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This chapter examines how people weigh and discuss opportunities for collective action to improve community health. Drawing from research on civic and social movement engagement, it focuses specifically on how cultural logics of pragmatism, activism, and cynicism are invoked in such debates.

Qualitative data come from four focus group discussions of strategies for reducing tobacco use in Atlanta’s lesbian, gay, bisexual, and transgender (LGBT) communities. Participants included 36 self-identified community members.

Pragmatic logics were used most often in evaluating the tobacco control strategies, with activist logics second and cynicism a distant third. This echoes prior research, but our participants used these logics in unexpected ways: they combined pragmatism and activism, downplaying the former’s emphasis on individual self-interest and the latter’s emphasis on contentious confrontation. In addition, use of the logics varied by focus group and strategy, but not with individual speaker’s identities.

Though limited by a narrow demographic focus and small convenience sample, our study suggests that public support for community health initiatives will likely depend on how they are framed and on the interactional dynamics and shared identities of the groups they are presented to.

Logics of pragmatism, activism, and cynicism inform debate over community health initiatives, as with other forms of civic action. However, use of these logics is not uniform but varies with the groups and issues at hand. Our study participants’ mutual LGBT identification gave them a sense of shared community and a familiarity with the politicization of personal life that led them to combine pragmatist and activist logics in novel ways.

Improving access and the quality of health services requires community health initiatives. However, in order for such efforts to be successful, there has to be some agreement at the community level as to which community initiatives ought to be pursued. With diversity of population, health disparities, limited resources, and competing needs, agreement is unlikely; instead a negotiated consensus among key stakeholders (community advocates, agency leaders, service providers, and consumers) must be developed. A negotiated consensus takes into account differences and allows for some kind of resolution of these differences in order to achieve a given end. A negotiated consensus is necessary for the identification of common goals, prioritizing these goals, and either seeking funding or utilizing available funding for selected community initiatives. The chapter examines efforts by a regional health care system which fostered community initiatives in four diverse sites. We develop a framework which can guide other community initiatives in health care.

As a movement for alternative means of food production and consumption has grown, so, too, have civic efforts to make alternative food accessible to low-income persons (LIPs). This article examines the impact of alternative food institutions (AFIs) on low-income communities in the United States and Canada, focusing on research published since 2008.

Through a three-stage literature search, I created a database of 110 articles that make empirical or theoretical contributions to scholarly knowledge on the relationship of AFIs to low-income communities in North America. I used an in vivo coding scheme to categorize the impacts that AFIs have on LIPs and to identify predominant barriers to LIPs’ engagement with AFIs.

The impacts of AFIs span seven outcome categories: food consumption, food access and security, food skills, economic, other health, civic, and neighborhood. Economic, social and cultural barriers impede LIPs’ engagement with AFIs. AFIs can promote positive health outcomes for low-income persons when they meet criteria for affordability, convenience and inclusivity.

This review exposes productive avenues of dialogue between health scholars and medical sociology and geography/environmental sociology. Health scholarship offers empirical support for consumer-focused solutions. Conversely, by constructively critiquing the neoliberal underpinnings of AFIs’ discourse and structure, geographers and sociologists supply health scholars with a language that may enable more systemic interventions.

This article is the first to synthesize research on five categories of alternative food institutions (farmers’ markets, CSAs, community gardens, urban farms, and food cooperatives) across disciplinary boundaries.

This chapter explores the significance and implementation of family planning practices, emphasizing their vital role in enhancing reproductive health outcomes. This chapter conducts an in-depth examination of family planning practices within marginalized communities in Bangladesh, shedding light on the unique challenges and opportunities faced by these populations. By uncovering the nuances of family planning practices in marginalized contexts, this chapter underscores the need for tailored and culturally sensitive family planning programs. It advocates for program designs that facilitate the effective adoption of family planning practices among marginalized communities, ultimately promoting better reproductive health outcomes. Furthermore, this chapter highlights the importance of empowerment strategies in reaching and engaging marginalized communities. Through practice enhancement initiatives, it seeks to empower marginalized populations with the knowledge and resources necessary to make informed decisions about family planning, thereby contributing to improved reproductive health and overall well-being.

Population, community, and public health notions are addressed separately in the Patient Protection and Affordable Care Act (ACA), have different foci and stakeholders, build on different frameworks to achieve their aims, and apply different measures to determine the long-term impact of interventions. This paper attempts to clarify each concept and proposes a method of evaluating each of these sets of health-related activities based on the benefits that accrue to the respective stakeholders.

In addition to indicating how to affect change and improvements in health, the ecological model of health also provides insight into how the benefits from health-related activities may or may not flow back to the entities sponsoring health interventions. By clearly defining each of the concepts and examining the methods and metrics being used to select activities and measure benefits, a valuation model is developed that measures the financial impact on the targeted population as well as the sponsoring institution.

Defining, measuring, and evaluating are important to bring clarity to how individual organizations can contribute to the overall health of the population, as well as the limits of any single organization in doing so. Collective and upstream action will be required to improve the population’s health, but identifying and justifying the role of each participating organization is a challenge that still lacks an overarching vision that can be explained and measured to the satisfaction of all stakeholders.

Decision makers must justify how resources are committed in an era of scarcity and limited financial means. Moreover, methods must be in place to measure the impact of potential collaborations. The proposed valuation framework lays out the natural incentives, the responses to those incentives, and how to select initiatives that maximize value from the perspective of the various stakeholders.

