Whether someone considers themselves to be integrated into their society or not, every human being is somehow a part of a community. Although most people have a general idea of what it means to be a part of a community, many people do not realize how broad and encompassing this term can be. To be precise, the World Health Organization [WHO] defines a community as, "A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time." It continues to say that members of a community, "exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them." The inclusion of this definition reveals the impact that a community can have on someone's life, and more specifically on health. It is through this understanding of what community includes, and seeing interactions within a community that I came to understand that changing someone's health is more effective if we can build a community where health is encouraged and supported, rather than just engaging an individual. 

​

          Although my involvement with volunteering started during my freshman year, it was during my junior year that I was able to draw the connections between being involved in a community and health. This realization came through my HPEB 300 class, which is Introduction to Health Promotion, Education, and Behavior. In this class, I learned how to utilize key concepts from varying fields and areas of public health in order to develop multidisciplinary interventions in specific communities. This often involved learning material from marketing, to economics, and even to psychology. This class integrated all these fields together and taught me how to apply what I learned in real life through the undertaking of a semester long Program Planning Project. This project was completed in a group and required an analysis of the public health need that addressed why the problem existed and what communities it affected most, and the development of a program that was targeted towards a specific behavior within a subset of a population that had the most need. In order to complete the project, it was necessary to devise a plan to involve the community in a way that they would see the benefit of the program we had planned and adopt the desired behavior. In order to effectively change behavior, the field of public health utilizes behavior models that predict what factors are necessary to achieve a change of behavior, whether it is a health, social, or physical related action. For example, in the project, my group chose to base our intervention on the Health Belief model, which considers a patient's perceived susceptibility and risk to a disease that can be focused on in order to motivate them to change their belief about a disease and shape their actions. The understanding and application of this model not only helped me to better understand how people look at a disease, but also how I could address those views in a way that would best suit them. It was also through this that I began to understand how models could be connected to various projects or activities that I was involved in. The particular model that I think applies universally to my community service activities is the Social Capital Model.

​

           Although the name of this model is technical and involves some background in social sciences to understand, it can easily be understood by knowing that it focuses on building communities and accomplishing a common goal. In order to explain this model, I think it is first necessary to highlight what social capital is. Simply defined, this term describes the social networks that exist within a society and the value that those connections have to not only society, but the individual members who make those connections. The model approaches this concept by considering how a program or individual can form bonds and utilize societal norms in order to bridge gaps between differing groups or communities, and therefore form a common trust and relationship between them. This concept of building trust between differing groups and leveraging those relationships for societal change is what drew a connection between this model and community service. 

           

            Regardless of which of my experiences that I choose to apply this model to, I can always realize the use of engaging the community and changing health through those actions. For example, during my time at Harvest Hope Food Bank, I observed how an organization within a community can use its position to build trust and influence community residents to consume a healthier diet that they may not considered before. Although this example perfectly highlights the connection between this model and real-life application, I would like to expand upon my experience at the Free Medical Clinic in Columbia, SC in order to highlight the impact that building a social relationship of trust can have on health outcomes. The Free Medical Clinic is a non-profit organization that is situated in a poverty stricken area of Columbia whose goal is to provide quality healthcare to uninsured individuals. The clinic's unique location and opportunity to work with a specific community of individuals requires a great deal of trust in the care that is being provided and in the organization that is providing it. Throughout my time at the clinic, I was able to serve in a role where I got to take the medical histories and vitals of the patients who were going to be seen at the clinic. This time was always full of many questions and the chance to engage with patients about the circumstances that brought them to the clinic, and those that contributed to their health, such as losing their insurance or not being able to fill prescriptions for insulin. Many times in these interactions the patients would share very personal information about their lives that I was not expecting to hear. For example, patients would discuss how they had lost their jobs or difficult housing situations that was putting even more burdens on them. A lot of the patients at this clinic struggled finding healthcare for their chronic conditions, despite the fact that most of them worked a steady job or had worked until retirement.The impactful stories that these patients were able to share within a few minutes of my time made me realize how it important it is to develop trust within these interactions, especially since that information would be important for the physician to make a diagnosis. I was also able to observe how building trust between the patients at the clinic and the clinic itself was facilitated and helped the patients to follow through with their treatment plans. For me, the most notable way to observe this is through the interactions that the patients and had as they moved through different staff in the clinic and were able to set up appointments with physicians that they would not be able to access otherwise and obtain the medications they needed. For these patients, healthcare does not mean going to the doctor for one thing and the pharmacy for another. The comprehensive care that the clinic provided by allowing these patients to access everything at once helps them to realize that the clinic is trying to achieve their best interest and encourages the patients to be a part of that. 

​

            The opportunity to observe first hand how an organization engages a community and uses those interactions to shape the health of that community has helped me to understand what it means to put a model into practice. Through these observations, I am not only able to understand what it looks like to use the Social Capital Model, but also how to connect the smaller concepts of that model to reach the end goal of changing health behaviors. In order to affect the health of a community, it is necessary for the members of that community to trust the organization that is providing its care. Through the creation of this trust, the members will be more likely to take charge of their own health and follow the advice that is given to them by healthcare providers. Although I was aware before my experience with the Free Medical Clinic and the Social Capital Model that trust is necessary within the physician and patient relationship, I never understood how impactful a relationship between healthcare organizations and communities could also be on health. If an organization can establish its identity in a community as one that cares about the wellbeing of individuals and the greater benefit of the community, then the members of the community will be more likely to support that organization and trust it as a source of advice and change within the community. Through this, organizations and individuals such as doctors can be a more effective source of change on individual health, since trust can create an environment where health is promoted. 

         

          The skills that I gained through seeing an organization that promotes a culture of health within a community will continue to influence my personal practice of medicine as I move forward in life. My experiences allowed me to gain insight into the fact that health is not just a individual concept, but one that requires connecting with others and utilizing a community approach. This does not simply apply to engaging a community that is medically underserved or where a risk factor is prevalent, but can deepen the understanding of how family, workplaces, churches, etc. can be all be utilized to encourage individual's to change their health. By using these skills as a physician, I will be able to fully address the needs of my patients and address the factors that are standing in between them and changing their health.These skills that I observed will help me to build interactions with patients in my own medical career and understand that changing health is more effective if patients and  their communities interact on a deeper level. Through gaining insights into how communities impact health, I will be able to better involve myself with that change in the future.