Reform of so monumental a subject, human value, and industry as health must be undertaken through the cultivation of public opinion in which understandings are reached and values shared. We must be offered the opportunity to come to terms with issues of value that may separate us in order to reach common judgments and a consensus on how to proceed. Ultimately, we need to develop a new understanding of how we perceive health. Instead, the Clintons offered us a Black Box, and with it, the call to trust them, a call which was antithetical to the only means by which their aims might have been achieved. The quality of governance has great bearing on the social capital of communities, and the political-social interaction works both ways.
Poor governance elicits the community's distrust of government.
The lesson for public health is that some public health strategies have the unintended negative consequence of pre-empting debate, and through it, the formation of public opinion and the growth of social capital. Community health educators should promote public process in the interest of empowering communities to better see themselves, exercise better judgment about what really matters to them and seek harmony in the values that matter. Community health education through dialogue should be seen as the heart of health promotion, and the responsibility of any health plan that countenances a mission of building healthier communities. The new National Public Health Performance Standards call upon public health to institutionalize a commitment to community processes that evaluate quality of life, prioritize problems and solutions and do so in consonance with community themes, all in the interest of expanding the social capital of communities. Done properly, community empowerment will replace short-term community engagement, and accountability will replace paternalism.