Measuring what matters: Empowering Local Communities with Timely Information

We know that health is not just about health care and that a range of factors (wider social determinants) affect our health and well-being. This great short film produced by Sudbury Community Health Centre in Ontario highlights the case in point: 'Let's start a conversation about health... and not mention health care at all'

 A number of the  social determinants affecting health are linked to social capital, such as the social networks and support we have access to, the extent to which we get along with our neighbours, whether we engage in community activities, the extent to which we feel safe in our community, how much we trust the people around us….you get the idea. 

 So whilst we can seek to measure some of the more tangible health outcomes such as GP and hospitals consultations, rates of disease, levels of physical activity, etc. - simply measuring these things doesn’t tell us much about the wider factors that influence health and well-being in communities.

I met with Sandy Ciske and Louise Carter from the Seattle and King County Public Health Department who are both involved in the Communities Count Project

Every three years, Communities Count reports on 38 social, economic, health, environmental and cultural indicators across King County in Washington State. Sandy explained that main audience for the data was policy makers, but that the reports are also aimed at public agencies, foundations, human service funders, non-profit agencies, community-based organizations, and residents.  

King County has a population of 1.9 million and Sandy explained that there are, “huge disparities in health across the county”. Whilst the County has one of the highest life expectancy rates across the US, there is an 8 year gap between the highest and lowest life expectancy across the county. Other examples of health inequalities can be seen in the smoking rates,  which is 12% across the county but as high as 30% in some areas within the county.

In order to agree what and how should be measured, the Communities Count project held community forums to enable residents to identify what matters and what should be measured. They also had an advisory group that provided guidance on how best to measure the selected indicators. Sandy explained that the indicators were, “focused around prevention and changing community conditions and the wider determinants of health – looking at root cause issues”.

The indicators are organized into the following six categories:

• Basic Needs & Social Well-Being
• Positive Development Through Life Stages
• Safety and Health
• Community Strength
• Natural and Built Environment
• Arts and Culture

Within this, I was able to spot a number of social capital indicators being measured e.g.

• Participation in life enhancing activities.
• Social support
• Neighborhood cohesion.
• Involvement in community organizations
• Community service (volunteering)

The intention is that the reports are a resource for informed decision-making and action. They have helped local areas identify where the problems are and Sandy told me about some of the ways the data had been used. 

"The data highlighted issues in communities that people didn’t realise were there and prompted them to do something about it. In one area, the data allowed the council to see what they should be investing in…they realised that rather than putting  money into more flowerpots to make downtown look pretty, they should be investing in youth programmes”. 

In another area where low rates of reading to young children were identified, they invested in more library resources and set up schemes to encourage parents to read with their children. In another area where low rates of school readiness among Latino children were identified, the council put resources into building capacity via a community based organisation so the Latino children were better prepared for school. Other communities have (as you might expect) used the data in  grant applications to gain funding for initiatives to address some of the issues highlighted.

In terms of implementing the changes and addressing some of the issues highlighted in the data, we agreed on the need to 'break down silos' and the need for integrated working across sectors. Sandy said, "when it comes to talking about disparities, language and the way concepts are framed is really important in terms of getting people [policy makers, funders] to listen. Talking about ‘fairness’ and ‘opportunity’ tends to get their attention more that just talking about ‘problems’ or ‘needs". 
 I also noticed the sub-title of the 2008 Communities Count report is "A Report on the Strengths of King County Communities" -  clearly displaying an asset and strength based approach to the work.  
On the issue of language, Sandy pointed me to the work of FrameWorks Institute whose mission is "to advance the nonprofit sector's communications capacity by identifying, translating and modeling relevant scholarly research for framing the public discourse about social problems."

Plenty of food for thought for those of us seeking to influence or seek support (financial or otherwise).

Small World...

So...I'm back in Blighty and am delighted to see there's been some discussion around Asset Based Community Development (ABCD) here in the UK whilst I've been away.

