Back in Blighty...

I left a sunny, warm, blue skied Cape Town on Sunday evening and landed in a grey, cold Manchester on Monday morning. Still - after a great and inspiring 3 weeks - it was good to be home.

I was also pleased to have a couple of publications waiting in my inbox which will help share the learning from my fellowship.

The first is an article based on learning from the North American leg of my trip which I wrote for the Centre for Local Economic Strategies (CLES) 'New Start' publication. You can access this CLES publication here.

The second is a feature on social capital which I wrote for Altogether Better's National Newsletter (see page 8). The newsletter also features an article on Asset Based Community Development, showcasing some of the work undertaken by our Sheffield project and an interview with ABCD expert, Cormac Russell (see page 7). Click here to download the newsletter.

A new take on ABCD - Asset Based Citizen Led Development?

The Ikhala Trust in Port Elizabeth is small grants funder that is all about identifying and mobilising community assets. Thier vision is to, "build self reliant, secure and virbrant communities through a holistic, sustainable and positive intervention." Through the provision of small grants to community organisations, Ikhala enables and empowers communities to gain what they need by building on what they have (to paraphrase Moses Coady!).

Mrs Bono (Seki) and Bernie Dolley (Ikhala)

I spent a useful and informative day with Bernie Dolley, Director of Ikhala. Bernie told me that, "the importance of human relations is at the heart of what Ikhala does" and that what people value most is, "to be respected, listened to and appreciated". So Ikhala is about building some central elements of social capital - networks, relationships and trust. As an organisation they see people as 'asset rich', which Bernie sees as essential to enabling change.

Bernie went on to tell me that Ikhala,  "works on the principle of sowing where people have already laid a foundation."  A grant will not be given unless social cohesion and mobilization are already demonstrated by the community, so the  grants reinforce and build on communities existing assets and mobilization. This approach differs from mainstream development approaches that tend to focus on deficits oriented and release large sums of money to  fill deficit gaps 



I asked Bernie about Ikhala's use of Asset Based approaches. ABCD commonly stands for Asset Based Community Development but Ikhala prefer to talk about Asset Based Citizen Led Development.  Bernie likes to think of ABCD as,  "an attitude and a state of mind - not a system to be followed." She went on, "It's more about how you see and value the world."  Appreciative Inquiry is one of the tools commonly used in ABCD and Ikhala have used this from the beginning to ask questions of communities using an asset based lens - such as:

• What are we proud of about our communities?
• Who has inspired us?

Bernie says she is often deeply humbled by people's responses to these questions and by the range of assets and resources they bring - especially as these are people from very poor communities who are often deemed to have 'nothing'. She sees ABCD as ultimately being about giving power to people in communities - which aims to, "shift the culture from one of dependency to one of hopes and inspiration." and Ikhala clearly has a role in enabling that to happen in the Eastern Cape. You can read more about Ikhala's work here.

Volunteer (aged 80!) cooking up meals

Whilst grants are relatively small in terms of financial contribution, they enable communities to make a big difference. We visited the Seki Women's Foundation which Ikhala helps to fund. They provide meals to local people from the New Brighten township (where they are located) 3 days a week. The local school also sends pupils identified in need  of a meal (school meals are not provided in state schools in the area). Mrs Bono, the founder of Seki, told me, "I know and am glad these children get to eat 3 days a week....but I have no idea what they do for food on other days. It's really a worry...". Many of the children were dressed in school uniforms and shoes that were in a poor state and really needed replacing. Ikhala also helps by providing school shoes and clothing for the children where possible.

Getting a good meal at the Seki Foundation

The Seki project's 'soup kitchen' is run by a small group of older women (some in their 80s) who prepare, cook and serve the hot meals. Bernie explained how they keep a register of who attends and so, if someone is missing, they will visit the home or make enquiries about their well being to make sure all is well. They also try to identify people who may be unwell or in need of some other support and signpost them to other sources of help where needed. They also have a role in identifying children who may be having problems at home and will alert the necessary services. In addition to providing the meals, the Seki Centre also has a community garden in the grounds which provides some of the food for the meals. All Ikhala projects are encouraged to have a community garden to help address issues of food poverty and encourage sustainability.

