35.2: Leading Initiatives to Transform Health Systems to Reduce Health Inequities
By the end of this section, you should be able to:
- Describe leadership behaviors that foster the attainment of health equity.
- Describe technology’s role in transforming care in public and community health practice.
- Identify initiatives for reshaping community and public health practice.
- Describe what population health will look like in the future.
By demonstrating certain leadership behaviors, nurses can create equitable health care environments, reduce health disparities, and improve health outcomes for all individuals and communities. In addition, they play a vital role in advocating for health equity and inspiring others to pursue equitable health care for all. This section considers nurses’ roles as leaders, explores technology’s role in transforming public and community health, examines three initiatives that are reshaping public and community health care, and imagines what population health will look like in the future.
Leadership Behaviors That Foster Health Equity
This text has emphasized social justice and health equity. Nurse leaders have an opportunity and an obligation to lend their skills as scientists, innovators, advocates, and educators to lead efforts to advance health equity for all (Azar, 2021). A nurse leader does not have to be in a position of authority; instead, they can carry an informal role of influence. For example, nurses can act as role models by embodying equity, inclusivity, and cultural competence principles. They can demonstrate respectful and compassionate care for all individuals regardless of their backgrounds or social determinants of health. By modeling inclusive behavior, nurses inspire others to follow suit. Nurses can lead initiatives to ensure the nursing staff receives ongoing training and education in cultural humility and sensitivity and advocate for language services and interpreter services to ensure effective communication and understanding. Table 35.4 demonstrates how nurses, as informal leaders, can use their influence and expertise to improve the population’s health. Refer to additional strategies presented in Advocating for Population Health and Engagement in the Policy Development Process for specifics.
| Practice Focus | Application |
|---|---|
| Practice advocacy |
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| Client advocacy |
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| Policy engagement |
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| Research and evidence generation |
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| Education and mentorship |
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| Collaborative partnerships |
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Technology’s Role in Transforming Care in the Public and Community Health Practice
Technology has revolutionized public health by improving health data collection, analysis, and sharing. Electronic records, data analytics , and digital surveillance systems have enabled faster responses to outbreaks and other health threats. Telehealth and mobile health apps have expanded access to health care services and facilitated remote monitoring and self-management (Figure 35.5). Integrating digital tools into health care delivery can enhance population health and the factors that impact health outcomes, including medical care. COVID-19 has highlighted the significance of integrating technology into health care delivery (Abernethy et al., 2022).
Technology will continue to shift care from hospital-centric care to community-based care. This transition is driven by the potential to improve client outcomes, reduce health care costs, and enhance the overall well-being of individuals by leveraging technology’s capabilities for remote monitoring, education, early intervention, and data-driven decision-making. Table 35.5 outlines current and emerging technological advancements that will continue to influence care delivery.
| Current and Emerging Technology | Application | Nurse’s Role & Responsibilities |
|---|---|---|
| Telehealth and telemedicine | Virtual visits, remote monitoring, and teleconsultations enable health care professionals to provide care and support remotely. | Nurses must understand telehealth platforms to assist in client education and ensure effective communication during virtual visits. Nurses play a role in developing telehealth systems and new virtual care models (Booth et al., 2021) and develop competency to deliver care using remote technology (AACN, 2021a). |
| Electronic health records (EHRs) | EHR systems allow health care providers to store and access client information electronically. | Nurses are responsible for maintaining ERH records and ensuring accurate and up-to-date client data is available to the entire care team. Nurses play a role in developing low-cost devices and software and promoting integration with existing mobile, internet, and other digital technologies (Booth et al., 2021). |
| Wearable health devices | Devices like smartwatches and fitness trackers can monitor various health metrics such as heart rate, sleep patterns, and activity levels. Wearable data can be incorporated into the plan of care to help improve client outcomes (Bowe et al., 2023). | Nurses can assist clients in understanding how to use these devices and the data generated and provide context for its significance. |
