C3 - A New Model
President Obama started his career as a community organizer on the South Side of Chicago, where he saw firsthand what people can do when they come together for a common cause. Citizen participation will be a priority for the Administration, and the internet will play an important role in that – www.whitehouse.org
In order for government and for private foundations to make effective social policy reform decisions they need current real time information on the state of the social issue under consideration. Social policy planning is only as good as the information presented, i.e, garbage in, garbage out. Given the ad hoc and disjointed nature of the current social services map, the out of date information and the lack of coordination between organizations, municipalities, states and federal government, our collective response is inefficient at best and potentially damaging at worst. In order to effect positive change we must work together.
In order to work together we need a health framework for change and that framework I call the C3 model. Compassion, Community and Code.
C3 Model
The overriding composition of the C3 health model is one of:
1) Compassion for all people and the willingness to reach beyond simply providing symptomatic relief and to look for and deal effectively with the cause of illness through a diagnostic appreciation of the social determinants of health (SDOH) and how they effect this person.
2) Community and working collectively for the greater good and on behalf of each of our clients. Sharing our resources, collaborating to maximize our resources, communicating to sharing our knowledge and experience, working under a model that makes sense.
3) In order to do this effectively and efficiently and to maximize the outcomes we need Code which can integrate the data from all these social agencies into an integral model of health and be used for effective social policy development which respects the SDOH.
It is my view that with the proper use of information technology to share information between agencies involved in the provision of services related to the social determinants of health we can drastically improve healthcare services throughout the world, without massive reorganization or relocation of services. Through united communities working in a collaborative manner through data exchange standards and protocols, and collectively agreed upon data collection standards we can significantly assist disadvantaged people through more targeted and timely care. Through having access to critical information when it is needed, we can save lives, improve living conditions and help more people become integrated parts of a healthy community. In Canada, the Canada Health Infoway is attempting to bring this vision to fruition through the inter-provincial collaboration around a shared electronic health record. The C3 Model expands that concept to reach more broadly into our communities to enable a collective response to the debilitating dysfunctions in our social systems.
So what does this have to do with community? Community social services providers are primarily concerned with the provision of the social determinants. Housing, shelter, food, counselling, socialization, education, care for people with disabilities, child welfare, etc., all fall under the rubric of social services. After the physicians have stopped the bleeding and put on the band aid, it is community which takes up the care, or in many cases does not and leaves it up to the individual.
These determinants have a profound effect on a person’s health in that the more positive any of these determinants are for you, the more healthy you probably are. The two most powerful underlying meta-determinants of health are social status and income. These two factors alone outweigh the other determinants. A recent study by the Public Health Agency of Canada supports the growing international understanding of the importance of these determinants regarding a healthy population.
A wealth of evidence from Canada and other countries supports the notion that the socioeconomic circumstances of individuals and groups are equally or more important to health status than medical care and personal health behaviours, such as smoking and eating patterns (Evans et al., 1994; Frank, 1995; Federal/Provincial/Territorial Advisory Committee on Population Health, 1999). The weight of the evidence suggests that the SDOH have a direct impact on the health of individuals and populations, are the best predictors of individual and population health, structure lifestyle choices, and interact with each other to produce health (Raphael, 2003). In terms of the health of populations, it is well known that disparities-the size of the gap or inequality in social and economic status between groups within a given population-greatly affect the health status of the whole. The larger the gap, the lower the health status of the overall population (Wilkinson, 1996; Wilkinson and Marmot, 1998).
The C3 health model anticipates the evolution of healthcare to include a broader definition of health and a more integral approach to healthcare. It anticipates a time where traditional medical services, i.e, hospitals and physicians become a pillar in a healthcare structure that also directly involves a person’s social and economic context.
It defines a person’s health as a combination of biological health, social wellbeing and economic sufficiency. Being healthy is not just a matter of disease management, but is an outcome from a combination of factors labeled : The Social Determinants of Health (SDOH).
So what are the Social Determinants of Health (SDOH)? The following is a list from the Canadian Government’s Public Health Agency of Canada who are very active in promoting research into community healthcare.
1. Income and Social Status
2. Social Support Networks
3. Education and Literacy
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices and Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture
The C3 health model brings medicine, sociology and economics together under the rubric of healthcare. The model anticipates a need for information technology at the core of this process to manage the ever increasing complexity of issues that define a person’s health.