The Goodness of Gardening

On Wednesday this week, I spent an inspiring and thought provoking morning with Rob Small of Abalimi Bezekhaya ('Farmers of Hope') in Cape Town.

Abalimi is an urban micro-farming organization operating in the townships of Cape Town. Abalimi teaches people how to create their own garden, grow - and potentially sell - their own vegetables, and feed their families.

Abalimi means "the Planters" in Xhosa, the predominant language among the target communities worked with. Through a series of programs, Abalimi helps to alleviate poverty (though increased food security and generation of jobs / income), empower communities and promote a better state of wellbeing. As Albalimi's newsletter (Sept 2009) states, this is often challenging work in communities where people are very poor and, in trying to survive, are, "often divided and disempowered, easily distracted and always looking for greener pastures."

However, almost 30 years since Albalimi began, it continues to support both home gardens, through providing people with training, advice, seedlings and manure to help establish their own gardens and also larger, community gardens. Through the home gardening projects, people gain more confidence and are able to move on and build themselves a new life.  

We visited two of the community gardens and met some of the farmers and gardeners, all working hard to tend the crops. Some of the produce from the community gardens is sold to the veg box scheme which supplies locally produced, reasonably priced, organic vegetables to customers in Cape Town. It also provides the farmers with an income and an incentive to keep farming!  As Rob explained, for these people, the garden is not just a 'nice to have', it is central to sustainability and poverty reduction. The gardens also provide an opportunity for community members to come together and to work together for both their individual benefit (through increased physical activity, improved healthy eating, social interaction, learning to run a business, etc) and for the greater good of the community (much of the produce is shared with community members).

Can you help?

It costs just £60 to establish one new township home vegetable garden or a new community market garden (including training, trees and follow up support). Please do consider a donation if you can support this fantastic work.

Want to know more?

You can view a CNN clip about Abalimi 's work, as explained by one farmer leader Christina Kaba here.

'We are Abalimi. We are the Farmers.' is a short documentary film about Albalimi made by American volunteer Matt Miller and Travis Blue. View it here.

Health Champions in the Eastern Cape

I saw 3 giraffes and 2 warthogs on my way to work yesterday….not something you see every day but what a great start to an informative and inspiring day spent with Lucy O’Keeffe and Kath Court from the Angus Gillis Foundation (AGF). AGF are based in Grahamstown in the Eastern Cape, considered to be the poorest province in the country with 72% of the population living in poverty and a third (32%) of households having an income of less than R200 (£20) per month.

Like Altogether Better, the AGF takes an empowerment approach, as illustrated in this quote from their website:

“The Angus Gillis Foundation facilitates and does not drive development in communities because we believe that, with the right support, community champions can drive their own development, thus bringing about genuine and lasting change” (Angus Gillis Foundation, 2011)

The AGF works with 12 communities in the Eastern Cape and facilitates development using asset based approaches which emphasise people's existing skills and capacities. They take a truly holistic approach operating 4 key programmes: 1) Self-help groups 2) Education 3) Economic Development and 4) Health.

Whilst the health and social needs in the Eastern Cape are very different to those in Yorkshire, AGFs Positive Health programme, facilitated by Kath Court, has many similarities with Altogether Better. They even have their own Community Champions and Positive Health Champions! I was keen to meet some of them and find out about their work. Kath told me that the Positive Health programme aims to, “provide communities with as much information as possible, to enable them to achieve optimal physical, mental and spiritual well-being. It's about presenting methods of preventing illness and staying healthy.”