| Internet of medical things (IoMT) | The internet of medical things (IoMT) integrates medical devices and wearables with internet connectivity for remote monitoring, real-time data collection, and better communication between clients and health care providers (Junaid et al., 2022). | Nurses can utilize this information to track vital signs, medication adherence, and health behaviors, providing essential information for personalized care and early intervention. |
| Mobile health apps | Many mobile apps are focused on health management, medication reminders, and chronic disease management. | Nurses can recommend suitable apps to clients, provide guidance on using them, and interpret the information generated. |
| Artificial intelligence (AI) | AI has the potential to analyze large data sets, diagnose medical conditions, predict outcomes, and personalize treatment plans while eliminating inefficiencies in clinical workflows. This branch of computer science has many subfields striving to mimic human intelligence (Tiase & Cato, 2021). | Nurses must understand their role in collaborating with AI systems to enhance decision-making and client care. Nurses should take responsibility for advocating for policies needed on professional accountability in using AI (Booth et al., 2021). |
| Robotics | Technological advancements have led to the development of robots as potential partners in nursing to supplement understaffing and provide efficient health care for people with disabilities, older adults, and vulnerable individuals (Clancy, 2020; Khan et al., 2020; Miyagawa et al., 2020; Soriano et al., 2022). Robots can assist with medication delivery, client transportation, and even surgery. | As robotics becomes more involved in health care delivery, nurses will need to evaluate their proficiency and expand their role to ensure health care robots’ safe and empathetic functioning (Soriano et al., 2022). |
| Genomic medicine | Genomic medicine uses an individual’s genomic information in clinical care for diagnosis or treatment decisions, impacting oncology, pharmacology, rare/undiagnosed diseases, and infectious disease outcomes and policies (National Human Genome Research Institute, 2020). Genetic advances have led to personalized medicine based on individuals’ genetic makeup. | Nurses can educate clients about genetic testing, help them understand the results, and support decision-making (Booth et al., 2021). |
| Augmented reality (AR), virtual reality (VR) | AR and VR technologies are used in various areas, from medical training to pain management, to supplement the real world with virtual objects and transform client education from static text-based material to interactive website-based systems (Adapa et al., 2020). | Nurses must ensure that AR and VR incorporate evidence-based client teaching materials, considering health literacy, vision, hearing, and cultural sensitivity (AACN, 2021a). |
| Internet of Things (IoT) | IoT is “a self-configuring and adaptive system consisting of networks of sensors and smart objects whose purpose is to interconnect ‘all’ things, including everyday and industrial objects, in such a way as to make them intelligent, programmable, and more capable of interacting with humans” (Laplante et al., 2018). IoT devices can connect medical equipment and enable real-time data monitoring and analysis. For example, “smart beds” can detect when they are occupied and when a client tries to get up, sending this information to nurses via the network/internet (Babu & Jayashree, 2015). | In planning IoT health care applications, nurses and engineers must collaborate to combine domain expertise and technological insights to benefit clients and providers (Laplante et al., 2018). |
| Workflow management software | Workflow management software can aid in improving client safety and reduce documentation or data access time. These tools can help nurses manage tasks, assignments, and schedules, optimizing their daily workflow and ensuring that client care tasks are timely. | Nurses must ensure that the software aligns with their workflow, ultimately enhances decision-making, and improves client care quality. |
| Smart homes | Homes equipped with sensors and wearable devices can track vital signs, activity levels, and health metrics. This data can be sent to health care providers in real time for remote client monitoring. Smart homes can help remind occupants to take their medications and perform other health-related tasks, as well as detecting falls or unusual movements. | In collaboration with family members, nurses can use this technology to tailor care decisions, such as supporting older adults with memory problems to remain in their homes (Booth et al., 2021). |
This short video introduces far-reaching changes that will transform every facet of health care.
Watch the video, and then respond to the following questions.
- What is a digital twin? How can a digital twin be used to promote health?
- Describe how precision medicine impacts care.
- How will AI-powered decision models be used?
- What is anticipatory health care?
Nurses are responsible for ensuring that technology facilitates efficient, safe, client-centered care delivery (Booth et al., 2021). Nurses must respect their clients’ values and uphold technology’s ethical and safe use. To achieve this, nurses can implement the following strategies:
- Educate clients about the benefits, risks, and potential implications of using specific technologies in their care. This empowers clients to make informed decisions based on their values and preferences.