The Big Lottery Fund (who also fund the Altogether Better programme in Yorkshire and Humber) brought together ABCD practitioners for a half-day seminar in London on 20th June as part of their 'People Powered Change' work. Over 80 community activists and other professionals gathered to hear the speakers and to discuss the issues which ABCD  raises.

 

So, whilst I was away learning about ABCD in Canada - Jim Diers (who I had the pleasure of meeting in Seattle) was in the UK talking about ABCD. It does feel like a small world sometimes...!

You can see an interview with Jim where he says:

"there is a lot of great work happening [in the UK] in the public health arena around building on community strengths"

I think Altogether Better is a great example of this kind of work! Our work on identifying social capital indicators has also been about identifying assets in communities (e.g. social networks, friendships, skills and knowledge, participation in volunteering, social support....I could go on!).

You can view Jim's inspiring and engaging presentations from the event (and those from other speakers) on the Guardian website.  

Being Active Together

Be Active Together (not to be confused with Altogether Better!) is a 5 year community based participatory research project (CBPR) in the High Point neighbourhood of West Seattle. The project is funded by the National Institute of Health and runs until 2013. The strapline for the project gives a clear clue as to what it’s about (see photo below):

I was keen to learn more so met with the Programme Director, Denise Sharify, who is based at Neighborhood House in High Point.

"Neighborhood house helps low income people become more self-sufficient. It seeks to build strong and vibrant communities where everyone feels attached. High point center is the home of anti-poverty services that strengthen families and support the development of a healthy, vibrant and green community." (taken from the Neighborhood House website)

Denise explained, that by taking a participatory research approach,  the 'Be Active Together' project was a means of, “bringing together community and research worlds and involving communities as partners – so they have more ownership over the results.”

With Denise Sharify at Neighborhood House,
High Point, Seattle

Denise explained how the ‘Be Active Together” project is based on the basic  notion that more  activity equals better health.

Being ‘active’ in the terms of this project has two elements. It refers to being both  physically active and also more politically active. So it’s not just about getting fitter, it’s about empowerment too.

The project began with a community impact survey which sought to help identify the barriers to being active (in both senses of the word), such as lack of access to physical activity opportunities, cultural and social barriers, financial barriers.

 The project has since come up with a range of initiatives to help overcome these barriers. All activities are aimed at promoting better social networking as well as physical activity. Some of these things that have been offered are:

• Free exercise classes
• Social events
• Field and hiking trips
• Scholarships for youth sports programmes
• Gardening opportunities with the Market Garden
• Connections with other free or low cost physical activity sessions

Denise gave an example of how the project had helped to address some of the cultural barriers faced by some community members by arranging women only swim sessions for  the Somali community.  Denise told me how initially, the women would come and just stand in the water and chat (!) which may have helped meet their social needs but was not necessarily increasing physical activity levels! The women then identified the need for swimming lessons – so they could gain confidence and skills in the water. The women now contribute to the cost of the lessions which are subsidized by the project and Denise has a waiting list of people wanting to take part.

Young residents of High Point being active through
dance at the Health Fair

Other barriers to being active are being addressed through physical  environmental changes. At a Community consultation event last year (led by Jim Diers), people were given 20 minutes to come up with a vision of , “what would an awesome High Point community look like?”. They were then invited to share their vision with others in the room. Denise told me, “people came up with all sorts of ideas for projects to make the community a  better place.” One 6 year old boy (who Denise  says she had never heard speak out before) stood up and said, very loudly; “I want swings. We need a swing set here.” Since that time, Denise has been able to secure funding for a new play park in the community – and so that little boy – and all his friends – will have their swings – another place they can ‘be active together’.

Be Active Together is also clearly about the promotion of community building and asset mobilisation by bringing neighbours together, connecting them to resources (assets)  and building community leadership through Community Action Teams . These teams, made up of 6-8 volunteers, work with project staff to:

·         Promote community activities and help provide the interventions

·         Help connect neighbours with each other

·         Advocate for healthy community

·         Address health disparities

To help them in their role, the Action Team  members are given some political advocacy training as well as support and mentoring to encourage empowerment.  Denise told me how, “Members are stepping up and having a voice in the sort of system and  environment change needed to sustain some the work”, e.g. lobbying for changes in pricing structures of parks and recreation dept facilities so that more people can access their services.