Lucy (left) and Kath (right) from AGF with Health Champion, Novulo
in the herb garden at the Community Centre

The Health Champions are people from within the community who have leadership potential, have good language skills and have developed the necessary health related knowledge. Kath told me how the self-help groups (SHG) which AGF established are often where the Champions are identified and first emerge. Through the SHGs, the women  begin to start sharing their problems and discuss social issues in the group. This helps a new relationship of trust and togetherness to develop so the SHGs  become a breeding ground for social capital as well as future community champions!

We travelled to the Brandeston community (situated within a private game reserve) to meet with Noluvo, a Positive Health Champion working in the community. Noluvo showed me around their community centre which housed a number of facilities for use by community members including a simple gym, a knowledge centre/library, a crèche and pre-school, a herb garden, and the workshop of the Siyakhula Doll Cooperative, run by women from the local area as a means of generating income.  Kath later explained to me how, before her involvement with the self help group and becoming a Health Champion, Noluvo would not have had the confidence to talk to a stranger such as me, "the strides she has made in terms of her knowledge, confidence and ability to engage with others have been huge."

We arrived at the Centre lunch time as the children were tucking into a healthy meal. Kath explained how the Centre used to provide the food mixed together, like in a stew or a soup, but that she had worked with the Champions and the children to explain the different food groups and why each was important in health terms. The children were proudly able to tell me that carrots were good for their eyesight, that the potato (carbohydrate) gave them energy and that the chicken (protein) made them strong. Kath had encouraged the workers to serve the food on a plate with separate sections which helped remind the children about the importance of different food groups (see photo above).

We then went on to a nearby community, Kalkeni, to meet Nomhlobo (see photos left and below), a retired nurse who had grown up in the area and moved back in recent years. She now works as a Positive Health Champion and told me how she helped with a range of health issues in the community including child health, nutrition, keeping active and sexual health. Nomhlobo felt strongly that people should be encouraged to help themselves and be self-sufficient, not always relying on help from outside. She explained how she had a role in encouraging people to grow and cook their own food and showed me the goats they were breeding which were then sold on to generate income.

Positive Health Champion - Nomhlobo

Our last stop was to meet Lindi in Glenmore (see photo to the left) – a community of around 2000 people. Lindi, in addition to working at the community run bakery, is also a Positive Health Champion. She attends the local health clinic (staffed by 3 nurses) every day to provide advice and support to people, she also runs workshops for community members on a range of different topics including child development, hygiene, gardening skills and parenting. She also provides 1:1 support and advice to people in their own homes when they are too sick to attend the clinic. Lindi told me how her own knowledge and confidence had grown enormously since becoming a Champions - and how she got great satisfaction from sharing her knowledge to help people.

On the way back, we stopped by at one of the safe play places for children. Kath explained how they had been taught about the importance of hand washing and, on Kath's instruction, all the children rushed outside to the hand washing bucket and duly washed their hands. Kath  explained how the children  were also 'champions' and in teaching them about basic health and hygiene, they will grow up as a future generation who value the importance of health and of keeping healthy and also understand and share what they can do to help with this.

Waiting in line to wash their hands.

There is much to be learnt from the AGF asset based approach to development. They deliberately avoid using any external material resources in the initial stages as this is seen as contrary to the Self Help concept. Although the people AGF work with are very poor, their personal assets and natural potential to manage their lives is identified and mobilized.  AGF see development as, "not about resources but about unlocking human potential". Conventional approaches often assume that poor people have no assets, AGF is clear that this is not the case and that they must first work with the assets people have and affirm them that they can do it. Then when they are strong, material resources can be introduced responsibly.

Worker in the Dolls Workshop

“As outsiders we cannot empower the weaker section, only they can empower themselves, to make choices or to speak out on their own behalf. We can walk alongside them, introduce resources responsibly when they are needed, and provide necessary training, support and motivation.” (Angus Gillis Foundation, 2011)

Wise words and important learning for us in the UK, especially at a time when external resources are scarce, and where the culture is often one of 'provider' and 'client' rather than one of  true empowerment.

