Who’s to say what makes us and our communities healthy? Concepts of what we need to make and keep us healthy may vary amongst individuals and from community to community. Having said that, we know there are some recognised determinants of health such as:
· where we live and our physical environment
· our income level and socio-economic status
· our education levels and whether we have a job (and what kind of job it is)
· the services we have access to
· our ability to cope and manage our lives
· our social networks and social support
· our gender and culture.
Colleen Cameron and Susan Eaton of the Coady International Institute have been heavily involved in development and implementation of the People Assessing Their Health (PATH) project in Canada and overseas. PATH is a community driven health impact assessment process, and both Susan and Colleen were keen to stress that, “Community engagement, empowerment and capacity building are central to the PATH approach.”
Sounded right up my street…. I was keen to learn more.
The PATH process provides a way for communities to identify what a healthy community means to them. The first stage of the PATH process involves the community identifying what impacts on their health – with a focus on the wider social determinants of health (those things listed above). They are tasked with answering the question: “What does it take to make and keep our community healthy?” and asked to devise a vision of a healthy community. Community members are invited to use the following prompts to help them come up with their responses:
“A healthy community is….” Or “In a healthy community…”
Some examples have been:
· A healthy community is a dynamic community.
· A healthy community is a changing community.
· In a healthy community, assets are valued.
· In a healthy community, diversity is valued.
· In a healthy community, people work together.
· In a healthy community, the goal is the overall health of the community.
[An example from the Antigonish Town & County Community Health Board is below to give an idea of what these might look like.]
Colleen explained that most groups identify the same kind of issues that affect health – with some cultural differences in terms of language and focus (e.g. for aboriginal peoples).
The next stage in the PATH process is for the community to design and test a Community Health Impact Assessment Tool (CHIAT) which can be used to assess the potential impact of any policy or intervention, actual or proposed. The CHIAT asks, “Will [name of intervention/policy] have an impact on…[dimension of a healthy community]” . The impact can be a positive or negative – and sometimes is both (some things can be both good and bad – depending on which way you look at it – right?).For example, a new factory may create more jobs and may also increase air pollution.
As Susan said, PATH isn’t about saying what is ‘right or wrong’ or ‘good or bad’ but that there was, ”great value in hearing different voices and viewpoints…it promotes dialogue.” Susan went on to explain that, “PATH is about a conversation, about social learning…it’s a way for communities to create new knowledge and that’s just so empowering”.
The final stage in the PATH process is for the group to make a plan to use the CHIAT to assess the impact of a proposed or actual policy or action. An example of a policy assessed using the CHIAT was that of proposed school closures. In one community the closure would have led to negative impacts and loss of services (as the building was used for many things) in another community, the process enabled the community to identify of how the school could be used for other community activity.
I asked about what changes had occurred as a result of the PATH process, but as Susan and Colleen explained – identifying what makes a healthy community is one thing – influencing policy change as a result is a different matter, “The central idea is that communities use the tool to assess the impact of policies or interventions on the health of the community…but the PATH process needs to be supported in some way. People need resources to keep going and to take actions.”
So - where does PATH fit into the ideas about asset based approaches and building social capital….?
Well, in identifying what makes the community healthy the PATH process helps people to identify the assets they have that make (or keep) them and their communities healthy. These might be individual assets such as having a job or having family nearby, or community assets such as a local market providing access to cheap fresh fruit & veg, a community garden or a good public transport so people can get around and are less isolated.
It also seems that PATH is an incredibly empowering process for community members. It helps participants develop analytical skills and articulate what makes and keeps them healthy. The PATH process facilitates the development of a unique health impact assessment tool that a community can use when considering the effect projects or policies will have on community well-being and is recognition that, when it comes to health, the community voice is a valuable voice.
The PATH process could also be a way of helping to develop health public policy in helping to identify that any impact on the wider social determinants of health are taken into account when implementing or considering changes in policy, practice or service provision.
The Antigonish Town & County Community Health Board (ATCCHB) is a community-based health planning board.
Mission:
To develop a community health plan through broad community participation and consultation that includes strategies that promote and improve the health of our community.
A healthy community is a dynamic community, which includes:
· Participation
· Community leadership (from women and men)
· People having control over decision-making that affects their lives
· Institutional support
A healthy community is a changing community, which means:
· It is evolving, not stagnant
· It is open to embracing new ideas, people and approaches
· It is prepared for change
· It encourages intergenerational activities
In a healthy community, assets are valued, which means:
· People’s various talents and skills are fully utilized
· People feel that they are listened to and that their opinions are respected
· Special attention is given to those not normally heard
In a healthy community, diversity is valued, which means:
· Valuing the things that different groups can bring to the community, not just focusing on what can be “done” for them
· Acknowledging that policies and programs can affect different groups in different ways
· Consciously integrating different groups and cultures into our work
In a healthy community, people work together, which means:
· There is collaboration (between churches, organizations, municipal governments, etc.)
· Efforts are made to foster cooperation and overcome community “turf” protection
· Leadership and participation skills are supported
· Communication uses clear language
In a healthy community, the goal is the overall health of the community, which means:
· Health includes all aspects of people’s lives (economic, social, spiritual and cultural, as well as physical)
· The health of people and the community is influenced by a broad range of factors generally called the “determinants of health”
· Primary health care (including health education, health promotion, disease prevention, rehabilitation, and the support and treatment of illness and injury including palliative care) is alive and well and available to all with no gaps.
More information on the PATH process as used by Antigonish Women's Centre can be found here.
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