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Presentation on theme: " Dr Ann Hemingway EACS MEMBER Public Health Lead for Research and Enterprise Centre for Practice Development Centre for Wellbeing."— Presentation transcript:

1 Dr Ann Hemingway EACS MEMBER Public Health Lead for Research and Enterprise Centre for Practice Development Centre for Wellbeing and Quality of Life Bournemouth University Sept 2010

2 2 Articulating humanisation for public health research and practice Why are humanising principles valuable for public health? Valuing the individual Valuing the community

3 3 This paper will focus on community development to reduce inequities in health as a key public health research and policy focus and will critique it in relation to the humanising value framework for research proposed by Todres, Galvin & Holloway (2009).

4 4 Background When we study communities we tend to record and describe `needs` or `problems` (health needs assessment) and calculate risks (epidemiology). This has created a research and practice focus on labelling and `problematising`. Public health research is poor at coming up with solutions for all these `needs` and `problems` (for instance, poverty, high crime rates, joblessness, high rates of teenage pregnancy, high levels of obesity, high levels of chronic disease, poor educational attainment, vandalism etc) although we are excellent at describing them (Marmot 2010, Hunter 2005, Nutbeam 1999).

5 5 There is a tendency in public health research and practice to drift to a medical model for answers and think of interventions and measuring effects with little thought given to studying action (Hunter 2005) with its roots in local communities. Indeed by its very nature it is hard to `measure` an intervention accurately in several communities and compare them because they are `unique` with unique assets and contexts within which people live.

6 6 This tension has resulted in the valuing of qualitative research within public health policy and practice to a degree although overall `guidance` for practice in the UK has its roots in the National Institute for Health and Clinical Excellence which is dominated by evidence derived from Randomised Controlled Trials.

7 7 A key concept for this paper From Clients to Citizens: Asset-Based Community Development as a strategy for community-driven development (Kretzmann & McKnight 1999)

8 8 An Overview of Asset Based Community Development Based on extensive enquiry into successful community initiatives in the U.S. ABCD is articulated as a way of counteracting the predominant needs based approach to development (Kretzmann & McKnight 1999). In the needs based approach the well intentioned efforts of organisations have generated needs surveys, analysed problems and identified solutions to meet needs. In the process however they have presented a one sided negative view of communities rather than contributed to capacity building.

9 9 This paper will consider how this `cup always half empty` process mirrors the way that individual patients in health care are labelled as a disorder or list of needs and their individual humanity and strengths are lost in the process.

10 10 In the initial phases of ABCD the approach to mobilising communities has much in common with appreciative enquiry which is a process that promotes positive change by focussing on the successes of the past. It relies on interviews and stories to collect these positive memories and on a collective analysis of the elements of success. Communities that have been defined by their problems internalise this negativity, research demonstrates extensively that children`s performance is shaped by teachers and parents expectations more than it is by their own innate ability (World Bank).

11 11 Consider the dimensions of humanisation (Todres Galvin & Holloway 2009) in relation to public health research and ABCD Insiderness/objectification Agency/passivity Uniqueness/homogenization Togetherness/isolation Sense making/loss of meaning Personal journey/loss of personal journey Sense of place/dislocation Embodiment/reductionist view of the body

12 12 However, the consideration of these elements will be undertaken in this presentation with a focus on action, actions that we can research and take in practice in order to have a positive impact on inequalities in health.

13 13 Consider a personal and community policy based perspective on humanisation Agency/Passivity A persons or communities ability to take action is a strength, how do we influence it?

14 14 Uniqueness/homogenisation How can we promote wellbeing for unique people in the context of their local community?

15 15 Togetherness/Isolation Does that person have any support, how can we maximise it? How does the local community provide support for those living there how can we maximise it? Arguably by treating relationships as assets, ABCD is a practical application of the concept of social capital (Puttnam)

16 16 Sense making/loss of meaning How do we help to make sense of an issue for an individual or community?

17 17 Personal journey/loss of personal journey This manifests itself in an excessive emphasis on how the community is (poor, jobless, beset with needs and problems) rather than who they are, what are their individual and group assets? How can we help grow these?

18 18 Sense of place/dislocation This is relevant for displaced groups or individuals for instance refugees or the homeless but also resonates in relation to how wellbeing cannot be separated from the `atmosphere` created by the built environment

19 19 Embodiment/reductionist views How can we view well being as a positive thing to plan for and not just the absence of illness?

20 20 Insiderness/objectification How can we build self and community esteem and not destroy it with labels and judgements

21 Do Methods which focus on humanisation and community assets give us a possible way forward to guide public health research and practice?

22 22 References Hunter D. & Griffiths S. 2007 New Perspectives in Public Health. Radcliffe Publishing Oxon Kretzmann J. & McKnight J. 1999 Leading by Stepping Back: A Guide for City Officials on Building Neighbourhood Capacity. Chicago, IL: ACTA Publications Marmot M. 2010 Fair Society Healthy Lives: The Marmot Review. London: The Marmot Review Nutbeam D. (1999) Theory in a Nutshell: A Guide to Health Promotion Theory. Australia: McGraw Hill Todres L., Galvin K. & Holloway I. 2009 The humanization of healthcare: A value framework for qualitative research. International Journal of Qualitative Studies on Health and Well-being. 1-10 iFirst article

23 Dr Ann Hemingway Public Health Lead for Research and Enterprise Centre for Practice Development and Centre for Wellbeing and Quality of Life 01202 962796

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