- Ensure clients provide informed consent before implementing a new technology or procedure involving technology. This involves explaining the purpose, procedures, potential benefits, and potential risks.
- Consider clients’ cultural, religious, and personal values when integrating technology into their care plans. Tailor the technology used to align with clients’ unique needs.
- Respect the client’s autonomy and explore alternative care options if a client chooses not to use certain technologies due to personal beliefs.
- Promote transparency by explaining how client data will be used, stored, and shared using technology. Clients should be aware of how their privacy is being safeguarded.
- Ensure that communication is secure and protected to maintain client confidentiality.
- Advocate for concerns within the care team. Collaborate with other health care professionals to find solutions that align with clients’ values.
- Use technology to empower clients to take an active role in their care decisions.
- Establish channels for clients to provide feedback on their technology experiences. This feedback can drive improvements and enhance client-centered technology solutions.
- Remain updated on technological advancements and ethical considerations related to health care technology to guide clients effectively.
- Join groups and organizations focusing on health care technology ethics to gain valuable insights and resources.
Initiatives for Reshaping Community and Public Health Practice
A variety of initiatives are reshaping public and community health care by emphasizing prevention, community engagement, and care coordination and addressing the social determinants of health. These initiatives aim to improve health outcomes, enhance access to care, and promote equity in health care delivery by focusing on holistic and client-centered approaches. This section examines three initiatives: community-based participatory research, Health in All Policies, and community health workers.
Community-Based Participatory Research
Community-based participatory research (CBPR) involves collaborative research partnerships among community members, researchers, and public health practitioners. This approach ensures that communities are actively involved in the research process, from identifying research questions to interpreting and disseminating findings. CBPR helps to address community priorities, build trust, and promote sustainable interventions (Agency for Healthcare Research and Quality [AHRQ], 2020).
At the core of CBPR lies collaboration, highlighting the significance of partnerships between researchers and community members. This approach recognizes communities’ immense knowledge and expertise regarding their health concerns. CPBR highly values community engagement and empowerment, involving community partners in all phases of the research process. Community members are active participants, co-researchers, and co-implementers of interventions. The ultimate goal of CBPR is to empower communities to take charge of the research process and use the findings to advocate for change and enhance their health outcomes (AHRQ, 2020).
CBPR is committed to producing actionable outcomes that lead to positive change in the community. It aims to translate research findings into interventions and policies that address community health concerns. CBPR considers sustainability, ensuring that research efforts have a lasting impact and support long-term improvements in community health (AHRQ, 2020).
In conducting community-based participatory research, ethical considerations are given the utmost importance, such as respecting community autonomy, cultural sensitivity, and informed consent and protecting human subjects. Adherence to ethical guidelines and protocols ensures the welfare and rights of all participants.
The research process has been extensively utilized in public health, health care, and social sciences to tackle health inequities, advance community health outcomes, and promote health equity. CBPR aims to create culturally appropriate, contextually relevant knowledge and significantly impact communities’ health and well-being by involving community members as active partners (AHRQ, 2020).
This short video illustrates a collaborative approach to conducting CBPR.
Watch the video, and then respond to the following questions.
- Define community-based participatory research.
- How does the CBPR approach promote shared power?
Health in All Policies
Health in All Policies (HiAP) seeks to incorporate health considerations into policymaking across various sectors and government agencies. As described in Engagement in the Policy Development Process, HiAP is “a collaborative approach that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people” (CDC, 2016a). It recognizes that health outcomes are influenced by various social, economic, and environmental factors extending beyond the health care sector. HiAP aims to ensure that health is considered and integrated into decision-making processes and policies at all levels of government.
HiAP emphasizes addressing health inequities and the underlying SDOH, given that health disparities often stem from unequal access to resources, opportunities, and power. HiAP strongly encourages collaboration among various sectors, including health care, education, transportation, housing, environment, and agriculture. This approach recognizes that addressing SDOH requires a comprehensive, coordinated effort. When these sectors work together, they can align policies, strategies, and actions to promote health and well-being. HiAP aims to address the social, economic, and environmental factors contributing to health inequities and achieve equitable health outcomes for all populations. HiAP stresses integrating health impact assessments, epidemiological data, and research findings into policy development processes, as evidence and data are crucial to informing policymaking (CDC, 2016b).
