APHN ProgramCulture Of Health

RWJF made grant available to the national network of public health institutes to distribute to states that would help to identify what they called innovative bridging strategies to bridge various stakeholders in the health system as a way to begin to transform health system in the context of health care reform.

Hawaii Public health Institute in partnership with Islander Institute, inspired by the work that had happened at Kokua Kalihi Valley KKV, say this as an opportunity to use storytelling and the development of stories as a way to first begin to define what is health to us in communities as opposed to other stakeholder groups and then to begin to knowing what that story is work with other stakeholders to start to try to change the health system. We even thought of it as flipping the health system to be more responsive and accountable to communities where health actually resides and is created. And so we knew that this was a powerful idea because early on other partners had gotten involved, the state department of health in particular the rural health program and the public health nurses were very interested in the idea of communities beginning to organize around what health means to them as a way to play a bigger role in the health system. Papa Ola Lokahi which is the organization that oversees our Native Hawaiian Health System and got involved with the Native Hawaiian health with our medical school at the University of Hawaii got involved. And we’re open to having as many different partners as we could as long as they were folks who were interested in what was happening in community first and foremost. We didn’t want communities to feel that this was a process that was being imposed from the outside. We wanted it to be something that was being grown organically, coming from community.

The concept was one part telling story of health in defining what is health is for individual communities in Hawaii, but finding common themes which became the 4 connections (Insert 4 connections: to place, past and future, better self, and others via text) being a language of health that all communities in Hawaii could start using. The second part was really about relationship building and about this idea that if we’re going to start working together to change huge system we can’t do as individual communities, we have to actually work together to build a stronger constituencies that can bridge with other constituencies to begin to change the system.

What we feel we accomplished is that we’re really on to something powerful, and we think universal in communities around health. These stories that we’ve heard on Kauai, Big Island, Molokai, Oahu, Maui, Lanai, in all 6 islands is this notion of these 4 connections. And Puni Jackson of Kokua Kalihi Valley, has named it Pili Na Ha…Pili Na…relationships, connections, associations and e Ha as a conjunction. Pili Na Ha being these 4 connections that these relationships that create life and health.

If we get back to what communities know which is that health is how we feel whole and happy that we can use that to transform the health system in a way that will help the system save a lot of money. Something that the system as we now hav it is interested in. it’s going to take thinking about it differently. We can’t get there the same way as we’ve been trying to get there, they haven’t been working and is a way that communities take responsibility for their health in the future.

The event was really powerful in that it was a group of people that would probably never have the opportunity to be together otherwise. There were all people asking the same questions from communities that are largely isolated from each other and it was one small step in creating this bigger community of people trying to change the health system and to do it from the communities perspective which is a really key difference between other health care reform efforts is that this one is driven by community and when communities are ready they’ll invite stakeholders in as opposed to always being the health care system always thinking we need to engage community and invite them to meeting and it’s really very important that it happen the other way around.