The Valuable Role of the Community Health Worker in South Africa

Housing in Jackson

Yesterday, I visited two communities in the Eikenhof suburb, around 20km outside of Johannesburg. First stop was Jackson, an ‘informal’ settlement made up of mass of small, self-built, single story dwellings made of corrugated iron, wood, plastic and any other materials people can lay their hands on. The only Government provision is a few porta-loos and a handful of water tanks placed every few hundred meters. There is also a school, housed in a number of portacabins, funded by the local NGO and the ‘Hope Centre’ which is run by a local catholic nun and provides soup once a day to people in the community. Our second stop was to Lehaye, a community of public housing not far from Jackson. Here the housing is single story, built from breeze blocks, and has more amenities in terms of water, sanitation and electricity. This housing is for those people earning less than R1000 (around £78)per month.

Housing in Lehaye

Access to health care services is problematic for the people of Jackson and Lehaye due to the location and the lack of public transport. However, a small, basic, health clinic serves both communities. 

The Health Clinic that serves Jackson and Lehaye

The clinic is staffed by 9 nurses and has a TB ‘centre’ (housed in a shipping container), where people can be tested for TB and receive treatment and a new HIV ‘centre’ (another portacabin) where people can be tested for HIV, receive counselling and pick up their treatment.

Eleven Community Health Workers (CHWs) also use the clinic as a base. As well as undertaking basic health promotion activities, the Community Health Workers fulfil a number of important roles for the community including delivering medicines to people too ill to get to the clinic, identifying possible symptoms of disease and alerting clinic staff, identifying any social needs beyond health care and signposting people to other services and sources of help.   

Housing in Jackson

We spent the morning with one of the CHWs, Glenys, and visited some of the people she supports. Glenys lives in Lehaye and has been working as a CHW since 2004. Glenys main task of the day was delivering food (in the form of porridge mix) to some members of the community who are HIV positive. Anti-viral medication for HIV needs to be taken with food, otherwise it causes the person to feel very nauseous and many people avoid taking the medication when they have not eaten for this reason. Food poverty (or a lack of food) can therefore mean that the symptoms of AIDs progress much faster as medication is not taken as and when it should be.

One man, who had recently been diagnosed with HIV, had travelled by taxi (which he could ill afford) to a clinic some distance away to collect his medication. He was worried he would have to find money to pay for a taxi each time he needed more medication. Glenys was able to advise him that he could collect his medication from the local clinic instead.

Glenys delivers porridge mix to a HIV patient in Jackson

Another man, who lived alone, had suffered serious burns to his upper body in an accident 12 months ago and has not been able to work since. He has been unable to claim any disability grant to which he may be entitled, and so needed help to get this.

There are around 40,000 CHWs in South Africa. They are recruited from the communities in which they work so they have an understanding of the communities needs.  They receive 69 days of training after which time they are (in theory at least) employed by a local NGO and  paid a stipend for the work they do. However, many CHWs still work as volunteers as arranging payment can be problematic. Also, as this is low paid work, there tends to be a high staff turnover.

Whilst the context, health issues and the inequalities here in South Africa are very different to the UK - CHWs, not unlike Community Health Champions, have a vital role in helping address the barriers to accessing services for many people. Nonhlanhla Nxumalo, a researcher from the Centre for Health Policy at the University of Witswatersrand, told me how CHWs can also be a crucial link and an enabler in communities and a facilitator for the identification of community resources and assets. They can also be a conduit for the development of social capital through identifying and enabling connections and building networks which help people get what they need. In South Africa, even more so than in the UK, there is a clear need for adequate resources, training and support to enable CHWs to continue the valuable role they have in helping those in most need. Nonhlanhla explained how, "a lack of support and resources can undermine the CHWs standing in a community - as well as their ability to make a difference." There is also ongoing debate about the role of the CHW within the wider primary health care system meaning that CHWs often go unrecognised and are under-utilised by health professionals.

