Dr Pritpal S Tamber explores the role of community power as a social determinant of health. Alongside his research, he is the author of the newsletter, Community & Health.
Dr Tamber’s journey to community power began when he was the Physician Editor of TEDMED in 2013. Through that role he was left unconvinced that the ‘big ideas’ he was seeing were likely to have much impact on our unhealthiest communities – those facing challenging social circumstances.
In parallel, Dr Tamber has always been concerned with the financial sustainability of health care. While there is much to be said for advances in medical science, his concern is that innovations in medical practice are driven by the sector rather than patients. As a consequence, health care is getting more expensive while delivering less value.
In response to these two observations, he founded the Creating Health Collaborative, a highly-curated, annual meeting of community-oriented practitioners. Through the meetings, and his wider research, Dr Tamber identified 12 practice-based principles for how to build a bridge between the health sector and communities.
From the perspective of the health system, the principles suggest what authentic community engagement looks like. But from the perspective of communities, they communicated something more fundamental – whether they have the ability to affect their circumstances. In other words, whether communities have power.
Elsewhere, community power is increasingly being recognized as the ultimate social determinant of health and health equity.
The Creating Health Collaborative led to a number of other projects, including a US-based nonprofit, a national symposium in Oakland, CA, and numerous research projects seeking to better understand how community power impacts health and what kind of interventions that suggests.
Dr Tamber’s newsletter, Community & Health, is aimed at leaders in health that understand that downstream interventions that focus on individuals (such as ‘behavior change’) or institutions (such as cross-sector collaboration) are unlikely to have a material or enduring impact on health and health equity.
Dr Tamber is the former Medical Director of Map of Medicine, a company that produced ‘clinical pathways’ to improve the flow of patients through health care systems. He’s also the former Editorial Director for Medicine for BioMed Central, the company that disrupted academic publishing by pioneering open access publishing and making it commercially sustainable. He started his career as an editor at The BMJ (formerly known as the British Medical Journal).
Since the late 1980’s, leading public health scholars and practitioners have been positing that lifestyle-based risk factors are unlikely to explain the social gradient in health. Using various terms, they have put forward the idea that power may be the ultimate determinant of health, whether it’s the power of an individual or a community. Informed by his ongoing research, Dr Tamber unpacks what these public health leaders were — and are — saying and proposes what it means for strategies that aim to address inequities in health.
Informed by his exploration of the health literature on community power and health equity, Dr Tamber pulls together the disparate evidence base to illustrate that, despite methodological challenges, there is a strong rationale for power-building as a public health strategy. Drawing from almost 100 studies over the last 30 years, he shows how community power leads to improvements in health. Drawing from the evidence, he illustrates the characteristics of community health strategies that are most strongly associated with success.
In many places, the ‘quick wins’ of cross sector collaboration have been realized but the impact on health has not been as big as hoped. As a result, institutions are increasingly unsure of how to move the dial in community health. Dr Tamber looks at some recent examples of collaboration to illustrate why they were important but limited. Based on the growing scholarship on the structural (rather than social) determinants of health, he proposes what institutions, such as health care providers, might do differently to sustainably improve the health of the people they serve.
Building on his 2017 report of the same title, Dr Tamber describes 12 principles key to the future of health. Based on five years of practice-based research, he shares what he has learnt about why community health projects rarely sustain and what can be done to prevent their demise. The principles are bi-directional. For health care and public health, they describe how to authentically engage communities. For communities, they present a process that has the potential to foster their agency – another word for power.
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