So people are becoming more physically active and more politically active. The evaluation of the process will seek to measure the impact on empowerment so will be sure to keep an eye out for the resullts.

Homeward bound....

Well - I can't quite believe it but today is last day of my trip and I fly back to the sunny Manchester early tomorrow morning.

I've been away for almost 8 weeks and travelled over 5000 miles within North America. I've travelled by plane, train, bus, bike, boat and pounded the pavements (sorry...sidewalks) in  8 different cities and towns. I have visited 17 organisations, attended 3 conferences and met countless people (I have over 50 business cards of people I have met but there have been many more including numerous random encounters on buses, at train stations, in cafes, by the bike hire stand in Montreal...I could go on! ).

I have talked to so many people about Altogether Better, Community Health Champions and social capital I really wish I'd had a t-shirt with a brief summary printed on it (save me repeating myself so many times over...!).

Whilst I've done a lot of talking about our work in the UK, I have also listened and learned a huge amount from the people I have met who so generously gave time to share their expertise, knowledge, enthusiasm, ideas (and in some cases – their homes!) to help me on my journey. My heartfelt grateful thanks goes out to you all...I couldn't have done this without you!  (I do have several more blog postings waiting in the wings so will continue to post these on my return to the UK - there just hasn't been the time or energy to report everything as I've gone along).

I also want to take this opportunity to mention and thank my funder, The Winston Churchill Memorial Trust, without whose generous financial support this trip would not have been possible. Any UK citizens who have been inspired to apply for a Fellowship should check out their website - applications for 2012 are now open!

So, yesterday was my last day of meetings and I was delighted to get to end my trip by meeting John McKnight of the ABCD Institute in Chicago (who just happened to be in Seattle) and to see Jim Diers again. Jim is a community organiser from here in Seattle (I highly recommend his fabulous book ‘Neighbor Power’) and was instrumental in helping me set up my visit to Seattle as well as connecting me with other people in other places. John is a leading light in the ABCD world and continues to travel the globe to speak about his passion and learn from others. Both John and Jim's work has been a great source of inspiration for my trip and so it seemed very fitting to end my time here in their company.



Me with Jim Diers and John McKnight of the ABCD Institute, Chicago

So it’s goodbye North America…and hello England (and jetlag)! But.... the journey doesn't quite end here....the second phase of my fellowship will take me to South Africa in October this year to learn about community engagement and health in a very different context. Watch this space for updates!

Coady and Celebrating Community

Whilst in Nova Scotia, I spent a useful few days at the Coady International Institute, at St. Francis Xavier University in Antigonish.

The Coady Institute is committed to, “advancing community self-reliance, global security, social justice and democratic participation and has been providing educational opportunities for community development workers from over 130 countries for over half a century”.

Citizen driven and asset based approaches are at the heart of what Coady does and their training on Asset Based Community Development attracts students from all over the world with many of the students coming from developing countries.



I made it! Outside the Coady Institute.



The Institute is named after Rev Moses Coady, who, back in 1939 described how the rural people of northeast Nova Scotia were "using what they have to create what they have not". Coady didn't call what he was doing back then ABCD, but his description was the same:

“promoting citizen-led development that combined people's skills, capacities, savings and social capital with physical and natural resources to build local economies.”

Today the Coady Institute continues to promote approaches to community development that place citizens at the centre of the development process and which draw on the assets communities already have to help create what they have not.

The very excellent library at the Coady Institute.

I spent a day in the Coady's excellent and well stocked library where I was able to watch the 'Unnatural Causes" series - which I highly recommend as essential viewing to anyone  interested in health inequalities and the social determinants of health.

I also had useful discussions about the Coady’s work on asset based approaches to community development with a number of people at the Institute including Gord Cunningham, Brianne Peters and Alison Mathie.