Children as 'Agents of Change' in South Africa

We know it can be difficult to shift the behaviour patterns of adults. In view of this, Soul City, a non profit health and development communication organisation based in Johannesburg, has been working with children aged 8 - 14 to raise awareness of issues affecting their health and development.

 

Through the Soul Buddyz programme , children are encouraged children to be ‘agents of change’ in their own environment and in all settings, including school and home. It has four interlinked elements:

•  A TV show shown on National TV which addresses Soul City campaign issues (e.g. HIV/Aids, alcohol, violence, sexual health). [This is ‘Edutainment’ – entertainment with an educational message].
• Printed Materials (e.g. magazines, educational resources)
• Radio shows
• Soul Buddyz Clubs
I was keen to learn more about the Soul Buddyz clubs as it sounded like Soul Buddyz could be Community Health Champions in the making! 



Mural on the school wall painted by the school children.



There are over 8000 Soul Buddyz clubs in primary schools across South Africa with a total of 178,422 members. Around 50% of the clubs are in rural areas, 20% are in townships and a further 20% are in urban areas. Each individual club has up to 25 members and so some schools have more than one club (one school has 8!!). Clubs meet once a week after school and are facilitated by a teacher, who Soul City provide with relevant training. Soul City also provides the materials (magazines, DVDs, education unit guides) for the clubs to use and keeps a database of all members so they can keep in touch.

I heard about some great examples of projects the clubs are undertaking to influence change in their communities by helping both individuals and the community as a whole. Here are just a few:

1)       In one area, a busy road next to the school was resulting in many children being injured or killed. The Soul Buddyz met with local councillors to explain the problem and discuss what could be done. As a result of this action, there are now speed bumps along the road and the number of injuries has reduced.

2)       In one school, a boy was missing school as he was caring for his ill mother. The club members got together to provide food parcels for the home, found a grant they could access to help with support needs, arranged for the health clinic to provide input to help with the care of the mother – all of which meant the child could come back to school, knowing that his mother’s needs were being attended to.

3)       In another school, the Soul Buddyz got together to provide clothing, bedding and other house hold items to help the family re-build what they had lost after a fire at the family home.

4)       At the Sesethu Primary School in King Williams Town, club members noticed that many of the younger children were arriving at school upset due to conditions at home. The Soul Buddyz decided to help by greeting the children at the gates at the start of the day and have “put the smiles back on their faces”.

Soweto View

I was lucky enough to visit one club at the Winnie Ngwekazi Primary School in Soweto. The school is based in a township and surrounded by low level, very basic housing. We were welcomed on arrival at the School by the Club Facilitator, Lindi, and the Club’s secretary who took us to meet the club members. A rousing Soul Buddyz chant greeted us from a group of around 20 children who sang so loudly I thought the roof would be raised off the classroom! Following a PT demonstration and a couple more  songs, we sat down to chat. I asked what the Soul Buddyz liked about the club – a sea of hands shot up as children were desperate to share their views. Some responses were, “I like doing PT”, “I like learning new things”, “I like the respect we have for one another”,  “I enjoy doing the projects”, and all the members were clear that the club gave them lots of activities to do and had allowed them to make new friends.

I asked them what they liked about their community – a resounding reply was. “the Soul Buddyz club”! It clearly is a great resource and asset which they value and cherish. They then went on to tell me about the things they didn’t like so much about their community – the problems associated with alcohol and drugs, the violence, the fact that people don’t help each other or talk nicely to each other, the rubbish, the thieving that goes on – even at school.

But they have also been working had to try and address some of theses issues through thier Special Projects....