The social determinants of health are the underlying fabric of the holistic reality of personal healthcare and are fast becoming recognized as integral elements to personal health and the health of a community. The one stop concepts discussed above are a recognition of this more holistic approach to social services.
The following quote from “The Solid Facts” published by the World Health Organization sets the stage for the importance of the social determinants of health and underscore the need to move away from a purely biological model of healthcare.
Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich. Not only are these differences in health an important social injustice, they have also drawn scientific attention to some of the most powerful determinants of health standards in modern societies. They have led in particular to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become known as the social determinants of health.
With Internet oriented technologies growing in sophistication and stability the prospect of new ways of using software are being developed all the time. One of the most significant is the concept of Cloud Computing. In general, Cloud Computing is online software delivery via ASPs (Application Service Providers). The breadth of software is amazing. The vast majority of successful ASPs provide very particular business to business software like inventory management or supply chain management software or social networking and gaming applications. ASPs for human services are still in their infancy however, but beginning to emerge in the same areas that the applications development process took, i.e, donor management, scheduling, volunteer management. Cloud technology on the other hand is really the forefront of technology development and the Internet is fast becoming the operating system of the world.
But these technologies are shells in that they don’t have content nor define content. Content is the king in an information age of course, so even with all these fantastic technologies hooked into a global infrastructure we still don’t have a unified human services infrastructure that we can use to gain a comprehensive picture of the social dynamics of our communities. Two things are needed:
1. Framework technologies that can adapt to many different kinds of social services agencies and enable each organization to function through the features the framework can be configured to handle;
2. a set of standards that are agreed for comparative analysis.
On point one, a number of companies have discovered this approach and are now beginning to make inroads into government and community and on point 2 little is being achieved yet and is where I propose the C3 Health Model.
Public health and security issues are beginning to attract significant attention both due to the enormous cost, but also as major political issues. Homelessness, disease surveillance, community justice, depression in the workplace, addictions management, child welfare, disabilities management and so on are now front page issues and billions of our tax dollars are supporting organizations trying to deal with these issues without a comprehensive record of outcomes. With the election of President Barack Obama, a former community organizer, government may be waking up and want to know where the money is going and the only way they will ever be able to make sense of this is through the right mix of technologies
In order for government and for private foundations to make effective social policy reform decisions they need current real time information on the state of the social issue under consideration. Social policy planning is only as good as the information presented, i.e, garbage in, garbage out. Given the ad hoc and disjointed nature of the current social services map, the out of date information and the lack of coordination between organizations, municipalities, states and federal government, our collective response is inefficient at best and potentially damaging at worst. In order to effect positive change we must work together.
In order to work together we need a health framework for change and that framework I call the C3 model. Compassion, Community and Code.
C3 Model
The overriding composition of the C3 health model is one of:
1) Compassion for all people and the willingness to reach beyond simply providing symptomatic relief and to look for and deal effectively with the cause of illness through a diagnostic appreciation of the social determinants of health (SDOH) and how they effect this person.
2) Community and working collectively for the greater good and on behalf of each of our clients. Sharing our resources, collaborating to maximize our resources, communicating to sharing our knowledge and experience, working under a model that makes sense.
3) In order to do this effectively and efficiently and to maximize the outcomes we need Code which can integrate the data from all these social agencies into an integral model of health and be used for effective social policy development which respects the SDOH.
It is my view that with the proper use of information technology to share information between agencies involved in the provision of services related to the social determinants of health we can drastically improve healthcare services throughout the world, without massive reorganization or relocation of services. Through united communities working in a collaborative manner through data exchange standards and protocols, and collectively agreed upon data collection standards we can significantly assist disadvantaged people through more targeted and timely care. Through having access to critical information when it is needed, we can save lives, improve living conditions and help more people become integrated parts of a healthy community. In Canada, the Canada Health Infoway is attempting to bring this vision to fruition through the inter-provincial collaboration around a shared electronic health record. The C3 Model expands that concept to reach more broadly into our communities to enable a collective response to the debilitating dysfunctions in our social systems.
So what does this have to do with community? Community social services providers are primarily concerned with the provision of the social determinants. Housing, shelter, food, counselling, socialization, education, care for people with disabilities, child welfare, etc., all fall under the rubric of social services. After the physicians have stopped the bleeding and put on the band aid, it is community which takes up the care, or in many cases does not and leaves it up to the individual.