I was keen to get a better understanding of how we could build on the work we have done on identifying assets and the development of social capital in the Altogether Better Programme, and how we could encourage greater use of asset based approaches to help sustain some of the work of our 16 projects.

Gord reflected that, ABCD is about a set of principles more than anything else and that these principles can be built into organisations and how they operate. He explained; “people are trying ABCD in their own ways…” and that a, “generic ‘strength’ based approach rather than pure ABCD is being used in many places”. Perhaps we need to think about how a similar set of ABCD principles could be incorporated into our work in the UK…

Gord described ABCD as, “a conversation about the rights and responsibilities of citizenship more than anything else”. Much of their thinking on ABCD approaches is encompassed in a recent publication, “From Clients to Citizens”. Gord explained how the process of simply identifying assets in communities can create positive momentum, “people are amazed at what [assets] they have”. Alison added to this by saying that, “ABCD is as much about asset building as it is about asset mobilising”.

Much of Brianne's work is with communities and organisations in Africa and she was able to give me some useful introductions to people in South Africa for the 2nd stage of my fellowship in October.

Whilst much of the Coady’s work is internationally focused –they also realised there was an example of ABCD in action happening closer to home - in the community of St Andrews – just 10 miles down the road.

I spent some time with Mary van den Heuvel from St Andrews, who completed the ABCD course at Coady in 2008 and now works at the Institute. St Andrew’s has a population of 1,100 and around 14 community organisations representing a range of interests.

Mary told me how the interest from the Coady Institute had ‘shone a light’ on St Andrews and highlighted what they were doing and achieving as a community. “This helped people to see the vast range of assets they had and encouraged people to mobilise these assets for better outcomes for the community.”

The St Andrew’s community has its own website which sums up their progress:

“The people of St. Andrews have built this community with a solid base of cooperation and volunteerism. During the last 30 years softball fields were built on land donated by a community member, the church and six cemeteries were upgraded, and a fire hall was established. In the last decade and a half, a curling rink and a community centre were built and money was raised to dig nine wells for villages in India and Haiti. In 2006, St. Andrews opened the first phase of a community-owned and community-managed housing project for seniors and the second phase opened in 2008. Community spirit continues in fourteen strong community organizations. “ (from www.standrewscommunity.ca)

The St Andrew’s Community Partnership is made up of representative from the 14 organisations in the community and they have even developed a strategic plan for the community. In 2009, St Andrews Community was awarded the ‘Community Spirit Award’ from the Lieutenant Governor for Nova Scotia and has also won the “Excellence in Collaboration Award” from the Provincial Government of Nova Scotia in recognition of its achievements in Community Development activities.

They continue to build on and mobilise community assets by asking three simple questions:

1.       What action is needed?

2.      What do we have inside? (what assets and resources)

3.      What do we need from outside?

Read more about St Andrews on their website here and in this summary produced by the Coady. 

My knowledge and learning around ABCD is growing thanks to my time at the Coady and has been enhanced further by meeting with Jim Diers in Seattle last week. Today I am getting the great opportunity to attend a session facilitated by Jim and John McKnight of the ABCD Institute in Chicago. Both Jim and John's work has been a great source of inspiration for my fellowship so feels a very fitting end to my journey (yes folks - this is my last week and I fly home on Wednesday 27th).

Use it or Lose it!

High Point Residents watch the actions from the 'bumping space'

I attended the High Point Community Health Fair in West Seattle on Friday. Much to the relief of the organisers (and to me...we have had a lot of rain of late...) - it was a gloriously sunny day which resulted in a great turn out from the community. High Point is a very diverse community and it was great to see so many people from different backgrounds working and mingling together.

The Health Fair was held at the High Point Centre where I'd visited earlier in the week to learn about the 'Be Active Together Project' (not to be confused with 'Altogether Better'...but has some things in common...which I'll come back to in a later blog).  The High Point Centre is, "a home for anti-poverty services that strengthen local families and support the development of a healthy, vibrant and green community” (see their website for more) and the health fair was a real hive of activity!