They told me about their work on the alcohol campaign where they had wanted to do something to influence levels of drinking in the area as this was leading to a lot of problems. The ‘Shabeens’ in township areas are the main suppliers of alcohol, often staying open late at night  resulting in heavy drinking and associated violence. The members worked with the group facilitator to raise their concerns about the issue and did a campaign across the school to highlight the dangers of drinking and the link to teenage pregnancy and violence. They also asked the facilitator to take their concerns to the Shabeen owners. Whilst these are all issues the club members have tried to address in some way – they are significant problems and clearly still remain a concern.

The club is also preparing for an intergenerational project  to celebrate and thank the grandmothers of the community. Much of the caring of the children is done by Grandmothers as many mothers are either out working or have problems of their own (e.g. drink / drug problems). Later this week, they are holding an event where the Grandmother’s will come into the school so the children can say thank you for all the work they do.

They showed me the ‘Healing Centre’ in the grounds of the school, a place where children and parents can come for help, support and counselling. They showed me the soft toys that were available to greet children using the service, telling me how, "just a cuddle from one of these can make you feel so much better."





With members of the Soul Buddyz Club, Winnie Ngwekazi Primary School, Soweto

By building awareness of common issues and problems in communities and encouraging a positive response – and by planting the seeds of cooperative working– the Soul Buddyz clubs are building adults of the future who will contribute to society and who are a real asset to current and future generations. They have an understanding of what matters – and that they can have a role on helping to address many issues. Soul Buddyz are true agents of change and Community Champions!

Bound for South Africa!

In just under a weeks time I will be flying to Johannesburg to begin Part 2 of my fellowship. I will spend 3 weeks in the country and visit a number of organisations to learn more about community engagement and development, well-being and asset based approaches in a very different context. 

I will be visiting the following organisations during my 3 week trip:

1) The Soul City Institute for Health & Development Communication, Johannesburg

 “The Soul City Institute is about improving lives; about changing situations for the better. It is about health communication; about individuals and communities focusing on human development. Soul City South Africa is about you – about showing you what is possible, what you can do, what social change means and how to achieve great things for your own health, your own quality of life and for those around you.”

 http://www.soulcity.org.za/

2) Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg
To learn about their work on 'Community Health Workers' as part of comprehensive primary health care in South African communities.

http://www.wits.ac.za/chp/

3) Ikhala Trust, Port Elizabeth

 Vision: Self reliant, secure and vibrant communities are built through a holistic, sustainable and positive intervention.

 www.ikhala.org.za

4) Angus Gilles Foundation, Grahamstown

Positive Health Champions and Positive Health Programme.

"This programme provides communities with as much information as possible, to enable them to achieve optimal physical, mental and spiritual well-being. The ‘Positive Health’ programme focus is more about presenting methods of preventing illness and staying healthy."

 http://www.angusgillisfoundation.co.za/index.php?p=127

 www.angusgillisfoundation.co.za

5) Community Development Resource Association, Cape Town

"Our purpose lies in contributing to the effectiveness and long term efficiency of organisations that do not marginalise but include, that maximise the value of diversity and that counter the tendency to use power to undermine and exploit in ways that diminish creative potential organisations that are empowering in their impact on society and in themselves. Our ultimate purpose is to contribute to building a society that is sustainable and civil. We promote organising principles, processes and practices that promote inclusion, dignity and development."

 http://www.cdra.org.za/

6) Reciprocity, Cape Town

Enterprise development work , inclusive business models and economic activity which increase social capital. http://www.reciprocity.co.za/micro-energy-aliance-mea.html

Reciprocity “the practice of exchanging  ideas, goods or services between two entities for their mutual benefit”

7) ABALIMI

An urban agriculture and environmental action association operating in the socio-economically neglected townships. Abalimi means: "the Planters" in Xhosa, the predominant language among our target community. We assist individuals, groups and community based organisations to initiate and maintain permanent organic food growing and nature conservation projects as the basis for sustainable lifestyles, self-help job creation, poverty alleviation.

