Challenges and difficulties with community health

Summary of Governance Issues, Strategies, and New/Lingering Problem

The complexity of community health and its various problems can make it difficult for
researchers to assess and identify solutions. Community-based participatory research (CBPR) is
a unique alternative that combines community participation, inquiry, and action.[25] Community-
based participatory research (CBPR) helps researchers address community issues with a broader
lens and also works with the people in the community to find culturally sensitive, valid, and
reliable methods and approaches.
Other issues involve access and cost of medical care. A great majority of the world does not have
adequate health insurance.  In low-income countries, less than 40% of total health expenditures
are paid for by the public/government. Community health, even population health, is not
encouraged as health sectors in developing countries are not able to link the national authorities
with the local government and community action.
In the United States, the Affordable Care Act (ACA) changed the way community health centers
operate and the policies that were in place, greatly influencing community health. The ACA
directly affected community health centers by increasing funding, expanding insurance coverage
for Medicaid, reforming the Medicaid payment system, appropriating $1.5 billion to increase the
workforce and promote training. The impact, importance, and success of the Affordable Care Act
is still being studied and will have a large impact on how ensuring health can affect community
standards on health and also individual health.

Community health in the Global South;-

Access to community health in the Global South is influenced by geographic accessibility
(physical distance from the service delivery point to the user), availability (proper type of care,
service provider, and materials), financial accessibility (willingness and ability of users to
purchase services), and acceptability (responsiveness of providers to social and cultural norms of
users and their communities). While the epidemiological transition is shifting disease burden
from communicable to non communicable conditions in developing countries, this transition is
still in an early stage in parts of the Global South such as South Asia, the Middle East, and Sub-
Saharan Africa. Two phenomena in developing countries have created a "medical poverty trap"
for underserved communities in the Global South — the introduction of user fees for public
healthcare services and the growth of out-of-pocket expenses for private services. The private
healthcare sector is being increasingly utilized by low and middle income communities in the
Global South for conditions such as malaria, tuberculosis, and sexually transmitted
infections. Private care is characterized by more flexible access, shorter waiting times, and
greater choice. Private providers that serve low-income communities are often unqualified and
untrained. Some policymakers recommend that governments in developing countries harness
private providers to remove state responsibility from service provision.
Community development is frequently used as a public health intervention to empower
communities to obtain self-reliance and control over the factors that affect their
health. Community health workers are able to draw on their firsthand experience, or local
knowledge, to complement the information that scientists and policy makers use when designing
health interventions.  Interventions with community health workers have been shown to improve
access to primary healthcare and quality of care in developing countries through reduced
malnutrition rates, improved maternal and child health and prevention and management of
HIV/AIDS. Community health workers have also been shown to promote chronic disease
management by improving the clinical outcomes of patients with diabetes, hypertension, and
cardiovascular diseases.
Slum-dwellers in the Global South face threats of infectious disease, non-communicable
conditions, and injuries due to violence and road traffic accidents. Participatory, multi-objective
slum upgrading in the urban sphere significantly improves social determinants that shape health
outcomes such as safe housing, food access, political and gender rights, education, and
employment status. Efforts have been made to involve the urban poor in project and policy
design and implementation. Through slum upgrading, states recognize and acknowledge the
rights of the urban poor and the need to deliver basic services. Upgrading can vary from small-
scale sector-specific projects (i.e. water taps, paved roads) to comprehensive housing and
infrastructure projects (i.e. piped water, sewers). Other projects combine environmental
interactions with social programs and political empowerment. Recently, slum upgrading projects
have been incremental to prevent the displacement of residents during improvements and
attentive to emerging concerns regarding climate change adaptation. By legitimizing slum-
dwellers and their right to remain, slum upgrading is an alternative to slum removal and a
process that in itself may address the structural determinants of population health.