Salus Health Care Forum: November 5, 2025

Bill B

Years ago, I wrote quite a bit about something called natural helping networks. Studies were done about how delivery of health—and human services in general—were done in many small communities through natural networks that were not formally acknowledged. When you go into community to improve health, the first thing you don’t do is set up a new clinic. The first thing you do is go in and find out how healthcare is being delivered informally in this community: “Helen, when your daughter is sick and you’re not sure what’s going on, who do you talk to?”  “Well, there’s this neighbor I have, this woman that we all seem to go over to her”.

What are those natural networks? Just one example. I was working with administrators at the University of California. They were having problems because people were walking on the grass at their University. They got really annoyed. They put up all these barriers and people kept walking on the grass. I was consulting with them and said: “Well, there are things called natural helping networks. Maybe there are natural walking networks. Maybe, instead of trying to force people to go on the sidewalks. Maybe you should put the sidewalks where people are walking.” This was an interesting example of a nature network in operation.

So, Jack, I was wondering: when you’re talking about these neighborhoods where they supposedly “don’t have” adequate health care services. They’re “poor” neighborhoods and communities. They have “horrible” healthcare services. Is it because they’re only measuring the formal healthcare systems and they’re ignoring what’s really going on in the community? For instance, I wonder about the Hopi community. Was the program initiated by the official walk bureau at the Hopi community? Was it led by the official director of walking in the Hopi community? Or was it initiated by leaders of a natural helping network?

Jack

I’m not as familiar with the Hopi, but I can speak to the previous question about communities. Certainly, there are communities that have poor health outcomes; however, the problem we get into with these communities is this dichotomization. There are the good ones and there are the bad ones. There are the rich ones and the poor ones. There’s the ones where you’re healthy and there’s the ones that have lower life expectancy. I think we’ve lost the nuance of sort of the community that it’s not a yes/no. It’s a sometime we are together here and there. Some of those are nuances where things are working. However, many of the solutions that get foisted on people are created outside the realm of the community. They’re created in isolation. They’re sort of the least common denominator solution. And they don’t necessarily get input from the communities for what’s working here.

Appreciative inquiry is a very powerful tool.  It’s a very powerful tool for community building. We’ve used it a lot in rural Colorado and around the country. And again, the problem is this dichotomy between good and bad. People love to point out problems: look at those people over there. It’s like being in junior high. Oh, I’m so glad I’m not like that guy. Oh, look at those poor suckers over there. And we get caught up in that dichotomy, rather than noting and thinking about a unique outlook on life presented by these people. And that community has some really cool things going for it. However, here is where the problem lies: we can’t fund those things. We can only fund the solution that came down from a larger organization. So, we have to think more at the community solution level until such a time as we outlaw profit, which would solve many of our problems in healthcare.