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Community health and wellbeing

Community health and wellbeing: Action research on health inequalities

Steve Cropper
Alison Porter
Gareth Williams
Sandra Carlisle
Robert Moore
Martin O’Neill
Chris Roberts
Helen Snooks
Copyright Date: 2007
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  • Book Info
    Community health and wellbeing
    Book Description:

    Improving health in populations in which health is poor is a complex process. This book argues that the traditional government approach of exhorting individuals to live healthier lifestyles is not enough - action to promote public health needs to take place not just through public agencies, but also by engaging community assets and resources in their broadest sense. The book reports lessons from the experience of planning, establishing and delivering such action by the five-year Sustainable Health Action Research Programme (SHARP) in Wales. It critically examines the experience of SHARP in relation to current literature on policy; community health and health inequalities; and action research. The authors make clear how this regional development has produced opportunities for developing general concepts and theory about community-based policy developments that are relevant across national boundaries and show that complex and sustained community action, and effective local partnership, are fundamental components of the mix of factors required to address health inequalities successfully. The book concludes by indicating the connections between SHARP and earlier traditions of community-based action, and by arguing that we need to be bolder in our approaches to community-based health improvement and more flexible in our understanding of the ways in which knowledge and inform developments in health policy. The book will be of interest to practitioners and activists working in community-based projects; students in community development, health studies and medical sociology; professionals working in health promotion, community nursing and allied areas; and policy makers working at local, regional and national levels.

    eISBN: 978-1-84742-276-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Table of Contents
    (pp. iii-iv)
  3. List of tables and figures
    (pp. v-vi)
  4. Preface
    (pp. vii-xii)
  5. Acknowledgements
    (pp. xiii-xiv)
  6. Notes on contributors
    (pp. xv-xviii)
  7. ONE Health inequalities in their place
    (pp. 1-22)
    Gareth Williams

    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...

  8. TWO ‘Policy experiments’: policy making, implementation and learning
    (pp. 23-48)
    Steve Cropper and Mark Goodwin

    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...

  9. THREE Policy innovation to tackle health inequalities
    (pp. 49-72)
    Alison Porter, Chris Roberts and Angela Clements

    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,...

  10. FOUR Action research partnerships: contributing to evidence and intelligent change
    (pp. 73-104)
    Steve Cropper, Helen Snooks, Angela Evans, Janet Pinder and Kevin Shales

    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...

  11. FIVE Engaging with communities
    (pp. 105-128)
    Bronwen Bermingham and Alison Porter

    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...

  12. SIX The role of the community-based action researcher
    (pp. 129-146)
    Martin O’Neill

    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...

  13. SEVEN Evaluation, evidence and learning in community-based action research
    (pp. 147-170)
    Sandra Carlisle, Helen Snooks, Angela Evans and David Cohen

    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...

  14. EIGHT Social theory, social policy and sustainable communities
    (pp. 171-198)
    Robert Moore

    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...

  15. NINE Beyond the experimenting society
    (pp. 199-220)
    Gareth Williams, Steve Cropper, Alison Porter and Helen Snooks

    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...

  16. Index
    (pp. 221-234)
  17. Back Matter
    (pp. 235-236)