www.abalimi.org.za

www.harvestofhope.co.za
www.farmgardentrust.org

8) GOLD Peer Education Development Agency

"A non-profit organisation playing a key role in the transformation of under-served communities through the roll out of a long term youth peer education model in collaboration with community based organisations." "It's about young people realising their value and being empowered to make informed decisions about the challenges they face. It's about equipping influential young people to impact their peers through positive peer pressure."

http://www.goldpe.org.za/

9) Dockda Rural Development Agency

Makes grants available to community projects and initiatives and strengthens community organisations and civil society through a dedicated Wellness Programme. We seek to promote links so that we can share mutual concerns and experience to enhance community's solution-finding capacity.

 http://www.dockda.org.za/about.htm

10) University of Cambridge Programme for Sustainability Leadership  (South African Office)

www.cpsl.cam.ac.uk / www.cpsl.co.za

The 'P' word: Poverty (and other determinants of health)

I noticed a much more explicit focus on poverty in my discussions about health and well-being  in North America. Perhaps it’s just the circles I’m moving in but it feels there’s much more  reference to the links between ‘health equity’ and the wider social determinants of health.

Liz Weaver (from the Tamarack Institute) uses this powerful quote from David Shipler to highlight the case in point:

“Every problem magnifies the impact of the others, and all are so tightly interlocked that one reversal can produce a chain reaction with results far distant from the original causes. A rundown apartment can exacerbate a child’s asthma, which leads to a call for an ambulance, which generates a medical bill that cannot be paid, which ruins a credit record, which hikes the interest rate on an auto loan, which forces the purchase of an unreliable used car, which jeopardizes a mother’s punctuality at work, which limits her promotions and earning capacity, which confines her to poor housing.”

David Shipler, The Working Poor:  Invisible In America (2004)

I also found this simple yet illuminating story on the Canadian Public Health Agency website which highlights the complex set of factors or conditions that determine the level of health we have;

"Why is Jason in the hospital?
Because he has a bad infection in his leg.
But why does he have an infection?
Because he has a cut on his leg and it got infected.
But why does he have a cut on his leg?
Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on.
But why was he playing in a junk yard?
Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them.
But why does he live in that neighbourhood?
Because his parents can't afford a nicer place to live.
But why can't his parents afford a nicer place to live?
Because his Dad is unemployed and his Mom is sick.
But why is his Dad unemployed?
Because he doesn't have much education and he can't find a job.
But why ...?"

This story highlights some of the key determinants of health which are:

·         Income and Social Status

·         Social Support Networks

·         Education and Literacy

·         Employment/Working Conditions

·         Social Environments

·         Physical Environments

·         Personal Health Practices and Coping Skills

·         Healthy Child Development

·         Biology and Genetic Endowment

·         Health Services

·         Gender

·         Culture

Community Health Champions (CHCs), and those in similar roles, can help address some of these determinants. Whilst the Altogether Better programme was funded to deliver health outcomes around healthy eating, physical activity and mental health, we have an increasing amount of evidence that CHCs can help to improve social networks and  provide social support creating better social environments. They can help with health practices, self management and coping skills and help improve health literacy by improving knowledge and understanding of issues affecting health in its broadest sense. Some CHCs report feeling having a renewed sense of purpose and increased self esteem  and confidence since becoming involved in our projects. Many have developed new knowledge and skills and an increasing number have gone on to complete further training, education and even obtain paid jobs. All factors which contribute to (and I would argue are essential to) improved well-being

There was also much talk in my discussions  with people about the need for health improvement initiatives to be as much about addressing the material circumstances in which people live – as about addressing community health needs. Where we live and work and raise our children has a huge impact on health. If people are living in circumstances where they are worried about paying the bills, being able to feed their children, having a roof over their head - then any talk of behaviour change related to eating more fruit and taking a little more exercise - are likely to have little impact until these broader, more basic, needs are addressed.

