A great deal has changed since the publication of Sir Douglas Black’s ground-breaking report on inequalities in health (DHSS, 1980). In response to an article published in the now defunctNew Societymagazine (Wilkinson, 1976), the report was commissioned by the Secretary of State for Health and Social Services in 1977, during the dying days of James Callaghan’s Labour government, in an economic environment characterised by deep cuts in public expenditure, sharply rising unemployment and growing industrial unrest. The Black Report finally entered the public domain in the bright light of a new Conservative dawn in British politics. ‘Published’ over...

There is an enduring interest in the ways in which public policy is formed, communicated and embedded into public (and private) life. We might expect that, where policy directly addresses community and individual well-being and health, there would be intense debate about the content of policy, especially as its implications for the distribution of responsibility, authority and action become clear. Given this, the design or, perhaps, the unfolding of the policy process is also a matter of some importance. A classic 1960s study of community politics asked: ‘Who governs?’ (Dahl, 1963). In commenting on Dahl’s study, Saunders (1979) noted that...

The first chapter of this book reviewed the large body of evidence that we have linking inequalities in health to social structure: a link that can be most crudely summarised by saying that poor people and people living in poor places tend to die younger and live unhealthier lives than richer populations in wealthier places. The health gradient across the social classes has remained over the past hundred years or so in Britain, despite overall improvements in both health and prosperity. We know a great deal about the associations between ill health and various factors: where you live, your wealth,...

The use of action research to inform and develop public policy and professional practice has a long tradition. Its roots can be found in a variety of intellectual traditions and practices. In the analysis of conflict between social groups, where the method originated (Lewin, 1948), in industry, where programmes of work on industrial democracy and quality of working life were pursued by the Tavistock Institute of Human Relations (Rapoport, 1970), and in health and social care (Winter and Munn-Giddings, 2001), where Hart and Bond (1995) published a comprehensive account, action research has become well recognised as a method for learning...

This chapter sets out learning from the Sustainable Health Action Research Programme (SHARP) about the character of communities, strategies for the development of relationships with communities, and the difficulties encountered in those relationships. It also considers the outcomes – more and less tangible – that may survive as meaningful resources for continuing community–agency relations. We consider community engagement as a continuing process, and one in which initial engagement and re-engagement offer particular challenges to both communities and to the SHARP partnerships.

Engagement of the SHARP projects with the communities within which they were working has been a fundamental criterion of their...

The value and importance of involving communities in the development and delivery of policies that affect them is increasingly being recognised, and this is reflected in policy directives (Welsh Office, 1998; DH, 2001). Throughout the development of the Sustainable Health Action Research Programme (SHARP), there was an emphasis on involving communities substantially and directly in an action research process aimed at tackling the health and wellbeing issues they faced. In Chapter Five, Bronwen Bermingham and Alison Porter set out some of SHARP’s learning about working with communities. This chapter focuses on one particular way in which projects sought to engage...

Policy makers, professionals of all kinds and the general public now recognise a wide range of social factors as important determinants of health; if community health interventions can help to address such factors, they can play a valuable role in protecting and improving health and wellbeing (Shediac-Rizkallah and Bone, 1998). Publicly funded approaches that develop community capacity and connectedness may also promote stronger partnerships between communities and service providers, potentially leading to more appropriate forms of service provision. Yet, despite a high volume of research across the UK and elsewhere describing the problem of health inequalities, there is still comparatively...

The 1998 White PaperBetter Health – Better Wales(Welsh Office, 1998) addressed the issues that most directly affect the health of people in the Sustainable Health Action Research Programme (SHARP) areas. The White Paper recognised the social causes of ill health and also noted that while health in Wales was slowly improving from a low base, health inequalities persisted (§ 6.16). In proposing policies to address poor health in Wales, the White Paper specifically aimed to reduce health inequalities (§ 6.16, 7.10), although, as in England (Graham, 2004), resulting policy documents employed the term ‘health inequalities’ in a number of...

The poor health in some of Wales’ more deprived communities could make the Sustainable Health Action Research Programme (SHARP) seem less like a bold experiment and more like a very inadequate sticking plaster on a deep and bloody wound. Nonetheless, to fund seven action research projects of the kind discussed in this book over a relatively long time period, as part of the wider programme of policy development, signalled a genuine commitment to a radical approach to health improvement for Wales. As Robert Moore indicated in Chapter Eight, the programme of community-based, public health-orientated action research to address health problems...