There was a ‘Healthy Food Walks’ encouraging people to explore the neighbourhood to find places they could access healthy foods including impressive looking produce from local market garden, a range of stalls and information from community groups and service providers, acupuncture sessions and physical activity sessions of all kinds.

There were also demonstrations from local community groups, including a line dancing session from the Providence Elizabeth House (PEH) Line Dancing Group. PEH is an independent residential facility for seniors and I got chatting to Charlotte and Kay who live at PEH and are committed members of the Line Dancing Group. Charlotte and Kay were proud of the Line Dancing Groups slogan,  “use in or lose it!”, emblazoned on their bright blue t-shirts. They dance once a week and visit other residential facilities for seniors, to demonstrate their dancing skills and encourage others to join in. Kay told me how much she valued the class, “I love it. I would do it every day if I could.”

Both Kay and Charlotte have lived in High Point for 5 years and seemingly love it - they told me a little more about why...

Charlotte and Kay from the PEH Line Dancing Group
and happy High Point residents.

Charlotte told me how residents of PEH came from all over the world, and whilst some of them did not have English as a first or second language, they all got along – as Charlotte said, “we have times when we sit and we share our stories and our histories...so we learn about where people have come from and how they live their lives…it’s really interesting and helps us understand one another.” She grinned as she added, “We are friends despite our differences.  We hug each other a lot…”…and I guess you can hug in any language.

Charlotte also pointed to the 'bumping space' and the small amphitheatre on the grass outside of the High Point Centre. She told me this was where people met to sit and chat or watch some local perfomance or activity. It's just across from PEH so is a great, yet very simple, facility for the residents and other community members.

Seems High Point is a community residents of PEH enjoy living in - and that the line dancing keeps them active, keeps them engaged, allows them to socialise and meet new people and seemingly helps keep them happy! Physical activity and social capital rolled into one….

A great day and some lovely, lovely people! :)

Food for thought…

Without wanting to state the obvious – access to food is an essential element of health and well-being. Lack of adequate food impacts on both our short and long-term health and also effects children’s psychosocial development and learning (Communities Count: Social and Community Indicators Across King County (2008).

In a 2007 survey, up to 8.2% of adults in one area of King County reported that they often or sometimes ran out of food and did not have money to purchase more. The same survey found that 8.4% of King County adults could not always afford to eat balanced meals (in Seattle the rate was 10.8%). (Figures from: Communities Count: Social and Community Indicators Across King County (2008), King County Public Health Department)

Seattle has a number of food banks which seek to address the issue of food insecurity. The number of King County residents who rely on food banks in order to have enough food for themselves and their families is not known but one programme, King County food banks, served 110,292 households and 215,941 people in 2007. These families used food bank services an average of 7.2 times during the year (Figures from: Communities Count: Social and Community Indicators Across King County (2008), King County Public Health Department).

I visited one Food Bank South of the city , in Auburn, to see what went on.



Debbie Christian, Director of Auburn Food Bank, WA.



Debbie Christian is the Director of the Auburn Food bank which serves around 2, 100 homes which equates to around 8,500 people each month. Auburn has a very diverse population of around 68,000 and also has the lowest income per capita in South King County. Auburn also has the highest teen pregnancy rate and the highest rate of single parents in the County.  As you might expect, there are also a large number of agencies serving the community but Debbie described the food bank as the “first line of defence for those in need”. They act as a hub for referrals from and to other agencies as many of the people accessing the food bank have multiple issues they may need support or assistance with.

Talking to Debbie about the Food Banks history – I realise Auburn Food Bank originated as a result of social capital in a community. It began as the Auburn Community Chest, an organisation set up after a family home was burned down in the 1930’s and local people got together to help rehouse the family and provide replacement furniture and furnishings. The Community Chest continued to provide furniture and resources to families in need until making a decision to focus solely on food provision.

