Creating Health in the 21st Century

If we really take community and connectedness seriously, we will be vigilant about the extent to which we strengthen or disrupt it when developing health interventions. We will value the knowledge and assets that all people have to offer from their unique relationships with people and place. And ultimately, we will commit to building the power that communities have to create health themselves, beyond clinical services and public health interventions.

Unfortunately, the systems we have created, rather than the solutions we now need, often drive current approaches to improving health. We have garnered from contributors to the series a number of principles to guide us as we develop new ways of doing things, as well as concrete steps toward contributing to a culture that values connections and relationships as much as treatments and health campaigns.


  1. Acknowledge that our success depends on each other. Creating health will happen among individuals and institutions, so we must set aside ego, trust others, and recognize that our individual knowledge is limited and our progress is collective.
  2. Bring more voices to the table. It is vital to understand the dynamics and relationships within a given community. To do that, we must ensure that all who may be affected by and involved in carrying out an intervention have the opportunity to comfortably share their visions and concerns.
  3. Expand what counts as knowledge. The insights that communities share often play second fiddle to what professionals and academics typically deem valuable. Putting them on a more equal footing influences what to implement, how to allocate resources, and conclusions about whether something “worked.”
  4. Embrace emergence, including unpredictability. We must abandon the linear approach favored by traditional health care and embrace the unpredictable nature of community-driven interventions. We must learn and adapt in real time, and remember that unexpected outcomes are one way an intervention can succeed.
  5. Value what people value. All too often we decide what to aim for and evaluate based on what we can easily measure. It is essential to flip this—to identify goals and then figure out ways of measuring progress toward them. …(More)