Background: Conventional community health promotion strategies often rely on top-down strategies and disease-specific fixes without engaging with the full spectrum of the social determinants of health.
Agentic approaches to support community health incorporate a broader understanding of positive health and community strengths alongside their health challenges and needs.
This research reviews key community health and development approaches based on assets, capacity building, and capabilities with the goals of 1) moving toward a relevant and consistent community health lexicon, and 2) identifying effective and sustainable strategies to support the social determinants of community health amidst global challenges like climate change, structural racism, and neoliberalism.
Methods: Synthesis review of community health literature on agentic approaches: assets, capacity building, and capabilities. Fieldwork in geographically isolated and socioeconomically marginalized communities in Kenya, Peru, Trinidad and Tobago, and the US (Alaska and the Gulf Coast). Participatory methodologies (participatory planning, learning, and action) and co-production of research-action components. In-person and remote interviews.
Findings:
Contemporary global challenges engage with local factors: Political decision-making outside of communities and without their input; Social conditions that exclude and marginalize certain groups; Economic poverty and lack of opportunities; Environmental degradation and conditions that are hazardous and in flux; Geographic remoteness.
Communities also face barriers to collective action: Culture of dependence on top-down management led by “experts”; Self-perception of lack of knowledge and capacity; Local skills and resources not valued internally and/or externally; Poverty, lack of access to resources, and remoteness; High opportunity cost for participating in or leading activities for change; Lack of or only partial responsibility for the health challenges they face.
These complex and systemic challenges call into question conventional approaches to community health promotion that are top-down and depend on technical, one-size-fits-all solutions
Agentic approaches to community health build on community assets, capacities, and capabilities for people to define and meet their own health needs and goals
Communities can leverage key assets to address health challenges and improve their holistic health, including in extreme and marginalized settings: Collaborative networks and community connections; Shared values and interests and desire to provide support; Inclusive knowledge production; Understanding of social determinants and root causes; Local materials and systems of governance.
Conclusions: Agentic approaches provide pathways to address complex and systemic challenges to community health
Mindset: The process of shifting toward an agentic mindset is an iterative two-way process that builds confidence and mutual trust, and it involves gradually developing an understanding of how to transform local realities in socioenvironmentallysustainable and self-sustaining ways.
Long-term partnerships: Partnerships work to strengthen the building blocks of and opportunities for health by building on longstanding and inclusive community networks, and relationships are nurtured through long-term two-way engagement.
