populations in the production of knowledge

This article discusses the role of populations affected by environmental injustice situations in the production of knowledge about environmental health stemming from inequalities and discrimination in the distribution of risks and benefits of economic development. Special attention is given to the epistemological and political limits to producing knowledge and alternatives that enable advances in building more just and sustainable societies are highlighted. Based on a broader view of health, the limits of scientific approaches are called into question by acknowledging the importance of local knowledge are discussed, either to analyze environmental risks or their effects on health, including epidemiological studies. These limits are linked primarily to the concealment of conflicts and uncertainties, the lack of contextualization of exposure to risk and effects on health, as well as the difficulties of dialogue with the communities. The article also presents contributions and advances presented by environmental justice movements. The conclusion is that a constructivist, procedural and democratic perspective of confronting forms of knowledge and practices can guide the scientific production to benefit of environmental justice.     

Tithing programs: pathways for enhancing and improving the health status of the underprivileged

Background

While quick and easy access to healthcare services is a reality for some, others experience significant hardships, even for receipt of the most basic health and medical care and attention. To those who effectively have been shut out of the healthcare marketplace due largely to economic deficiencies, healthcare providers engaged in the delivery of charitable services are a critical lifeline. Myriad attempts by governmental entities to remedy disparate access and shore up the delivery of healthcare services directed toward the disadvantaged have failed to close gaps, warranting pursuit of novel methods that offer potential and the hope that sufficient access might one day become a reality.

Discussion

One innovative approach for enhancing and improving charitable healthcare endeavors in communities was developed by Willis-Knighton Health System. The initiative, known as the Tithing the Bottom Line program, essentially takes a portion of the health system’s earnings and directs these resources to fund pursuits that improve quality of life in the community, with the enhancement of health and wellness services for the underprivileged being a top priority. These resources magnify the efforts of establishments already endeavoring to serve those in need and create powerful synergies which positively impact the health status of disadvantaged populations. To shed light on Willis-Knighton Health System’s unique charitable initiative, this article describes its tithing program in detail, supplying operational guidance that will permit healthcare institutions to establish like programs in their communities.

Conclusions

With healthcare access gaps remaining pronounced despite numerous attempts by governmental entities to realize full access, grassroots efforts remain critical to bolster health and wellness broadly in communities. Deficiencies carry dramatic consequences for both the disadvantaged and the greater communities in which they reside. The synergistic, cooperative effort realized by Willis-Knighton Health System’s tithing program offers great potential for reducing healthcare disparities, yielding healthier populations, enhanced opportunities, and better communities.

     

Community involvement in the ethical review of genetic research: lessons from American Indian and Alaska Native populations

The National Bioethics Advisory Commission has proposed that regulatory oversight for research with human subjects be extended beyond the protection of individual research participants to include the protection of social groups. To accomplish this, the commission recommends that investigators and ethics review boards a) work directly with community representatives to develop study methods that minimize potential group harms, b) discuss group implications as part of the informed consent process, and c) consider group harms in reporting research results. We examine the utility of these recommendations in the context of research with American Indian and Alaska Native communities. Because much attention has been given to the question of how best to consult with members of these communities in the design and conduct of research, we believe it behooves investigators to consider the lessons to be learned from research involving American Indians and Alaska Natives. After describing several difficulties surrounding the application of the commission's approach to these research contexts, we propose a research agenda to develop best practices for working with local communities in the ethical assessment of epidemiologic and environmental health research.     

Maximizing effects of wellness programs for the elderly

The authors studied 84 randomly selected participants who live in retirement communities to discover factors leading to successful completion of a wellness enhancing program. Four variables formed a discriminant function that correctly grouped 69 percent of participants. The authors discuss issues in identifying those most and least likely to benefit from wellness programs.     

A people-centered approach to primary health care implementation in Mvumi, Tanzania

The Mvumi community-based health care programme in Dodoma Region has been attempting to involve communities in promoting their health. It established a dialogue using communication and adult training skills and assisted communities only in those activities which they themselves planned and which they were ready to finance. Such activities included training of community resource persons such as traditional midwives and village health promoters/workers. Within only 4 years substantial output and outcome results could be demonstrated. Many village communities, for example, have assumed responsibility for the village-based nutrition rehabilitation of their severely malnourished children.