Dr. Pritpal S Tamber is an independent writer, researcher, and consultant focussing on community health. His work examines the realities of bridging the health sector and communities.
Dr. Tamber is the former Physician Editor of TEDMED, TED’s dedicated health event. Through that role, he was left convinced that ‘innovation’ in health is unlikely to have much impact on the health of communities in difficult social circumstances, such as poverty or exclusion.
In response, Dr Tamber has founded and run several projects examining the realities of bridging the health sector and communities, including the Creating Health Collaborative, a highly-curated meeting of community-oriented practitioners willing to share the realities of their health-related work, and Community Agency & Health, a two-day symposium in Oakland, CA, that explored how the health sector might work differently to better understand communities.
Through his work, Dr. Tamber has learned that a core issue is health care’s inability to appreciate health as more than ‘the absence of disease’. This has fuelled the disconnect between the health sector and communities, and, to some extent, fuelled medicalization, health care inflation and the rise of non-communicable chronic conditions.
To help overcome this, Dr. Tamber has discerned 12 practice-based principles for how to build a bridge between the health sector and communities.
For the health sector, the principles encourage its leaders to acknowledge people’s social contexts, something that is known to be responsible for up to 80% of health. For communities, the principles have the potential to foster their agency – their ability to influence their circumstances. This is known to be core to health.
Fundamentally, Dr. Tamber’s work illustrates how the health sector has to radically renegotiate its relationship with citizens and society.
Dr. Tamber now produces Community & Health, a regular newsletter in which he reviews often-overlooked evidence, shares the work of courageous community-oriented practitioners, and comments on work described as ‘community health’ or the ‘social determinants of health’. He also consults to organizations willing to considering their broader impact on health, such as those in health care and real estate.
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 making open access commercially sustainable. He started his career as an editor at The BMJ (formerly known as the British Medical Journal).
The Realities of Responding to the Social Determinants of Health
As the health sector increasingly recognizes that clinical services alone cannot keep people healthy, it has started to embrace the social determinants of health. While attempts to bring the sector closer to other sectors, such as food, housing, and transport, are important, those at the frontline of this cross-sector work are acknowledging that gains are incremental. Through his work with community-oriented practitioners, Dr. Tamber will show how the challenge is a societal one that requires the health sector to re-examine its relationship with communities.
The True Opportunity of Value-Based Healthcare
Proponents of value-based health care describe it as the strategy that will fix the industry. But this self-ascribed validation of the much-needed shift from fee-for-service fails to understand the true opportunity it presents. Dr. Tamber will illustrate how value-based health care offers us the opportunity to ask what care is for, and, based on the answers, reimagine our health systems so that they return to being of service and value to communities. Doing so requires challenging the unvoiced assumptions that define our current approach to care.
It’s Time for Benefits Programs to Evolve
Workplace benefits programs continue to be framed by the idea of ‘health behaviors’ despite the fact that research has made clear that focusing on individuals is insufficient. Indeed, actuarial evidence is clear that targeting individuals largely only ‘works’ in those that would have changed their behavior anyway. As health care costs continue to consume a growing portion of companies’ resources, it’s time the benefits sector evolved beyond individual health behaviors. Dr. Tamber will share what his work has told him about how companies need to think in terms of communities, not just employees.
Population Health versus Health Equity
Most organizations limit their definition of population health to ‘the outcomes experienced by a group of individuals’. By failing to embrace the full definition, which includes ‘the distribution of outcomes within the group’, they render their population health efforts inert before they even start. Truly embracing the full definition of population health forces organizations to confront their responsibilities in achieving health equity. Dr. Tamber shows how community-oriented practitioners are acknowledging their (often inadvertent) role in consolidating inequity and how they’re changing what they do to embrace true population health.
Fostering Agency to Improve Health
It has been understood for some time that risk factors alone – whether personal, social or environmental – cannot fully explain why someone is healthy or sick. The missing link is whether people have a sense of control over their lives, something that requires individuals and communities to have ‘agency’ – the ability to make purposeful choices. Through his work, Dr. Tamber has gleaned 12 practice-based principles for how health care can work with communities in a way that intentionally fosters individual and collective ‘agency’. Those same principles also act as a mirror to health care to ask whether it can more authentically engage communities.
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