The overall objective of this research was to elucidate the ecosystem of women’s health social enterprises (WHSEs) based in the United States. The Aim I was to conduct a secondary data analysis of a random national sample of non-profit WHSEs based in the United States regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of WHSEs based in the United States regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity category using descriptive statistics, statistical tests, and multivariable regression analysis via SPSS. Aim II utilized in-depth interviewing and grounded theory analysis via MAXQDA 2018 to identify novel themes and core categories while using an established framework for mapping social enterprise ecosystems as a scaffold.

Aim I findings suggest that WHSE activity is more predominant in the south region of the United States but not geographically concentrated around cities previously identified as social enterprise hubs. WHSEs take a comprehensive approach to women’s health, often simultaneously focusing on multiple areas of health interventions. Although most WHSEs demonstrate a risk for financial distress, very few exhibited severe risk. Risk for financial distress was not significantly associated with any of the measured enterprise characteristics. Aim II generated four core categories of findings that describe the ecosystem of WHSE: (1) comprehensive, community-based, and culturally adaptive care; (2) interdependent innovation in systems, finances, and communication; (3) interdisciplinary, cross-enterprise collaboration; and (4) women’s health as the foundation for family and population health. These findings are consistent with the three-failures theory for non-profit organizations, particularly that WHSEs address government failure by focusing on the unmet women’s health needs of the underserved populations (in contrast to the supply of services supported by the median voter) and address the market failure of over exclusion through strategies such as cross-subsidization and price discrimination. While WHSEs operate with levels of financial risk and are subject to the voluntary sector failure of philanthropic insufficiency, the data also show that they act to remediate other threats of voluntary failure.

Aim I findings highlight the importance of understanding financial performance of WHSEs. Also, lack of significant associations between our assessed enterprise characteristics and their financial risk suggests need for additional research to identify factors that influence financial performance of WHSE. Aim II findings show that WHSEs are currently engaged in complex care coordination and comprehensive biopsychosocial care for women and their families, suggesting that these enterprises may serve as a model for improving women’s health and health care. The community-oriented and interdisciplinary nature of WHSE as highlighted by our study may also serve as a unique approach for research and education purposes. Additional research on the ecosystem of WHSE is needed in order to better inform generalizability of our findings and to elucidate how WHSE interventions may be integrated into policies and practices to improve women’s health.

This study aims to establish the perspectives of community providers on challenges and enablers in developing child mental health capacity in disadvantaged communities in South Africa.

The authors involved 29 community providers operating in a large urban-deprived area in the Gauteng Province, east of Johannesburg. Community providers had educational, social and health care backgrounds. Their perspectives were captured through three focus groups, two participatory workshops and reflective diaries. Data were integrated and subjected to inductive thematic analysis.

Three interlinked themes were identified. Community mobilization was viewed as pre-requisite through mental health awareness and strategies to engage children, youth and parents. Service provision should take into consideration contextual factors, predominantly inequalities, lack of basic needs and gender-based issues (domestic violence, teenage pregnancy and single motherhood). Participants referred to severe mental health needs, and related to physical health conditions, disabilities and impairments, rather than to common mental health problems or wellbeing. They proposed that capacity building should tap into existing resources and integrate with support systems through collaborative working.

Child mental health policy and service design in Majority World Countries (MWCs), should involve all informal and structural support systems and stakeholders. Contextual factors require consideration, especially in disadvantaged communities and low-resource settings, and should be addressed through joined up working.

Children’s mental health needs are largely unmet in MWC-disadvantaged communities. These findings capture the experiences and perspectives of various community providers on how to enhance mental health provision by mobilizing communities and resources.

The purpose of this paper is to show how the Turning Point Initiative to improve the health of populations by improving the USA public health system has many lessons on collaboration for governance systems.

The article synthesizes published literature outlining the results of a Robert Wood Johnson Foundation/W.K. Kellogg Foundation grant program to 21 USA states and 43 communities and relationships to administrative practice.

Turning Point's creation of a formalized network of public health partners across the USA has led to innovations in collaboration, increased system capacity, and alternative structures for improving health.

Turning Point's efficacy in community health system improvement can be mirrored in clinical governance. A major potential for improvement in clinical delivery systems is available by re‐thinking key partners, organizational structures, and system administrative capacity.

States that it seems self‐evident that a hospital should be a healing environment, a healthy place to work, should not harm the health of the environment and should contribute to and be a source of health in the community, but argues that hospitals have not paid a great deal of attention to many of these issues until recently. Suggests that in recent years, a new and broader understanding of health promotion has led to a re‐examination of the ways in which hospitals can be both healthy and health‐promoting. Begins by exploring the broader concepts of health promotion that lay the foundation for the creation of healthy and health‐promoting hospitals and provides some examples of how these approaches are being applied.

This study aims to examine how the social capital embedded in health communities influences the knowledge sharing of participating members and drives their organic food consumption.

The structural equation modeling method was used to analyze 228 group members in health knowledge communities established by multi-level marketing firms. Non-response bias was also assessed statistically and appropriate measures taken to minimise the impact of common method variance.

The empirical results showed that: structural capital has no significant relationship with members' knowledge sharing; both the relational and cognitive capital positively affect members' knowledge sharing; members' knowledge collecting behaviour positively affects their purchase intention toward organic foods, but their knowledge donating behaviour has no significant effect; members' purchase intention toward organic foods positively affects their actual purchase behaviour.

This paper indicates that higher quality of social capital embedded in that health community would increase more interactive opportunities for participating consumers to understand the organic foods through community activities, and strengthen the organic food value cognition of community members. Hence, companies can make good use of health communities to modify the customers' value propositions, thereby driving their organic food consumptions.

Unlike many other empirical studies, this study makes an important contribution to the literature by examining how social capital influences consumers' organic food consumption and their adoption of organic food's values in a detailed manner.