Better late than never (!) - here are the conclusions and recommendations from my Fellowship report to WCMT. You can read the full report here:
a)
There is a need for a holistic
approach to improved well-being which takes into account the wider social
determinants of health. This requires partnership working across sectors
(health, social care, housing, education) to avoid ‘silo’ working which can be
issue specific. Community Health Centres
in North America are one mechanism for the potential delivery of this.
b)
There are weaknesses associated with vertical health improvement
activities focused on single lifestyle issues (e.g. smoking, obesity) in that
they ignore the wider social
determinants of health. To help reduce health inequalities, health
improvement activities need to be as much about addressing the social and
material circumstances in which people live as about addressing specific health
needs. There is a need for greater emphasis on the importance of ‘place’ as where people live and work has a huge
impact on health. A short film produced by Sudbury Community Health Unit in
Ontario highlights the case in point[1].
c)
Addressing
health and well-being needs requires an understanding of those factors which
have an impact on health from a community perspective. This recognises that concepts of health and well-being differ in different
communities. What communities need to stay healthy may be different and need to
be explored and understood for interventions to be effective. There is a
need to consider a process of identifying the indicators that impact on health
and well-being through consultation with community members. An example of this is People Assessing Their Health (PATH)
programme.
d)
There
is a need to recognise and capitalise on the role of community assets in promoting well-being, particularly amongst
those populations in most need. Many strengths and resources exist within all
communities and are often unrecognised and ‘untapped’. Often the process of
simply identifying assets in communities and individuals can lead to increased
empowerment and recognition of what people can do for themselves. Examples of
approaches which identify and mobilise assets include: Neighborhood Matching
Fund (Seattle), Community Planning Teams (Ontario).
e)
Effectively engage
with communities.
Bringing community members together in forums such as Community Planning Teams
(Ontario) and Community Action Teams (Seattle) are mechanisms for engaging with
communities and identifying and mobilising individual and community assets
which can serve to improve well-being and what communities can do for
themselves to meet their needs with existing assets and resources.
f)
There
is a strong rationale for involving people in health improvement activities and
a clear link to the reduction of health inequalities. There are many models for
involving communities in improving health and well-being via roles such as Community Health Champions, Peer Supporters Community Advocates (see
section 3.4 for examples). These roles also are a potential vehicle for the
building of social capital in communities.
g)
To
better understand and articulate, ‘what works’ in addressing health
inequalities, relevant evidence needs to
be interpreted and communicated in an accessible and timely way to the
right people. The National Collaborating Centre for Determinants of Health
(NCCDH)[2] in
Canada translates and shares information and evidence
about the social determinants of health with practitioners, policymakers and
researchers with a view to improving practice and outcomes.
h)
Gardening projects have the potential
to influence a range of health and well being outcomes;
·
Healthy eating – through growing and using
and eating fresh produce.
·
Help reduce food poverty issues (Food Banks)
and provide an income.
·
Physical Activity – Gardening can be hard
work and requires physical excretion.
·
Mental Health – brings people together to
work together and share skills and knowledge.
·
Gardens can be a social space for people to
meet, use the produce, cook meals and build social capital.
i)
Language matters! When it comes to
talking about health inequalities and disparities, the way concepts are framed
is important, especially when targeting policy makers and funders. Talking
about assets and ‘fairness’ and ‘opportunity’ can be more helpful than talking
about ‘problems’ or ‘needs. Similarly, using the language of an asset based approach which talks
of strengths instead of weaknesses, partners instead of consumers,
collaborations instead of silo provision, abilities and capacities instead of
disabilities, citizens instead of clients – can be empowering in itself.
j)
The recent focus on strong communities/networks and social capital
as a key determinant of health should not be ignored. An outcome of ‘improved social
capital’ could be a more explicit and central aim of funded projects and programmes
aimed at reducing health inequalities. It is recognised that measurement of
social capital indicators is not always straight forward but there are examples
and tools we can learn from, including the Communities Count
Partnership[3]
in King County, Washington which measures a number of social capital indicators e.g.
Participation in life enhancing activities, Social support, Neighborhood cohesion, Involvement in community
organizations and Community service (volunteering).
k)
Funders and commissioners of health improvement
activities should seek to:
·
encourage
the identification and mobilizing of community assets
·
embed and
promote the principles of community engagement in any new work
·
encourage
building social capital as an aspect of any proposal
As an example, the criteria
for funding applications to True Sport Foundation states that all
projects should; i) Enhance a sense of belonging to the community, ii) Allow neighborhood
residents to give back to the community (e.g. Volunteering); iii) Build skills,
knowledge and ability to continue to strengthen the community in the future
l) Good commissioning should engage with communities. Projects
funded by the Neighborhood Matching Fund[4]
(NMF) in Seattle are an example of good commissioning
practice which engages communities. As a core criterion, the NMF require that
all projects are: fun, engaging and empowering and reflect all sectors
in the community (e.g. different age groups, ethnic groups, gender, locations,
housing type). They must also encourage people to have access to the project
planning process – not just the finished work.
m)
In the UK, many opportunities exist for
advancing these ideas in the following areas:
- Area based working & multi agency service planning which could provide a structure for asset based approaches.
- More innovative commissioning & service delivery around the wellbeing agenda via Consortium of voluntary/community sector and Health and Well being Boards (HWBB).
- ‘Localism’ which encourages disaggregated services and delivery down to neighbourhood level wherever possible.
- Develop rich and vibrant JSNAs (Joint Strategic Needs Assessments) which offer a clear picture of the strengths and assets of communities rather than a description of the needs and problems. Consider the use of JSAAs - Joint Strategic Assets Assessments – instead.
