1. Assets Based Approach to Health Improvement-
October 2012
Assets Based Approach to Health Improvement
Carol Owen – Principal Health Promotion Specialist

2. Assets for Health
Aim
to stimulate discussion and explore how Pubic Health Wales our (Public Health Wales’ ) contribution to an assets based approach to health improvement in Wales.
Theoretical Framework -Salutogenesis
Carol Owen, Principal Health Promotion Specialist

3. Going back to basics ! Ottawa Charter (1986) Principles:-
Participation , Equity and Empowerment
This presentation has forced me as a Health Promotion Specialist to go back to basics .
I wanted to explore the ‘fit’ between the assets based approach and the Ottowa Charter.
Underpinnng principles being about ‘enabling’, participation, equity and empowerment.
Carol Owen, Principal Health Promotion Specialist

4. Salutogenesis Antonovsky (1979,1987) Salutogenic question :
“What creates health rather than what causes disease”?
Talks about health and wellbeing rather than disease
Its not new and infact has been around for approx 30 years
Antonovsky was interested in how some people can cope with extremely stressful events (a group of israeli women who survived the Holocaust- these became his study group) He did not believe that the outcome of such horrendous circumstances was a matter of chance.
Centre for Salutogenesis Research in Helsinki in Finland
Focuses on two main concepts – sense of cohernce and general resistance resources
The origin of salutogenesis derives from the interviews of Israeli women with experiences from the concentration camps of the Second World War who in spite of this stayed healthy.
Carol Owen, Principal Health Promotion Specialist

5. Salutogenesis Comprises : Sense of Coherence – (SOC)
General Resistance Resources
Antonovsky believed that it was down to in the main two factors.
A person’s sense of coherence and the availabilty to general resisitance resources
Carol Owen, Principal Health Promotion Specialist

6. Sense of coherence Comprehension Manageability Meaningfulness
Measure this using the SOC Scale
Comprehension – individuals understand their world , their world has a sense of structure and predictability.
Manageability – that people believe that they have the resources to deal with life’s challenges
Meaningfulness –that people believe that the challenges are worth overcoming and therefore worth the time and effort involved
Carol Owen, Principal Health Promotion Specialist

7. Generalised Resistance Resources
GRR- resources (both internal and external) that help move people in the direction of positive health.
The are acquired through life experiences which include what we would consider the norm – positive parenting, good quality home life, education, exposure to moderate stress , social networks etc.
Carol Owen, Principal Health Promotion Specialist

8. Health Asset Assets can be described as the collective
resources which individuals and communities
have at their disposal, which protect against
negative health outcomes and promote health
Glasgow Centre for Population Health 2011
Now when we look at assets , they can be described
Carol Owen, Principal Health Promotion Specialist

9. Carol Owen, Principal Health Promotion Specialist
When we have a look at what is coined the salutogenc umbrella they assets are viewed as a combination of soc, and grr and depening on the discupline that we come from will use words to explain what infact is commen sense in reality. If we as individuals and communities are in possession of any of these ‘asset’s’ we are more likely to fell healthy and well. Our perception of our own health will undoubtedly improve. i.e we will feel good about ourselves and proud of our community. We will be
Carol Owen, Principal Health Promotion Specialist

10. Is it good old fashioned community development ?
Probably – but it focuses on using the assets and strengths of individuals and communities – empowering them to make a difference for themselves.
I know we like to think that this is what we do, however I feel that sometimes our interventions over professionalise life. From my experience we tend to focus on the deficits – ie. needs assessments – informing people how deprived and ill they are or are likely to be , what they need to do to address their risks. I think we need a combined approach, and work upstream to focus our attention on soc , raising aspirations ,
Carol Owen, Principal Health Promotion Specialist

11. Assets for Health
Deficits Model Assets Model Negative Paradigm Positive Paradigm Pathogenesis Salutogenesis
Move away from the deficits approach – where we measure risk, identify need and develop interventions to fill the gap. ‘do to /for ‘ people –
This approach searches for the protective factors
Carol Owen, Principal Health Promotion Specialist

12. Why the change
“....Policy development has focused too much on the failure of individuals and local communities to avoid disease rather than their potential to create and sustain health and continued development “
Source :Morgan and Ziglio (2007) )
Carol Owen, Principal Health Promotion Specialist

13. Health Assets
Although health assets are an integral part of individuals and communities of (hand , heart and mind)
Q- How do we unlock these assets in each community in Wales?
What is our unique contribution?
Glasgow Centre for Population Health 2011
Carol Owen, Principal Health Promotion Specialist

14. What are we measuring
Again it focuses on measuring deprivation, ill health , risk factors etc. Q- Should we be measuring empowerment, sense of coherence, resilience ? What is our unique contribution to this work?
Local vs national
Carol Owen, Principal Health Promotion Specialist

15. Carol Owen, Principal Health Promotion Specialist

16. Evidence sythesis At its core, salutogenesis asks:
• What external factors contribute to health
and development?
• What factors make us more resilient(more able to cope in times of stress)?
What opens us to more fully experience
life?
What produces overall levels of well
being?
Source Morgan and Ziglio (2007)
Too often we say there is insufficent evidence to support, can i suggest that it is our job as public health practitioners is to undertake the research, ask the right questions and generate the evidence.
Carol Owen, Principal Health Promotion Specialist

17. Assets - Action
“Good health needs assessment should provide a means of identifying the health assets and needs of a given population to inform decisions about service delivery.” (Morgan & Ziglio 2007)
Rebalance between needs and assets
Carol Owen, Principal Health Promotion Specialist

18. Assets - Action Asset Mapping on 3 levels Primary building blocks
Secondary building blocks
Potential building blocks:
Primary building blocks: assets and capacities
located inside the neighbourhood
and largely under neighbourhood control
(e.g. skills, talents and experience of
residents, citizen associations etc).
• Secondary building blocks: assets located
within the community but largely controlled
by outsiders (physical resources
such as vacant land, energy and waste
resources; public institutions and services).
• Potential building blocks: resources originating
outside the neighbourhood outside
the neighbourhood controlled by Secondary building blocksoutsiders (e.g. public capital improvement
expenditures).
Carol Owen, Principal Health Promotion Specialist

19. Assets Evaluation
We need to develop a new set of indicators Evaluation based on theoretical context on which programmes are developed Assets/salutogenic approach to evaluation may help us understand what creates health rather than what causes disease.
Carol Owen, Principal Health Promotion Specialist