I asked Debbie about how people accessed the Food Bank and she explained that the only criteria is that they must live in Auburn, “All that is required is proof of an Auburn address”, (an exception is made for homeless people who do not need to provide this). Access to the food bank provision is not means tested as, as Debbie said, “we work on the basis that if people turn up it’s because they need to and they’re hungry – I don’t believe people would choose to visit a food bank if they had a choice – it’s a matter of pride and dignity”.

People can access food packages twice a month. Packages are made up of tinned fruit and vegetables, rice or grain, bread products. 90% of the food is donated from a regional food bank supplier and the rest from local grocery stores and people in the community. Often times the food packages will include other personal care items such as soap and toilet paper – as Debbie said, “if you can’t afford food – you’re not going to be buying soap or personal hygiene products and we know it’s important for people’s self-respect and self-esteem that they can look after themselves and start the day ‘fresh’…especially if they might be looking for work or whatever.”

Food Bank Vounteer Sandy -
sorting food and making up packs.

The food bank has a large number of volunteers and relies on around 20 volunteers each day to function. On the day I visited, volunteers were hard at work on the front desk, bagging and packing food in the kitchen, unloading newly arrived produce off the van, and handing out the surplus food out front (food that needs to be taken and used that day) - it was a real hive of activity and energy! I asked about the food bank  volunteers and Debbie explained that, many had been with the organisation for a long time and gave a huge committment and that Auburn has, “a lot of loving caring people who say they’ll take care of their own.”

In addition to the direct food provision, the food bank also provides:

·         Two Community Dinners each week and a number of lunch programmes.

·         Two food delivery programmes, one delivers food packages to seniors who are house bound and another is for families with small children.

·         A financial aid programme where people can apply for up to $250 to cover ‘emergencies’ such as paying unpaid bills or emergency medicine needs.

·        Signposting and referrals to other services e.g. homeless shelter, pregnancy care programme.

They have also recently appointed a cook who runs a two hour session every Wednesday to help people learn what to do with some of the produce and items they may get in their packages. Debbie explained, “Often times there might items such as dried beans or other unfamiliar foods in the food packages, and many people don’t know how to use these. So, the cooking sessions were set up to help overcome this issue.”

The YMCA and the city of Auburn have also run a course on "eating healthy on a tight budget” to help people make better shopping choices. In addition to teaching people new skills, these sessions have proved a good meeting place for community members who have started to turn up early to sessions to chat and play cards together. The sessions have become a social occasion thereby increasing community engagement, reducing social exclusion and helping build social capital – as well as building capacity and teaching new skills.

The Auburn Food Bank really is a central hub for people - not only to access essential food - but to find out about other services, meet new people and learn new skills - and is clearly making an important contribution to building social capital in the community it serves. 

Advocating for Community Health and Well-being in Seattle

Today I visited my first American Community Health Centre. The International Community Health Services (ICHS) is a non-profit community health centre that offers affordable health care services to Seattle and King County's Asian, Native Hawaiian, and Pacific Islander communities, as well as other communities in need. ICHS delivers and advocates for health interventions that are comprehensive and culturally competent, empowering community members to improve their health and well-being.

Sounded the kind of place I needed to learn more about….

Over the past 35 years, ICHS has grown from a small storefront clinic in Seattle’s International District into the largest Asian, Native Hawaiian, and Pacific Islander community health centre in Washington State. It offers a full range of primary medical and dental care, preventive health education services, as well as Chinese Traditional Medicine.  ICHS charges patients a fee based on their family size and household income. Those without insurance are helped to identify if they qualify for any free or low-cost insurance programs.

ICHS has 7 Community Advocates who act as para-professional health educators, teaching ICHS patients and other community members about a variety of health issues, such as cancer screening and diabetes. They represent ICHS at community events, sharing their knowledge of ICHS services with prospective and current patients. They also provide interpretation and translation for ICHS. Community Advocates are paid staff members of the ICHS. Each community advocate works with a different community (Chinese, Filipino, Korean, Mien, Pacific Islander and Vietnamese).  