 Increased empowerment and giving people a 'voice' and a say in their communities and neighbourhoods can  be mechanisms for addressing the material and environmental circustances in which people live. The Be Active Together Project, Seattle's Neighborhood Matching Fund and Vibrant Communities in Canada are partly about trying to address these needs - based on the notion that improved environments / communities = improved well-being. They are also about identifying and mobilising community assets (e.g. people, skills, organisations)  to improve communties and the places people call home.

This short film from Sudbury & District Health Unit makes valuable viewing for anyone interested in learning more...

 Let's start a conversation about health...and not mention health care at all.

 The Unnatural Causes series is also essential viewing for anyone interested in the social determinants of health and the impact of place and where we live on health and well-being.

A bumper crop: Seattle's P-Patch Gardens

Gardening has the potential to hit on a range of health and well-being outcomes including:

• Healthy eating – through growing and eating fresh fruit and veg.
• Physical Activity – gardening can be hard work and requires physical exertion!
• Mental Health – gardening can bring people together to work together and share skills and knowledge - increasing confidence, skills and self esteem and reducing social isolation.
• Improved social networks - Gardens can be a social space for people to meet up and connect with new people through a shared interest.

In order to increase gardening opportunities and encourage the development of these related outcomes - Seattle has over 75 ‘P-Patch’ gardens across the city, serving around 4,500 gardeners. Overseen by the the P-Patch community garden team at the Dept of Neighborhoods and the P-Patch Trust, the gardens are managed by the communities they serve. The P-Patch scheme is similar to the allotment system in the UK -  although people usually rent out  a smaller ‘patch'.

I visited quite a few P-Patches during my time in Seattle – all slightly different both in terms of size, locations, who uses them and what is grown there – but all had a burgeoning array of fruit, vegetables and flowers blooming. I was mightily impressed (and made hungry!) by what I saw.

I visited the Interbay P-Patch which is on the site of an old dump. It sits by the side of a highway but provides an oasis of calm with its glorious colourful flowers and abundant vegetable crop. 

Some of the gardens have kitchens so people can cook together, others have playgrounds so that kids can play while parents garden. The Coleman garden also has a children section to the garden so that children can learn about plants and growing stuff from an early age.

Gardeners at High Point preparing produce for the Market Garden

The people who use the gardens tend to reflect the community where the garden in based and this in turn influences what is grown there. In one area in South Seattle, there is a large Somali population and they grow the kinds of things they might grow at home - so – it’s not always the more traditional veggies you might expect to see…
Julie Bryan of the P-Patch Community Gardening Programme told me how she has had tried to learn the names of plants in a multitude of languages so she can help the gardeners in different communities. Julie has a role in supporting people to make best use of the gardens – providing advice where needed on growing and harvesting but also dealing with the management of the gardens when needed.

Many of the PPatches have an area that is dedicated to providing produce to local Food Banks. So, the gardeners are helping out their neighbours who may not have access to fresh produce easily.

Some of the gardens also have ‘bumping spaces’ (in the form of a shared seating area, a meeting room, a gazebo) - areas where the gardeners can get together maybe over lunch or for a meeting about garden planning or just for a chat. So they are also a potential breeding ground for  improved social capital!

It's easy to see how the P-Patch scheme is helping communities to help themselves in a whole range of ways.

For the past 37 years, P-Patch community gardeners have been:

• Growing community
• Nurturing civic engagement
• Practicing organic gardening techniques
• Fostering an environmental ethic and connecting nature to peoples’ lives
• Improving access to local, organic, and culturally appropriate food
• Transforming the appearance and revitalizing the spirit of their neighborhoods
• Developing self-reliance and improving nutrition through education and hands-on experience
• Feeding the hungry
• Preserving heirloom flowers, herbs, and vegetables
• Budding understanding between generations and cultures through gardening and cooking

Children's Play Park at Coleman P-Patch

You can read more about P-Patch Gardens here.

Community gardeners preparing vegetables for sale at the Farm Stand.