Health promotion by communities and in communities: current issues for research and practice

Jane Southj.south@leedsmet.ac.uk

7th Nordic Health Promotion Research Conference, 17th-19th June, 2013, Vestfold University College

Acknowledgements• ‘People in Public Health’, study funded through National Institute

funded by National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) Programme: http://www.leedsmet.ac.uk/piph

• Evidence reviews & thematic evaluations on community health champions, commissioned by Altogether Better: www.altogetherbetter.org.uk

• People Centred Public Health (2012) South, J. White, J., Gamsu, M. The Policy Press http://www.policypress.co.uk/display.asp?K=9781447305309&sf1=contributor&st1=Judy%20White&m=2&dc=2

• A pilot study of the walking for wellness project and the befriender role,2010-11, commissioned by Natural England.

What are the known knowns and the known unknowns?

Communities• Central place in health

promotion.• Social ties and networks

are a powerful determinant of health.

• Community-based interventions that work

• Challenge of persistent health inequalities, exacerbated by current economic drivers.

Assuring the Conditions

for Population

Health

Health care delivery system

Employers and Business

The Media

Academia

Governmental Public Health Infrastructure

Communities

Source: Hunter. D.J, Marks. L, Smith. K (2007), The Public Health System in England a Scoping Study, Centre for Public Health, Durham University

To promote participation in policy-making and implementationWe pledge to:• (ii) Empower the role of communities and strengthen civil

society contribution to policy-making and implementation by adopting measures to enable their effective participation for the public interest in decision-making;

• (v) Consider the contributions and capacities of civil society to take action in advocacy, social mobilization and implementation on social determinants of health;

Community as..• a health setting• a (target)

population• a health resource• an essential part of

a health system• as part of public

health action

Local action – population effects?

Contemporary challenges

1. What is the place of communities in a public health system?

2. How can community-based action impact on health inequalities at a population level?

3. Can we develop a convincing evidence base to underpin the work?

Community Health Champions• Empowerment

approach• 15,000 + champions

recruited and supported in one region

• Roles vary in intensity from talking to people as part of their daily lives through to organising community activities

The community contribution• Skills, knowledge and

experience• Bridging and connecting to

address inequalities• Pathways for individuals

can build capacity in communities

• Small scale at local delivery level

Walking for Health

• Volunteer–led walks

• In 2010, 11,000 + active walk leaders

• Volunteers receive 1 day of standardised training

How would you describe your group?

We’re a big group of friends, social people who happen to walk on a Monday morning. Again it’s like secondary really, the walking.

Helpful as well. If you see somebody

struggling we look after each other.

It’s a talking group that goes for walks.

A couple of hours well spent in the morning.

A spectrum of participationSouth, J., et al (2012) Health Education Research, 27, (4) pp. 656–670

‘Power over’ ‘Responsibility for’

Implications for research“Ecological and Systemic thinking, then, not only considers the community as a multi-level, multisectoral, and multicultural context but also considers how structural and interpersonal relationships between the intervention and relevant community components affect the development and success of the intervention.”

Trickett, E.J., et al., Advancing the science of community-level interventions. American Journal of Public Health, 2011. 101(8): p. 1410-1419.

Implications for practice

• Design health systems that facilitate involvement; and have a connection between what people do in communities and how decisions are made.

• Create interfaces where relationships can be formed and community voices can be heard.

• Invest in community infra-structure.

Concluding remarks

“Lay involvement is possible at all levels, planning, design, delivery and governance of public health activities . . . but requires people to think differently and be prepared to demonstrate trust”. (Expert hearing 3)

South, J., Meah, A., Branney, P. (2011)Health Promotion International. 27: 2: 284-294.