The role of Community Advocates is to:

·         Link patients and community members to appropriate resources

·         Advocate for patient / community needs

·         Provide basic health education and support

·         Identify patient needs

·         Provide follow up and guidance to patients

·         Empower patients to advocate for their own health

·         Know when to refer patients and where to

I met with one of the ICHS Community Advocates, Irene Chen, who works with the Chinese community. Irene (also known as 'the lady with purple hair' as some of her clients have trouble pronouncing her name!) came to Seattle in 1963 from Hong Kong and has worked as a community advocate for the past 16 years.



Community Advocate, Irene Chen (2nd from right)
and CISC Colleagues at the Advocacy Info Stand.



We met at the Chinese Information Service Center (CISC) in the International District of Seattle where Irene runs a drop in session every week to provide advocacy support to people new to the city from China or Vietnam.  Irene explained, “when people arrive in the city...they often have no health insurance, no job, no income”. Irene’s role is to help people identify what they need, provide support and refer them onto to relevant agencies.

Irene is employed for 30 hours a week – but in reality, she says she is on call 24/7, “people recognise me and approach me in restaurants and when I’m out and about…you can’t tell people to go away because you’re busy…my phone is always ringing”. Irene also does a lots of translation support work, as many of the people she works with do not have English as a first language. She provides an essential bridge between communities and services and enables people to make choices.

In addition to the drop in at the CISC, Irene also runs a diabetes training course– a 6 week programme based loosely on the Stanford model – and also has a role in encouraging the uptake of cancer screening (breast and cervical) by recruiting and enrolling people onto screening programmes.

Whilst at CISC (after being force fed home made green tea jelly by Irene!) I also met Andes Kong who co-ordinates the Sunshine Garden Seniors Day Care Center. The Sunshine Center opened in 1987 and runs a wide variety of activities for seniors living in the community. Their impressive calendar of events included Tai Chi, fall prevention exercises, a singing group, meditation, game playing…and of course – that old favourite - bingo! The Sunshine Centre also provide health checks and information – whilst I was there, a group of people were waiting to have their blood pressure checked, they also have health professionals come and do talks on different health topics on a regular basis.

But it’s not just about bringing in expertise from outside, the group members themselves also contribute to the activities. Andes told me how the seniors within the group share their skills with each other - so someone might do a cookery demonstration, or show people how to do a new craft or art technique. It’s a way of people sharing their skills and knowledge (their assets), encouraging participation and enabling others to learn something new.

Later in the day, I had a useful discussion with Abbie Zahler and Michael McKee at the ICHS who manage the Community Advocates scheme. They explained the origins of the Community Advocates and how they were initially the ‘visible presence’ of the ICHS in the community. The role has developed into more of a health education role over the years as the skills of the advocates developed and different funding streams became available (e.g. funding to increase cancer screening or hep B testing) and the ICHS saw a role for the Advocates in achieving these outcomes. The Community Advocate role also developed out of recognition of the numerous barriers to accessing the US health care system for new arrivals.
Community Advocates have received training on a range of different health issues to enable them to respond to the wide range of queries and requests they receive (e.g. diabetes, cancer screening, smoking, Hepatitis B).



Exchanging materials & ideas about
 Community Health Advocacy
 with Abbie and Michael at ICHS, Seattle.

I asked about the criteria for recruiting and selecting Community Advocates. Michael explained how they key qualities they needed were to be:

 i) bi-lingual

ii) bi—cultural

iii) a trusted leader in their communities.

Abbie explained how a ‘cookie cutter’ approach to selecting Community Advocates is not appropriate as the needs of different communities vary so much.



Other key skills Community Advocates have include:

·        Networking with patients and community members

·         Health disparities

·         Effective patient education

·        Motivational interviewing / self-management

·         Public speaking / group facilitation

·         Health education

·         Building community leadership

·         Multitasking

·         Computer skills

·         Immigrant laws and benefits

Some of which sounds familiar hey…?

Read more about ICHS Community Advocates and view a short film here.