Collaboration between community and public health nurses and professionals from various sectors and government agencies is crucial for promoting HiAP. By engaging in intersectoral partnerships, community and public health nurses can work with policymakers, community organizations, schools, transportation departments, and housing authorities, and other concerned parties to advocate for policies that address social determinants of health. Community and public health nurses can provide expertise on health promotion, disease prevention, and community needs to inform policy discussions. They can also support the implementation of health impact assessments (HIAs), which evaluate the potential health effects of proposed policies, plans, and projects across different sectors. Nurses can contribute their understanding of local health needs, data, and community perspectives to ensure that HIAs are comprehensive and reflect the specific community context. Additionally, they can collect and analyze data on health outcomes, SDOH, and the impact of policies on population health to provide evidence for the effectiveness of HiAP interventions. HIA and HiAP are policy tools that include health considerations in decision-making processes across sectors such as transportation, education, criminal justice, and equity (Rogerson et al., 2020). By sharing this evidence with partners, the community, and public health, nurses can advocate for evidence-based policy changes that promote healthier communities.
Public health nurse Josh can use the data analysis he performed to identify areas within his community to be the focus of intervention. For example, the data revealed a high prevalence of obesity and related chronic conditions, and Josh has identified significant health disparities and inequities, with limited health care, education, and healthy food options characterizing the community. Josh’s examination of interventions attempted in the past reveals that traditional approaches to improving health have not been sufficient and decides to adopt the HiAP framework to address the underlying social determinants of health.
Josh works with the local government and initiates a HiAP team to promote cross-sector collaboration involving representatives from various health, transportation, housing, education, and urban planning departments. Regular meetings and working groups facilitate communication, collaboration, and information sharing. This collaboration ensures that health considerations are integrated into policy discussions across sectors. The HiAP team collects and analyzes a wide range of data related to health outcomes, social determinants of health, and existing policies.
The HiAP team identifies critical health indicators, disparities, and areas where policy interventions can significantly impact health equity. This data-driven approach provides the necessary evidence to guide policy development and implementation. The HiAP team reviews existing policies and identifies opportunities for alignment with health goals. They identify policies that have the potential to impact health determinants, such as transportation infrastructure, affordable housing, access to parks and recreation, and healthy food options. The team works with relevant departments to integrate health considerations into policy development, ensuring that decisions prioritize health equity.
The HiAP team establishes mechanisms to assess the impact of policies on health outcomes and health equity. They track vital indicators, collect data, and evaluate the effects of policy changes on various population groups. This evaluation process helps to identify successes, challenges, and areas for improvement. The findings are shared with policymakers and community partners to inform future decision-making processes.
The local government actively engages with the community throughout the HiAP process. They conduct community consultations, focus groups, and public hearings to ensure that community members’ voices are heard and their health needs are considered in policy development.
Community feedback and perspectives are integrated into policy decisions to ensure relevance and responsiveness to local needs. Through the implementation of HiAP, the city government has witnessed several positive outcomes and impacts. Policies and interventions are designed and implemented with health equity in mind, resulting in improved access to health care services, increased availability of healthy food options, enhanced public transportation systems, and revitalized neighborhoods. Health disparities begin to narrow, and community members report improved health outcomes and a sense of well-being.
Community and public health nurses can work with community members to implement a Health in All Policies (HiAP) approach to address health disparities and promote well-being in the chosen community.
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Step 1: Community Selection
- Choose a local community you are personally connected to or are interested in working with.
- Consider demographics, health disparities, existing policies, and community resources when selecting your community.
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Step 2: Understanding the Situation
- Research and gather data on the health issues affecting your chosen community.
- Analyze the social determinants of health that contribute to these issues.
- Identify existing policies, programs, and partners related to health and well-being in the community.
- What are the key health issues affecting the community?
