Healthy
Michael Coughlin, MS
Community Health Planner
Massachusetts Department of Public Health
Adjunct Instructor of Human Services and Psychology
David Weed, PsyD.
Psychologist
Corrigan Mental
Adjunct Faculty
This article was published in Colloquia: Conversations on Teaching & Learning,
Partners for a
Healthier Community Inc. is one of the 27 Community Health Network Areas
organized by the Department of Public Health (DPH) across the state. The
mission of Partners is to establish a working partnership among area residents and
organizations to improve health status in the City of
Fall River Mayor Edward Lambert has committed staff of the Department of Public Health and Human Resources over the life of the project. This will ensure that the various functions of this Department, including elder services, public health and youth services, will be integrated into the Initiative. This level of commitment from a city executive is rare within the Commonwealth.
BCC Involvement in the HCFR
The HCFR reflects one priority of the BCC strategic plan: “Nurture and enhance community partnerships and outreach”. It provides the BCC community with multiple opportunities for student participation and professional development through community service, increased experience in peer partnership and professional collaborative activities that serve the wider community.
On March 25, 2004
The keynote
speaker at the
BCC was a
co-sponsor of the
As the only
institution of higher learning in
Healthy Communities Approach
The
healthy communities approach to community capacity building takes a broad view
of health and employs a cross-section of activities and community resources to
achieve improved health status and quality of community life. It is based on
the premise that health is more than the absence of disease and that social and
environmental conditions play an important role in determining a population's
health. Efforts to improve health
are best addressed through intentional efforts involving community residents
working in partnership with government and other stakeholders.
This approach differs from a more traditional focus on increasing individual responsibility for health behavior and focuses instead on the empowerment of groups that have more acute and chronic health problems and who are disadvantaged by "systems of inequality" (Stoller and Gibson, 1994). Lawrence Wallack (1993) argues that "contemporary public health is as much about facilitating a process whereby communities use their voice to define and make their health concerns known as it is about providing prevention and treatment." The primary objective of this approach is to increase empowerment, which can be defined as "a social-action process that promotes participation of people, organizations and communities toward the goals of increased individual and community control, political efficacy, improved quality of community life and social justice" (Wallerstein, 1992). The method employed by this approach is community organization, "the process by which community groups are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching the goals they collectively have set" (Minkler and Wallerstein, 1997).
Principles
The HCFR is intentionally constructed to reflect the Principles of Healthy Communities that guide successful efforts to create healthy communities (Ayre, et.al. 2001). These principles further define the concept of Healthy Communities first identified in the Ottawa Charter:
A review of the literature which documents the efficacy of these principles in contributing to improved health and quality of life in a community follows.
The Determinants of Health Broadly Defined
Many factors, including social, environmental, and biological conditions shape community health (IOM 2003). Among the specific factors are quality education, adequate housing, gainful employment, job skills training, efficient public transportation, recreational opportunities, healthy and clean physical environments, and health education and preventive services (Ayre, Clough, Norris 2002). The healthy communities approach defines health broadly by identifying the key determinants of the community’s health and identifies strategies to address them.
Physical determinants of health include environmental factors that contribute to health problems, such as toxins and other pollutants; as well as the presence of environmental factors that contribute to good health such as the built environment enabling or blocking access to healthy foods or physical activity. People who live in aging buildings in urban areas and in crowded unsanitary conditions may also experience increased levels of lead in their blood, or increased rates of asthma and allergies (CDC 2001).
Social
determinants of health include consideration of socio-economic status and
racial and ethnic disparities. Many
minority groups in the
The state of
Communities Develop Shared Vision
“A community’s vision is the story of its desired future, reflecting the core values of its diverse members. It is a living expression of shared accountability to priorities” (Norris & Pittman, 2000).
Developing a
vision has been a major focus of the HCFR to date. Between June and September 2003, thirty
visioning sessions were conducted throughout the City. A web site (www.gfrpartners.com) listing hundreds of
recommendations from local citizens was posted for all to share. In September
2003, a "voting booth" was created by a local volunteer woodworker to
display ballots with 43 categories of "Action Priorities" listed.