These determinants have a profound effect on a person’s health in that the more positive any of these determinants are for you, the more healthy you probably are. The two most powerful underlying meta-determinants of health are social status and income. These two factors alone outweigh the other determinants. A recent study by the Public Health Agency of Canada supports the growing international understanding of the importance of these determinants regarding a healthy population.
A wealth of evidence from Canada and other countries supports the notion that the socioeconomic circumstances of individuals and groups are equally or more important to health status than medical care and personal health behaviours, such as smoking and eating patterns (Evans et al., 1994; Frank, 1995; Federal/Provincial/Territorial Advisory Committee on Population Health, 1999). The weight of the evidence suggests that the SDOH have a direct impact on the health of individuals and populations, are the best predictors of individual and population health, structure lifestyle choices, and interact with each other to produce health (Raphael, 2003). In terms of the health of populations, it is well known that disparities-the size of the gap or inequality in social and economic status between groups within a given population-greatly affect the health status of the whole. The larger the gap, the lower the health status of the overall population (Wilkinson, 1996; Wilkinson and Marmot, 1998).
The C3 health model anticipates the evolution of healthcare to include a broader definition of health and a more integral approach to healthcare. It anticipates a time where traditional medical services, i.e, hospitals and physicians become a pillar in a healthcare structure that also directly involves a person’s social and economic context.
It defines a person’s health as a combination of biological health, social wellbeing and economic sufficiency. Being healthy is not just a matter of disease management, but is an outcome from a combination of factors labeled : The Social Determinants of Health (SDOH).
So what are the Social Determinants of Health (SDOH)? The following is a list from the Canadian Government’s Public Health Agency of Canada who are very active in promoting research into community healthcare.
1. Income and Social Status
2. Social Support Networks
3. Education and Literacy
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices and Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture
The C3 health model brings medicine, sociology and economics together under the rubric of healthcare. The model anticipates a need for information technology at the core of this process to manage the ever increasing complexity of issues that define a person’s health.
The social determinants of health are the underlying fabric of the holistic reality of personal healthcare and are fast becoming recognized as integral elements to personal health and the health of a community. The one stop concepts discussed above are a recognition of this more holistic approach to social services.
The following quote from “The Solid Facts” published by the World Health Organization sets the stage for the importance of the social determinants of health and underscore the need to move away from a purely biological model of healthcare.
Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich. Not only are these differences in health an important social injustice, they have also drawn scientific attention to some of the most powerful determinants of health standards in modern societies. They have led in particular to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become known as the social determinants of health.
With Internet oriented technologies growing in sophistication and stability the prospect of new ways of using software are being developed all the time. One of the most significant is the concept of Cloud Computing. In general, Cloud Computing is online software delivery via ASPs (Application Service Providers). The breadth of software is amazing. The vast majority of successful ASPs provide very particular business to business software like inventory management or supply chain management software or social networking and gaming applications. ASPs for human services are still in their infancy however, but beginning to emerge in the same areas that the applications development process took, i.e, donor management, scheduling, volunteer management. Cloud technology on the other hand is really the forefront of technology development and the Internet is fast becoming the operating system of the world.
But these technologies are shells in that they don’t have content nor define content. Content is the king in an information age of course, so even with all these fantastic technologies hooked into a global infrastructure we still don’t have a unified human services infrastructure that we can use to gain a comprehensive picture of the social dynamics of our communities. Two things are needed:
1. Framework technologies that can adapt to many different kinds of social services agencies and enable each organization to function through the features the framework can be configured to handle;
2. a set of standards that are agreed for comparative analysis.
On point one, a number of companies have discovered this approach and are now beginning to make inroads into government and community and on point 2 little is being achieved yet and is where I propose the C3 Health Model.
Public health and security issues are beginning to attract significant attention both due to the enormous cost, but also as major political issues. Homelessness, disease surveillance, community justice, depression in the workplace, addictions management, child welfare, disabilities management and so on are now front page issues and billions of our tax dollars are supporting organizations trying to deal with these issues without a comprehensive record of outcomes. With the election of President Barack Obama, a former community organizer, government may be waking up and want to know where the money is going and the only way they will ever be able to make sense of this is through the right mix of technologies
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