- How are social determinants of health contributing to these health issues?
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Step 3: Identifying Partners
- Who are the key groups in the community who should be involved in a HiAP approach?
- How can you engage community members, local businesses, and other sectors to collaborate?
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Step 4: Policy Analysis
- What are the current policies that might impact the health and well-being of the community?
- Which policies might inadvertently contribute to health disparities or unequal access to resources?
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Step 5: Developing a HiAP Strategy
- How can you unite diverse sectors such as housing, transportation, education, and health care to address health disparities collaboratively?
- What strategies could you use to advocate for policy changes prioritizing health and well-being?
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Self-Reflection
- How do your values and cultural background influence the way you work with diverse communities?
- What challenges might you face in navigating cultural differences and engaging various partners in the HiAP process?
- How can you ensure the HiAP approach is inclusive and respects the community’s cultural diversity?
Community Health Workers
As introduced in Implementation and Evaluation Considerations, community health workers (CHWs) are essential public health workers who serve as a critical link between communities, health care systems, and state health departments. CHWs are trusted liaisons between the health care system and its communities. They provide culturally appropriate education, outreach, and support to individuals and families, particularly those facing health care difficulties. They significantly enhance health literacy, facilitate care coordination, and promote preventive health behaviors (CDC, 2022).
For example, CHWs conduct community outreach activities to connect individuals with health care resources and services. They may assist community members in navigating the health care system, scheduling appointments, completing paperwork, accessing insurance coverage, and understanding their rights and responsibilities. CHWs provide emotional support, encourage self-advocacy, and help individuals overcome barriers to health care access (CDC, 2022).
As collaborators with health care providers and other community organizations, the CHW facilitates care coordination for individuals with complex health needs. They help individuals understand their treatment plans, adhere to medications, and navigate the health care system. CHWs also make referrals to resources, such as social services, mental health providers, substance misuse treatment programs, and support groups (CDC, 2022).
CHWs serve as advocates for the health needs of their communities. They raise awareness of health disparities, promote policy changes to address social determinants of health, and engage in community organizing activities. CHWs empower community members to participate in decision-making that actively affects their health and well-being (CDC, 2022).
Community and public health nurses frequently collaborate with CHWs, offering training, supervision, and assistance. This partnership enables public health agencies to utilize CHWs’ cultural proficiency, valuable insights, and strong community ties to develop targeted interventions, enhance health care accessibility, and tackle health disparities effectively. When these groups work together, public health efforts can have a broader reach and more significant impact, ensuring that interventions are tailored to meet the specific needs of the communities they serve.
Some states require certification or training for CHWs, which may be implemented by the Department of Health, Department of Public Health, Department of Human Services, board of nursing, or third-party entities. Certification is often necessary for reimbursement, and some CHWs view it as a tool for career advancement, while others may not see it as necessary for their role or community connection (Rural Health Information Hub, 2023).
This short video introduces Magdalena, a client at Loma Linda University Health’s Diabetes Treatment Center. She was depressed and immobile, having difficulty navigating the complex health system—but a community health worker was able to help.
Watch the video, and then respond to the following questions.
- Describe the role of community health worker.
- How does a community health worker bridge the gap in care?
- How might a population health nurse work with a community health worker?
Public health nurses like Josh recognizes CHWs as a critical link between communities, health care systems, and state health departments. Josh advocates for funding to support hiring a CHW to serve the county. Josh and CHW Tawana conduct a comprehensive needs assessment to identify the health needs and concerns of the community. They engage community members through surveys, interviews, and focus groups to understand their specific challenges, cultural beliefs, and preferences. Based on the findings, Josh and Tawana developed a joint plan that aligns with the community’s priorities and addresses the identified health issues.
They collaborate to design and deliver health education programs tailored to the community’s needs. They also develop culturally sensitive materials and workshops on chronic disease prevention, healthy lifestyle choices, and disease management. The CHW is vital in bridging cultural and language barriers, ensuring the information is accessible and relatable to community members.