Citizens were then invited to select their three highest priorities, in order
of importance, from this list.
Over 600 people cast their vote for the most important
recommendations. Throughout this
process, Partners and the Mayor's office demonstrated a high degree of
cooperation and skill in a truly representative vision of a healthier
community. Their efforts
reached all sectors, communities, and corners of the
Improved Quality of Life
The results of the
HCFR visioning process were organized into five “Action Priority
Areas” and presented at the Healthy Fall River Summit in March 2004: Safety and Substance Abuse; Environment;
Health Education; Adult Education, Job Training, and Employment; and Community
Planning and Housing. Participants
in the summit developed goal statements in each of the areas and task forces
were formed to develop action plans.
This broad agenda transcends health issues to address a wide spectrum of
community concerns that impact the quality of life of everyone who lives and
works in the
Two communities in
Diverse Citizen Participation
A key feature of
healthy community efforts is active and diverse citizen participation in all
aspects of the initiative from vision setting through planning, implementation,
and evaluation. In this way health
communities harness the “social capital” of the community. Robert Putnam is perhaps the most
frequently referenced scholar studying social capital. In his highly regarded study of the
decline of social capital in the
While Bowling Alone documents the decline of
citizen participation and involvement in American life – its title is
inspired by the documented decline of participation in organized bowling
leagues over the last several decades – Putnam and a co-author recently
released a follow up study that documents a series of case studies across the
U.S. that illustrate forces working against this trend (Putnam and Feldstein,
2003). For example, they study the
city of
The HCFR is
attempting to harness the social capital of the City of
Systems Change
“The healthy communities movement contemplates a different vision for the way people live and work together, how community services are delivered, how information is shared, how local government operates, and how business is conducted. It demands that resource allocation and decision making be spread throughout the community.” (Norris, 2000). Systems change in a community results in approaches to problem solving that involve all of those with a stake in the outcome – providing people with a say in decisions that affect their lives. It speaks to horizontal problem solving rather than the traditional top down approach (Ayre et.al.).
System changes
address community problems at their root cause. A community with high rates of chronic
disease and whose residents report high incidence of smoking and sedentary
lifestyles might traditionally have responded by seeking additional medical and
health care services from the state or other outside sources. The healthy community approach suggests
that such a community would address their health problems by attacking the root
cause and attempt to create an environment in their community which promotes
physical activity – by improving parks and adding bike and
running/walking trails; and by promoting new policies or ordinances which
restrict smoking in public places.
For example, ninety six of the three hundred fifty one cities and towns
in
Some additional opportunities for systems change are zoning for community gardens, food service at schools and intergenerational programs between schools and senior citizens and other initiatives which cut across traditional lines and boundaries for economic development, planning, education, human service delivery and so on.
Developing Local Assets and Resources
Healthy communities identify and build on a community’s existing strengths and successes. McNight and Kretzman (1993) suggest that when communities focus on their problems and deficits they may actually contribute to a cycle of dependence. An asset-based approach, on the other hand, helps communities mobilize themselves and build on what they already do well.
McNight and Kretzman have developed a process whereby communities “map” the collective assets, skills, and capacities of residents, civic organizations, and local institutions.
“Each community boasts a unique combination of assets upon which to build its future. A thorough map of those assets would begin with an inventory of the gifts, skills, and capacities of the community’s residents.” (McNight & Kretzman). They argue that historic evidence indicates that significant community development takes place only when local community people are committed to investing themselves and their own resources in the effort. Secondly, communities with multiple needs and low economic indicators have little expectation that large scale industrial or service corporations, the government, or another “white knight” will descend on them bearing high paying jobs and other gifts. Their future is dependent on their own efforts – utilizing their own assets to improve their quality of life, thereby also making their community more attractive for outside investment.
