Dr. Mark DeHaven has built a successful research program starting over the past two decades, combining clinical science, epidemiology, and informed social action for improving health in vulnerable communities. His research program is guided by his understanding that most health-related suffering is preventable and unnecessary. Mark and his team constantly strive to refine innovative community-based participatory research (CBPR) models and programs for improving health outcomes and life chances among those at greatest risk of preventable disease. By working with communities rather than merely in communities, they seek to develop replicable models for understanding health and disease determinants, and supporting mechanisms for promoting healthier life circumstances for individuals, families, neighborhoods, and communities.
As a community health researcher and community medicine division chief in three major cities, he has witnessed firsthand the high levels of persistent chronic and acute diseases among predominantly employed low-wage earners and minorities residing in the inner city.
Economically vulnerable individuals and minorities face numerous disparities in health outcomes, such as Native Americans being twice as likely as whites to develop diabetes, Hispanics being twice as likely to die from diabetes, and African-Americans having a 40% higher death rate from heart disease. The causes of health disparities are complex, and are related to a broad range of social, environmental, individual behavioral and genetic factors. However, by and large they tend to be a reflection of the social inequalities found throughout society. Ultimately, social inequalities contribute to health inequalities, so that society’s most impoverished tend to have limited access to care and are far less likely to receive preventive care, three times more likely to postpone seeking care because of cost, four times more likely to not get care when needed, three to four times more likely to report problems receiving needed care, more likely to be hospitalized for preventable conditions, and more likely to be diagnosed with late stage cancer.
Presently, Mark and other members of the Academy for Research on Community Health, Engagement, and Services (ARCHES) are refining the community health science approach that has evolved during the past 20 years.
The model exists at the intersection of clinical medicine, epidemiology, and social science. Clinical medicine concentrates on individuals, seeking to diagnose, treat, and prevent disease by maximizing the health and functional capacity of the individual. By contrast, epidemiology concentrates on populations, seeking to maintain the health of all people through actions taken collectively. From a community health science perspective, clinical medicine and public health alone cannot create health, although they can contribute to developing effective prevention and treatment programs. Rather, in order to be effective in creating health, clinical care and epidemiology must be linked to community organization. That is, although treating disease requires the application of medical technology, the actual creation of health is based on the application of social technology. Accordingly, health is best seen as a social outcome resulting from a combination of clinical science, collective responsibility, and informed social action. The ARCHES seeks to move the community health science approach to a new level, by helping to create a health care system in the United States – rather than a disease care system. A transformed system will require a more realistic distribution of health care resources, one that moves beyond the current distribution of 95% devoted to treatment and only 5% to prevention.
A transformed system should be based on addressing the social determinants of health, community based health promotion, and effective disease prevention models in order to reduce the risk of disease and the need for expensive medical care in the first place. The ARCHES team is developing and testing truly generalizable methods and means for improving community health outcomes through collaborative and participatory approaches. The nation will need these models and associated evidence as we seek to improve the health of our communities in the 21st Century.