Josh and Tawana work together to reach out to community members, particularly those who are underserved or face barriers to health care access. They conduct home visits, organize community health fairs, and partner with local organizations and faith-based groups. Their combined efforts raise awareness about available health care resources, facilitate access to services, and empower community members to take control of their health. Josh leverages his clinical expertise to develop care plans, provide health assessments, and offer specialized services. Meanwhile, Tawana serves as a trusted advocate, assisting with appointment scheduling and medication management and connecting individuals to social services. Together, they ensure continuity of care and support for individuals throughout their health journey.
Josh and Tawana regularly evaluate the effectiveness of their collaborative efforts. They track key indicators, such as health care utilization rates, client satisfaction, and health outcomes. By analyzing the data, they identify areas of improvement, make necessary adjustments to their interventions, and measure the impact of their work on community health. The collaborative work of Josh and Tawana yields several positive outcomes and impacts in the community. Through their joint efforts, they increase health literacy and empower individuals to make informed decisions about their health. The collaborative approach also strengthens community engagement, fosters trust, and promotes cultural competence in health care delivery. As a result, community members experience improved health outcomes, reduced health disparities, and a sense of empowerment and ownership over their well-being.
Population Health in the Future
To provide optimal care for populations, nurses must continue meticulously monitoring crucial metrics such as mortality and morbidity rates, vaccination rates, and lifestyle habits, including smoking, physical activity, and nutrition. This enables them to accurately assess their clients’ overall health status and quality of life.
With the rise of data analytics, nurses will collaborate with health care professionals, researchers, policymakers, and community leaders to develop comprehensive population health approaches. They will use data to identify health trends, allocate resources, and customize interventions to specific populations.
Addressing SDOH, such as socioeconomic status , education, and housing, will become crucial to enhancing overall population health outcomes. Nurses must reduce health disparities by addressing inequalities in health care access and outcomes among different population groups, utilizing technology for remote monitoring, telehealth, and health education, promoting health literacy, and empowering individuals to actively manage their health.
Nurses must consider genetic, environmental, and lifestyle factors when planning interventions for effective population health strategies. Additionally, they will be called upon to advocate for policies promoting a healthier environment in response to climate change influencing client health status and safety.
Addressing mental health disparities and promoting mental wellness will gain more prominence in population health initiatives . Public and community health nurses will lead the way in improving the health and well-being of residents in rural communities. They will work across borders to address global health challenges and promote health equity worldwide.
Community and public health nurses will continue prioritizing health promotion, disease prevention, and education with health care technology enhancing their role. However, hospital-centered care will shift to community-based care, improving client outcomes, reducing costs, and enhancing well-being through remote monitoring, education, early intervention, and data-driven decision-making.
Overall, the future of nursing in the community will be characterized by a proactive, technology-driven, client-centered, and collaborative approach. Community nurses will work as educators, advocates, and health partners, striving to improve the health and well-being of diverse populations and promote equitable access to care.
Read the scenario, and then respond to the questions that follow.
Tania is a registered nurse working in a community health center who has observed significant changes in her role and responsibilities, with a growing emphasis on population health. Tania is curious about nurses’ evolving role in addressing the health needs of diverse populations and the challenges and opportunities associated with this shift.
- What are the key metrics that nurses like Tania should monitor to assess the overall health status and quality of life for populations?
- How can data analytics enhance the role of nurses in population health initiatives? What are the potential benefits of data-driven approaches?
- What are some of the social determinants of health that nurses should address when working on population health? How can they reduce health disparities among different population groups?
- How can technology, such as remote monitoring and telehealth, be leveraged by nurses to promote health literacy and empower individuals to manage their health actively?
- How can nurses consider genetic, environmental, and lifestyle factors when planning population health interventions? Provide examples of how these factors can impact health outcomes.
- How might climate change influence client health status and safety, and how can nurses advocate for policies to respond to this challenge?
- How can nurses address mental health disparities and promoting mental wellness within populations?
- How might rural communities benefit from the leadership of public and community health nurses? What challenges may they face in these settings?
- How is health care evolving from hospital-centered care to community-based care, and what are the potential advantages of this shift for client outcomes and costs?
- What approaches, roles, and responsibilities will define the future of nursing in the community?