Healthy community
literature is rich with examples of communities that successfully utilized
their own assets to create positive changes. In low income
Putnam and
Feldstein (2003) write about the success of the Valley Interfaith Project and
other faith-based community alliances organized in
During the
visioning sessions of the summer of 2003,
Measuring Progress
Healthy communities use community indicators and other performance measures to measure progress toward achieving their goals. “Indicators are small data sets that reflect the status of a larger system that is too large to see directly or in its entirety. A car’s gas gauge and speedometer are examples of indicators people use routinely to make informed decisions.” (Ayre et.al. 2002). Indicators show changes and trends over time and are a means of evaluating the success of community initiatives in achieving goals and changing systems.
The city of
The Design Team of the HCFR, led by the City Grant Writer, compiled “An Overview of Current Data: City of Fall River” which profiled the city according to a database that included demographics, Healthy People 2010 indicators, and statistics on poverty, the local economy, education performance, and other health-related indicators (Bershevsky, 2003). This database will serve as the basis by which to measure progress for the HCFR in the coming years.
In conclusion, the HCFR provides an excellent example of how the Healthy Community model can be applied in a real setting to achieve an improved quality of health in a diverse, low-income community. It also illustrates the role that a community college can play in supporting this kind of broad-based effort.
For more information about the Healthy City Fall River and Partners for a Healthier Community visit www.gfrpartners.com
References
Ayre, D., Clough, G., Norris, T. (2002). Trendbenders: Building Healthy and Vital
Communities.
Bershevsky, Susan, (2003). Overview of Current Data: City of
Centers for Disease Control and Prevention (CDC)
(2001). CDC Fact Book
2000/2001: Profile of the
Nation’s Health.
Gedan, Benjamin, (2003, 20 Dec.) Some Pubs Rebel at
Hancock, Trevor (1993). Healthy Cities/Healthy Communities. Journal of Public Health Policy. Spring 1993.
McNight, J. & Kretzmann, J., (1993). Building Community from the Inside
Out.
Minkler, Meredith, (1997). Community Organizing Among the Elderly
Poor in
Minkler, M. and Wallerstein, N. (1997) Improving health
through community organization and community building: A health education
perspective in Minkler, M. (Ed.) Community
organizing and community building for health.
Norris, T. & Pittman, M. (2000). The Healthy Communities Movement and the Coalition for Healthier Cities and Communities. Public Health Reports, May/June 200, v. 115. p. 188-124.
Putnam, Robert D. (2000). Bowling Alone: The Collapse and Revival of American
Community.
Putnam, R. & Feldstein, L. (2003). Better Together: Restoring the American Community.
Seifer, Sarena, (2000). Engaging Colleges and Universities as Partners in Healthy Community Initiatives. Public Health Reports, May/June 2000, v. 115. p. 234-237.
Stoller, E.P., and Gibson, R. (1994) Worlds of difference: inequalities in the aging experience.
Twiss, J., et.al. (2000). Twelve Years and Counting:
Wallack, L., Dorfman,L., Jernigan, D. and Themba, M. (1993) Media advocacy and public health: Power
for prevention.
Wallerstein, N. (1992) Powerlessness, empowerment and health: Implications for health promotion programs. American Journal of Health Promotion 6:197-205
Wilcox, R. & Knapp A., (2000). Building Communities that Create Health. Public Health Reports, May/June 200, v. 115 p. 139-143.
World Health Organization
Authors:
Michael Coughlin, MS is a Community Health Planner and
Contract Manager in the Office of Healthy Communities at the Massachusetts
Department of Public Health, where he oversees a statewide system of Regional
Centers for Healthy Communities. He
is the Team Leader for MDPH with Partners for a Healthy Community, the Community
Health Network (CHNA) serving Greater Fall River. Mr. Coughlin is an adjunct faculty
member at
David S. Weed, Psy.D. is a
licensed clinical psychologist with over 30 years of experience in community
mental health setting in
The authors wish to think Peter Lee, M.PH. for his assistance in reviewing this article.