About

In 2013, I started looking for community-oriented innovation. At the time, I was the Physician Editor of TEDMED and was motivated by three things:

1. It was clear that our approach to health (especially health care) was unsustainable and new ideas were needed
2. Most innovations in health seemed to lack any appreciation of people’s social contexts, especially that health may not be their priority
3. There was evidence that communities with ‘social capital’ tended to be healthier

I defined community-oriented innovation as new approaches to population health that were sensitive to people’s contexts and priorities, and mindful of protecting and building social capital. My aim was to find a set of principles that might outline what community-oriented innovation was in order to build a field of practice.

Under the name Wellthcare, I visited and wrote about numerous innovative projects, many in the US and some in the UK, the Netherlands, Mexico, New Zealand and elsewhere. After a while, some of the innovators wanted to meet the others so in 2015 I founded a ‘collaborative’ — a space for them to describe their work, share their struggles and explore solutions.

The Creating Health Collaborative, as I called it, met in New York and took its name from Aaron Antonovsky’s idea of salutogenesis — literally ‘creating health’. In looking for innovations based on people’s contexts and priorities, I realised that what people really want is for their lives to make sense. Antonovsky observed something similar. In 1979, he argued that understanding health on the basis of sickness was inadequate. What mattered was whether people had a ‘sense of coherence’ — whether they felt their lives were meaningful, comprehensible and manageable.

Some of the innovators in the Collaborative were influenced by the work of S. Leonard Syme. Working down the corridor from Antonovsky at UC Berkeley, he observed that risk factors were not enough to understand people’s health. In 1989, he proposed that what helped fully explain health outcomes was whether people felt they had control over their destinies. To have control requires agency — the ability to act to produce a result.

Through the Collaborative and my wider research and writing, it became clear that many community-oriented innovators understood the importance of sense of coherence, control and agency. Their ways of working sought to promote all three. By 2017, I’d observed 12 commonalities to how they worked and called them 12 principles key to the future of health. To aid their adoption, I co-founded a nonprofit and created an implementation tool.

Around that time, there was growing appreciation that our social conditions influence our health. I turned my attention to how people with agency might collectively change their conditions. In 2017, my nonprofit held a symposium in Oakland, CA, called Community Agency & Health at which a number of community groups showcased their work to try to make their conditions more health promoting and protecting.

From 2019, my work became increasingly focused on community agency. Despite the strong philosophical and practical understanding of its importance to improving social conditions, it was unclear whether there was any empirical evidence that communities with agency could improve their health. In 2019, I closed my nonprofit and partnered with The California Endowment, a health foundation, to review the biomedical literature and found an encouraging, if disorganised, evidence base.