There is increasing evidence that bringing people together is good for their health. In addition, working with communities in such a way that their strengths are emphasised, their experience is recognised and their views and outlook is respected, leads to improved services, better health outcomes and maybe less cost.
This brief paper outlines the basis for ideas about Community Development and Health and their political significance.
WHAT IS COMMUNITY DEVELOPMENT?
Community Development is defined within the National Occupational Standards as : a long term value- based process which aims to address imbalances in power and bring about change founded on social justice, equality and inclusion.
The process enables people to organise and work together to:
- identify their own needs and aspirations
- take action to exert influence on the decisions which affect their lives
- improve the quality of their own lives, the communities in which they live, and societies of which they are a part.
Key roles in the field of health include:
- Developing social networks
- Developing and supporting groups
- Developing an agenda for change from the views and recommendations of local people and decision-makers
- Bringing people together to respond to those needs themselves, so far as possible, while at the same time:
- Working with decision-makers in health to ensure that local views are taken into account and responded to.
- Impacting on entrenched Health Inequalities nationally
NICE, in its recent paper uses the terms ‘community engagement’ and ‘community development’ almost interchangeably. However, the terms can be distinguished by saying that community engagement is the top-down effort to involve people in a given agenda, while community development is the bottom-up stimulus and facilitation for people to become involved through their own priorities.
WHY COMMUNITY DEVELOPMENT?
There has long been good evidence that social networks offer significant benefits for all of us. Being linked to other people seems to confer not only better health but also emotional and economic outcomes.
Community development is one key way of developing and supporting social networks.
The NHS is keen to make Patient & Public Involvement effective across the service. Although the NHS is getting better at listening to what local people are saying to us, we often need support with responding to those recommendations. Community development can become a key approach to participatory democracy.
Community development is one key way of supporting local people in getting their voices heard.
It appears that health inequalities in a rich economy are mediated not only through poverty, but also through isolation and a profound feeling of powerlessness.
Community development is a key way of reducing isolation and supporting empowerment.
Health improvement through engagement and self-care is essential to the functioning of the NHS, as Wanless made clear. Working closely on a long-term, systematic basis with communities is essential to make this a reality.
Community development is a powerful technique for community engagement for health.
Community development is increasingly seen as a coherent response to many key problems both in the NHS and in local authorities. Indeed, local authorities have seen support and development of social networks and Community development as a key part of their procedures.
Community development is now advocated as a key approach in:
- World Class Commissioning, as a method of reaching the most sophisticated level 4 competency in the patient experience section.
- Tackling Health Inequalities
- Techniques to be employed by Local Involvement Networks
- Patient and public involvement in Practice Based Commissioning
- Community engagement, as described by NICE
WHAT ALREADY EXISTS?
There are national Community Development organisations that offer a network-type service but, for the most part, these organisations do not have a specific focus on the NHS and only deal with health incidentally.. These are the Community Development Foundation which is sponsored by the Department of Communities and Local Government , the Community Development Exchange funded by the Cabinet Office, and the Federation for Community Development Learning . In addition, a new group called PACES are developing ideas in this field There are numerous examples across the world where CD has made significant impacts on health and engagement.
CO-PRODUCTION
This is a term that incorporates these ideas, but does not particularly expect Community Development workers to be involved. There are numerous examples of agencies choosing to work in ways that engage communities in a positive and asset-based way.
COMMUNITY ORGANISING
To all intents and purposes, this American term means the same as Community Development. Obama used to be a community organiser in Chicago. The term has been taken up by organisations such as London Citizens who support local people to take up issues and campaign for them.
THE BIG SOCIETY
The Tories and the Coalition have taken up these ideas and propose a community organising process, backed by 5000 new community organisers.
The positive aspects of this are that it makes the participatory democratic approach more likely. It could mean that all the benefits of social networks and improvements to civil society are more likely to happen. An asset-based approach would reap many dividends, strengthening communities and making a significant impact on health.
On the other hand, the details that we do have suggest that outcomes will be far less than might otherwise be the case. One key reason is that these organisers will not be paid, but will have to fund-raise for their own jobs. The political context is also worrying: this approach could be seen as rolling back the state and committing small voluntary organisations to run erstwhile statutory functions. This is quite unacceptable. Collaboration and mutual learning – yes. Hiving off to the voluntary sector – no.
THE SHA POSITION – Community Development and Health
The Socialist Health Association endorses an approach that empowers communities through community development enabling social networks to form and be sustained. We know that this will enhance patient and public engagement, improve health inequalities and improve people’s health.
The SHA supports the idea of community engagement outlined in The Big Society, but remains concerned that the devil in the detail may derail benefits.
We shall continue to watch progress and work with existing organisations to make community development a key approach to boost health and civil society.
Bringing People In (by Stephen Peckham and Dr Margaret Godel)