Health's Approach To Community Health And Health Promotion

Community based programmes are widely believed to be beneficial and have become an important strategy to enhance health (Nilson 2006). Community and community participation have been used increasingly in public health in past years with various definitions attributed to these concepts. Communities may be defined by locality, interests, religious beliefs, age or ethnicity, social networks or shared needs (Hubley and Copeman 2008). Identifying what constitutes a particular community is complex and for health promotion to be effective it has to focus on the perceived need of that community (Gottwald and Goodman-Brown 2012).

Health promotion approaches have moved from the biomedical individualistic approach to the socio-ecological approach which focuses on the social and environmental factors which effect health (Craig, Davies and Macdowall 2013). A key principle of health promotion identified by WHO (1986) is to strengthen community action in order to improve health. This may be done through community development which is ‘a process where community members come together to take collective action and generate solutions to common problems’ (Frank and Smith 1999 pp.3). This concept is underpinned by the core values of social justice and equality, participation, capacity building and partnerships (SCCD 2001).

Health community development is underpinned by various theories and approaches with social support and social capital being key assets in collective approaches to health promotion as they promote social cohesion and inclusion (Coulter 2009). Health promotion within communities should take a bottom-up approach, engaging communities at the beginning of initiatives through a health needs assessment, focusing on what is perceived ...

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... social and environmental factors which effect health. The food strategy recognises that food governance involves commitment from a wide range of entities with a strong emphasis on community participation. Thus improving access to healthy food, increased income, healthy environment, and increased social capital which results in improved health and wellbeing and reduces inequalities.

Critique for the healthy setting approach is the lack of evidence of effective outcomes (Taylor 2010). WHO (2008) asserts that healthy cities are long term projects that take years to achieve significant change in health outcomes, thus evaluation should focus on processes instead of outcomes. Although there is documented evidence that healthy cities work; an evidence base needs to be generated to support informed decision-making in community health (Leeuw and Skovgaard 2005).